Distraction Index Research Articles

What Are the Potential Benefits and Risks of Using Magnetically Driven Antegrade Intramedullary Lengthening Nails for Femoral Lengthening to Treat Leg Length Discrepancy?

What Are the Potential Benefits and Risks of Using Magnetically Driven Antegrade Intramedullary Lengthening Nails for Femoral Lengthening to Treat Leg Length Discrepancy?

Influence de l’âge sur la consolidation osseuse après un allongement des membres par une méthode intramédullaire

BackgroundDistraction osteogenesis with an intramedullary motorized nail is a well-established method to treat leg length discrepancy (LLD). The complex process of bone consolidation is affected by age, location, co-morbidities, smoking and gender. The purpose of this case series was to investigate influencing factors in bone regeneration after intramedullary callus distraction. HypothesisAdvanced age influences the outcome of intramedullary limb lengthening. Patients and methodsThis retrospective analysis included 19 patients after intramedullary telescopic nailing (PRECICE) on the lower limb with a mean age of 43 years. Bone healing was assessed by distraction and healing parameters such as distraction-consolidation time (DCT), distraction index (DI), healing index (HI), lengthening index (LI), and consolidation index (CI). ResultsConfounding factors such as smoking, previous operations on the treated bone, but also the occurrence of complications, and the number of revision surgeries are independent of the patients’ age. Younger patients showed a shorter distraction distance, a lower DCT, a lower DI, a higher HI, and a higher CI than older patients. The complication rate requiring nail exchange was higher among the younger patients. Bony healing was observed in all age groups treated with a telescopic nail regardless of age. ConclusionAdvanced age did not influence bone healing or complication rate in intramedullary lengthening. However, the conclusion is limited by the small patient number. Level of evidenceIV; case control study.

Stacking‐based ensemble learning method for cognitive distraction state recognition for drivers in traditional and connected environments

Compared with the traditional environment, a connected environment in which multiple types of intelligent vehicles share roads will be more complicated. However, do changes in the traffic environment affect the driver's distraction level and distraction recognition? Relatively few studies have addressed these questions. This study constructs traditional and connected environments and conducts driving simulation experiments. Distracted driving data for 60 drivers were collected in each environment, and the one-way repeated analysis of variance (ANOVA) method was used to select the distraction indices with significant differences as the input indices. An independent t-test was applied to analyse changes in the distraction indices in the two environments. The results show that the distraction indices, including the standard deviation (SD) of the horizontal fixation angles, blink frequency, mean pupil diameter, mean saccade speed, SD of the steering wheel angle, mean speed and SD of the lane acceleration, differ in the two environments; therefore, the distraction recognition model in the traditional environment is no longer suitable for connected environments. A distraction state recognition model developed with a stacking-based ensemble learning algorithm composed of a support vector machine (SVM), extreme gradient boosting (XGBoost), long short-term memory (LSTM), and bi-directional LSTM with an attention mechanism (AT-Bi-LSTM) was proposed for each environment. The recognition accuracy reaches 95.71% in the traditional environment, and the accuracy rate reaches 97.92% in the connected environment. Compared with traditional algorithms, the proposed approach yields greater recognition accuracy and can be applied in intelligent vehicle distraction early warning assistance systems to improve road safety.

The influence of advanced age in bone healing after intramedullary limb lengthening

BackgroundDistraction osteogenesis with an intramedullary motorized nail is a well-established method to treat leg length discrepancy (LLD). The complex process of bone consolidation is affected by age, location, comorbidities, smoking and gender. The purpose of this case series was to investigate influencing factors in bone regeneration after intramedullary callus distraction. HypothesisAdvanced age influences the outcome of intramedullary limb lengthening. Patients and methodsThis retrospective analysis included 19 patients after intramedullary telescopic nailing (PRECICE) on the lower limb with a mean age of 43 years. Bone healing was assessed by distraction and healing parameters such as distraction-consolidation time (DCT), distraction index (DI), healing index (HI), lengthening index (LI), and consolidation index (CI). ResultsConfounding factors such as smoking, previous operations on the treated bone, but also the occurrence of complications, and the number of revision surgeries are independent of the patients’ age. Younger patients showed a shorter distraction distance, a lower DCT, a lower DI, a higher HI, and a higher CI than older patients. The complication rate requiring nail exchange was higher among the younger patients. Bony healing was observed in all age groups treated with a telescopic nail regardless of age. ConclusionAdvanced age did not influence bone healing or complication rate in intramedullary lengthening. However, the conclusion is limited by the small patient number. Level of evidenceIV; Case control study.

