Fellowship recommended articles

BACKGROUND: The treatment of idiopathic congenital vertical talus has traditionally consisted of manipulation and application of casts followed by extensive soft-tissue releases. However, this treatment is often followed by severe stiffness of the foot and other complications. The purpose of this study was to evaluate a new method of manipulation and cast immobilization, based on principles used by Ponseti for the treatment of clubfoot deformity, followed by pinning of the talonavicular joint and percutaneous tenotomy of the Achilles tendon in patients with idiopathic congenital vertical talus...

Important differences exist in the management of child and adult amputees. Many factors, including the etiology of childhood limb deficiencies, expected skeletal growth, functional demand on the locomotor system and prosthesis, appositional bone stump overgrowth, and psychological challenges, make caring for these young patients particularly challenging. Adherence to the general principles of childhood amputation surgery will typically guide one to the optimal functional result. These principles can be summarized as follows: (1) Preserve length...

BACKGROUND: Decision aids serve to prepare families for a meaningful discussion with their physician during the shared decision-making (SDM) process. Although SDM processes have been used primarily in adult health care settings, we sought to develop a decision aid for use in pediatrics. The treatment of neuromuscular scoliosis was selected due to the complexity of decision making when surgery is considered. Our objective was to determine whether this tool would improve families' knowledge and satisfaction while decreasing decisional conflict...

Surgical correction of juvenile hallux valgus (JHV) by soft tissue balancing or skeletal realignment is associated with a high rate of recurrence of the deformity. An alternative treatment strategy for the management of symptomatic or progressive JHV, consisting of lateral hemiepiphyseodesis of the great toe metatarsal physis, has been used at our institution since 1996. A review of these cases was performed to determine the outcomes in the technical and patient satisfaction domains. Preoperative and follow-up radiographs of the foot were analyzed to measure the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the proximal metatarsal articular angle (PMAA), and the metatarsal length ratio...

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BACKGROUND: Reduction of unstable slipped capital epiphysis has a bad reputation, especially in severe slips. Treatment frequently causes avascular necrosis (AVN). This study analyzes the role of capsulotomy with evacuation of intraarticular fluid and gentle reduction done as an emergency procedure followed by fixation with unthreaded Kirschner wires (K-wires). METHODS: We treated 64 consecutive cases of unstable slips (37 boys and 27 girls) following the same protocol...

The authors' current experience in the surgical treatment strategy of stable slipped capital femoral epiphysis deformities was reviewed. From this, a treatment algorithm was developed that could be utilized as a guide in the evaluation and treatment of future patients with slipped capital femoral epiphysis. The clinical parameters of patients' histories of symptoms, physical examinations, and radiographic assessments of slip severity were used in formulating the algorithm. The intent was to prepare a comprehensive algorithm providing necessary alternate treatment pathways for the variable slip deformity in accordance with the surgical experience/expertise of the treating surgeon...

Correct identification of fusion levels in surgical planning for the management of adolescent idiopathic scoliosis is a complex task. Several classification systems and algorithms exist to assist surgeons in determining the appropriate levels to be instrumented. The Lenke classification is the benchmark system. Among the many factors and measurements that are taken into account when selecting the proper upper instrumented vertebra and lower instrumented vertebra are planning for selective fusion; preserving motion segments; preventing proximal and/or distal junctional kyphosis, shoulder imbalance, and neck pain; and maintaining short fusion lengths...

BACKGROUND: Lower extremity angular deformities are common in children with skeletal dysplasia and can be treated with various surgical options. Both acute correction by osteotomy with internal fixation and gradual correction by external fixation have been used with acceptable results. Recently, the Guided Growth concept using temporary hemiepiphysiodesis for correction of angular deformities in the growing child has been proposed. This study presents the results of temporary hemiepiphysiodesis using eight-Plates and medial malleolus transphyseal screws in children with skeletal dysplasia with lower extremity angular deformities...

Spinal muscular atrophy is a neurodegenerative disease that requires multidisciplinary medical care. Recent progress in the understanding of molecular pathogenesis of spinal muscular atrophy and advances in medical technology have not been matched by similar developments in the care for spinal muscular atrophy patients. Variations in medical practice coupled with differences in family resources and values have resulted in variable clinical outcomes that are likely to compromise valid measure of treatment effects during clinical trials...

