Postoperative Cast Research Articles

Comparison of clinical and quality of life outcomes of patients who underwent early postoperative rehabilitation and cast immobilization after Achilles tendon repair

Comparison of clinical and quality of life outcomes of patients who underwent early postoperative rehabilitation and cast immobilization after Achilles tendon repair

Comparison of K-wire versus screw fixation after open reduction of transitional (Tillaux and triplane) distal tibia fractures.

Our study aimed to compare the clinical and radiographic outcomes of transitional distal tibia fractures treated with K-wire fixation versus screw fixation after open reduction. A retrospective study was performed on all displaced transitional distal tibia fractures that underwent operative fixation. Following open reduction, surgical fixation was performed using either percutaneously inserted 2.0 mm K-wires, or 4.0 mm partially-threaded cannulated cancellous screws. Clinical and radiographic outcomes between the two groups were assessed using the modified Weber score. Other outcome measures assessed were surgical time, casting duration, follow-up duration and duration before return-to-sports. We recruited 49 patients with transitional distal tibia fractures requiring open reduction and surgical fixation. There were 18 patients in the K-wiring group (KWG), and 31 patients in the screw fixation group (SFG). All patients in both groups had excellent clinical and radiographic outcome based on the modified Weber's scoring, full radiological healing, and no residual displacement upon final follow up. The KWG had significantly shorter surgical time (41.0 min versus 75.1 min, P < 0.0001) and shorter follow-up duration needed before discharge (5.4 months versus 8.7 months, P = 0.024). However, they required a longer post-operative casting duration (7.3 weeks versus 5.3 weeks, P = 0.006). No significant difference was found for the duration before return to sports between both groups. Complications were few in this study group. Superficial pin site infection was noted in one patient in the KWG, and valgus deformity of the ankle was noted in one patient in the SFG. In our study, surgical treatment of transitional distal tibia fractures demonstrated equally excellent outcomes when treated by open reduction with either K-wire or cannulated screw fixation. Level of evidence: III.

Quadruple Versus Double Flexible Intramedullary Nails to Treat Pediatric Distal-third Tibial Shaft Fractures: A Biomechanical Comparison

The vast majority of pediatric distal-third tibial shaft fractures can be treated with closed reduction and casting. If conservative measures fail, then these fractures are usually treated with 2 antegrade flexible intramedullary nails. A postoperative cast is usually applied because of the tenuous fixation of the 2 nails. Recent studies have described the use of 4 nails to increase the stability of the fixation, a technique that may preclude the need for postoperative casting. The purpose of this biomechanical study is to quantify the relative increase in stiffness and load to failure when using 4 versus 2 nails to surgically stabilize these fractures. Short, oblique osteotomies were created in the distal third of small fourth-generation tibial sawbones and stabilized with 2 (double) or 4 (quadruple) flexible intramedullary nails. After pilot testing, 5 models per fixation method were tested cyclically in axial compression, torsion, and 4-point bending in valgus and recurvatum. At the end of the study, each model was loaded to failure in valgus. Stiffness values were calculated, and yield points were recorded. The data were compared using Student's t tests. Results are presented as mean±SD. The level of significance was set at P≤0.05. Stiffness in valgus 4-point bending was 624±231 and 336±162 N/mm in the quadruple-nail and double-nail groups, respectively (P=0.04). There were no statistically significant differences in any other mode of testing. The quadruple-nail construct was almost 2 times as stiff as the double-nail construct in resisting valgus deformation. This provides biomechanical support for a previously published study describing the clinical success of this fixation construct.

Evaluation of Results of Closed Reamed Nailing for Diaphyseal Fracture of the Tibia-Experience of 35 cases

