Slipped capital femoral epiphysis (SCFE) usually occurs in children around the time of the growth spurt. There is a shearing force across the epiphysis at the hypertrophic zone allowing the slip. In the vast majority of cases, the slip occurs in the varus direction. Valgus slipped capital femoral epiphysis (SCFE) is an uncommon entity. Although there are a few isolated cases reported in the literature, to date this entity has not been sufficiently reviewed and understood. Such a case is presented and a review of the published literature on this subject is carried out.
We present our experience of forearm lengthening in children with various conditions performed by a single surgeon between 1995 and 2009. A total of 19 children with a mean age of 9.8 years (2.1 to 15.9) at the time of surgery had 22 forearm lengthenings using either an Ilizarov/spatial and Ilizarov circular frame or a monolateral external fixator. The patients were divided into two groups: group A, in whom the purpose of treatment was to restore the relationship between the radius and the ulna, and group B, in whom the objective was to gain forearm length. The mean follow-up after removal of the frame was 26 months (13 to 53). There were ten patients (11 forearms) in group A with a mean radioulnar discrepancy of 2.4 cm (1.5 to 3.3) and nine patients (11 forearms) in group B. In group A, the mean lengthening achieved was 2.7 cm (1.0 to 5.5), with a lengthening index of 11.1 weeks/cm. Equalisation or overcorrection of the discrepancy was achieved in seven of 11 forearms, but lengthening was only partially successful at preventing subluxation or dislocation of the radial head. In group B, the mean lengthening achieved was 3.8 cm (1.9 to 6.8), with a lengthening index of 7.25 weeks/cm. Common complications in both groups were pin-site infection and poor regenerate formation. Forearm lengthening by distraction osteogenesis is a worthwhile procedure in children that can improve cosmesis and function, particularly in patients with shortening of both radius and ulna.
Background: The purpose of our study was to evaluate the effectiveness of treating extremity aneurysmal bone cysts (ABC) by percutaneous curettage compared with open intralesional excision. Methods: A retrospective review of 17 patients with histologically proven primary ABCs and no evidence of a secondary lesion treated either by percutaneous curettage or open intralesional excision with at least 24-month follow-up was undertaken. The percutaneous curettage group was uniformly treated on an outpatient basis using angled curettes under image guidance followed by intralesional evacuation. The primary outcome was radiographic healing using the Neer/Cole 4-grade classification. Complications were noted. Results: Seventeen patients with a mean age of 11.7 years (range, 1.7 to 17.5) were evaluated. Nine patients underwent percutaneous curettage and 8 had an open intralesional excision. The 2 treatment groups were comparable with regard to age, sex, number of procedures, morphologic type of ABC, and follow-up period. At follow-up, the proportion of patients with satisfactory healing (Neer/Cole grades I and II) were similar among the 2 groups (P=0.74). In the percutaneous curettage group, 2 cases recurred necessitating repeat procedures, whereas 1 case recurred in the open intralesional excision group and was successfully treated percutaneously. Conclusions: Percutaneous curettage is a safe and minimally invasive alternative for extremity ABCs that can be performed as an outpatient procedure. Not all ABCs require wide exposure and an open intralesional excision. Level of Evidence: III.
We report the case of a 43-year-old woman who developed life threatening hyponatraemia 4 days following burr hole drainage of a spontaneous chronic subdural haematoma (CSDH). Syndrome of inappropriate secretion of antidiuretic hormone was confirmed. This is the first report of delayed life threatening hyponatraemia developing postoperatively in CSDH. The mechanism remains unclear but may involve brain shift on the pituitary stalk following subdural evacuation.
Objectives: Pilon fractures are challenging to treat and associated with complications such as skin necrosis and superficial and deep infections that can potentially lead to amputation.This meta-analysis aimed to compare the postoperative outcomes following open reduction and internal fixation (ORIF) versus external fixation for pilon fractures.Methods: We searched several databases from January 1990 to July 2017, for any observational or experimental studies that evaluated the postoperative outcomes of pilon fractures.We pooled the effect sizes using fixed-effect models that compared the postoperative outcomes of ORIF versus external fixation.Descriptive and qualitative data were also extracted.Results: Of the 485 articles identified, 13 were eligible for the meta-analysis, with a total of 683 pilon fractures in 679 patients.The pooled estimate for major infection in external fixation of pilon fractures showed comparable events compared to those who underwent ORIF (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 0.56-1.96,I 2 = 42.2%).External fixation was also found to be associated with higher events for minor infection (OR = 2.83, 95% CI: 1.63; 4.93, I 2 = 0.00%), delayed union (OR = 2.42, 95% CI: 1.02; 5.72, I 2 = 0.00%), nonunion (OR = 1.58, 95% CI: 0.79; 3.18, I 2 = 0.00%), malunion (OR = 3.14, 95% CI: 1.65; 5.97, I 2 = 0.00%), and posttraumatic arthritis (OR = 2.55, 95% CI: 1.40; 4.63, I 2 = 0.00%).These results did not change even after doing sensitivity analysis comparing limited internal fixation with external fixation, uniplanar external fixation, and circular external fixator, to ORIF.Conclusions: External fixation was associated with the same chance of having adverse events that required additional procedure(s) or intravenous antibiotics compared to ORIF in pilon fractures, but the difference in bone healing complication was much more observed.ORIF allows accurate articular reduction with comparable infection rates and lower bone healing complications.
Slipped capital femoral epiphysis (SCFE) is one of the most common adolescent hip conditions. Unstable SCFE is characterized by sudden and severe hip pain with the inability to weight bear, even with crutches. Osteonecrosis of the femoral head is increased in patients with unstable SCFE. The aim of our study was to systematically review the literature that compares hip decompression to no hip decompression of unstable SCFE.We searched several databases from 1946 to 2014 for any observational or experimental studies that evaluated hip decompression and osteonecrosis of unstable SCFE. We performed a meta-analysis using a random effects model to pool odds ratios (ORs) for the comparison of osteonecrosis between patients undergoing hip decompression and no hip decompression. We also investigated the type of hip decompression performed. Descriptive, quantitative, and qualitative data were extracted.Of the 17 articles identified, nine studies (eight case series and one retrospective cohort study) were eligible for the meta-analysis, with a total of 302 unstable SCFE. The pooled OR = 0.91 of osteonecrosis between hip decompression and no hip decompression was in favor of hip decompression, but was not statistically significant [95 % confidence interval (CI): 0.47, 1.75; p = 0.54, I (2) = 0 %]. No significant differences in the rates of osteonecrosis were detected in unstable SCFE with open and percutaneous hip decompression alone (OR = 0.97, 95 % CI: 0.36, 2.62; p = 0.69, I (2) = 19.1 %) or hip decompression with bony procedures (OR = 0.99, 95 % CI: 0.35, 2.79; p = 0.69, I (2) = 0 %).The cumulative evidence at present does not indicate an association between hip decompression and a lower rate of osteonecrosis of unstable SCFE. However, hip decompression of unstable SCFE remains an option that can potentially decompress the intracapsular hip pressure and optimize the blood flow to the femoral head. Thus, multicenter prospective cohort studies are required and will be able to answer this question with more certainty and a higher level of evidence.Level III/IV.
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