Quality and Accuracy of Cervical Radiculopathy-specific Information on the Internet: A Cross-sectional Analysis.

Cross-sectional analysis. This study aimed to evaluate the quality and accuracy of the content surrounding cervical radiculopathy available on the internet. Those experiencing cervical radiculopathy and their families are increasingly browsing the worldwide web for medical information. As the information offered is likely to influence their health care choices, spine care providers must understand the quality and accuracy of that information. Independent searches were conducted on the three most commonly accessed search engines (Google, Yahoo, and Bing) using the keyword "cervical radiculopathy." The searches were performed on June 28th, 2019. The top 50 sites from each search engines were reviewed. The websites were evaluated using quality, accuracy and usability markers. Seventy-seven unique websites were analyzed; 54.5% were physician or medical group professional sites, 20.8% as non-physician, 10.4% as unidentified, 7.8% as academics, and 6.5% were commercial. Accuracy ranged from <25% to >75% were recorded with a mean accuracy of 3.5 signifying 50% to 75% agreement. Overall, website categories had a significant effect on Journal of American Medical Association (JAMA) score, content quality, accuracy, total summary scores, distraction index, reading ease, and grade level (P < 0.05). Academic sites had the highest mean quality content, accuracy and total summary scores. Four of the top five websites with the highest total summary scores were physician driven. On average, Health on the Net code (HONcode) certified websites had lower grade level readability with greater reading ease and higher DISCERN and JAMA scores than uncertified sites (P < 0.05). Despite the wide number of sources available, the quality, accuracy, pertinence, and intelligibility of the information remains highly variable. Clinicians treating patients with cervical radiculopathy should direct them to verifiable sites with regulated information and, where possible, contribute high- quality information to those sites.Level of Evidence: 4.

Auto Strut: a novel smart robotic system for external fixation device for bone deformity correction, a preliminary experience.

PurposeSeveral hexapod external fixators are used in the treatment of bone fracture and deformity corrections. One characteristic of all of them is the requirement for manual adjustment of the fixator struts. The purpose of this study was to introduce a novel robotic system that executes automatic adjustment of the struts.MethodsTen patients were treated for various bone deformities using a hexapod external fixator with the Auto Strut system. This new system automatically adjusts the fixator struts according to a hexapod computer-assisted correction plan. During each visit, the progress of the correction was assessed (clinically and radiographically) and reading of the strut scale numbers was performed and compared with the original treatment plan.ResultsAll patients completed treatment during the follow-up period, achieving all planned correction goals, except from one patient who switched to manual struts due to personal preference. The device alarm system was activated once with no device-related adverse events. Duration of distraction ranged between ten and 90 days with a distraction index ranging between eight and 15 days/cm. Regenerate consolidation time between one and seven months. In total, 48 struts of eight patients were recorded and analyzed. In all, 94% of the final strut number readings presented a discrepancy of 0 mm to 1 mm between planned and actual readings, indicating high precision of the automatic adjustment.ConclusionThis study presents preliminary results, showing that Auto Strut can successfully replace the manual strut adjustment providing important advantages that benefit the patient, the caregiver and the surgeon.Level of EvidenceLevel II

Changes in the femoral osteotomy level coefficient and neck shaft angle during limb lengthening with an intramedullary magnetic nail.

