Fat Graft Interposition Research Articles

Tarsal Coalition: Surgical Management in the Young Athlete.

Tarsal coalition is an abnormal bony, cartilaginous, or fibrous bridge between 2 or more tarsal bones. Adolescent athletes with tarsal coalitions typically present with symptoms that include foot and/or ankle pain and limited range of motion. Loss of mobility can lead to abnormal loading, articular instability, deformity, and joint degeneration. Nonoperative management includes immobilization, physical therapy, and custom foot orthosis. Surgical options include coalition excision and fat graft interposition, foot realignment, or a combination of these. Surgical treatment requires evaluation of the coalition type, foot alignment, and degenerative changes in the adjacent joints.

Fibrin Glue is a Viable Alternative to Fat Graft for Interposition After Tarsal Coalition Resection.

Tarsal coalition is one of the most common foot and ankle pathologies in children, yet there is no consensus regarding what to interpose after resection. Fibrin glue could be considered, but the literature comparing fibrin glue to other interposition types is sparse. The purpose of this study was to evaluate the effectiveness of fibrin glue for interposition compared with fat graft by analyzing the rate of coalition recurrence and wound complications. We hypothesized that fibrin glue would have similar rates of coalition recurrence and fewer wound complications compared with fat graft interposition. A retrospective cohort study was performed examining all patients who underwent a tarsal coalition resection at a free-standing children's hospital in the United States from 2000 to 2021. Only patients undergoing isolated primary tarsal coalition resection with interposition of fibrin glue or fat graft were included. Wound complications were defined as any concern for an incision site that prompted the use of antibiotics. Comparative analyses were conducted using χ 2 and Fisher exact test to examine relationships among interposition type, coalition recurrence, and wound complications. One hundred twenty-two tarsal coalition resections met our inclusion criteria. Fibrin glue was used for interposition in 29 cases and fat graft was used in 93 cases. The difference in the coalition recurrence rate between fibrin glue and fat graft interposition was not statistically significant (6.9% vs. 4.3%, P =0.627). The difference in wound complication rate between fibrin glue and fat graft interposition was not statistically significant (3.4% vs 7.5%, P = 0.679). Fibrin glue interposition after tarsal coalition resection is a viable alternative to fat graft interposition. Fibrin glue has similar rates of coalition recurrence and wound complications when compared with fat grafts. Given our results and the lack of tissue harvesting required with fibrin glue, fibrin glue may be superior to fat grafts for interposition after tarsal coalition resection. Level III, a retrospective comparative study between treatment groups.

Rare complication of open reduction and internal fixation of fracture distal radius

CaseA 57-years old man who sustained left distal radius fracture. We performed distal radius ORIF. At follow up visit, he could not achieve any supination-pronation movements. Radiographs showed radioulnar synostosis. Four months later, we performed excision of synostosis with interposition of fat graft in the left forearm. A year later, the patient showed good forearm pronation and supination.ConclusionThis a rare case of radioulnar synostosis after ORIF distal radius fracture. Surgical intervention will help to improve the outcomes.

Endoscopic Physeal Bar Resection Combined with Guided Growth using Local Fat Graft Interposition and Post-Operative CT Assessment for the Treatment of Genu Valgus: a case repor

Distal femur physeal arrest due to physeal bar formation with progressive deformities is an unwanted complication following injury to the femur. Various techniques of physeal bar resection, either using open techniques or endoscopic methods, have been described in the available literature. The associated angular deformities could be addressed either with osteotomy in acute correction or gradual correction with an external fixator or guided growth principle. We would like to recommend the use of fat tissues from the surgical wound used for the guided growth and evaluation of the recurrence of the physeal bar via computed tomography in our case. To our knowledge there is no previous reports using similar approach. We shall share case of a severely comminuted distal femoral physeal injury Salter-Harris IV complicated with central physeal bar causing growth disturbance and angular knee deformity treated via endoscopic resection surgery and simultaneous 8-plate insertion for which has shown a good radiological and functional outcome.

