New technique in congenital scoliosis involving fixation to the pelvis after hemivertebra excision.

STUDY DESIGN: The authors conducted a retrospective study involving description of a new surgical technique. OBJECTIVES: The objective of this study was to describe and evaluate the efficacy of a new technique to stabilize the spine of young and small patients with congenital scoliosis after lumbosacral hemivertebra excision. SUMMARY OF BACKGROUND DATA: Congenital scoliosis develops as the result of anomalous vertebral development and asymmetric growth. The vertebral anomalies include congenital fusions and congenital hemivertebrae. With lumbosacral hemivertebrae at the lumbosacral junction, surgical excision followed by instrumentation to close the resulting space is frequently the best way to correct the deformity and obtain spinal balance. Surgical stabilization is required for preventing recurrent deformity and restoration of spinal balance. METHODS: A new surgical technique for spinal correction and stabilization in congenital scoliosis is described. The technique involves hemivertebra excision followed by fixation of the adjacent normal vertebra to the ilium with screws and cables. This technique allows efficient correction in both the coronal and sagittal planes. RESULTS: This construct was prospectively studied in 3 cases over a 3- to 5(1/2)-year period. All cases had solid fusion and well-balanced spine at latest follow up. CONCLUSIONS: This prospective study demonstrates a successful surgical technique for spinal stabilization after congenital hemivertebra excision in infants and young children with relatively small and soft bones when standard constructs like pedicle screws may not be optimal devices. Coronal and sagittal balance (restoration with improvement of lordosis) was successfully achieved in all cases.

Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children.

BACKGROUND: Titanium elastic nails are commonly used to stabilize femoral fractures in school-aged children, but there have been few studies assessing the risks and benefits of this procedure compared with those of traditional traction and application of a spica cast. This prospective cohort study was designed to evaluate these two methods of treatment, with a specific focus on the first year after injury, the period when the treatment method should have the greatest impact. METHODS: Eighty-three consecutive children, six to sixteen years of age, were studied prospectively. Factors that were analyzed included clinical and radiographic data, complications, hospital charges, and outcome data. Outcome and recovery were assessed both with the American Academy of Orthopaedic Surgeons Pediatric Outcomes Data Collections Instrument, version 2.0, and according to a series of important recovery milestones including the time to walking with aids, time to independent walking, time absent from school, and time until full activity was allowed. RESULTS: Thirty-five children (thirty-five fractures), with a mean age of 8.7 years, were treated with traction and application of a spica cast, and forty-eight children (forty-nine fractures), with a mean age of 10.2 years, were treated with titanium elastic nails. All fractures healed, and no child sustained a complication that was expected to cause permanent disability. At one year after the fracture, eighty of the children had acceptable alignment and no inequality between the lengths of the lower extremities. The remaining three children, who had an unsatisfactory result, had been treated with traction and a spica cast. Twelve patients (34%) treated with traction and a cast had a complication compared with ten patients (21%) treated with titanium elastic nails. Compared with the children treated with traction and a cast, those treated with titanium elastic nails had shorter hospitalization, walked with support sooner, walked independently sooner, and returned to school earlier. These differences were significant (p < 0.0001). We could detect no difference in total hospital charges between the two groups. CONCLUSIONS: The results of this prospective study support the recent empiric observations and published results of retrospective series indicating that a child in whom a femoral fracture is treated with titanium elastic nails achieves recovery milestones significantly faster than a child treated with traction and a spica cast. Hospital charges for the two treatment methods are similar. The complication rate associated with nailing compares favorably with that associated with traction and application of a spica cast.