The intramedullary magnetic IM nail enables bone graduated distraction. Proximal femur osteotomies for ante grade IM lengthening nails have a tendency towards varus-procurvatum malalignment. We examined the effect of the level of the osteotomy and of trochanteric versus piriformis entry points on the neck shaft angle (NSA) during lengthening with the PRECICE IM magnetic nail. A novel parameter, the osteotomy level coefficient (OLC), was introduced as a guide to determine the level of an osteotomy at the proximal femur. The OLC was defined as the ratio between the distances from the tip of the greater trochanter to the osteotomy divided by the full length of the femur. A retrospective review of all femoral lengthening procedures with the PRECICE ante grade IM lengthening nail between 2013 and 2018 was carried out. 31 femurs were lengthened in 30 patients (16 males and 14 females, mean age at surgery years 17.1. The average amount of lengthening was 4.4cm. Trochanteric entry points were used in 24 femurs, and piriformis entry points in seven femurs. The OLC values ranged from 0.16 to 0.34 (average 0.25). The average follow-up period was 10.15months. The distraction index average 10.5days/cm (Range 8.6-11.9), Consolidation index 32.1days/cm (14.3-51.9). The average post-operative NSA was significantly reduced from 133.5º to 128.5º [t (31) = 5.57, p = 0.000]. There was no correlation between the OLC and the change in the NSAs. The trochanteric entry point showed a greater tendency to reduce the NSA (Mdif = - 6, SD = 4.8) compared to the piriformis entry point (Mdif = - 0.86, SD = 2.27) [t (31) = -3.96, p = 0.001]. Proximal femur lengthening with the PRECICE IM nail significantly reduced the NSA and might cause Varus deformity. The level of osteotomy by OLC did not influence the amount of NSA reduction. The trochanteric entry points have a greater tendency to reduce the NSA compared to the piriformis entry points.

Juvenile pubic symphysiodesis associated with pectineus myectomy for treatment of hip dysplasia in dog

Background: Hip dysplasia (HD) is the most common non-traumatic orthopedic disease in large breed dogs. Treatment is chosen according to the severity of the condition, the age of the dog and the involvement of osteoarthritis (OA). For puppies up to 20-weeks-old, surgical treatment by the juvenile pubic symphysiodesis (JPS) technique can be performed. This procedure promotes the ventrolateral rotation of the acetabulum over the femoral head, which improves hip joint congruence and stability. The objective of this study is to report the case of a young dog with HD treated with JPS and pectineus myectomy. Clinical and radiographic outcomes were assessed for up to one year after surgery.Case: A 17-week-old Saint Bernard puppy was attended at the University Veterinary Hospital showing abnormal weight bearing and lameness in pelvic limbs, without history of previous trauma. On orthopedic examination, there was a marked hypotrophy of the pelvic limb muscles, severe pain and laxity in the hip joints, and positive feature in the Ortolani test. The hip joint subluxation angle (SA) and reduction angle (RA) were measured. A radiographic study was carried out to evaluate the hip joints and measure the Norberg angle (NA), distraction index (DI), acetabular angle (AA) and dorsal acetabular rim angle (DARA). The 20-week-old dog underwent surgical treatment by JPS technique. A ventral surgical approach to the pubis was performed and the pubic symphysis was cauterized with electrocautery. Partial pectineus myectomy technique was also performed. Drug therapy and restriction of physical activities were indicated in the early postoperative. The dog was evaluated by clinical and radiographic examinations at 4 months and 1 year after the surgical procedure. In the reassessment after 4 months of surgical treatment, the patient showed improvement in clinical signs, with mild lameness and absence of painful sensitivity in the movement of the hip joints. Radiographically, hip joint incongruity was observed, but with progressive improvement in the values of the measured variables. In the clinical examination 1 year after the procedure, the dog showed satisfactory weight bearing with slight lameness in pelvic limbs in the running gait. There was improvement in the thigh muscles and no painful signs were observed in the hip joints, but a positive result was detected in the Ortolani test. In the radiographic examination, bilateral articular incongruity was still observed, however, there was a mild improvement in the coverage of the acetabulum over the femoral head. The measured angles and indices showed favorable results regarding the recovery of hip joint stability and proper development.Discussion: Studies evaluating the JPS technique for the treatment of HD have shown to be a relatively simple and effective procedure, which allows altering the acetabular coverage, reducing the development of HD and the progression of OA. The need for an early diagnosis of this condition is essential, so that the JPS technique can be used in young dogs and offer effective results. In the present report, in the late postoperative period, the dog showed improvement in clinical signs, with favorable weight bearing and ambulation in pelvic limbs, recovery of limb muscles, absence of pain in the hip joints and decrease in RA and SA. Radiographically, the reduction in joint subluxation, improvement in acetabular coverage over femoral heads, increase in NA and AA, reduction in DI and DARA are evidence of the favorable outcome of ventrolateral rotation of the acetabulum after surgical treatment. The surgical technique used was effective, which enabled the dog to recover the functional use of the pelvic limbs and improve the quality of life.Keywords: hip dysplasia, juvenile pubic symphysiodesis, hip joint, osteoarthritis, dog.Título: Sinfisiodese púbica juvenil associada à miectomia do pectíneopara tratamento de displasia coxofemoral em cãoDescritores: displasia coxofemoral, sinfisiodese púbica juvenil, coxofemoral, osteoartrite.