Introduction: Tibia is a subcutaneous bone and is more prone to trauma. Different treatment modalities exist for fracture shaft of the tibia. Intramedullary nailing in the treatment of fractures of the long bones was technically developed and popularized by Küntscher in the 1940’s. Treatment of tibial fracture in adult is a challenge to orthopedic surgeons due to poor soft tissue coverage and blood supply.&#x0D; Materials and methods: This study was prospective and interventional. This study was carried out in the private hospitals in Rajshahi over a period of 3 years. Total 35 patients with tibial shaft fracture were studied. Inclusion criteria were displaced closed diaphyseal fracture shaft of the Tibia, open fracture with Gustillo 1, 2 and 3A attended within 24 hours. Exclusion criteria were patient’s age below 16 years, grossly lacerated fracture, undisplaced fracture, patient unwilling to operate. Thirty three cases were operated within one week only two cases operated at 2 months due to angulations following conservative treatment. Open fracture was fixed within 24-48 hours. Broad spectrum antibiotic injectable Moxifloxacin was used in most of the cases for 2 doses then oral, Injectable Meropenem was used for the open fracture. Those patients suffering from G-3A fracture wound were covered by Hemisoleal flap Two weeks after primary surgery and were uneventful. In most of the cases image intensification was not used only three cases needed image intensification in case the fractures in lower ¼ th of the shaft to see the end of the Nail.&#x0D; Results: Two patients developed postoperative superficial wound infection which was recovered by regular dressing. Only one patient needed post-operative cast support because the fracture was comminuted. All patients started Knee bending from first post-operative day. Full range of knee movement was found in all patients. All fracture united properly within 12 weeks to 22 weeks with mean of 17 weeks. No cases of implant failure detected during the study period.&#x0D; Conclusion: The results of the current study reveal that the reamed interlocking nail in treatment of tibial diaphyseal fracture is safe, easy, successful and preferable method may be recommended as a stable fixation with early return to daily activities.&#x0D; TAJ 2019; 32(1): 9-16

Anorexia and supracondylar fracture of the femur following surgery for bilateral lower limb joint contracture in a case of severe cerebral palsy with mental retardation: a case report.

Objective: Postoperative management of children having cerebral palsy (CP) with mental retardation is difficult. This report presents a case of severe CP with mental retardation, which resulted in anorexia and condylar fracture of the femur following a surgery for bilateral lower limb joint contracture.Case report: A 14-year-old male was diagnosed with CP having severity of Gross Motor Functional Classification System Level V, and severe mental retardation. Due to bilateral spasticity in hip adduction, knee flexion, and valgus of the feet, tenotomies of the adductors of both hips, bilateral lengthening of the hamstrings and bilateral tenotomy of the peroneal tendons were performed. At 4 weeks postoperatively, knee casts were used; thereafter, knee extension braces were attached for 12 weeks. After surgery, he showed severe anorexia for 8 weeks and weight loss of 8.8 kg (from 35.2 kg to 26.4 kg) during the 4 months of hospitalization. Six months postoperatively, he was diagnosed with supracondylar fracture of the right femur.Discussion: Severe CP with mental retardation requires attention to the physical symptoms caused by stress related to the hospitalization, surgery, fixation by casts, and braces. Moreover, care must be taken not to increase the risk of fracture by fixation or immobility of the postoperative cast, because it can lead to the progression of low bone mineral density.

Foam padding in postoperative lower extremity casting: an inexpensive way to protect patients

Foam padding in postoperative lower extremity casting: an inexpensive way to protect patients

Foam Padding in Postoperative Lower Extremity Casting: An Inexpensive Way to Protect Patients.

Although postoperative cast immobilization is routinely used in children, it is not without complications. Few studies have focused on interventions to decrease their frequency. The purpose of this study was to determine if foam padding in postoperative lower extremity casts decreased the rate of cast complications. A retrospective review of patients who underwent lower extremity casting after elective surgery at a tertiary pediatric hospital from 2006 to 2013 was conducted. Postoperative casts were classified by type (A-frame, short leg, long leg, spica) and the presence of foam. Charts were reviewed for skin complications, cast splits for apparent neurovascular deficits, cast splits for patient complaints, unplanned outpatient returns for cast-related issues, and compartment syndrome. In total, 920 patients with 2,481 casts were included. In total, 612 (24.7%) casts had foam placed during casting. The incidence of skin complications was significantly lower in A-frame casts with foam (4.5%, 5/112) than without (13.4%, 11/82) (P=0.03) and long leg casts with foam (0.9%, 2/225) than without (4.3%, 19/444) (P=0.02). Patients with static encephalopathy casted with foam had a lower incidence of skin complications (0.7%, 2/279) than those without (3.6%, 22/615) (P=0.01). There was no difference in the overall incidence of skin complications in casts with and without foam (P=0.44), short leg casts (P=0.37), and spica casts (P=0.34). Patients with skin complications (20.3±7.1 kg/m) had a higher body mass index than those without (18.9±5.4 kg/m) (P=0.04). Postoperative A-frame casts with foam (0.0%, 0/112) were split less often for apparent neurovascular deficits than those without foam (4.5%, 3/67) (P=0.05). The cast split rates for apparent neurovascular deficits in casts with and without foam (P=0.58), long leg casts (P=0.67), short leg casts (P=0.63), and spica casts (P=1.0) were comparable. The use of foam in postoperative lower extremity casting is an effective intervention to reduce the incidence of skin complications in patients with static encephalopathy, in an A-frame cast, or in a long leg cast. Level III-retrospective comparative study.

