[Fractures of the lateral condyle of the humerus in children : High risk of secondary dislocation with conservative treatment]. / Frakturen des Condylus radialis humeri beim Kind : Hohes Risiko der sekundären Dislokation bei konservativer Therapie.

BACKGROUND: Fractures of the lateral condyle of the humerus in children are articular fractures with difficult diagnostics due to the incompletely ossified elbow joint. The aim of this study was to evaluate the method of treatment at initial presentation and to analyze the frequency of subsequent displacement during follow-up. MATERIAL AND METHOD: Retrospective analysis of the frequency of primary fracture dislocation and subsequent displacement of fractures of the lateral condyle of the humerus in children under 16 years of age between 2004 and 2021. Conventional radiographs in two planes at the time of the accident and in the follow-up after 5-7 days were evaluated. RESULTS: A total of 285 fractures of the lateral condyle of the humerus were evaluated. The average age was 5.3 years. Of the fractures 109 (38.3%) were directly surgically treated in cases of primary displacement and 176 fractures (61.7%) were not primarily displaced and were initially treated conservatively. During follow-up, subsequent displacement was evident in 46 fractures (26.1%). A total of 130 fractures (45.6%) were treated conservatively and 155 fractures (54.4%) were treated surgically using open joint visualization and screw osteosynthesis or K­wire osteosynthesis. CONCLUSION: Fractures of the lateral condyle of the humerus occur more frequently in a certain age group and require targeted radiological diagnostics. Nondisplaced fractures can be treated conservatively but essential radiological follow-up shows a high number of subsequent displacements, so that open surgical stabilization is often necessary.

Grade 3 Giant Cell Tumour of the Distal Humeral Epiphysis Treated with Intralesional Curettage, High Speed Burring and Bone Grafting: A Case Report.

Giant cell tumours of bone are benign but locally aggressive neoplasms involving the epi- and metaphysis of long bones. Tumours of the distal humeral epiphysis with cortical disruption and invasion into the joint and the soft tissues are rare and generally treated with wide resection and joint reconstruction. We present the case of a 19-year-old woman in whom such a tumour was successfully treated with intralesional curettage, high speed burring and autologous bone grafting. The patient underwent regular clinical and radiological follow-up. Ten years after the procedure she had no signs of tumour recurrence or degenerative changes, and she was pain free and had a normal elbow function.

Grade 3 Giant Cell Tumour of the Distal Humeral Epiphysis Treated with Intralesional Curettage, High Speed Burring and Bone Grafting: A Case Report

@#Giant cell tumours of bone are benign but locally aggressive neoplasms involving the epi- and metaphysis of long bones. Tumours of the distal humeral epiphysis with cortical disruption and invasion into the joint and the soft tissues are rare and generally treated with wide resection and joint reconstruction. We present the case of a 19-year-old woman in whom such a tumour was successfully treated with intralesional curettage, high speed burring and autologous bone grafting. The patient underwent regular clinical and radiological follow-up. Ten years after the procedure she had no signs of tumour recurrence or degenerative changes, and she was pain free and had a normal elbow function.

[The modified Dunn procedure to treat severe slipped capital femoral epiphysis]. / Die modifizierte Dunn-Operation zur Behandlung der schweren Epiphyseolysis capitis femoris.

The modified Dunn procedure enables restoration of the proximal femoral anatomy and normal hip function in patients with slipped capital femoral epiphysis (SCFE). Surgery is indicated in severe SCFE and in hips with a moderate slip angle and impaired function. To prevent further dislocation of the femoral head, the authors recommend non-weightbearing until surgery, since an accurate evaluation of slip stability is not possible in the clinical setting. Only a well-trained orthopedic surgeon with a high level of expertise in hip preservation surgery should perform this procedure. Precise knowledge of the vascular anatomy of the proximal femur is essential to perform successful surgery with low rates of complications such as avascular necrosis of the femoral head. Surgical hip dislocation with osteotomy of the greater trochanter is the approach used. After arthrotomy, stability of the physis is checked. To prevent rupture of the retinacular vessels in hips with an unstable physis, these heads are prophylactically pinned before dislocation out of the socket. Blood supply to the femoral head as well as intraarticular damage can be judged in the dislocated position of the femoral head. The retinacular flap preserves epiphyseal perfusion while the femoral head is dislocated from the femoral neck. Resection of posteromedial callous formation from the femoral neck as well as removal of the remaining physis from the femoral head prevent stress on the retinacular vessels after reduction of the femoral head (epiphysis) on the neck.

