Tag Archive | pseudarthrosis

What’s New in Limb Lengthening and Deformity Correction 2019

Every month, JBJS publishes a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Click here for a collection of all OrthoBuzz Specialty Update summaries.

This month, Mark T. Dahl, MD, co-author of the August 21, 2019 What’s New in Limb Lengthening and Deformity Correction,” selected the five most clinically compelling findings from among the 40 noteworthy studies summarized in the article.

Congenital Pseudarthrosis
–Authors of a retrospective study of 119 patients with Crawford type-II congenital pseudarthrosis of the tibia found a 69% union rate at maturity. They did not identify specific factors influencing rates of union or refracture, however.1

3-Dimensional Printing
–The models created with this technology can help surgeons preoperatively assess specific anatomical geometries. Corona et al.2 used 3-D-printed titanium truss cages, along with the Masquelet technique, to treat massive infected posttraumatic defects.

Growth Prediction in Limb Lengthening
–A comparative evaluation of the predictive accuracy of 4 methods to correctly time epiphysiodesis in 77 patients found the multiplier method to be the least accurate. In a separate study of 863 epiphysiodeses, authors reported a 7% complication rate.3 The most common complication was incomplete arrest that resulted in angular deformities; half of those cases required reoperation.

Congenital Limb Deficiencies
–Over 16 years, Finnish children born with lower-limb deficiencies had 6 times the number of hospital admissions and 10 times the number of days in hospital per child, compared with children born without a limb deficiency.4

References

  1. Shah H, Joseph B, Nair BVS, Kotian DB, Choi IH, Richards BS, Johnston C, Madhuri V, Dobbs MB, Dahl M. What factors influence union and refracture of congenital pseudarthrosis of the tibia? A multicenter long-term study. J Pediatr Orthop. 2018 Jul;38(6):e332-7.
  2. Corona PS, Vicente M, Tetsworth K, Glatt V. Preliminary results using patient-specific 3D printed models to improve preoperative planning for correction of post-traumatic tibial deformities with circular frames. Injury. 2018 Sep;49(Suppl 2):S51-9.
  3. Makarov MR, Dunn SH, Singer DE, Rathjen KE, Ramo BA, Chukwunyerenwa CK, Birch JG. Complications associated with epiphysiodesis for management of leg length discrepancy. J Pediatr Orthop. 2018 Aug;38(7):370-4.
  4. Syvänen J, Helenius I, Koskimies-Virta E, Ritvanen A, Hurme S, Nietosvaara Y. Hospital admissions and surgical treatment of children with lower-limb deficiency in Finland. Scand J Surg. 2018 Nov 19:1457496918812233. [Epub ahead of print]

What’s New in Spine Surgery: Level I and II Studies

Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Here is a summary of selected findings from Level I and II studies cited in the June 17, 2015 Specialty Update on spine surgery:

  • A database study to determine the prevalence of venous thromboembolic events after spinal fusion found that risk factors for such events included hypercoagulability, certain medical comorbidities, older age, and male sex.
  • An RCT comparing allograft alone versus allograft plus bone marrow concentrate to accomplish spine fusion in adults with spondylolisthesis found very poor union rates in both groups, although allograft with bone marrow concentrate delivered slightly better results.
  • A meta-analysis of five studies (253 patients) found no pain or functional differences when unilateral percutaneous kyphoplasty was compared with bilateral (same-vertebra) kyphoplasty for osteoporotic compression fractures. The unilateral approach was associated with shorter operative times, however.
  • An RCT comparing the analgesic efficacy and clinical utility of gabapentin, pregabalin, and placebo in patients undergoing spinal surgery found that pregabalin outperformed the other two interventions immediately after surgery postoperative and up to three months postoperatively.
  • In an RCT comparing open-door to French-door laminoplasty for cervical compressive myelopathy, both techniques were found to be equivalent in terms of neurological recovery and perioperative complications, but patients receiving the open-door technique had more kyphosis and less cervical range of motion postoperatively.
  • An update to a 2002 Cochrane review found no significant outcome differences between supervised and home-exercise rehabilitation programs after lumbar disc surgery.
  • A systematic review/meta-analysis showed that radiofrequency denervation of facet joints is more effective than placebo in achieving functional improvement and pain control in patients with chronic low back pain.
  • A Level II diagnostic study concluded that with a magnification of 150% and a good pair of flexion and extension radiographs following anterior cervical arthrodesis, pseudarthrosis was noted with >1 mm of motion between fused interspinous processes with 96.1% specificity and a positive predictive value of 96.9%.
  • A Level I therapeutic study comparing the efficacy of intravenous tranexamic acid, epsilon-aminocaproic acid, and placebo to reduce bleeding in 125 adolescent patients undergoing posterior fusion for idiopathic scoliosis found less intraoperative and postoperative blood loss and higher hematocrit levels with the antifibrinolytics than with placebo. However, transfusion requirements were no different between the groups.
  • A randomized comparison of navigated versus freehand techniques for pedicle screw insertion during lumbar procedures found that surgeon radiation exposure with freehand technique is up to 10 times greater than with use of navigation.