Circumferential Periosteal Release to Treat Paediatric Leg Length Discrepancy: Medium Term Outcomes.

Aims: This study aims to report the medium term outcomes of circumferential periosteal release of the distal femur and distal tibia in treating paediatric leg length discrepancy (LLD). Materials and methods: A retrospective case series was performed on all patients undergoing circumferential periosteal release of the distal femur and/or tibia between 2006 and 2019. Data collected included demographics, surgical indications, post-operative leg lengths, and complications. Leg length discrepancy was calculated as actual values and percentages of the longest limb length. Final actual and percentage discrepancies were compared to initial discrepancies using a paired t-test. Patterns of discrepancy over time were analysed using linear mixed models. Results: Eighteen patients (11 males) were identified, who underwent 25 procedures. The mean age at first surgery was 5.8 (range, 2-13). The commonest indication was congenital limb deficiency (7 patients). Five patients underwent repeat periosteal release, and one patient had three releases. The mean follow-up was 63 months [standard deviation (SD), 33.9]. Fifteen patients had sufficient data for statistical analysis.The mean actual discrepancy decreased from 2.07 cm (SD, 1.07) to 1.12 cm (SD, 1.62), and the mean relative discrepancy from 4.3% (SD, 2.8) to 1.5% (SD, 2.4). Significant mean reductions were seen in both actual discrepancies [0.61 cm (95% CI: 0.05-1.16; p = 0.034)], and percentage discrepancy [2.10% (95% CI: 1.0-3.1, p = <0.001]). In five patients, the operated limb overgrew the contralateral limb. Patients whose operated limb overgrew still had a reduction in LLD, with a mean residual discrepancy less than 1 cm (mean 0.7 cm, 95% CI: From -0.9 to 2.4). Conclusion: Circumferential periosteal release produces a significant decrease in both actual and percentage LLD. We believe this procedure is best indicated in younger patients with congenital LLD in whom the discrepancy is predicted to increase as they age. Clinical significance: Circumferential periosteal release produces a significant decrease in LLD. This procedure can be used to manage symptoms during growth, particularly at the point where orthotic usage may become problematic, and to potentially reduce the magnitude of surgery needed at an older age. How to cite this article: Chatterton BD, Kuiper JH, Williams DP. Circumferential Periosteal Release to Treat Paediatric Leg Length Discrepancy: Medium Term Outcomes. Strategies Trauma Limb Reconstr 2023;18(2):67-72.

Talonavicular dislocation with associated cuboid fracture following low-energy trauma.

Isolated talonavicular dislocations are uncommon injuries, usually occurring as a result of high-energy trauma. As a result extensive disruption of the midfoot ligamentous structures commonly occur with these injuries, often resulting in a poor outcome. Due to its rarity these injuries remain poorly understood, and several opinions exist on the probable mechanisms of injury and the optimal treatment. Five main injury types have been classified based on the deforming forces and direction of displacement; medial, lateral, longitudinal, plantar, and crush. However new mechanisms and injury patterns continue to be reported. We report a case of a medial swivel type talonavicular dislocation, associated with a cuboid body fracture, which is previously undescribed.

Heat treatment of arthroscopic knots and its effect on knot security.

PURPOSE: The purpose of this study was to investigate heat application to arthroscopic knots as a method of improving knot security. METHODS: Heat treatment was assessed on 4 suture materials--Ethibond (Ethicon, Somerville, NJ), PDS (Ethicon), Orthocord (DePuy Mitek, Raynham, MA), and FiberWire (Arthrex, Naples, FL)--tied by use of the Duncan loop, compared with untreated controls. A hand-tied surgeon's knot with Ethibond was included as the gold standard. Knots were tied around a plastic rod immersed in a saline solution-filled water bath at 37 degrees C, with heat treatment performed by use of the Mitek VAPR 3 electrosurgical unit and VAPR S(90) electrode (DePuy Mitek), applied directly to the knot body. Loops were subjected to a 5-N preload, followed by loading to clinical failure (>3 mm of displacement) and ultimate (breaking) failure by use of a tensile tester. RESULTS: Load to ultimate failure was significantly higher in the FiberWire 1-second heat treatment arm (26.0% increase, 234.25 +/- 62.34 N, P < .03), Orthocord 1-second heat treatment arm (55.6% increase, 204.72 +/- 78.47 N, P < .03), and Orthocord 5-second heat treatment arm (69.2% increase, 222.58 +/- 56.57 N, P < .001) than in controls. Load to clinical failure was significantly higher in the Orthocord 10-second heat treatment arm (34.7% increase, 78.58 +/- 13.88 N, P < .0001) when compared with controls. The FiberWire 5- and 10-second heat treatment arms showed lower load to clinical and ultimate failure (P < .001). Ethibond, Orthocord, and FiberWire showed higher load to clinical failure than PDS (P < .0001). Ethibond and Orthocord knots were more likely to fail through knot slippage after heat treatment compared with controls (P < .01). CONCLUSIONS: Heat treatment resulted in greater knot security when combined with Orthocord and FiberWire suture materials. Heat-treated Ethibond and Orthocord knots were more likely to fail through suture breakage than knot slippage. CLINICAL RELEVANCE: This study presents a simple and novel technique of improving knot security in the arthroscopic repair. The effects of heat were extremely well tolerated in the Orthocord and FiberWire groups, making this technique particularly suitable for clinical use.