Snir Heller

Guiding femoral rotational growth in an animal model.

BACKGROUND Guided growth is most commonly utilized about the knee and ankle for the correction of coronal-plane deformities by the use of plates positioned perpendicular to the physis. Sagittal-plane deformity correction has been described as well. The purpose of our study was to examine the ability to affect axial-rotational growth. Our hypothesis was that placement of plates in an oblique orientation relative to the physis can induce rotational growth deformity. METHODS Our hypothesis was tested with use of a mathematical model and a bone model and subsequently in a rabbit model. Thirteen six-week-old rabbits underwent a rotational guided growth procedure involving the distal aspect of the right femur, with a sham procedure performed on the left side. Two plates were positioned in an oblique orientation relative to the physis, medially and laterally, to guide either internal or external rotational growth. After the rabbits were killed six weeks after the surgery, the femoral rotational profile was assessed by computed tomography scans of the dissected femora and the growth plates were examined histologically. RESULTS A significant effect on the rotational profile was found in the treated femora. When the plates were positioned to guide external rotation, the rotational profile was significantly greater in the treated femora (29.0° compared with 11.3° in the sham femora; p = 0.008). There was a positive linear correlation between the right-left difference in rotational profile and the change in inter-plate angle (R2 = 0.72, p = 0.001). Every 1° of inter-plate angle change induced 0.367° of rotational profile difference (p = 0.001). Histologically, a swirling effect of the physeal cell columns was seen in the treated femora. CONCLUSIONS Guided growth using plates was demonstrated to alter axial-rotational growth in a predictable fashion in a rabbit model. CLINICAL RELEVANCE Guided growth using plates may be effective for correction of rotational and multiplanar deformities.

Ankle tourniquet pain control in forefoot surgery: a randomized study.

Background: Forefoot surgery is often performed under regional anesthesia in awake patients, using tourniquet or Esmarch bandage to obtain a bloodless field. The purpose of this study was to examine the value and need for local tourniquet pain control using local subcutaneous analgesic mixture in patients undergoing forefoot surgery under ankle block anesthesia. Materials and Methods: We prospectively randomized 56 patients who underwent forefoot surgery under ankle block to receive either subcutaneous local anesthetic mixture under the tourniquet or no additional anesthetic. We checked for local tourniquet pain score (VAS 0 to 100) and skin condition during and after the procedure. Results: The tourniquet was quite tolerable in both groups, with an average VAS score of 7 to 21. No difference was observed between groups throughout most of the procedure. No correlation between VAS scores and procedure length or patients age or gender was found. Conclusion: An ankle tourniquet was well-tolerated by patients without need for local anesthetic beneath the cuff. Level of Evidence: II, Prospective Comparative Study

Chondrolysis of the Hip following Septic Arthritis: A Rare Complication of Magnetic Resonance Arthrography

Magnetic resonance arthrography (MRA) is commonly used to detect labral tears of the hip. Complications of MRA are unusual and include minor reactions such as chemical synovitis and urticaria. This paper presents a rapidly progressive chondrolysis of the hip in a young patient after arthrography. The patient had suffered from acute septic arthritis and was treated by emergent arthroscopic surgery followed by appropriate antibiotics. At 18 months of followup, there were no signs of active infection but evidence of joint chondrolysis. Magnetic resonance arthrography (MRA) of the hip is an invasive procedure and should therefore be recommended judiciously. Post-MRA pain is common but often mild and temporary, while post-MRA joint infection is rare; nevertheless, severe joint pain and limitation should raise suspicion for septic hip.

THE EFFECTS OF USING A TOURNIQUET IN TOTAL KNEE ARTHROPLASTY: A STUDY OF 77 PATIENTS

Introduction: Total Knee Arthroplasty (TKA) is usually performed with a tourniquet. Previous studies investigated the relationship between tourniquet and blood loss. This study evaluated tourniquet usage regarding parameters such as blood loss, drainage, blood administration, knee flexion, and complications. Patients and Methods: A cohort of 77 patients who underwent total knee arthroplasty was reviewed. Results: No difference in 24-hours postoperative hemoglobin levels was observed. Blood collected in drains was slightly higher in the tourniquet group, yet there was more overall administration of blood for non-tourniquet group: a mean of 1.2 units of packed RBC versus a mean of 0.63 units for the tourniquet group. Complication rate was comparable, but a higher rate of local infection in tourniquet group was observed. No thromboembolic events were observed. Conclusion: With regards to direct blood loss parameters, there was no statistical difference between groups, provided that meticulous hemostasis is undertaken. Operating without a tourniquet poses a risk of increased demand for blood products. There is also some concern regarding local complication rate when tourniquets are used.

The early results of minimally invasive technique for hallux valgus repair

Hallux valgus deformity is a common disorder, affecting about –4% of the population (Myerson [10]). Coughlin and Thompson stimated that more than 200,000 hallux valgus corrections are erformed in the United States each year [11]. The indication or surgical correction is pain associated with deformity. A distal steotomy of the first metatarsal can be used to achieve correcion inmild-to-moderate hallux valgus, with a first intermetatarsal ngle [8] of 10–20◦ [1,2,8]. There are many procedures described n the literature for distal osteotomies of the first metatarsus, most f which require soft tissue procedure combined with extensive edial approach and capsulotomy, thus risking blood supply to he metatarsal head. A percutaneous technique, as developed by Bosch et al. [12] and opularized by Magnan et al. [9], involves osteotomy of the subapital region through aminimal 1 cmmedial approach and sliding he capital segment laterally. The osteotomy is fixed using a robust mm Kirsches wire which is inserted extraperiostally to buttress gainst the metatarsal head, using the bunion to displace the head aterally. The Kirsches wire is driven into the metatarsal shaft to old the osteotomy in position for 6 weeks until bony union is chieved. The potential advantages of a minimally invasive percutaneous pproach are a reduction in operating time and surgical dissection, he possibility of performing the procedure bilaterally with fewer omplications, the use of distal ankle-block anesthetic techniques 5], and early weight-bearing (Magnan et al. [9]).