Distal Femoral Physeal Bar Resection Combined With Guided Growth for the Treatment of Angular Limb Deformity Associated With Growth Arrest: A Preliminary Report.

Distal femoral growth arrest can result in progressive deformities and functional disability. The treatment is challenging given the significant growth potential of the distal femoral physis. This study addresses the short-term outcomes after distal femoral physeal bar resection combined with guided growth for the treatment of angular limb deformity. We conducted a retrospective analysis of patients treated with distal femoral physeal bar resection, fat graft interposition, and growth modulation with a tension-band plate. Data recorded included patient demographics, growth arrest cause, physeal bar size, time-to-surgery, details of the operative procedure, and complications. The mechanical axis zones, tibiofemoral angle, and the anatomic lateral distal femoral angle were assessed on 51-inch anteroposterior standing radiographs. Five patients (3 male individuals) with valgus (n=4) and varus deformities (n=1) due to physeal arrests of the distal femur were analyzed. The cause of the physeal arrest was trauma (n=3) and infection (n=2). The average age at the time of surgery was 6.6 years (range: 2 to 11 y). Average size of the physeal bar was 413.4 mm, which represented 16.8% of the total distal femoral physis (range: 12% to 26%). Four of the 5 patients had a total correction of the deformity in 14.3 months (range: 9 to 22 mo). One patient required correction by osteotomy and external fixation. Postoperatively, 1 patient presented no improvement, and 4 had restoration of the longitudinal bone growth and alignment. Two patients had rebound valgus: one is being observed and another has undergone a repeat guided growth procedure. Distal femoral physeal bar resection combined with tension-band hemiepiphysiodesis provides a viable option for the correction of angular deformities associated with physeal arrest. Longer follow-up is required to evaluate future growth of the distal femoral physis after this combined procedure. Level IV-therapeutic study.

Osseous bridge resection for the treatment of adult talocalaneal coalitions without arthritis

To analyze clinical outcomes of osseous-bridge resection for the treatment of adult symptomatic talocalcaneal coalitions without arthritis. The clinical data of 12 patients (15 feet) with symptomatic talocalcaneal coalitions without arthtitis from January 2013 to June 2016 were respectively analyzed. All cases were secondary talocalcaneal coalition. There were 9 males (11 feet) and 3 females (4 feet) with a mean (26.6±3.3) years old (ranged, 18 to 33 years old). According to the Rozansky classification, there were 4 (6 feet) type I, 3 (3 feet) type II, 2 (2 feet) type III, 1 (1 feet) type IV, and 2 (3 feet) type V. All patients received coalition resection and interposition of fat graft. Complication, recurrence and range of motion was regularly recorded after operation. Clinical efficacy was evaluated according to the visual analogue scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scale. All patients were followed up for an average duration of (28.7±18.3) months (ranged, 12 to 48 months). All the incisions were primarily healed. There were no wound necrosis, infection, neurovascular or tendon injuries. Range of motion was improved in 13 feet. All patients returned back to work. Recurrence happened in 1 case 2 years after surgery, the patient received a secondary coalition resection. At the latest follow-up, VAS was 2.1±0.8 and AOFAS score was 82.7±7.2, were siginificantly improved when compared with the preoperative scores(8.2±0.7, t=6.233, P<0.01; 48.4±6.8, t=5.747, P<0.01). For adult patients with symptomatic talocalcaneal coalitions without arthritis, simple coalition resection could provide good clinical outcomes with minimal complications.

Fat Graft and Bone Wax Interposition Provides Better Functional Outcomes and Lower Reossification Rates Than Extensor Digitorum Brevis After Calcaneonavicular Coalition Resection.