Patients with severe slipped capital femoral epiphysis treated by the modified Dunn procedure have low rates of avascular necrosis, good outcomes, and little osteoarthritis at long-term follow-up.

AIMS: The modified Dunn procedure has the potential to restore the anatomy in hips with severe slipped capital femoral epiphyses (SCFE). However, there is a risk of developing avascular necrosis of the femoral head (AVN). In this paper, we report on clinical outcome, radiological outcome, AVN rate and complications, and the cumulative survivorship at long-term follow-up in patients undergoing the modified Dunn procedure for severe SCFE. PATIENTS AND METHODS: We performed a retrospective analysis involving 46 hips in 46 patients treated with a modified Dunn procedure for severe SCFE (slip angle > 60°) between 1999 and 2016. At nine-year-follow-up, 40 hips were available for clinical and radiological examination. Mean preoperative age was 13 years, and 14 hips (30%) presented with unstable slips. Mean preoperative slip angle was 64°. Kaplan-Meier survivorship was calculated. RESULTS: At the latest follow-up, the mean Merle d'Aubigné and Postel score was 17 points (14 to 18), mean modified Harris Hip Score was 94 points (66 to 100), and mean Hip Disability and Osteoarthritis Outcome Score was 91 points (67 to 100). Postoperative slip angle was 7° (1° to 16°). One hip (2%) had progression of osteoarthritis (OA). Two hips (5%) developed AVN of the femoral head and required further surgery. Three other hips (7%) underwent implant revision due to screw breakage or change of wires. Cumulative survivorship was 86% at ten-year follow-up. CONCLUSION: The modified Dunn procedure for severe SCFE resulted in a low rate of AVN, low risk of progression to OA, and high functional scores at long-term follow-up. The slip deformities were mainly corrected but secondary impingement deformities can develop in some hips and may require further surgical treatment. Cite this article: Bone Joint J 2019;101-B:403-414.

Achieving selectivity for copper over zinc with luminescent terbium probes bearing phenanthridine antennas.

A family of terbium probes was synthesized and evaluated for the luminescence detection of copper and zinc in water at neutral pH. Each probe incorporates a terbium ion chelated by a macrocyclic polyaminocarboxylate and conjugated to either one, two, or three phenanthridine antennas via a diamine linker. All three probes, Tb-1Phen, Tb-2Phen, and Tb-3Phen, exhibit similar responses toward copper and zinc. In each case, the terbium-centered time-gated phosphorescence decreases upon binding either CuI or CuII but not upon addition of ZnII. The phosphorescence of Tb-2Phen is also not significantly affected by other metal ions including MgII, CaII, MnII, FeII, NiII, CdII, and HgII. Tb-1Phen, on the other hand, responds weakly to MnII, FeII and NiII. The lack of affinity of each probe for ZnII was further confirmed by competition experiments with CuI and CuII. Notably, whereas the terbium-centered emission of each probe is quenched upon copper coordination, the phenanthridine-centered luminescence emission is not. As such, each probe functions as a ratiometric probe for the selective detection of copper over zinc. Theoretical calculations further demonstrate that the turn off response of the probe is due to an increase in the distance separating the lanthanide ion from its phenanthridine antennas upon coordination of copper, which in turn decreases the efficiency of terbium sensitization by the phenanthridines.

The modified Dunn procedure for slipped capital femoral epiphysis: the Bernese experience.

PURPOSE: Based on previous investigations on the vascular blood supply to the femoral head, a technique for anatomical reduction after slipped capital femoral epiphysis was developed. This technique is a modification of the original technique by Dunn using a retinacular soft-tissue flap. This allows the visual control of the epiphyseal vascular blood supply. We report the experience at the inventor's institution with a critical discussion of the available literature. METHODS: Using a trochanteric osteotomy for surgical dislocation of the hip, a retinacular soft tissue flap is created containing the deep branch of the medial femoral circumflex artery, the external rotators and the capsule. The femoral epiphysis can be mobilised safely and reduced on the femoral neck after resection of the almost constantly present reactive metaphyseal callus. RESULTS: In our institution, the rate of avascular necrosis with 2% is comparably low to Dunn's original results. It is only present in cases where no bleeding was already evident before reduction of the epiphysis. The ten-year long-term results are favorable in these cases with a good functional result and only little progression of osteoarthritis. However, other authors have reported higher rates of avascular necrosis up to 24% in their initial experience. CONCLUSIONS: In experienced hands using the correct meticulous surgical technique, the results are favorable regarding the rates of avascular necrosis, the functional outcome and the development of radiographic osteoarthritis - even in acute and severe cases. Avascular necrosis is rare but can be observed if there is no evidence of intra-operative femoral head perfusion before and after reduction of the epiphysis.