SURGICAL TREATMENT OF CHRONIC PATELLAR TENDON RUPTURE; A CASE SERIES STUDY

Background: Early detection and treatment of extensor mechanism rupture are essential for a long-term functional knee joint. In chronic cases, quadriceps muscle retraction and contracture make surgery difficult and results are less predictable. Objectives: The purpose of this study was to evaluate outcomes in the cases of late repaired patellar tendon rupture. Methods: This study included patients with chronic patellar tendon rupture who were operated at Shafa orthopedic hospital from 2006 to 2013. Results: A total of ten patients were evaluated, wirh 12 cases of chronic patellar tendon rupture. Patients had a mean age of 34.4 years (range 18 - 58). Seven cases were caused by a traffic accident and three by a fall. The mean length of time from injury to surgery was 23 months (range 3 - 132). The mean time of follow-up was 6.2 years (range 3 - 9). Cerclage wire reinforcements were applied in nine of the knees and three knees had fiber wire reinforcement. Tendon graft augmentation was applied in ten of the knees; six with semitendinosus and gracilis autograft, two with semitendinosus autograft, one with an Achilles tendon allograft, and one with a tibialis anterior allograft. Means for preoperative/postoperative active knee range of motion, extension lag, subjective international knee documentation committee score, and modified Cincinnati scores were 81/117, 32/2, 22.7/84.5 and 24/87, respectively. Wire breakage was seen on all nine knees but wires were removed in only two symptomatic cases. Conclusions: Good to excellent results were obtained in terms of functioning with operative treatment of chronic patellar tendon rupture. Direct repair with autogenous or allogenic graft augmentation and cerclage wire reinforcement and postoperative cast immobilization are recommended.

336 Expanding Multidisciplinary Collaboration In Burn Care To Improve Patient Outcomes

Multidisciplinary collaboration and communication are essential to maximize outcomes for burn survivors. However as patients move through the continuum of care, real time collaboration becomes challenging. The purpose of this report is to highlight the importance of ongoing dialogue and involvement in nontraditional settings to improve outcomes. This is a case report of a 20 year old female with a history of 95% TBSA thermal injury at 4 years of age. She had a recalcitrant elbow flexion contracture, requiring multiple contracture releases of same area with dermal substitutes and autologous graft. The initial surgical plan was to release a 90 degree elbow flexion contracture with autologous graft placement at the new available range acquired. Per protocol a splint would be applied in the same position as the release and graft placement. Therapy was present in the OR to assess the patient and noted bicipital tightness limitations. In consultation with the surgeon an alternate plan was developed, specifically serial casting to increase range of motion (ROM) prior to graft placement. Post release, the surgeon noted tissue stretch end-feel and no apparent traction to neurovascular structures at 60 degrees of elbow flexion. The treatment plan was finalized following contracture release and ROM, the case was placed at 40 degrees elbow flexion and correct tightness and elbow extension limitations. Post-operatively, therapy stretched the patient and cast was applied two times a day for three days. The final cast prior to surgey was applied at 5 degrees of elbow flexion. The day of autografting surgery repeat ROM was performed by the therapist in the operating suite. Autologous grafts were laid on the antecubital fossa and a post operative cast was applied at the previously achieved 5 degrees of elbow flexion. Post-op Day 3 the patient was again stretched and placed into a cast at full elbow extension in the operating room. This position was maintained until discharge with no subsequent graft loss. Subsequent ROM after graft adherence was provided by therapist prior to discharge. By having therapy present in the OR to facilitate real-time communication and modification of surgical plan, this patient was able to achieve full elbow extension at the time of discharge through serial casting and delayed autologous graft placement. Serial casting is a common intervention that therapists use, with this intervention the patient gained 60 degrees of further elbow extension and, more significantly, full functional range. Multidisciplinary communication is an essential element of comprehensive burn care. Therapists and surgeons in collaboration can provide optimal functional outcomes.