Calcaneonavicular coalitions are the most common form of tarsal coalitions. The prefered treatment for symptomatic coalitions is surgical resection; however, there are no published studies that directly compare different interposition techniques. The purpose of the present study was to retrospectively compare pain relief, functional outcomes, and complications of children and adolescents who had a resection of a symptomatic calcaneonavicular coalition with interposition of fat graft, bone wax, or extensor digitorum brevis (EDB). In total, 48 patients (56 ft) underwent calcaneonavicular coalition resection-interposition at 3 institutions from July 2008 to July 2015. There were 23 feet in group 1 (fat graft), 18 feet in group 2 (bone wax), and 15 feet in group 3 (EDB). Patient demographic characteristics were similar between all groups for age, sex, coalition type, and symptoms onset. Data concerning clinical and radiographic features, surgical technique, and postoperative complications were obtained from all available medical records. Radiographs were evaluated at last follow-up to determine coalition regrowth. Preoperative and postoperative pain was assessed with the visual analog scale, and function was assessed with use of the American-Orthopaedic-Foot and Ankle Society (AOFAS) score. Pain improved to an average of 0.5 in the first group (range, 0 to 6), 0 in group 2, and 1.7 in group 3 (range, 0 to 5) (P=0.033). The average AOFAS score improved from 59 (range, 33 to 71 points) to 98 points (range, 62 to 100 points) in the fat graft group, from 50 (range, 34 to 62 points) to 98 points (range, 88 to 100 points) in the bone wax group, and from 48 (range, 30 to 60 points) to 75 points (range, 70 to 95 points) in the EDB group (P<0.001). Eight feet had regrowth of the coalition on the postoperative radiographs: 1 in group 1 (4%), 1 in group 2 (6%), and 6 in group 3 (40%) (P=0.004). Five feet from the third group developed progressive symptoms. In our study, autogenous fat graft and bone wax interposition techniques provided better pain relief, gave better functional scores, and avoided more effectively coalition reossification than EDB technique. Further studies are required to evaluate safety of bone wax as an interposition material. Level III-therapeutic.

The role of covering the facial nerve and parotid surface in prevention of the postparotidectomy complications

Background Few operations in the head and neck region present challenges such as parotidectomy. The tumors detected are usually benign and patients expect normal function postoperatively. Complications of parotidectomy can be divided into early and late complications. The most serious of late complications are Frey syndrome and cosmetic deformity. Our aim is to evaluate the role of dermal fat graft interposition in preventing postparotidectomy complications. Patients and methods This study included 72 patients with benign parotid tumors who were treated between May 2012 and December 2015 in the Department of General Surgery, Menoufia University Hospitals. These patients are randomly divided into two groups: group A (control group) included 36 patients treated with parotidectomy without using dermal fat graft, and group B (study group) included 36 patients treated with parotidectomy and interposition of dermal fat graft. Results Most of our patients were females in both groups (66.7 and 77.8%), respectively. The most common pathology was pleomorphic adenoma in both groups (61.1 and 66.7%). There are no statistically significant differences between both groups as regards the operative time and the incidence of facial nerve palsy. Group B (study group) had a significantly lower incidence of Frey syndrome compared with group A (control group) either by subjective or objective methods (P=0.011 and 0.002). There was also a significant reduction in the incidence of sialocele and cosmetic unsatisfaction in the study group (P=0.030 and 0.003, respectively). Conclusion The dermal fat graft is a simple idea for restoring facial contour and preventing the postoperative complications after parotidectomy.

