Aims

There has been limited literature regarding outcomes of acetabular rim syndrome (ARS) with persistent acetabular os in the setting of acetabular dysplasia. The purpose of this study was to characterize a cohort of adolescent and young adult patients with ARS with persistent os and compare their radiological and clinical outcomes to patients with acetabular dysplasia without an os.

Infection and re-fracture are well-described complications following open paediatric forearm fractures. The purpose of this paper is to determine if patient, injury, and treatment characteristics can be used to predict the occurrence of these complications following the surgical management of paediatric open forearm fractures.

This is an IRB-approved retrospective review at a single-institution paediatric level 1 trauma centrefrom 2007–2013 of all open forearm fractures. Medical records were reviewed to determine the type of open fracture, time to administration of initial antibiotics, time from injury to surgery, type of fixation, length of immobilisation, and complications. Radiographs were studied to document fracture characteristics.

262 patients with an average age of 9.7 years were reviewed. There were 219 Gustillo-Anderson Type 1 open fractures, 39 Type 2 fractures, and 4 Type 3 fractures. There were 9 infections (3.4%) and 6 re-fractures (2.3%). Twenty-eight (10.7%) patients returned to the operating room for additional treatment; 21 of which were for removal of implants. Contaminated wounds, as documented within the medical record, had a greater chance of infection (21% vs 2.2%, p=0.002). No difference in infection rate was seen with regard to timing of antibiotics (p=0.87), timing to formal debridement (p=0.20), Type 1 versus Type 2 or 3 open fractures (3.4% vs 5.0%, p=0.64), 24 hours vs. 48 hours of post-operative IV antibiotics (5.2% vs 3.5%, p=0.53), or when comparing diaphyseal, distal, and Monteggia fracture patterns (3.6 vs 2.9% vs 5.9%, p=0.81). There was no difference in infection rate when comparing buried or exposed intramedullary implants (3.5% vs 4.2%, p>0.99). Rate of re-fracture was not increased based on type of open wound (p>0.99) or fracture type (0.4973), although 5 of the 6 re-fractures were in diaphyseal injuries.

In this series of open paediatric both bone forearm fractures, initial wound contamination was a significant risk factor for subsequent infection. The rate of infection did not vary with timing of antibiotics or surgery, type of open fracture, or length of post-operative antibiotics. A trend to higher re-fracture rates in diaphyseal injuries was noted. Surgeons should consider planned repeat irrigation and debridement for open forearm fractures with obviously contaminated wounds to reduce the subsequent infection risk.

Osteochondromas occur are most commonly in the distal femur, proximal tibia and fibula and the proximal humerus. There are no large studies focusing on the clinical presentation, management and outcome of treatment for patients with an osteochondroma involving the proximal fibula. The purpose of this study is to specifically understand the manifestation of the proximal fibular osteochondroma on the preoperative peroneal nerve function, and how surgical management of the osteochondroma affects function immediately postoperatively and at long-term followup.

This is an IRB-approved retrospective review of a consecutive series of patients with a proximal fibular osteochondroma (PFO) treated operatively at a single institution from 1990 to 2013. The medical record was carefully reviewed to identify demographic data, clinical data and especially the status of the peroneal function at various time points.

There were 25 patients with 31 affected extremities who underwent surgical excision of the PFO at an average age of 12.4 years (range 3.0–17.9 years). There were 16 males and 9 females. The underlying diagnosis was isolated PFO in 2(8%) patients and multiple hereditary exostosis (MHE) in 23(92%) patients. Preoperatively, 9 (29%) had a foot drop and 22 (71%) did not. Those with preoperative foot drop underwent surgery at a younger age (9.1 vs 13.8 years) (p<0.004). Five of the nine (55.5%) had complete resolution, three (33.3%) had improvement, and one (11.1%) persisted postoperatively and required AFO. Of the 22 who were normal preoperatively, 5 (22.7%) developed a postoperative foot drop-three (60%) completely resolved, 1 (20%) improved, and 1 (20%) persisted and was found to have a transected nerve at exploration. In total, 23 of the 25 (92%) patients who had a PFO excision, had a normal or near-normal peroneal nerve function including those who had poor function preoperatively.

A proximal fibular osteochondroma can result in a high incidence of peroneal nerve dysfunction prior to any treatment, but responds the majority of the time to surgical intervention with removal of the osteochondroma. For those who have normal preoperative function, 1 in 4 will develop a postoperative foot drop but nearly all improve spontaneously unless iatrogenic injured.

Purpose: Few studies have analyzed spinal cord monitoring (SCM) during spine deformity surgery when neural axis abnormalities (NAA) are present. Our purpose was to compare the effectiveness of SCM between NAA and AIS patients.

Methods: This is a retrospective review of all patients from 1993–2002 with an isolated NAA who had SCM during spinal deformity surgery. These were compared to a randomly selected group of AIS patients during the same time period when techniques for somatosensory-evoked potentials (SSEP) and motor-evoked potential (MEP) monitoring remained the same.

Results: There were 41 NAA patients and 139 AIS patients. The age at surgery was similar (14.4 vs. 14.5 yrs), but there were more males (48.8 vs. 18.7%)* in the NAA group. For NAA patients, the most common abnormalities were syringomyelia (n=29) and tethered cord (n=5) for which 68% required neurosurgery. The preoperative curve magnitude was greater in the NAA group (65.9° vs 59.6°)* but there were no differences in surgical time (39.6 vs. 35.9 min/level) and estimated blood loss (99.4 vs. 82.0 cc/level) between the groups. There was a trend towards more surgical complications in the NAA group (7.3 vs. 3.6%). Good baseline values were achieved less often in the NAA group for SSEPs (85% vs 99%)* and MEPs (83% vs 100%)*. Significant deviations from baseline values were seen more often in the NAA group for SSEP (5.0% vs. 1.4%)* and MEP (4.0% vs. 2.5%)*. * (p< 0.05)

Conclusions: Obtaining baseline SCM values was more difficult and deviations from baseline were more common in the NAA patients when compared to AIS patients. However, SCM did not miss a neurologic injury and was found to be very useful and necessary during spine deformity surgery in the NAA population.