Newer modified technique for treatment of idiopathic clubfoot deformity with combination of modified ponseti casting and posterior, posteromedial soft tissue release in 6 month to 5 year age group children

Specific Objectives: Congenital talipes Equinovarus (clubfoot) is one of the most common foot Anomalies which can be treated by serial casting technique with high rate of success. Surgery is indicated for deformities that do not respond to conservative treatment or the patients that seek medical intervention too late or neglected by family without medical treatment. In our study, we reviewed the result of our newer modified technique for treatment of idiopathic clubfoot deformity with combination of modified ponseti casting and posteromedial soft tissue release in 6 month to 5year age group children. Material and methods: Between May 2015 to May 2016, we treated twenty (20) feet with idiopathic CTEV in sixteen (16) children who were between 6 month to 5year age-group who were evaluated by Pirani scoring system before and after our newer modified technique for treatment of idiopathic clubfoot deformity. All the feet were given a trial of serial manipulation and cast application with 15 days interval with 4 to 5 number of CTEV cast then postero-medial soft tissue release was done with single incision and full correction achieved. Sutures were removed after 15 days followed by manipulation and cast application. postoperative cast immobilisation continue for 2 months in over corrected position or age more than 9 month old children given walking modified fibre CTEV cast and mobilisation with ‘Babagadi’ for 2 month in over corrected position. Our modified walking fibre CTEV cast change in 15 day interval with corrected position and mobilisation done atleast for 2 -3 month then we were made CTEV over corrected specialized shoes in which we were adviced. Patient to walk with CTEV shoes in day time and rest of night sleeping time. At the end of 6 and 12 months all feet were evaluated according to pirani Scoring system. Results: All 20 feets were treated between 6 month to 60 months age-group children with mean age of 28months. Postoperatively the patients were followed up for a minimum of 6 month to maximum 18 months with mean of 12months. Post operative evaluation was done according to total score obtained by pirani scoring system. According to this 14 feet evaluated as pirani score 5.5, 4 feet b/w 5.5 to 4.5, 2 feet b/w 4 – 4.5. NO any patients had residual deformity, no any patients had relapse. Conclusion: The timing of surgery did not change the final outcome considerably below 5 years of age in clubfeet. With our new modified technique for treatment of idiopathic clubfoot deformity with combination of modified ponseti casting and postero-medial soft-tissue release in 6 month to 5year age-group children. 95 percent of cases had excellent to good results. In our modified technique had chances of relepse and retained residual deformity are less. Relepses did not occur in one and half year follow up period. Our new technique had better functional outcome with faster recovery to other mode of treatment.

Surgical Treatment of Chronic Patellar Tendon Rupture: A Case Series Study

Background: Early detection and treatment of extensor mechanism rupture are essential for a long-term functional knee joint. In chronic cases, quadriceps muscle retraction and contracture make surgery difficult and results are less predictable. Objectives: The purpose of this study was to evaluate outcomes in the cases of late repaired patellar tendon rupture. Methods: This study included patients with chronic patellar tendon rupture who were operated at Shafa orthopedic hospital from 2006 to 2013. Results: A total of ten patients were evaluated, wirh 12 cases of chronic patellar tendon rupture. Patients had a mean age of 34.4 years (range 18 - 58). Seven cases were caused by a traffic accident and three by a fall. The mean length of time from injury to surgery was 23 months (range 3 - 132). The mean time of follow-up was 6.2 years (range 3 - 9). Cerclage wire reinforcements were applied in nine of the knees and three knees had fiber wire reinforcement. Tendon graft augmentation was applied in ten of the knees; six with semitendinosus and gracilis autograft, two with semitendinosus autograft, one with an Achilles tendon allograft, and one with a tibialis anterior allograft. Means for preoperative/postoperative active knee range of motion, extension lag, subjective international knee documentation committee score, and modified Cincinnati scores were 81/117, 32/2, 22.7/84.5 and 24/87, respectively. Wire breakage was seen on all nine knees but wires were removed in only two symptomatic cases. Conclusions: Good to excellent results were obtained in terms of functioning with operative treatment of chronic patellar tendon rupture. Direct repair with autogenous or allogenic graft augmentation and cerclage wire reinforcement and postoperative cast immobilization are recommended.