Epiphyseal Bar Resection for Correction of Clinodactyly

Clinodactyly is a digital angulation in the radio-ulnar plane. Mostly it is seen on the little finger. The middle phalanx typically has a triangular or trapezoid shape (delta phalanx), resulting in radial deviation of the distal phalanx. Resection of the longitudinal epiphyseal bracket (physiolysis) with fat graft interposition is a possible surgical technique, which uses children's growth potential to correct the axial deviation. The purpose of our study was to review the degree of correction at least 2 years postoperatively and after an average of 5 years postoperatively, and to find out if children´s age influences the results. 23 children (43 little fingers) underwent physiolysis and were retrospectively analyzed after a median follow-up of 5 years (2.1-7.9 years). The active range of motion of the little finger's MP, PIP and DIP joints and finger-palm-distance were measured. Lateral deviation was determined by using standardized radiographs and subsequently compared with preoperative values. Patients were divided into 2 subgroups: younger than 3 years (16 fingers, group A), older than 3 years (27 fingers, group B). The achieved correction of the lateral deviation was compared between both groups. All patients showed full active range of motion in all joints of treated fingers. Finger-palm-distance was 0 cm. No complications occurred. The mean preoperative deviation of all patients was 37°±11, which improved after surgery by 17°±11 (i. e. 44.0%±23.1 of initial findings). Group A demonstrated a mean preoperative lateral deviation of 40°±9, and group B a mean deviation of 36°±12. In both groups we saw a similar improvement (group A mean: 17°±10, group B mean: 17°±11). In group A there was a wider dispersion of postoperative results. In the age group 7 to 10, the results of individual cases show the large variability of the corrective potential. X-rays revealed the following incidental findings after surgery: a premature fusion of the proximal radial epiphyseal plates in 2 fingers and a sinuous-shaped proximal radial epiphyseal plate in 12 other fingers. Resection of the longitudinal epiphyseal bracket with fat graft interposition is a technically simple and effective treatment option for clinodactyly, particularly in children of 3 to 6 years of age.

Treatment of Talocalcaneal Coalitions

The purpose of this study was to review outcomes of patients treated for symptomatic talocalcaneal coalition with resection and interposition of fat graft. A retrospective review was performed on all patients who underwent surgical treatment for symptomatic talocalcaneal coalition over a 13-year period. Ninety-three feet were treated with excision and fat graft interposition by 6 surgeons. All patients underwent a chart review. Patient's outcome was assessed at the last follow-up using the American Orthopaedic Foot and Ankle Society Hindfoot scale. Postoperative computed tomography scans were available for 20 feet. Forty-nine feet had follow-up of at least 12 months and had a score obtained through the American Orthopaedic Foot and Ankle Society Hindfoot scale. At an average of 42.6 months of follow-up, the average score obtained was 90/100 (excellent). The postoperative computed tomography scans demonstrated 1 recurrence (3%), which was treated with repeat excision. An additional patient was reoperated for failure to excise the coalition completely. Eleven patients (34%) underwent a subsequent surgery to correct the alignment of the foot. To the best of our knowledge, none of the patients excluded because of short follow-up had repeat surgery or recurrence. A symptomatic talocalcaneal coalition can be treated with excision and fat graft interposition, and achieve good to excellent results in 85% of patients. Patients should be counseled that a subset may require further surgery to correct malalignment. Level IV-case series.

Percutaneous resection of calcaneo-navicular coalition with interposition of synthetic graft

Background Surgical resection of calcaneo-navicular coalition (CNC) with interposition of fat or muscle graft is indicated when there is failure of conservative treatment. Objectives to evaluate the clinical and functional of outcome of a new mini-invasive technique for resection of CNC and interposition of synthetic graft. Methods This is a prospective case series study on 9 patients (12 feet) with symptomatic CNC. Percutaneous resection of the CNC was done using a motorized bone burr through a small incision in the sinus tarsi under image intensifier control. After complete resection a synthetic graft of Teflon or Dacron measuring 15 mm × 30 mm was interposed to prevent re-union of the bone bar. Results The mean follow up period was 26.44 months (±1.5 SD). There was statistically significant improvement in the mean total AOFAS score from 47.89 (±8.49 SD) preoperatively to 90.22 (± 5.26 SD) at two years follow up ( P < 0.05). The mean time to return to full daily activity was 7.44 weeks (±0.88 SD) Conclusion Percutaneous resection of calcaneo-navicular bar with interposition of synthetic graft is an effective mini-invasive method for treatment of calcaneo-navicular coalition with good results in 44.4% of patients and excellent results in 55.6% of patients.