Intramedullary Bone Lengthening Following Preceding Hip Surgery-A Case Series.

Limb length discrepancy (LLD) is a common problem after joint-preserving hip surgeries, hip dysplasia, and hip deformities. Limping, pain, sciatica, paresthesia, and hip instability are common clinical findings and may necessitate limb-lengthening procedures. The study included five patients (two female and three male, mean age of 28 years (20–49; SD: 12)) with symptomatic limb length discrepancy greater than 2.5 cm (mean: 3.6 cm) after total hip arthroplasty (THA), hip dysplasia, or post-traumatic hip surgery. They underwent either ipsi- or contralateral intramedullary limb-lengthening surgeries using the PRECICE™ telescopic nail. All patients achieved complete bone healing and correction of the pelvic obliquity after intramedullary lengthening. None of the patients had a loss of proximal or distal joint motion. The mean distraction-consolidation time (DCT) was 3.8 months, the distraction index (DI) 0.7 mm/day, the lengthening index (LI) 1.8 months/cm, the consolidation index (CI) 49.2 days/cm, the healing index (HI) 1.1 months/cm, and the modified healing index (HI*) 34 days/cm. Intramedullary limb lengthening after LLD in cases of hip dysplasia, hip deformity, and various kinds of hip surgery is a useful and safe procedure in young patients to achieve equal limb length. No functional impairment of the preceded hip surgery was seen.

Wire bending development and progression during Ilizarov system tibial lengthening in skeletally immature patients with achondroplasia

Summary Background Tensile strength develops on wires during distraction osteogenesis (DO) using the Ilizarov system. The increase of tensile strength can lead to bending of the wires. The purpose of this study was to investigate the development and progression of wire bending during tibial lengthening using the Ilizarov system. We also identified factors that contribute to wire bending. Methods Seventy-two segments of 36 skeletally immature achondroplasia patients (mean age, 8.5 years; range, 5.1–14.4 years) with bilateral tibial lengthening with the Ilizarov system were included in this study. The wire bending was defined as cases with loss of linearity of the wire during DO. The average distance of proximal and distal wires to the adjacent ring throughout the entire DO was measured to determine the progression of wire bending. In addition, age, height, weight, initial tibial length, gain of length, amount of correction of angular deformity, distraction index, external fixation index, and healing index were investigated to identify potential contributors to wire bending. Wire-related complications, including wire breakage, were also assessed. Results Wire bending increased in the distraction phase (p ​ Conclusion This study indicated that the wire bending, which represented tensile strength on the wire, changed during the course of the DO. In addition, the amount of lengthening and the patient’s weight may contribute to the degree of the wire bending. The translational potential of this article Because excessive wire bending could lead to wire-related pain or even wire breakage, it is necessary to finely check and reduce the tension of the wire during DO in particular case of heavy patients or patients undergoing large amount of lengthening. Nevertheless, in case of wire breakage, remove the broken wire or fix it using the additional small plate to the Ilizarov system.