Intramedullary Screws versus Kirschner Wires for Metacarpal Fixation, Functional, and Patient-Related Outcomes.

Purpose The purpose of our study is to compare the intramedullary fixation of metacarpal fractures with cannulated headless screws and antegrade Kirschner wires in terms of final total active motion, grip strength, patient-related outcomes, need for casting, and return to work times. Methods The authors performed a retrospective review of the hospital records. Thirty fractures were included in the study, 19 in the screw fixation group, and 11 in the Kirschner wire group. Grip strength, and total active motion, was measured at the latest follow-up for both the injured and contralateral hand. Pain was measured on the visual analog scale. Patients were requested to fill a Quick disabilities of the arm and hand score (DASH) questionnaire at the latest follow-up. Satisfaction was measured on a scale from 0 to 10. The time to return to work was quantified from the accident to the point when the patient was back to active duty. Postoperative casting time was also quantified. Results The authors did not find any differences between the two groups in total active motion, grip strength, pain, satisfaction, or Quick DASH scores. We did find a difference in the return to work and casting times; these appeared to be shorter in the screw group. Conclusion Due to the small number of cases, we have been unable to clearly conclude that there were any benefits in the application of one particular technique when compared with the other.

Genu varum with medial compartment osteoarthritis treated with puddu plate

Background Gonarthrosis in the relatively young and active population causes major daily discomfort and disability. If the arthritic process is mainly limited to the medial compartment, the axis of a varus knee can be realigned laterally with high tibial osteotomy (HTO) to unload the medial compartment and allow some cartilage regeneration and pain relief. Many techniques have been developed (i.e. closing wedge, opening wedge, dome, and ‘en chevron’ osteotomies), but opening (medial) and closing (lateral) wedge osteotomies are the most commonly used. With opening wedge HTO, good long-term results are obtained with a correct patient selection (a young patient Aim The aim of this study was to confirm that medial opening wedge HTO with Puddu plate fixation can be a reliable procedure for the treatment of medial compartment osteoarthritis of the knee associated with varus deformity. Patient and methods With meticulous patient selection, an open-wedge HTO using the Puddu plate was performed in 15 knees of 15 patients at El-Sahil Teaching Hospital between May 2010 and March 2013 for a young patient population ( Results All of the patients were followed up for an average of 12 months (8–16 months). There was no nonunion or delayed union in this group, and all patients were encouraged to start full weight-bearing after 6 or 8 weeks. The overall fineness rate was 80% (12/15) at the end of the follow-up with improved symptoms. Two cases of wound infection were treated with antibiotic and daily dressing. One case of deep vein thrombosis was treated satisfactorily with medical therapy. Two had patients had undercorrection, two patients need cancellous bone graft, and three patients needed postoperative casting. Conclusion With meticulous patient selection, medial opening HTO using the Puddu plate has a very high success rate. The benefits of this technique is the short time of operation in comparison with other techniques, no graft used, and no casting postoperatively because the Puddu plate gives rigid fixation, which leads to early range of motion in the knee.

Novel Suture Anchor Technique with Continuous Locking Stitch for Collateral Ligament Repair.

Collateral ligaments are difficult to repair due to large amount of fraying in detached ligaments and attenuated stumps that may not provide enough strength after the repair. Although strong locking sutures are used to repair the ligament with proper tension, these damages can cause pull-out failure or relaxation of the repaired ligaments even from undersized load that may extend postoperative splinting or casting time. Furthermore, current suture techniques can repair varus or valgus instability of the elbow and radial or ulnar instability of the fingers, but these techniques do not offer rotatory stability of these areas. We have developed a novel suture anchor technique that has overcome this problem of current suture techniques, and this can be used to correct rotatory instability in the elbow and fingers. We used this procedure in seven cases with injury of collateral ligament in the elbow and eight cases with detached collateral ligaments of finger joint. No patient experienced rerupture or any kind of residual instability. We believe that the proposed method can produce much stronger repair and may shorten the postoperative immobilization period.

