L. Pedretti

Autologous fat graft as treatment of post short stature surgical correction scars

INTRODUCTION Surgical limb lengthening is undertaken to correct pathological short stature. Among the possible complications related to this procedure, painful and retractile scars are a cause for both functional and cosmetic concern. Our team has already shown the efficacy of autologous fat grafting in the treatment of scars with varying aetiology, so we decided to apply this technique to scars related to surgical correction of dwarfism. A prospective study was conducted to evaluate the efficacy of autologous fat grafting in the treatment of post-surgical scars in patients with short-limb dwarfism using durometer measurements and a modified patient and observer scar assessment scale (POSAS), to which was added a parameter to evaluate movement impairment. PATIENTS AND METHODS Between January 2009 and September 2012, 36 children (28 female and 8 male) who presented retractile and painful post-surgical scars came to our unit and were treated with autologous fat grafting. Preoperative and postoperative mean durometer measurements were analysed using the analysis of variance (ANOVA) test and POSAS parameters were studied using the Wilcoxon rank sum test. RESULTS There was a statistically significant reduction in all durometer measurements (p-value <0.05) and in all but one of the POSAS parameters (p-value <0.05) following treatment with autologous fat grafting. DISCUSSION Surgical procedures to camouflage scars on lower limbs are not often used as a first approach and non-surgical treatments often lead to unsatisfactory results. In contrast, our autologous fat grafting technique in the treatment of post-surgical scars has been shown to be a valuable option in patients with short-limb dwarfism. CONCLUSION There was a reduction of skin hardness and a clinical improvement of all POSAS parameters in all patients treated. Moreover, the newly introduced POSAS parameter appears to be reliable and we recommend that it is included to give a more complete evaluation of patient perception.

A new way to treat forearm post-traumatic non-union in young patients with intramedullary nailing and platelet-rich plasma

INTRODUCTION Non-union rate in forearm fractures is generally less than 2% when a proper technique is used; this rate increases when ulnar lesions are involved. PATIENTS AND METHODS We present a case series of seven young patients whose average age was 14 years (range 11-19 years) at the time of surgery and who presented with a forearm post-traumatic non-union that was previously treated in different ways (three isolated ulnar non-union, two isolated radial non-union and two combined). Average follow-up was 34 months (range 9-72 months). Surgical treatment began with the removal of the previous synthesis and with curettage of the non-union area. The Acumed ulnar rod, Acumed radial rod and Thalon elastic nail (all of them are unreamed and locked nails) together with autologous platelet-rich plasma (PRP) obtained with the Biomet System (concentration of 158.2×10(4) platelets/μL) were chosen to treat the patients. X-rays and clinical controls were conducted every 30 days until recovery. RESULTS All patients recovered: average recovery was 23 weeks from operation (range 16-36 weeks) and nails were removed 3 months after complete healing. Six patients had excellent results and one patient had a good result (Patient 2, forearm pronosupination 60-0-40 degrees). DISCUSSION The purpose of the case series was to establish a better way of treatment and to find a technique that could avoid the use of bone grafts, because obtaining autologous bone requires a further surgical procedure that can be really invasive depending on the amount of bone needed. CONCLUSION All patients in the study showed complete recovery, with excellent clinical outcomes. Although there were only seven patients in this case series, and there is a need to analyse more patients, this study showed that the use of a specific locking nail system can provide proper stability to ulnar or radial atrophic non-union despite rotational forces, and when combined with autologous growth factors (PRP) is sufficient to promote bone healing in young patients without the necessity to take autologous bone grafts.

Anterior cruciate ligament recostruction with bone-patellar tendon-bone autograft in Tanner 3 stage patients with open physes.

Ten skeletally immature patients were treated with an arthroscopic-assisted anterior cruciate ligament reconstruction with bone-patellar tendon bone autograft (compass, 50–55°; holes, 7–9 mm). Radiological assessments (standard radiograph), Orthopädische Arbeitsgruppe Knie (OAK) score and KT 1000, were conducted on all patients, 1 year after surgery. Skeletal maturity had been reached by all patients and no complications were observed. All patients returned to their preinjury sport level. Drilling more vertical tunnels when bone-tendon-bone autograft was chosen to avoid partial epiphysiodesis and offers good functional and isometric results.

Comparison between external fixation and elastic stable intramedullary nailing for the treatment of femoral shaft fractures in children younger than 8 years of age.

The main objective of this study was to compare external fixation (EF) with elastic stable intramedullary nailing (ESIN) for the treatment of femoral shaft fractures in children aged 8 or younger. Fifteen children with femoral shaft fractures treated by EF and 23 children with femoral shaft fractures treated by ESIN were retrospectively reviewed. All patients were pain free at the last follow-up, with good ranges of motion in the hip and knee. Partial and full weight bearing occurred sooner in patients treated with EF than with ESIN, although more polytrauma patients were present in the ESIN group. In conclusion, EF and ESIN can be considered as safe and effective methods for femoral shaft fracture treatment in children younger than 8 years of age.

Supracondylar humerus fractures in children: a comparison of experiences.

The most common elbow lesions found in pediatric practice are supracondylar fractures. We compared two groups of 34 patients each with a supracondylar humerus fracture grade III (Gartland classification). The first group was treated with percutaneous pinning with Kirschner wires, with patients in a supine position, sometimes preceded by transkeletal traction. The second group was treated with percutaneous pinning with Kirschner wires, with patients in a prone position, within 6 h of the trauma. No statistically significant differences with regard to clinical outcomes and neurovascular complications were revealed in the comparison. Therefore, we can state that both treatment techniques used are valid.

Achondroplasia in female twins: surgical indications.

Although in literature achondroplasia has been described profusely, reports on achondroplastic twins are limited. We present two cases of monozygotic female twins with achondroplasia, who underwent limb-lengthening surgical procedure with external fixation in the following five steps: tibia, femur, tibia; femur, homer. Both the cases presented a good limb length and an optimal correction of associated deformities after the treatment, fulfilling the indications. Surgical indications were mostly led by the axial deviations of the lower limbs, and the timing of the limb-lengthening procedures has been the same in both couples showing the importance of this aspect.

Le lesioni del legamento crociato anteriore del ginocchio del paziente in accrescimento

ACL injuries in prepubescent patients are being seen with increasing frequency. The reasons include intensive year round training regimens and early sport specialisation, but also a more precise diagnosis of the trauma and its causes. The traditional treatment was conservative, but with poor outcomes and an high rate of chondral and articular damages caused by prolonged instability. As a result, there is the need for surgical anterior cruciate reconstruction even in skeletally immature patients. Many surgical techniques have been described to achieve a physeal sparing reconstruction, thus avoiding iatrogenic damages of the limb growth. The proposed techniques can be divide into three groups: extra-epiphyseal, trans-epiphyseal and all-epiphyseal. Some issues are related to the non-anatomical stabilisation achieved with the extra-epiphyseal reconstruction. All-epiphyseal reconstruction, which involves some technical complexities, should be preferred in younger patients with fully open physes. The trans-epiphyseal approach has shown satisfactory outcomes in patients with older skeletal age, reducing the surgical impact on growth cartilages with some technical adjustments if compared with the usual technique for adults.

Benzodiazepines provide no additional benefit over physiotherapy and analgesia in acute lumbar disc prolapse

Commentary on: BrötzDMaschkeEBurkardS. Is there a role for benzodiazepines in the management of lumbar disc prolapse with acute sciatica? Pain 2010;149:470–5.