Prevention of growth arrest by fibrin interposition into physeal injury

This study investigated the repair effects of fat and fibrin graft interposition through a proximal tibia transphyseal injury model and assessed the effectiveness of treatment to physeal injury with the fibrin. In this study, a unilateral growth plate injury was created in the right proximal tibia of 28 rats without any graft interposition; all left tibias were left untouched. In the other group of 28 rats, a bilateral physeal injury was made with the left tibia filled with autogenously adipose tissue and the right tibia filled with fibrin. To compare the malformed extents induced by different interventions, the length and the metaphyseal-diaphyseal angle of the tibia of three injured groups were examined. Further studies on bone density analysis and histological change were used to compare the bony bridge formation under different interventions. Results showed that the deformity angle and medial length of the tibia were significantly different between the grafted groups and nongrafted group at 4, 16, and 24 weeks postoperative (P<0.01). Results also showed no significant difference between fibrin-graft and fat-graft groups (P>0.05). Furthermore, the bone mineralization density of bony bridge induced by injury was significantly different between the grafted group and nongrafted group at 4, 16, and 24 weeks postoperative (P<0.01). Histological findings showed that bony repair after physeal injury was inhibited by both fibrin and fat interventions. We concluded that fibrin could be a substitute of adipose tissue in preventing the deformities induced by epiphyseal injury. Similar to autogenous fat, fibrin was found to alleviate limb shortness and prevent angular malformation by forming a scar instead of a bony bridge. The use of fibrin can help us to develop effective and compound intervention grafts to prevent skeletal deformity and regenerate normal cartilage tissue in the future.

Calcaneonavicular Coalition

Symptomatic calcaneonavicular coalitions treated with resection and interposition of the extensor digitorum brevis (EDB) muscle often have unpredictable improvement of symptoms. Concerns with regard to skin cosmesis from a bony prominence on the lateral aspect of the foot and inadequate filling of the resection gap potentially causing reossification have motivated us to use fat graft interposition instead. The purpose of this study was to describe our surgical technique and report our clinical and radiographic outcomes for fat graft interposition after resection of a calcaneonavicular coalition. A retrospective review of all pediatric patients surgically treated with a calcaneonavicular coalition resection from January 1999 to December 2006, was performed. Presenting symptoms and examination findings were recorded. Postoperative examinations and imaging studies were evaluated to grade reossification, and functional outcomes were assessed for all patients with minimum 1-year postoperative follow-up. In addition, a cadaveric study was performed to compare the efficacy of EDB and fat graft interposition in terms of filling the postresection gap. Foot pain was the most common presenting complaint, though limitation of activities, stiffness, preoperative hindfoot malalignment, and associated injuries were also frequently observed. One year after resection, 87% of the patients returned to sport or their past activities, whereas 5% had symptomatic regrowth requiring repeat resection. Seventy-four percent had improvement of subtalar motion and 82% had improvement of plantarflexion; which was identified as an additional clinical sign of a calcaneonavicular bar. Preoperative pain averaged 7 of 10, whereas postoperative pain averaged less than 1 of 10 at rest, while walking, and with activities. The cadaveric study showed that the EDB was able to fill on average only 64% of the resected gap, leaving approximately 10 mm of the plantar gap unfilled. Reossification and reoperation rates with fat graft interposition in our series were lower than in most published reports of EDB interposition. Ankle and subtalar motion improved in a vast majority of the patients, and most patients returned to sport without requiring further surgery. Resection of a calcaneonavicular coalition with interposition of fat graft, when meticulously performed, is an effective way to relieve symptoms, restore subtalar motion, and return patients to activities, while preventing reossification.