BACKGROUND: Early-onset scoliosis is a heterogeneous condition, with highly variable manifestations and natural history. No standardized classification system exists to describe and group patients, to guide optimal care, or to prognosticate outcomes within this population. A classification system for early-onset scoliosis is thus a necessary prerequisite to the timely evolution of care of these patients. METHODS: Fifteen experienced surgeons participated in a nominal group technique designed to achieve a consensus-based classification system for early-onset scoliosis...

STUDY DESIGN: Three-dimensional computed tomography (CT) radiographic analysis. OBJECTIVE: To describe the parameters for a trajectory through a sacral starting point as a method of pelvic fixation in spinal deformity and to compare this technique with insertion from the posterior superior iliac spine (PSIS). SUMMARY OF BACKGROUND DATA: Long anchors projecting into the ilium provide optimal pelvic fixation. The traditional starting point in the PSIS requires muscle dissection and connectors or rod bends...

STUDY DESIGN: Retrospective review of adolescent idiopathic scoliosis (AIS) patients. OBJECTIVE: To investigate the clinical deformity and radiographic features of Lenke 1A and 1B curves to determine if the "A" and "B" lumbar modifiers actually describe 2 distinct curve patterns. SUMMARY OF BACKGROUND DATA: The Lenke classification system attempts to address some of the shortcomings of the King-Moe classification system by providing a more comprehensive, reliable, and treatment-based categorization of all AIS deformities...

STUDY DESIGN: A biomechanical study of the Charleston brace. OBJECTIVE: To model the nighttime Charleston brace treatment and study its biomechanical action. SUMMARY OF BACKGROUND DATA: The Charleston brace has been proposed as an alternative to the traditional daytime thoracolumbosacral orthosis for the treatment of moderate scoliotic deformities. It is worn at night and imposes a supine side-bending to reduce the major scoliotic curve. The biomechanics of the Charleston brace is still poorly understood...

STUDY DESIGN: A prospective study. OBJECTIVES: To introduce a new technique, direct vertebral rotation, and to compare the surgical results of direct vertebral rotation with those of simple rod derotation. SUMMARY OF BACKGROUND DATA: Pedicle screw fixation with a simple rod derotation maneuver enables a powerful coronal and sagittal plane correction in scoliosis surgery. However, the ability of achieving rotational correction is still unclear...

STUDY DESIGN: Prospective clinical series. OBJECTIVE: To determine how many thoracic scoliotic pedicles have cancellous versus cortical versus absent channels. SUMMARY OF BACKGROUND DATA: Although morphologic evaluations of thoracic pedicles have been well reported, the results do not practically reflect clinical findings during actual pedicle screw placement. We propose a novel pedicle channel classification describing the osseous anatomy encountered during pedicle probe insertion...

The pedicle is a power nucleus of the vertebra and offers a secure grip of all 3 columns. Pedicle screw instrumentation has advantages of rigid fixation with improved three-dimensional (3D) correction and it is accepted as a reliable method with a high margin of safety. Accurate placement of the pedicle screws is important to reduce possible irreversible complications. Many methods of screw insertion have been reported. The author has been using the K-wire method coupled with the intraoperative single posteroanterior and lateral radiographs, which is the most safe, accurate and fast method...

BACKGROUND: Spinal bracing is widely utilized in patients with moderate severity adolescent idiopathic scoliosis with the goal of preventing curve progression and therefore preventing the need for surgical correction. Bracing is typically initiated in patients with a primary curve angle between 25 and 40 degrees, who are Risser sign 0 to 2 and <1-year postmenarchal. The purpose of this study is to determine whether nighttime bracing using a Charleston bending brace is effective in preventing progression of smaller curves (15 to 25 degrees) in skeletally immature, premenarchal female patients relative to current standard of care (observation for curves <25 degrees)...

BACKGROUND: The role of bracing in patients with adolescent idiopathic scoliosis who are at risk for curve progression and eventual surgery is controversial. METHODS: We conducted a multicenter study that included patients with typical indications for bracing due to their age, skeletal immaturity, and degree of scoliosis. Both a randomized cohort and a preference cohort were enrolled. Of 242 patients included in the analysis, 116 were randomly assigned to bracing or observation, and 126 chose between bracing and observation...

In a preliminary report in 1965, Axer proposed femoral varus derotation osteotomy as an alternative method for treating Legg-Calve-Perthes disease. Thereafter, this became one of the most popular operative methods in the treatment of the disease. A literature analysis of this method experienced during the years is discussed and the investigator's personal approach is described.