Early Ankle Mobilization Promotes Healing in a Rabbit Model of Achilles Tendon Rupture

The use of early mobilization of the ankle joint without orthosis in the treatment of Achilles tendon rupture has been advocated as the optimal management. The goal of this study was to compare outcomes in a postoperative rabbit model of Achilles tendon rupture between early mobilization and immobilized animals using a differential proteomics approach. In total, 135 rabbits were randomized into the control group (n=15), the postoperative cast immobilization (PCI) group (n=60), and the early mobilization (EM) group (n=60). A rupture of the Achilles tendon was created in each animal model and repaired microsurgically, and tendon samples were removed at 3, 7, 14, and 21 days postoperatively. Proteins were separated using 2-dimensional polyacrylamide gel electrophoresis and identified using peptide mass fingerprinting, tandem mass spectrometry, NCBI database searches, and bioinformatics analyses. A series of differentially expressed proteins were identified between groups, some of which may play an important role in Achilles tendon healing. Notable candidate proteins that were upregulated in the EM group were identified, such as CRMP-2, galactokinase 1, tropomyosin-4, and transthyretin. The healing of ruptured Achilles tendons appears to be affected at the level of protein expression with the use of early mobilization. The classic postoperative treatment of Achilles tendon rupture with an orthosis ignored the self-protecting instinct of humans. With a novel operative technique, the repaired tendon can persist the load that comes from traction in knee and ankle joint functional movement. In addition, kinesitherapy provided an excellent experimental outcome via a mechanobiological mechanism.

Commode injury (toilet seat injury) of the Achilles tendon: A rare mechanism

Background: Open cuts of the Achilles tendon are caused by various modes. The toilet seat as a cause of such injury is extremely rare. We report this mechanism of injury, its management and the results after treatment. Materials and methods: 11 patients (9 males and 2 females) with cut wounds over Achilles tendon were included in this prospective study. Right side was involved in 7 and left in 4 cases. All patients sustained the injury when their foot had slipped into the Indian type toilet seat and the edge had inflicted the cut. After thorough washing and debridement, primary repair of the tendon was done in all cases. Postoperative casting was done as per recommendations and was standardised. At 1 year follow up results were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) hind foot scale. Results: 9 patients were satisfied with the final results and 2 were not. As per AOFAS scale 9 had excellent and 2 fair results, and the average score was 92. Out of 7 cases with complete tear, 2 developed postoperative infection. Rerupture was not seen in any case. Conclusion: Toilet seat injury is an important cause of tendon cut in Indian population. Judicial debridement and washing under antibiotic cover help to contain the infection in such potentially contaminated wounds. Such injuries can be avoided by the use of western toilet system.

Accelerated Versus Traditional Rehabilitation After Anterior Talofibular Ligament Reconstruction for Chronic Lateral Instability of the Ankle in Athletes

Background: Although several reconstruction procedures for chronic lateral ankle instability using autografts have been reported, all have recommended postoperative immobilization and a nonweightbearing period. Hypothesis: Reconstructive surgery with a gracilis autograft using an interference fit anchoring system for chronic lateral ankle instability enables early accelerated rehabilitation and recovery with a return to activity without requiring immobilization. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 33 patients (33 feet) who underwent reconstruction of the anterior talofibular ligament with a gracilis autograft using interference screws were included; 15 were followed for 4 weeks with postoperative cast immobilization (group I), while 18 were followed with accelerated rehabilitation without immobilization (group A). Clinical and radiological results were evaluated based on the Karlsson and Peterson score, talar tilt angle, anterior displacement of the talus on stress radiography, and time between surgery and return to full athletic activity. Results: The mean Karlsson and Peterson scores before and 2 years after surgery were the following: for group I: 62.3 ± 4.7 (range, 54-72) and 94.4 ± 7.1 (range, 76-100), respectively (P < .001), and for group A: 64.1 ± 4.8 (range, 57-70) and 91.7 ± 7.7 (range, 74-100), respectively (P < .001). The mean difference in the talar tilt angle compared with the contralateral side and mean displacement of the talus on stress radiography before and 2 years after surgery were the following: for group I: 8.7° ± 2.6° and 7.7 ± 1.8 mm and 3.8° ± 1.5° and 4.0 ± 1.6 mm, respectively, and for group A: 10.5° ± 3.4° and 8.7 ± 2.1 mm and 4.3° ± 1.8° and 4.3 ± 1.2 mm, respectively. Radiography revealed significantly improved postoperative outcomes in both groups (P < .0001). No significant differences in the score and any parameters on stress radiography were evident at 2 years after surgery between the groups. The mean time between surgery and return to full athletic activity was significantly higher in group I (18.5 ± 3.5 weeks) than in group A (13.4 ± 2.2 weeks) (P < .0001). No cases of reinjury were reported, and no differences in athletic performance ability were observed between the groups. Conclusion: Patients in group A returned to full athletic activity 5 weeks earlier than those in group I, demonstrating the advantage of accelerated rehabilitation after surgery.

