Limb Reconstruction After Premature Growth Arrest Secondary to Bone Infections.

During recent years, the detection of osteoarticular infections has increased, thanks to improvement and wide availability of diagnostic tools. Despite that, surgeons and patients still have to deal with long-term sequelae, including osteoarthritis, chronic osteomyelitis, and premature physeal arrest. Subsequent joint reconstruction is the most difficult challenge when the hip or knee has been affected. Most surgical procedures described to manage these devastating consequences are only palliative, with the goal focused on improving stability and pain control, but seldom ending with a highly functional joint. Premature physeal arrest has an unpredictable course after an osteoarticular infection. The prognosis depends on the age of the child, the type of injury (partial or total bony bar), the proportion of the physeal surface affected, and the bone compromised. Peripheral injuries lead to angular limb deformities, whereas central bars lead to limb-length discrepancies. Surgical treatment should be oriented to preserve physeal function and allow normal growth to resume. In those cases where preserving physeal function is not possible, the orthopaedic surgeon must deal with the sequelae of limb-length discrepancies and/or bone deformities.

Arthroscopic fixation of displaced tibial eminence fractures: a new growth plate-sparing method.

PURPOSE: Fractures of the tibial eminence can be treated arthroscopically. Numerous ways to attach an anterior cruciate ligament avulsion from the tibial eminence have been designed. This report describes a new physis-sparing reduction and fixation technique using an anchor passing nonabsorbable braided sutures through the substance of the anterior cruciate ligament, holding the avulsed bone fragment by tying a locking knot. This study was performed to evaluate a consecutive group of patients who underwent reduction and fixation of tibial avulsion fractures fixed with an anchor with sutures. METHODS: The evaluation was performed by use of objective and subjective International Knee Documentation Committee (IKDC) scores, KT-1000 measurement (MEDmetric, San Diego, CA), Lachman and pivot-shift tests, and Lysholm score. RESULTS: The global IKDC objective score was normal (A) in 4 knees and nearly normal (B) in 3, without extension or flexion limitations. The mean IKDC subjective score was 92 out of 100 (range, 86 to 98). The results of the anterior drawer, Lachman, and pivot-shift tests were negative. The mean Lysholm score improved from 29 to 94. The mean side-to-side difference in anterior tibial translation was 2 mm (range, 1 to 3 mm). CONCLUSIONS: Arthroscopic stabilization by use of an anchor with sutures was possible in all cases of tibial spine fracture. We were able to obtain excellent results in this series using this fixation method. LEVEL OF EVIDENCE: Level IV, therapeutic case series.