The correction of Ollier’s disease induced extremities deformity using distraction osteogenesis by intralesional osteotomy in children patients: a cases series study

Abstract Objective the present study was aimed at evaluating the effect of distraction osteogenesis using monolateral external fixators by intralesional osteotomy in children patients of Ollier’s disease. Methods 2 male and 4 female children patients of Ollier’s disease with an average age of 7.8 years received treatment between 2008 and 2016 were included in the study, and 1 ulna, 3 femurs, 4 tibias, 1 radius, and 1 humerus were involved. The Ollier’s disease induced extremities’ deformities were corrected by distraction osteogenesis using monolateral external fixator (LRS), and the intralesional osteotomy was conducted. The original length and the distracted length, the severity of angular deformity, and the mechanical axis deviation of the affected bones were measured. The initial and ending dates of bone lengthening, as well as the installation date and removal date of frames were recorded. The distraction index (DI) and the external fixator index (EFI) were calculated. Postoperative follow-up efficacy was assessed by regular radiographic examinations. Results after treatment in all cases the length discrepancy of the affected limbs with contralateral side were less than 3 ​cm, and the angular deformities were corrected. The mean lengthened bones were 52.8 ​mm ​± ​14.9 ​mm, the average DI was 12.9 days/cm ± 1.6 days/cm, and the mean EFI was 50.5 days/cm ± 12.5 days/cm. Pain as the complication were found in all cases and was managed by analgesics. Pin site infection were reported in one case and was cured by wound care and normal use of antibiotics. One case was found to have delayed bone healing but the volume and size of the affected bone was recovered to normal about 3 months after removal of the frames. Conclusion this study revealed that distraction is beneficial for the conversion of enchondromal bone into normal bone, and intralesional osteotomy is safe and supposed to protect the remaining healthy bone segment. Taken together, distraction osteogenesis using monolateral external fixators is effective in managing the length and angular deformity of extremities caused by Ollier’s disease in children patients. The translational potential of this article: To date, no consensus for the correction of extremities deformity induced by the Ollier’s disease has been established. This study found that distraction as a treatment could promote conversion of enchondromal bone into normal bone, and intralesional osteotomy is safe and beneficial for saving the limited healthy bone on the whole bone segment from being iatrogenically damaged. Such findings will provide some references for the treatments of extremities.

Tibial lengthening using a retrograde magnetically driven intramedullary lengthening device in 10 patients with preexisting ankle and hindfoot fusion

Background and purpose — Motorized intramedullary lengthening nails (ILNs) have been developed as an alternative to external fixators for long bone lengthening. The antegrade approach represents the standard method for tibial ILN insertion. In patients with preexisting ankle and hindfoot fusion a retrograde approach provides an alternative technique that has not been evaluated so far. We report the outcome of this method in 10 patients. Patients and methods — This retrospective study included 10 patients (mean age 18 years [13–25]) with preexisting ankle and hindfoot fusion who underwent tibial lengthening with a retrograde ILN (PRECICE). The mean leg length discrepancy (LLD) was 58 mm (36–80). The underlying conditions were congenital (n = 9) and post tumor resection (n = 1). The main outcome measures were: ILN reliability, distraction achieved, distraction index (DIX), time to bone healing, consolidation index (CIX), complications, and functional results. Results — All patients achieved the goal of lengthening (mean 48 mm [26–80]). Average DIX was 0.6 mm/day (0.5–0.7) and mean CIX was 44 days/cm (26–60). Delayed consolidation occurred in 2 patients and healed after ILN dynamization or nail exchange with grafting. Toe contractures in 2 other patients were resolved with physiotherapy or tenotomy. Until last follow-up (mean 18 months [12–30]) no true complications were encountered, knee motion remained unaffected, and full osseous consolidation occurred in all patients. Interpretation — In patients with LLD and preexisting ankle and hindfoot fusion distal tibial lengthening using a retrograde ILN is a reliable alternative to the standard approach with equivalent bone healing potential and low complication rates leaving the knee unaffected.

Comparison of Two Distraction Devices for Assessment of Passive Hip Laxity in Dogs.