[Rotation or derotation osteotomy of the tibia]. / Rotations- oder Derotationsosteotomie der Tibia.

OBJECTIVE: Corrections for congenital or posttraumatic malrotation of the lower leg, considering alignment of the contralateral leg, with an osteotomy and fixation using locking compression plates (LCP). INDICATIONS: Posttraumatic deformity due to malunion. Increased tibial torsion in residual clubfoot deformity as long as the foot has been realigned. Idiopathic internal or external rotational deformity if the child is regularly tripping and falling, has psychological problems (other children making fun of the child because of the unusual gait), or is bothered by the deformity (age > 10 years, relative indication). CONTRAINDICATIONS: Rotational deformities at other levels, mainly the hip. Children under the age of 3 years due to the remodeling potential during growth. SURGICAL TECHNIQUE: Osteotomy at supramalleolar level and fixation with 3.5 mm 90° locking plate. Perpendicular osteotomy at the intersection of midshaft to distal shaft. After achieving the desired correction, fixation by a straight four-hole 3.5-mm locking plate. POSTOPERATIVE MANAGEMENT: Following fixation of the osteotomy with the four hole 3.5 mm LCP, a lower leg cast is recommended for 4-5 weeks. Applying the 3.5 mm 90° LCP allows immediate postoperative full weight bearing. Osteotomy material should be removed 1 year postoperatively. RESULTS: Assuming an uneventful postoperative course, consolidation of the fracture can be expected within 4-6 weeks. The stable fixation with locking plates provides stability without loss of correction at follow-up.

[Proximal Femoral Osteotomies with the Paediatric Hip Plate (LCP): Valgus osteotomy]. / Osteotomien am proximalen Femur mit der winkelstabilen kindlichen Hüftplatte (LCP): Valgusosteotomie.

OBJECTIVE: Proximal femoral osteotomy with stable fixation and sufficient correction. Low complication rates due to exact preoperative planning. INDICATIONS: Congenital or traumatic femoral neck pseudarthrosis. Coxa vara. CONTRAINDICATIONS: None. In severe deformities, a single femoral osteotomy may not solve the problem; thus, additional correction, e.g., a pelvic osteotomy, is required. SURGICAL TECHNIQUE: Correct planning of the correction angle. Lateral approach. Subperiosteal detachment of vastus lateralis muscle. Place guide wire on the femoral neck to judge anteversion. Insert positioning wire 5 mm distal to trochanteric physis. Insert 2.8 mm Kirschner wire in the femoral neck. Osteotomy of the femur after marking the rotation by Kirschner wires or oscillating saw. Slide LC plate over Kirschner wires. Replace Kirschner wires with screws. Reduction of the femoral shaft to the plate with bone forceps. Definitive fixation of the plate to the femoral shaft by cortex or locking screws. Readaptation of vastus lateralis muscle over the plate. POSTOPERATIVE MANAGEMENT: Partial weightbearing for 4-6 weeks depending on the age of the patient without any external fixation (e. g. cast) is possible. RESULTS: Recent studies support the authors' findings of sufficient correction and stable fixation after proximal femoral osteotomy with the LCP pediatric hip plate. Low complication rates and stable fixation.

[Operative treatment of congenital hip osteoarthritis with high hip luxation (Crowe type IV)]. / Die operative Versorgung der sekundären Coxarthrose bei kongenitaler Hüftluxation (Crowe Typ IV).

