Derotational Subtrochanteric Osteotomy and External Fixation for the Treatment of Neurogenic Hip Dislocation in Children with Cerebral Palsy: Could This Be a Viable Method of Treatment?

Purpose The treatment of painful and chronic dislocated hip in children with severe cerebral palsy (CP) is particularly demanding and controversial. Numerous surgical techniques have been described, and their outcomes vary a lot. The purpose of the present study is to evaluate a new method, which combines varus derotational subtrochanteric osteotomy (VDSO) and external osteosynthesis: (VDSOEO). Methods Six non-ambulatory children with spastic quadriplegia and chronic dislocated painful hips were treated. The technique involved a small incision on the subtrochanteric site of the osteotomy, followed by retention with a single-sided external osteosynthesis with rotational correction capability [swiveling clamp (SC)] for the reduction of the femur head in the acetabulum, and finally by the osteotomy. Hardware was removed without a second intervention four-six months postoperatively and after the osteotomy was healed. Evaluation of the method was based on clinical, functional, and radiological criteria. Results  Four patients achieved improved radiological scores. Two patients demonstrated resubluxation during the period of the osteotomy's healing process. However, no patients experienced pain, and all were able to sit post-surgery, while caregivers reported improved capacity for nursing care. Conclusions It is our strong belief that this approach can improve the quality of life in children with severe CP and painful and chronic dislocated hips. It is a viable and definitely less invasive procedure than classic pelvic or femur osteotomies.

Salmonella Osteomyelitis of the Proximal Tibia in a Previously Healthy Adolescent: A Case Report.

Salmonella osteomyelitis is an uncommon pathological condition. Usually, it is associated with hemoglobinopathies or other underlying disorders. Osteomyelitis due to Salmonella is extremely rare in a previously healthy patient. We present a case of a 12-year-old previously healthy male who suffered Salmonella osteomyelitis of the proximal tibia as well as the diagnostic algorithm and therapy protocol. In our case, Salmonella osteomyelitis was identified by direct inoculation of the sample in blood culture bottles. Traditional cultures were negative. The practice of blood culture bottles seems to be essential for diagnosis, so the appropriate treatment is performed.

Atlas Fracture with Concomitant Vertebral Artery Hypoplasia, a Rare but Potentially Hazardous Combination: A Case Report.

The fractures of the first cervical spine vertebrae (atlas) represent 7% of all the overall cervical spine fractures. Hypoplasia of the vertebral artery is also rare (10% of the general population), but even rarer is the combination of those both conditions. This combination should always be identified and treated because sometimes it can be extremely dangerous for the patient. We present a case of a 24-year-old patient who suffered an atlas fracture with concomitant vertebral artery hypoplasia (VAH). We also present the diagnostic algorithm and the treatment management that we have followed. In case of cervical spine trauma the neurovascular symptoms should not be underestimated. Any neurological symptom (sensory, motor, reflex deficits) should be evaluated in detail. In some cases, with uncommon neurological symptoms such as, in our case, unilateral headache, dizziness and vertigo (or generally, involuntary eye movements and salivation, impaired speech and hearing, diplopia, blur vision, incoordination, imbalance, limb weakness) head injury or vertebral artery (VA) injuries have to be suspected. Further evaluation with brain computed tomography (CT) scan and computed tomography angiography (CTA) should be provided. In case of cervical spine trauma over a pre-existing VAH the complications rate is even higher and the early diagnosis and treatment are crucial.

Strangling Congenital Constriction Ring Band of the Forearm with Fracture: A Rare Case Report.

Congenital constriction ring syndrome (CCRS) is a well-described pathological entity that is caused by fibrous bands that entrap parts of the fetus. The manifestations of this syndrome may vary a lot. We present a case of an almost intrauterine amputation of a fetus's upper limb. Our case is infrequent because the constriction band caused a fracture of the fetus's forearm during pregnancy. Both the band and the fracture resulted in ischemia to the hand and a salvage procedure was applied after birth. Not many authors have reported fractures due to constriction ring bands and even less have reported fractures of the upper limb. A literature review of this rare entity was conducted.