Canine hip dysplasia is the most common orthopedic developmental condition in the dog and early hip laxity is the main risk factor. The importance of hip laxity in young animals in the development of hip dysplasia is unanimously recognized among researchers and veterinarians due to its medical applicability in terms of disease control and prevention. In the market, there is some certified hip distractors to promote joint laxity. However, the clinical use of some of these distractors complies with a set of usage rules, that can limit its medical application. In this study was compared the technical quality of radiographs and hip distraction using a certified hip distractor (CertD) and Dis-UTAD in 104 dogs (208 joints). The mean pelvic tilting of 1.5 ± 1.6° and 1.5 ± 1.8° were similar when using the CertD and the Dis-UTAD distractors, respectively (P > 0.05). In the CertD sample, the mean hip distraction index (DI) was 0.46 ± 0.17 and in the Dis-UTAD 0.46 ± 0.16; the mean DI differences was 0.001 ± 0.045, resulting in a non-significant paired t-test (P = 0.65) and a significant intraclass correlation coefficient of 0.96, with the 95% lower limit confidence interval of 0.95 (P < 0.05). The statistical power analysis showed a very low distraction index difference effect size. The results suggest that the statistical reproducibility of CertD hip distraction by the Dis-UTAD and the DI mean differences of 0.001 might be considered without clinical importance. The Dis-UTAD might be considered adequate to promote dog hip laxity.

Distraction index and Norberg angle to distinguish dysplastic and non-dysplastic hips based on FCI score.

Radiographic hip scoring according to the Fédération Cynologique Internationale (FCI) and PennHIP (Pennsylvania Hip Improvement Program) method was performed with the purpose to compare the PennHIP and FCI results as well as coxofemoral joint laxity by correlation of Norberg angle and distraction index measurements. A total of 167 dogs of various breeds presented for official screening examination in a veterinary teaching hospital in Germany were included. Using receiver operating characteristic analysis, the best Norberg angle and distraction index cut-off values to distinguish between dysplastic and non-dysplastic groups based on FCI grades and to distinguish between lax and tight hip joints according to the PennHIP proposal were calculated. More than one third (38.2 %) of dogs that passed the breeding criterions according to FCI (grades A and B) were in the half of the population with lax hip joints and should not be used for breeding according to the PennHIP proposal. A cut-off value for the distraction index of 0.44 with sensitivity of 82.7 % and specificity of 84.2 % was superior to the best cut-off value for the Norberg angle at 101.8° with sensitivity of 82.7 % and specificity of 71.9 % to discriminate between non-dysplastic joints (A, B) and dysplastic joints (C, D, E). Our results show a limited impact of laxity on the FCI grading. Breeding selection processes that are based on the FCI method could profit by an additional and complementary use of the distraction index.

Distraction index measurement on the dog's hip joint using a dedicated software

ABSTRACT The aim of this study was to test the accuracy of a new automated computer software tool for the assessment of passive hip laxity. The hip laxity was estimated using the dedicated computer software by two blinded evaluators, one previously trained and one without specific training for distraction index measurement, in two independent sessions using 230 hip joints from 115 dogs that underwent screening for passive hip laxity using the distraction view. Previously, all of these radiographs were sent to PennHIP Analysis Center for an official distraction index record. The measurement repeatability of the two sessions was adequate for both evaluators. The reproducibility of the official distraction index measurement, mean distraction index±standard deviation 0.44±0.15, was adequate (P&gt;0.05) for the trained evaluator, 0.44±0.15, and non-adequate (P&lt;0.05), for the non-trained evaluator 0.47±0.17. The distraction index measurement tool proposed can be used with confidence for hip laxity evaluation by trained evaluators, as it provided good repeatability and reproducibility of official reports. The simplicity of the process described leads to a less time-consuming and more affordable procedure.

