Kinematic and kinetic analysis of distal derotational osteotomy of the leg in children with cerebral palsy.

Patients with cerebral palsy often develop rotational deformities of the lower extremities. These deformities may be caused by abnormal muscle tone, soft-tissue contractures, or bony malalignment. When rotational deformity persists after correction of the soft-tissue components, bony-realignment procedures are warranted to improve gait in ambulatory patients. We performed a retrospective review of 10 ambulatory children with cerebral palsy and tibial torsion who underwent 13 distal tibial and fibular derotation osteotomies. Preoperative and postoperative three-dimensional gait analysis were used to determine the effect of distal tibial and fibular derotation osteotomy on tibial rotation, foot-progression angle, gait velocity, and moments about the ankle. Mean tibial rotation and foot-progression angle were significantly improved by the procedure. Gait velocity improved but not significantly. Moment data demonstrated a trend toward normal. This study demonstrates that the derotational distal tibial and fibular osteotomy stabilized with percutaneous crossed Kirschner wires is a safe, reliable, and effective procedure for correcting rotational deformities of the leg in patients with cerebral palsy.

Distal tibial/fibular derotation osteotomy for correction of tibial torsion: review of technique and results in 63 cases.

Despite a tendency for rotational abnormalities of the lower leg in children to improve spontaneously over time, some fail to correct and require corrective derotation osteotomy. In this retrospective study, we report the technique and results of the distal transverse tibial and fibular derotation osteotomy with Kirschner-wire fixation performed in 63 limbs of children with cerebral palsy, clubfoot, idiopathic tibial torsion, and myelomeningocele, as well as other less common conditions. There were no significant infections, neurologic complications, delayed or nonunions, or compartment syndromes as a result of the osteotomy. There were three (4.8%) complications, including late fracture (one), cross-union (one), and distal physeal closure (one). We conclude that transverse, same-level, distal tibial and fibular osteotomy fixated with crossed Kirschner wires is a safe, efficient, and effective surgical approach to the treatment of children with tibial torsion in a variety of clinical conditions.

Successful separation of ischiopagus tripus conjoined twins with comparative analysis of methods for abdominal wall closure and use of the tripus limb.

The authors report the successful delivery, preoperative management, and postoperative courses of ischiopagus tripus twin girls successfully separated at 5 months of age. Surgical objectives were predicated on survival and optimum postseparation reconstructive potential for both girls. Each twin has subsequently undergone additional procedures, and both are doing well 2 years after separation. The authors reviewed 17 known cases of ischiopagus tripus separation, comparing anatomic findings, use of the tripus limb, operative strategies, and attainment of abdominal closure. This 18th case includes the first report of splitting the tripus limb and giving each girl a femur. The authors found that detailed systemic investigation, advanced coordinated teamwork with appropriate technical support, applications of new technologies or reapplication of existing technologies, meticulous planning, and favorable anatomy were vital in yielding favorable outcomes.

Vertebrodiatasis experimental lengthening of the juvenile goat spine.

The purpose of this study is to describe the biology of spinal lengthening (vertebrodiatasis) in a juvenile goat model. A small Orthofix dynamic fixator was affixed to 5.5 mm pedicular halfpins placed bilaterally at T12, L1, L5 and L6 in six juvenile goats. Distraction was performed across vertebral endplates between L1 and L5. Uninstrumented twins served as controls. Two pairs of animals were deleted due to anesthetic complications. Lumbar lengthening was successful in 3 animals resulting in an increase in length of up to 696% from L1 to L5 compared to the growth rate of the controls (mean 4.3 cm vs. mean .56 cm, respectively). Lengthening of the spinal cord was not associated with brain stem migration or spinal cord injury.

Pathomechanical analysis of thoracolumbar burst fracture reduction. A calf spine model.

Burst fractures were created in the spines of twelve dairy calves and the mechanism of indirect canal clearance studied. The spines were reduced posturally and divided in to four subsets--control, and subsets in which either the posterior longitudinal ligament (PLL), the PLL and annulus, or posterior osteoligmentous structures were sectioned. The specimens were then instrumented and further reduction obtained through application of extension and distraction forces. Statistically significant reduction of the intracanal burst fragment occurred even if the PLL or PLL and annulus were incompetent but did not occur in that group in which the posterolateral complex had been sectioned.