Anatomic Characteristics of the Distal Oblique Bundle of the Interosseous Membrane of the Forearm.

The distal oblique bundle of the forearm is a structure that has been under vigorous investigation for the past decade. It is part of the distal interosseous membrane (DIOM) and seems to have an important stabilizing effect in the distal radioulnar joint. In this essay, we have tried to summarize the anatomical characteristics of the structure. We have also compared and contrasted this to our own experience with eight freshly frozen forearms. It is our strong belief that the distal oblique bundle (DOB) may play a keystone role in future stabilization techniques of the distal radioulnar joint, and its anatomy characteristics need to be fully investigated.

A Bridging: Distraction External Fixation for a Severely Comminuted Fracture of the Middle Phalanx. A Case Report.

Severely comminuted fractures of the middle phalanx of the digits are known to be demanding cases for hand surgeons. The restoration of the length and axis of the phalanx, such as the anatomic reduction of the articular surface in case of intra-articular association are basic principles that have to be followed. A simple and cheap device consisting of two Kirschner wires and a nylon suture can work as an external fixation system based on the principle of ligamentotaxis. As a result, the anatomic reduction of the fracture with minimal soft tissue damage and simple surgical equipment is feasible.

Morphometric characteristics of the thoracοlumbar and lumbar vertebrae in the Greek population: a computed tomography-based study on 900 vertebrae-"Hellenic Spine Society (HSS) 2017 Award Winner".

BACKGROUND: Vertebrae morphology appears to have genetic and ethnic variations. Knowledge of the vertebra and pedicle morphology is essential for proper selection and safe application of transpedicular screws. The aim of this study is to create a morphometric database for thoracolumbar and lumbar vertebrae (T9-L5) among individuals of both sexes in the Greek population. MATERIAL AND METHODS: The morphometric dimensions of T9-L5 vertebrae on computed tomography (CT) scan images were measured in 100 adults (79 males and 21 females), without spinal pathology, age from 33 to 87 years old (mean 70 ± 8.73 years). The anterior vertebral body height (AVBH), the posterior vertebral body height (PVBH), the angle formed by the upper end plate of vertebral body and the horizontal line in the sagittal plane, the inner cancellous and outer cortical pedicle height and width, the angle formed by the longitudinal trajectory of the right- and left-sided pedicles and the midline anteroposterior axis of the vertebra (pedicle axis angle (PAA)), and the postero-anterior trajectory's length of the pedicle from the entry point to the anterior cortex of the vertebra (PTLP), for the right- and left-sided pedicles, were calculated. The Mann-Whitney U tests were conducted to compare the differences in various morphometric characteristics between sexes. The collected data were statistically analyzed using the SAS/STAT software 3.1.3 and SPSS version 22. The statistical significance was set at the level of p < 0.05. The intra- and inter-observer reliability of the measured parameters was also calculated. RESULTS: The L5 vertebra had the maximum AVBH with a mean of 28.47 mm (SD ± 2.55 mm) in males and 26.48 mm (SD ± 1.61 mm) in females. The maximum PVBH in males was at L1 vertebra with a mean of 27.77 mm (SD ± 1.64 mm) and in females at L2 vertebral with a mean of 27.11 mm (SD ± 1.27 mm). Regarding the left pedicle dimensions, the maximum inner cancellous and outer cortical pedicle height was at T11 with a mean of 12.86 mm (SD ± 1.26 mm) and 18.82 mm (SD ± 1.37 mm) in males and 10.24 mm (SD ± 1.88 mm) and 16.19 mm (SD ± 3.27 mm) in females, respectively. The maximum inner cancellous and outer cortical pedicle width was at L5 with a mean of 11.57 mm (SD ± 1.97 mm) and 17.08 mm (SD ± 1.97 mm) in males and 10.24 mm (SD ± 1.88 mm) and 16.27 mm (SD ± 3.27 mm) in females, respectively. The largest PAA was found at the L5 with a mean angle of 26.23° (SD ± 2.65°) in males and 23.63° (SD ± 4.59°) in females, respectively. The maximum PTLP was found at the level of L4 with a mean of 55.31 mm (SD ± 4.52 mm) in males and 48.7 mm (SD ± 4.17 mm) in females, respectively. Regarding the right pedicle dimensions, the maximum inner cancellous and outer cortical pedicle height was found at T12 with a mean of 13.03 mm (SD ± 2.01 mm) and 18.01 mm (SD ± 1.56 mm) in males and 10.24 mm (SD ± 1.23 mm) and 16.14 mm (SD ± 1.23 mm) in females, respectively. The maximum inner cancellous and outer cortical pedicle width was at L5 with a mean of 11.3 mm (SD ± 2.86 mm) and 16.34 mm (SD ± 2.98 mm) in males and 12 mm (SD ± 3.18 mm) and 15.69 mm (SD ± 2.59 mm) in females, respectively. The greater PAA was at the L5 vertebral with a mean of 25.7° (SD ± 5.19°) in males and 25.56° (SD ± 5.31°) in females, respectively. The maximum PTLP was at the level of L3 with a mean of 54.86 mm (SD ± 3.18 mm) in males and 49.01 mm (SD ± 2.97 mm) in females, respectively. At all vertebrae, the only statistically significant difference (p < 0.0001) between the two sexes was the mean PTLP of the right and the left pedicle. The L5 vertebra was found to have the largest AVBH, PAA, and pedicle width in male and female populations. CONCLUSIONS: This study provides a database of morphometric characteristics on thoracolumbar and lumbar vertebrae from T9 to L5 in the Greek population. This database may prove to be of great significance for forthcoming comparative studies. It can also serve as a basis in order to detect pathological changes in the spine and furthermore to plan operative interventions. It was found that the dimensions of thoracolumbar and lumbar vertebrae in the Greek population are sex-dependent. In the current study, vertebra and pedicle dimensions seem to have some similarities compared to other Western populations. However, in the thoracolumbar region, the pedicles of T9 and T10 may hardly accommodate a 4.00-mm pedicle screw given the narrow inner cancellous pedicle width. Importantly, the vertebra and pedicle dimensions measured in the current study can be used to guide the selection of transpedicular screws in the Greek population and to guide further research.