Effectiveness of PennHIP and Orthopedic Foundation for Animals measurements of hip joint quality for breeding selection to reduce hip dysplasia in a population of purpose-bred detection dogs

To examine the effectiveness of applying selective pressure to improve hip joint quality in purpose-bred detection dogs by use of PennHIP distraction index (DI) values along with Orthopedic Foundation for Animals (OFA) hip joint scores and to determine whether age, sex, coat color, breed, and body weight were associated with hip joint quality. 615 purpose-bred detection dogs assessed for hip joint quality. Orthopedic records of 615 purpose-bred detection dogs (569 Labrador Retrievers and 46 Labrador Retriever-German Wirehaired Pointer crossbred dogs) from 2000 through 2017 were analyzed. From 2000 to 2014, hip joint quality scores were determined by OFA evaluation only (429 dogs). Beginning in 2015, both PennHIP and OFA evaluations were used to select male and female breeding stock (179 dogs; 7 dogs were removed from analysis because they did not undergo both evaluations). Selection threshold DI value for sires and dams was ≤ 0.30; all had hip joint scores of excellent or good by OFA standards. Standard ventrodorsal hip joint-extended and stress (compression and distraction) pelvic radiographs were submitted for OFA and PennHIP evaluations. Hip joint quality scores were unchanged by use of OFA measurements only. When both PennHIP and OFA measurements were used for the selection of breeding stock, hip joint quality scores improved significantly. Sex and age were significant predictors of DI values. PennHIP DI values were an effective measurement of hip joint quality for selecting breeding stock, and the addition of DI values to OFA measurements significantly improved hip joint quality in a population of purpose-bred dogs.

Triple pelvic osteotomy with a 12.5° and a 20° Slocum-type plate: A short-term prospective clinical pilot study in 38 dogs.

To determine whether using 12.5° Slocum-like triple pelvic osteotomy (TPO) plates would create sufficient femoral head coverage and lower the occurrence of overrotation compared with using 20° TPO plates in dogs with hip dysplasia. Prospective clinical study. Thirty-five dogs with hip dysplasia (38 hips). Nineteen hips were surgically treated with a custom-made Slocum-type 12.5° TPO plate, and these were matched to 19 hips surgically treated with a 20° commercial Slocum TPO plate. Hips were case matched according to size and breed. Ortolani sign, angles of subluxation and reduction, distraction index, and femoral head coverage (FHC) were compared between groups. Excessive coverage was defined as >80%. In the 12.5° group, FHC was ≥50% in all hips, with mean FHC (67%), gain (37%), and excessive coverage (11%) all significantly less than in the 20° group (79%, 54%, and 42%, respectively). The 12.5° plate produced sufficient FHC compared with the 20° plate, with fewer hips with excessive coverage. The 12.5° TPO plate may result in sufficient FHC with a lower occurrence of excessive coverage compared with 20° plates.

Cross sectional analysis of scoliosis-specific information on the internet: potential for patient confusion and misinformation.

Patients and their families are increasingly turning to the internet for medical information. Most of these patients believe the information to be accurate and reliable. However, the quality and accuracy of that information on the internet is variable and unregulated. Accurate and applicable information may align patients' expectations and improve satisfaction and overall outcomes. This study aimed to evaluate the quality and accuracy of scoliosis-related information available on the internet. Cross-sectional analysis. Independent searches were conducted on the three most commonly accessed search engines (Google, Yahoo and Bing) using the keyword "scoliosis". The top 30 sites from each search engine were reviewed. Each website was categorized as per its authorship and sourcing. Each site was then evaluated for accuracy, readability and with quality-assurance markers such as Health on the Net code (HONcode), DISCERN, Journal of American Medical Association (JAMA) systems. The accuracy of the website was assessed by two fellowship-trained spine specialists. Website accuracy was rated on a scale of 1-4 based on the level of agreement with the information presented. Websites with greater than 75% agreement were rated 4.Finally, the sites were evaluated with a validated website distraction index and assessed for mobile friendliness. 42 unique websites were analyzed. 31% of the sites were categorized as academic (13 academic, 9 healthcare system, 12 health news outlets and 8 unspecified) and had the highest rate of physician authorship (54%). Accuracy ranged from less than 25% to more than 75% were recorded with a mean accuracy of 3 signifying 50-75% agreement. Academic sites had the highest scoliosis specific accuracy score (P < 0.05). Overall, average readability was at a 12th grade reading level. More than 90% of the sites were mobile friendly. Approximately 71% of the websites did not have HONcode certification, although health news outlets had the highest rate of certification (67%). There was a significant effect of HONcode certification on DISCERN, JAMA, grade level and reading ease. On average, HONcode certified websites had lower grade level readability with greater reading ease and higher DISCERN and JAMA scores than un-certified sites (p < 0.05). On average, health news outlets had the highest DISCERN, JAMA, and reading ease scores and were written at the lowest grade reading level but had the highest level of distraction (p < 0.05). For the iGeneration and their care-givers, the internet remains the most popular source of health-related and medical information. Despite the wide number of sources available, the quality, accuracy, pertinence and intelligibility of the information remains highly variable. As clinicians, we should direct patients to verifiable sites with regulated information and, where possible, contribute high quality information to those sites.