Superficial Musculoaponeurotic System Elevation and Fat Graft Reconstruction After Superficial Parotidectomy

Elevation of the superficial musculoaponeurotic system (SMAS) with or without fat graft interposition during superficial parotidectomy prevents a concave facial deformity and Frey's syndrome. Retrospective, case-control study. Charts for 248 patients who underwent superficial parotidectomy were reviewed for pathologic, radiographic, clinical, and operative data. Sixteen patients who underwent SMAS elevation and 34 patients who underwent SMAS elevation with fat graft interposition were included in two study groups. Nonreconstructed controls were randomly selected from a pool of patients who had unilateral, superficial parotidectomy and were matched based on pathologic specimen volume. Patients were surveyed for their postoperative symptoms. Patients undergoing SMAS elevation alone (n = 16) compared with controls (n = 19) had greater facial symmetry (12% vs. 32%, P = .147) and a lower incidence of symptomatic Frey's syndrome (6.3% vs. 18.6%, P = .382). Patients undergoing SMAS elevation and fat graft interposition (n = 34) compared with controls (n = 38) had less facial asymmetry (9% vs. 39%, P = .002) and a lower incidence of symptomatic Frey's syndrome (6% vs. 28%, P = .04). Complications among the study and control groups were comparable. Simultaneous reconstruction of a superficial parotidectomy defect using SMAS elevation with or without fat grafting may improve postoperative facial symmetry and decrease the incidence of symptomatic Frey's syndrome without increasing complications.

Imaging findings after fat graft interposition in an injured growth plate: an experimental study in rabbits.

To assess the magnetic resonance (MR) features of fat graft interposition in experimentally induced growth plate injury, to correlate these features with histologic findings, and to compare the growth disturbances of fat-grafted and nonfat-grafted growth plate injuries. The growth plate injury model was created in 20 skeletally immature rabbits. In 14 rabbits, a bilateral growth plate defect was made in the medial half of the proximal tibia. The defect of the right tibia was filled with autologous fat; the left tibia was left empty. In another 6 rabbits, a unilateral growth plate defect was created with (n = 3) or without (n = 3) fat graft interposition in the right tibia. MR imaging was performed at 2, 4, and 12 weeks postoperatively using a 1.5-T MR unit. T1-weighted images, T2-weighted images, gradient echo images, and contrast-enhanced T1-weighted images were obtained in the coronal plane. The authors evaluated the MR features of the growth plate defects with or without fat graft, and the remaining growth plate. The length and angulation of the grafted tibia were compared with those of the nonfat-grafted tibia. RESULTS At 2 weeks postoperatively, the grafted area showed low signal intensity mixed with high signal intensity (71%) on T1-weighted imaging. At 2 weeks, most of the growth plate defect in the control animals showed low signal intensity in all image sequences. At 4 weeks, most of the grafted area showed low signal intensity on T2-weighted imaging. A bone bridge was revealed in 15% of the grafted tibia and in 62% of the control animals at 4 weeks. On gradient echo images, high signal intensity of the remaining growth plate was preserved in grafted tibias, but in the control animals this became invisible 4 weeks postoperatively. At 12 weeks, most of growth plate defect area became isointense on all image sequences in grafted tibia and in the control animals. Histologically, the fat-grafted area was replaced by fibrous connective tissues with thin, trabecular bone formation. Growth plate defects of the control animals were filled with mature fatty marrow with trabecular bone formation. The varus angle and medial length of the tibia were significantly different between fat-grafted tibias at 4 weeks and 12 weeks postoperatively. MR imaging was helpful for evaluating growth plate modifications and subsequent changes after fat graft interposition. Fat graft interposition had a role in reducing growth disturbance in growth plate injury.

Physiolysis for correction of clinodactyly in children.