McHale Operation in Patients with Neglected Hip Dislocations: The Importance of Locking Plates

Neglected hip dislocation in patients with cerebral palsy is a challenge for the pediatric orthopedic surgeon. Many patients experience pain, limitation of hip motion, and sitting and hygiene problems. Arthrodesis, proximal femoral head resection, and subtrochanteric valgus osteotomy are effective salvage procedures for patients with painful hip dislocation and restricted hip motion when reconstruction of the hip is not possible. Osteopenia is one of the problems that can complicate the postoperative course in these patients. Postoperative cast immobilization may further worsen the osteopenia and can predispose to fractures of the femur after cast removal. Standard plating of the proximal osteotomy may not always provide adequate stability of the fixation. In order to prevent postoperative osteoporotic fractures we use locking plates, without casting. Since 2003 until 2011, we operated on 9 patients (14 hips) with painful neglected hip dislocations. The first three patients (five hips) were operated on using standard nonlocking plates. All other patients (nine hips) were operated on using locking plates. During the followup, the hardware failed in one of these cases. All patients treated with locking plates had not been casted postoperatively, and none had loss of fixation or fractures during the followup.

Correction of pelvic obliquity in neuromuscular spinal deformities using the “T construct”: results and complications in a prospective series of 60 patients

We present the results of a prospective series of 60 patients treated for neuromuscular spinal deformities with an original spinopelvic construct using two sacral screws and two iliac screws. Clinical and radiological results obtained with this new surgical technique were studied and discussed according to the epidemiological data and relevant literature. From January 2008 to June 2010, the clinical data of every patient who underwent spinopelvic fixation for treatment of a neuromuscular spinal deformity were recorded prospectively. Sixty patients were operated on during the study period. Spinal correction and fusion was performed by posterior approach. In six patients with a residual spinopelvic imbalance more than 15° on lateral preoperative bending films, an anterior release of the thoracolumbar junction was performed on the same day, before posterior correction. Preoperative pelvic obliquity (PO) ranged from 4° to 44° (mean 21.6°). Postoperative pelvic obliquity ranged from 0° to 14 (mean 4.6°). No significant loss of correction was noted at the last follow-up. One patient died 3months after the initial procedure due to respiratory compromise. 11 patients had early postoperative infections of the posterior approach. Despite a high rate of infectious complications, optimal correction of pelvic obliquity requires extension of spinal instrumentation to the pelvis. Spinopelvic fixation remains a difficult challenge in neurological patients with hypotrophy. We think that pelvic fixation with the "T construct" did provide effective and improved spinal stabilization in these patients, while reducing the need for a postoperative cast or brace. As a result, patients had a favourable postoperative course with early mobilization and return to a comfortable sitting position.

Long-term follow-up of DDH patients who underwent open reduction without a postoperative cast

We present the results - assessed after bony maturation - of an early anterior approach open reduction performed using our modified technique on 49 hips at 6-24 months of age. We start postoperative functional treatment using a Pavlik harness and an abduction splint, abandoning plaster cast. Secondary surgeries were performed in 11 hips (22.4%) at 3-7 years of age. Our results were 'satisfactory' (Severin Grade I, II) in 96% of the cases. According to the joints' Severin Grade, the total hip replacement probability at an early age is 8.16% in our series. Our principles and practice, introduced in 1980 in terms of secondary surgeries, are in total harmony with the recent literature.