Lower Limb Stump Fistula Treated with Laser Ablation. A Possible Alternative Minimal Invasive Technique.

Stump-wound infections are a common cause of complications after amputation. Wound infections, usually after major lower-limb amputation, vascular disease, or trauma, may lead to fistula formation. The main therapeutic options for these infections include antibiotic administration alone or antibiotic treatment in combination with surgery. Fistula management may require multiple surgical interventions that increase morbidity and cost and require long-term treatment prohibiting early mobilization of patients. We present a novel technique based on diode laser energy to destroy the fistula tract. This method has been applied on two patients with excellent results. It is easy to perform, safe, repetitive, well tolerated, and it can be performed under local anesthesia. This technique seems to offer excellent results.

Pathological Hip Fractures in Children and Adolescents Due to Benign Tumor or Tumor-Like Lesions.

Hip fractures are uncommon in childhood and adolescence. A high-energy injury is the most common cause. Low-energy trauma may result in a pathological hip fracture or stress fracture of the femoral neck, on the grounds of a preexisting skeletal disease, a tumor, or a tumor-like lesion. Surgical or conservative treatment may be provided based on underlying disease and/or age, Delbet and/or Colona classification, and displacement of the fracture. We present a case series of 13 children with pathological hip fracture. Mean age of patients was 7 years, and average follow-up was 3 years. There were types I and II, 3 type III, and 10 type IV fractures according to Delbet/Colona classification. Patients were treated conservatively, by open reduction and internal fixation or by minimally invasive surgery. In 11 children (84.5%), the outcome was satisfactory; one child (7.75%) presented with nonunion and refracture after minimally invasive surgery, and another (7.75%) presented with refracture after conservative treatment. Both patients were treated with open reduction and internal fixation. Pathological hip fractures are rare in children and should be treated properly. Surgical treatment with open reduction, internal fixation, and bone grafting is preferred in displaced fractures. In nondisplaced fractures, the choice between conservative and surgical treatment should be based on Delbet/Colona classification and patient profile.