Congenital clinodactyly is a lateral deviation of a finger frequently caused by an abnormal middle phalanx (trapezoidal or triangular delta phalanx). The physis extends longitudinally on the short side of the middle phalanx. Resection of the abnormal longitudinal physis and fat graft interposition (physiolysis) has been reported to correct the lateral finger deviation in growing children. We reviewed 35 fingers that had a physiolysis procedure. The age at surgery varied from 2.9 to 10.9 years (mean, 6.6 y), the preoperative angulation was 20 degrees to 29 degrees in 9 fingers, 30 degrees to 39 degrees in 16 fingers, and 40 degrees or more in 10 fingers. Thirty-one fingers presented a trapezoidal phalanx and 4 fingers a triangular phalanx. Ten fingers had a second surgery using the same procedure. Follow-up time ranged from 1.2 to 5.3 years (mean, 3.2 y). After 1 procedure the degree of correction varied from 0 degrees to 30 degrees (mean, 11.1 degrees). The residual angulation was <15 degrees in 8 fingers, 15 degrees to 19 degrees in 4 fingers, 20 degrees to 29 degrees in 15 fingers, 30 degrees to 39 degrees in 6 fingers, and > or =40 degrees in 2 fingers. Correction obtained in the trapezoidal phalanges was better (mean 12.5 degrees) than in the triangular phalanges (mean, 2.8 degrees). The fingers presenting a more severe preoperative deformity (angulation > or =40 degrees) had a better correction (mean, 20 degrees) compared with fingers with a lesser deformity (mean, 7.5 degrees). The correction was also better in children who had surgery before 6 years of age (mean, 17.9 degrees) compared with older children (mean, 6.5 degrees). A second physiolysis procedure was not beneficial in 8 of 10 fingers reoperated and 2 premature fusions of the proximal transverse physis were found among these 10 fingers. There were no other complications. The physiolysis procedure is simple and effective, particularly in children presenting with a trapezoidal phalanx who have surgery before 6 years of age.

MR imaging of changes of the growth plate after partial physeal removal and fat graft interposition in rabbits.

The most important complication of skeletal injuries involving the growth plate is growth disturbance. The purpose of this study was to evaluate MR features of growth plate modification after fat graft interposition in growth plate injury and to correlate these findings with pathological findings. A growth plate injury model was used in 12 skeletally immature rabbits. A longitudinal drill hole 5 mm in diameter was created in the central part of the growth plate in the distal femur, bilaterally. One side was filled with autologous fat, and the contralateral defect was left empty as a control. Magnetic resonance imaging was obtained 1, 3, and 6 months after surgery, and routine histological study was performed. The authors evaluated sequential changes in MR images and the histological basis of MR findings. In grafted femur, the signal intensity of the grafted area was lower than that of the surrounding bone on T2-weighted images at 1 month. The growth plate defect at 3 to 6 months was modified and had a proximally tapering appearance. The ratio of the growth plate defect was smaller in the grafted femur than in the control femur after surgery. Histologically, the fat-grafted area was replaced by fibrous connective tissue. In the control femur, a bony bridge was rectangular in the longitudinal direction and showed isosignal intensity with a rim of low signal intensity on T1-weighted imaging. Histologically, the defect was filled with mature fatty marrow with new bone formation in the control femur. The proximally pointing appearance and the low signal intensity of the grafted area on MR suggested fibrous degeneration of grafted fat that prevented solid bony bridge formation in experimentally induced growth plate injury.

Free Fat Interpositional Graft in Acute Physeal Injuries: The Anticipatory Langenskiöld Procedure

Free fat graft interposition has been used extensively in management of physeal injuries with established growth disturbances. The use of this technique as part of the management of acute physeal injuries has not been reported. Here we report on its application in acute physeal injuries, where it has prevented the formation of an anticipated physeal arrest.

Posterior talocalcaneal coalition

Tarsal coalition is a rare congenital deformity. The most common coalitions involve the calcaneonavicular joint and the medial facet of the talocalcaneal joint. The posterior facet is rarely involved. We report a case of a patient with a posterior talocalcaneal bar who presented with painful limitation of subtalar motion without the classical appearance of spastic flat foot. Resection of the bar with interposition of fat graft resulted in an almost full range of pain-free subtalar motion.

Prognostic Factors of Physeal Bar Resection and Fat Graft Interposition in the Treatment of Partial Physeal Arrest

Prognostic Factors of Physeal Bar Resection and Fat Graft Interposition in the Treatment of Partial Physeal Arrest