Limb lengthening for deformities in Ollier's disease: a systematic review.

The management of limb deformity, shortening, and bone defects in treatment of Ollier's disease is a major challenge. This study aims to summarize and compare the different surgical treatments, and to evaluate the outcome and possible prognostic factors of leg lengthening in these patients. A systematic review of the literature from 1993 to 2017 was performed. Nineteen articles were found including a total of 121 patients with limb deformities because of Ollier's disease. The mean patients' age at the time of first surgery was 12years. A total of 272 segments were surgically treated (14 segments in the upper limbs) with variable techniques including osteotomies and external fixation, intramedullary nails, as well as epiphysiodesis and lengthening over nail. We studied the bone healing index (BHI), distraction index (DI), distraction time, gained length, total treatment time, and complications. Available implants and techniques allowed correction of patients' deformities (lengthening and correction of angular defects) in most cases. External fixators, circular or monolateral frames were the most commonly used technique. The Ilizarov external fixator was the most commonly used frame (196 segments). The BHI was significantly better when the external fixation was combined with intramedullary nails. Epiphysiodesis was most likely to be more associated with the past than to the present. Joint stiffness, infection, early consolidation, pathological fracture, deformity recurrence, delayed union, non-union, neurapraxia, and overlengthening were the reported complications with an overall rate of 27.9%. There is no consensus for the optimal surgical technique and implants for correction of limbs deformities in patients with Ollier's disease. External fixators most commonly circular are the most commonly used implants; however, complications do occur.

Complications and Effectiveness of Intramedullary Limb Lengthening: A Matched Pair Analysis of Two Different Lengthening Nails

BackgroundIntramedullary limb lengthening has become an accepted concept in reconstructive surgery, but as yet comparative clinical studies are missing. We compared the complications and effectiveness of two types of intramedullary limb lengthening devices (ISKD®; Fitbone®).Materials and methodsIn a retrospective series of 278 consecutive patients with internal limb lengthening, we found 17 matching pairs in terms of predefined matching parameters (group I with ISKD® and group II with Fitbone®). The surgeries were all performed with the same technique and managed with equivalent pre- and postoperative treatment protocols. The performance of the implants was evaluated using the distraction index and the weight-bearing index. Complications were rated according to Paley's classification for external lengthening.ResultsThe distraction index in group I (ISKD®) was 0.99 mm/day (range 0.55–1.67) and in the group II (Fitbone®) 0.55 mm/day (range 0.14–0.92) (p value = 0.001). The mean weight-bearing index differed between group I and group II from 32.0 day/cm (range 16.4–64.0) to 51.6 day/cm (25.8–95.0) (p value = 0.001). There were 17 recorded incidents in group I and 19 in group II during lengthening.ConclusionSpecific technical handicaps of the two systems, such as the so-called runaway of the ISKD® and backtracking of the Fitbone® nails seem to result in different distraction index and weight-bearing index. Further comparative studies might induce technical progress in intramedullary limb lengthening.How to cite this articleThaller PH, Frankenberg F, Degen N, et al. Complications and Effectiveness of Intramedullary Limb Lengthening: A Matched Pair Analysis of Two Different Lengthening Nails. Strategies Trauma Limb Reconstr 2020;15(1):7–12.