OBJECTIVE: The aim of the therapy is mechanical and functional stabilization of high dislocated hips with dysplasia coxarthrosis using total hip arthroplasty (THA). INDICATIONS: Developmental dysplasia of the hip (DDH) in adults, symptomatic dysplasia coxarthrosis, high hip dislocation according to Crowe type III/IV, and symptomatic leg length inequality. CONTRAINDICATIONS: Cerebrospinal dysfunction, muscular dystrophy, apparent disturbance of bone metabolism, acute or chronic infections, and immunocompromised patients. SURGICAL TECHNIQUE: With the patient in a lateral decubitus position an incision is made between the anterior border of the gluteus maximus muscle and the posterior border of the gluteus medius muscle (Gibson interval). Identification of the sciatic nerve to protect the nerve from traction disorders by visual control. After performing trochanter flip osteotomy, preparation of the true actetabulum if possible. Implantation of the reinforcement ring, preparation of the femur and if necessary for mobilization, resection until the trochanter minor. Test repositioning under control of the sciatic nerve. Finally, refixation of the trochanteric crest. POSTOPERATIVE MANAGEMENT: During hospital stay, intensive mobilization of the hip joint using a continuous passive motion machine with maximum flexion of 70°. No active abduction and passive adduction over the body midline. Maximum weight bearing 10-15 kg for 8 weeks, subsequently, first clinical and radiographic follow-up and deep venous thrombosis prophylaxis until full weight bearing. RESULTS: From 1995 to 2012, 28 THAs of a Crow type IV high hip-dislocation were performed in our institute. Until now 14 patients have been analyzed during a follow-up of 8 years in 2012. Mid-term results showed an improvement of the postoperative clinical score (Merle d'Aubigné score) in 86 % of patients. Good to excellent results were obtained in 79 % of cases. Long-term results are not yet available. In one case an iatrogenic neuropraxia of the sciatic nerve was observed and after trauma a redislocation of the arthroplasty appeared in another case. In 2 cases an infection of the THA appeared 8 and 15 months after index surgery. No pseudoarthrosis of the trochanter or aseptic loosening was noticed.

Bernese periacetabular osteotomy in males: is there an increased risk of femoroacetabular impingement (FAI) after Bernese periacetabular osteotomy?

BACKGROUND: The Bernese periacetabular osteotomy (PAO) is a popular option for treating symptomatic acetabular dysplasia. We noted symptomatic impingement after PAO in several male patients. QUESTIONS/PURPOSES: We therefore determined (1) the incidence of clinical signs of FAI after PAO in the male population; and (2) whether any factors were associated with the positive impingement signs after PAO in males. PATIENTS AND METHODS: We retrospectively reviewed 38 males who underwent 46 periacetabular osteotomies (PAO) between 2000 and 2007. Clinical and radiographic data were analyzed with the focus on pre- and postoperative incidence of femoroacetabular impingement. Minimum followup was 12 months (average, 43 months; range, 12-90 months). RESULTS: We found a positive impingement sign in 19 of the 46 hips during the preoperative examination compared to 22 (47.8%) hips postoperatively. The ROM (flexion and internal rotation) decreased postoperatively compared to preoperatively. Radiographic parameters of coverage LCE-, ACE- and Tönnis angle improved into the normal range. Twenty hips had postoperative heterotopic ossification to varying degrees, mostly minor. WOMAC scores improved in the function and pain domains postoperatively. CONCLUSIONS: Despite normalization of coverage we found a high postoperative rate of clinical signs of FAI after PAO in males. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Femoroacetabular cam-type impingement: diagnostic sensitivity and specificity of radiographic views compared to radial MRI.

PURPOSE: To retrospectively assess the diagnostic sensitivity of 45° Dunn view and cross-table lateral radiographs for the assessment of cam deformity by comparison with radial MRI. MATERIALS AND METHODS: 60 cases with radiographs (38 a-p and 45° Dunn views, 22 a-p and cross-table lateral views) and radial MRI were assessed. Alpha angle measurements were obtained both for radiographs and radial MRI. Statistics included frequency analysis, bivariate linear correlation analyses of MRI and radiograph measurements and cross-table analyses testing for the sensitivity and specificity of radiographs for the detection of an alpha angle larger than 55°. RESULTS: 53.3% had the maximum alpha angle in the superior-anterior aspect of the femoral head-neck junction. Cam deformity was found in 45/60 cases (75%) in radial MRI. Pearson correlation demonstrated the Dunn view was most accurate for the superior-anterior aspect (.772, P<.001). The cross-table lateral views were best suited for the anterior-superior aspect (.511, P<.05). The sensitivity for cam deformity in the Dunn view was 96.4% vs. 70.6% in the cross-table lateral view. CONCLUSION: The 45° Dunn view can improve the first line of impingement diagnostics. Radial MRI however remains indispensable for pre-operative planning and the evaluation of symptomatic cases without obvious deformity.

High-Resolution Study of the X22Pi3/2 --> X12Pi1/2 Fine Structure Transitions of PbF and PbCl.

The near-infrared emission spectra of the X22Pi3/2 --> X12Pi1/2 fine structure transitions of PbF and PbCl have been investigated by high-resolution Fourier-transform spectrometry. Despite the large fine structure splitting, the bands can be equally well analyzed with Hund's case (a) or case (c) formalisms. Accurate rotational constants for the v = 0 vibrational levels of 208PbF and 208Pb35Cl and hyperfine structure constants for 207PbF have been derived. Copyright 1998 Academic Press.