Clinical and psychosocial outcomes following correction of supination deformity in obstetrical brachial plexus palsy patients: A retrospective study.

BACKGROUND: Forearm supination contracture is the mostAQ common deformity of the forearm following obstetric brachial plexus palsy (OBPP). Supination deformities in OBPP may be corrected by performing forearm osteotomy; however, the high recurrence rate limits patient satisfaction. Apart from the cosmetic impairment of this deformity, there are no previous reports on the clinical and psychosocial outcomes of forearm osteotomy in patients with supination deformities secondary to OBPP. Therefore, our study aimed to assess the clinical, functional, and psychosocial outcomes following forearm pronation osteotomy in OBPP patients with supination deformity. METHODS: This retrospective study was conducted after a chart review of all OBPP sequelae with supination forearm deformity in patients who underwent forearm pronating osteotomy from 2006 to 2018. Data relating to OBPP were gathered, and functional and psychosocial outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire through interviews RESULTS: This study included 60 patients with a mean age of 8.7 years at the time of surgery. A total of 46 patients had lesions involving C5-T1 (76.7%). The mean preoperative supination deformity position was 68.5°, the mean amount of correction was 98.9°, and the mean forearm position was 30.5°, postoperatively. In the DASH assessment scale used postoperatively, 24 patients (42.9%) reported no restrictions on their daily activities, 25 patients (44.6%) believed that their social activities were unaffected, and 20 patients (35.7%) strongly disagreed with feeling less capable or less confident due to arm, shoulder, or hand problems. The factors significantly affecting position at the final follow-up were the amount of correction (p = 0.011), postoperative position (p = 0.005), and degree of pronation achieved (p = 0.02). The amount of correction significantly affected both self-confidence (p = 0.049) and activities of daily living (p = 0.033). CONCLUSION: In conclusion, our study showed that the position at the final follow-up, the degree of pronation achieved intraoperatively, and the postoperative position significantly affected the position at follow-up and the outcome assessment. The amount of intraoperative correction was significantly associated with higher self-confidence and normal activities of daily living.

Removal of Antibiotic Cement-Coated Interlocking Nails.

OBJECTIVES: To report the outcomes of antibiotic cement-coated interlocking nail (ACCIN) removal, detail a removal technique that mitigates debonding of coating, and describe how to address occurrences intraoperatively. DESIGN: Retrospective case series. SETTING: Level II trauma center. PATIENTS: Twenty-eight patients who underwent ACCIN removal between January 2014 and August 2019. INTERVENTION: Removal of ACCINs that were coated using the silicone tubing method. MAIN OUTCOME MEASUREMENTS: Successful removal of the nail with intact antibiotic coating. RESULTS: A total of 42 ACCIN removals were included in this study. Successful ACCIN removal was achieved in 37 cases (88.1%), with debonding in only 5 cases (11.9%). Eight nails (19%) required 1 additional removal procedure, and 3 nails (7.1%) required 2 additional removal procedures. The main reasons for the additional procedures were nonunion and persistent infection. CONCLUSIONS: ACCIN insertion and removal can be challenging. The proper technique of coating and insertion can facilitate later removal. Removal of knee-long fusion rods can be more challenging. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Sagittal Plane Assessment in Deformity Correction Planning: The Sagittal Joint Line Angle.

Aim: Evaluate the validity of a recent approach to calculate the knee flexion or extension contracture contributing to the overall sagittal deformity using the sagittal mechanical axis angle (SMAA) for the overall alignment assessment and sagittal joint line angle (SJLA) for soft tissue contribution. The methods of evaluating these angles and their clinical applications are discussed. Materials and methods: In total, 107 normal limbs met the criteria and were divided into two groups: skeletally mature and immature. Sagittal alignment was evaluated using the Bone Ninja iPad application, and the posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA), SMAA and SJLA were recorded. Results: In skeletally immature patients, mean SJLA was 13.46° [standard deviation (SD), 4.55°], and in mature patients, it was 16.91° (SD, 2.948°). The PDFA and PPTA were consistent with previously published measurements. Conclusion: The SJLA method is a practical way to quantify the soft tissue contribution and degree of contracture. It can also be used for monitoring deterioration or improvement of knee range of motion during lengthening or physical therapy. Clinical significance: All patients in this study presented to our clinic with symptoms on the contralateral side. This, in addition to the retrospective nature, was a limitation in our study.We recommend a validity study to compare our SJLA method to the classic anterior cortical line angle (ACL) method in addition to an inter-observer and intra-observer reliability study for the SJLA. We also recommend a study on completely normal asymptomatic subjects to better standardise the angle measurements in skeletally immature patients at different ages. How to cite this article: Abalkhail TB, McClure PK. Sagittal Plane Assessment in Deformity Correction Planning: The Sagittal Joint Line Angle. Strategies Trauma Limb Reconstr 2022;17(3):159-164.

Removal of a Broken Stainless-Steel Intramedullary Lengthening Stryde Nail: A Case Report and Review of the Literature.

CASE: We report a 15-year-old female patient who underwent femur lengthening with a stainless steel intramedullary lengthening Stryde nail that broke at the end of the lengthening course and required removal. Given the solid noncannulated nature of the nail, this required special strategy to remove broken parts. CONCLUSION: Stryde nails are stainless steel lengthening nails that were developed to allow more freedom with weight bearing. Regardless of this change, hardware failure remains possible. In addition to maintaining regenerate integrity, a surgeon must be creative when attempting to remove solid nail types because many techniques for removing failed hardware were developed for cannulated devices.