ObjectiveThis study aimed to compare limited open reduction and transepiphyseal intramedullary fixation with Kirschner wire (LOR-TIKW) versus open reduction and internal fixation with plate and screw (ORIF-PS) for treatment of irreducible distal radius diaphyseal–metaphyseal junction (DMJ) fracture in older children.MethodsData of children (aged 10–14 years) treated in our hospital for distal radius DMJ fractures with LOR-TIKW or ORIF-PS from January 2018 to December 2019 were retrospectively analyzed. Follow-up was until radiographic union. Demographic, clinical, and radiographic data; treatment cost; healing time; functional outcome (by Price criteria); complications; and postoperative angulation and displacement were compared between children treated by the two methods. Statistical analysis was performed with alpha set at P < 0.05.ResultsA total of 26 children were included: 14 treated with LOR-TIKW and 12 with ORIF-PS. Operation time was less (22.1 min vs. 46.7 min, P < 0.0001), surgical incision smaller (2.43 cm vs. 5.00 cm, P < 0.0001), cost of internal fixation lower (US$, 40.6 vs. 2020, P < 0.0001), and healing time shorter (4.79 weeks vs. 5.64 weeks, P = 0.03) with LOR-TIKW; however, postoperative fracture angulation was slightly larger (1.07° vs. 0.83°, P = 0.85) and displacement slightly more (0.86 mm vs. 0.58 mm, P = 0.44) in the LOR-TIKW group. Rate of union, functional outcome, and complications were not significantly different between the groups.ConclusionFor irreducible DMJ fracture of distal radius in older children, LOR-TIKW appears to be a promising method with several advantages over ORIF-PS.
Introduction: The repair and regeneration of growth plate injuries using tissue engineering techniques remains a challenge due to large bone bridge formation and low chondrogenic efficiency.Methods: In this study, a bilayer drug-loaded microspheres was developed that contains the vascular endothelial growth factor (VEGF) inhibitor, Bevacizumab, on the outer layer and insulin-like growth factor-1 (IGF-1), a cartilage repair factor, on the inner layer. The microspheres were then combined with bone marrow mesenchymal stem cells (BMSCs) in the gelatin methacryloyl (GelMA) hydrogel to create a composite hydrogel with good injectability and biocompatibility.Results: The in vitro drug-release profile of bilayer microspheres showed a sequential release, with Bevacizumab released first followed by IGF-1. And this hydrogel simultaneously inhibited angiogenesis and promoted cartilage regeneration. Finally, in vivo studies indicated that the composite hydrogel reduced bone bridge formation and improved cartilage regeneration in the rabbit model of proximal tibial growth plate injury.Conclusion: This bilayer microsphere-based composite hydrogel with sequential controlled release of Bevacizumab and IGF-1 has promising potential for growth plate injury repair.
ObjectiveCurrently, individualized navigation templates are rarely applied in pediatric orthopedic surgery. This study aimed to explore the potential of navigation templates obtained using computer-aided design and three-dimensional (3D) printing to correct lower limb deformities in children by the guided growth technique.MethodsWe prospectively studied 45 children with leg length discrepancy (LLD) or lower limb angular deformities, who underwent guided growth surgery involving 8-plate. In total, 21 and 24 children were included in the navigation template (group A) group and in the traditional surgery (group B) group, respectively. Mimics software was used for designing and printing navigation templates. The operation time, X-ray radiation exposure, damage to cartilage, and postoperative complications were recorded.ResultsThe mean operation time in groups A and B were 20.78 and 28.39 min, respectively, and the difference was statistically significant. Compared with group B, the intraoperative exposure of X-rays in group A was reduced by 25% on average. After 9–24 months of follow-up, the deformities were corrected in both groups. No significant differences in the treatment effect were noted between the groups, and no complications occurred.ConclusionsUsing the individualized navigation template in the guided growth technique made the surgical procedure convenient and simple to perform. In addition, the operation time and intraoperative exposure to X-rays were reduced. We consider that 3D printed navigation templates can facilitate the accurate completion of corrective surgeries for lower limb deformities in children, which is worthy of promotion and application.
Background This study describes the use of closed reduction percutaneous intramedullary fixation with Kirschner wires in 4 children with displaced metaphyseal-diaphyseal junction (MDJ) fractures of the distal humerus. Material/Methods Between August 2016 and August 2019, 4 patients (3 boys and 1 girl), whose mean age was 4 years 5 months (range: 3 years 6 months to 5 years 4 months), with displaced MDJ fractures of the distal humerus were treated using closed reduction percutaneous intramedullary fixation with Kirschner wires. Three of the fractures were oblique and 1 was transverse. The operation time and the frequency of intraoperative fluoroscopy were recorded. All children were followed up for greater than 18 months, taking anteroposterior and lateral radiographs of the elbow joint to evaluate the outcomes. At the last follow-up, the Flynn elbow joint function score was used to evaluate clinical outcomes, and complications were recorded. Results The mean operation time was 37.5 min (range: 35–40 min) and the frequency of intraoperative fluoroscopy was 11.7 times (range: 8–15 times). All of the fractures were confirmed to be healed based on radiographic results at 4 weeks after surgery. At the last follow-up, 4 children had normal elbow joint motion without elbow deformity. The Flynn score showed their outcomes were excellent. Conclusions Closed reduction percutaneous intramedullary fixation using Kirschner wires was an effective treatment for displaced MDJ fractures of the distal humerus in the 4 children described and was shown to be easy to perform with a short operation time.
The purpose of this study was to investigate whether an anteroposterior pelvic radiograph alone is sufficient to confirm hip reduction after conservative treatment or whether MRI could be alternatively performed. A total of 133 children (145 hips) were enrolled. All children were examined by anteroposterior pelvic radiographs and MRI. Three experts interpreted anteroposterior pelvic radiographs and then verified these results on MRI. For patients with inconsistent results between anteroposterior pelvic radiographs and MRI, the continuity of Shenton’s line and Calve’s line was recorded, and the medial clear space of bilateral hips was measured for unilateral cases. There was complete agreement between the three experts in the interpretation of anteroposterior pelvic radiographs of 111 (76.55%) hips; there was disagreement in the remaining 34 hips, with two experts diagnosing satisfactory reduction in 13 hips and dislocation in 21 hips. Assuming that the judgment of two or more doctors on anteroposterior pelvic radiographs was taken as the final result, 17 hips (11.72%) were misjudged. There was no statistically significant difference between the actual in-position group and the actual dislocation group in terms of the continuity of Shenton’s line (P = 0.62) and Calve’s line (P = 0.10) and the medial clear space of bilateral hips (P = 0.08). In children less than 1 year of age with developmental dysplasia of the hip treated conservatively, the use of anteroposterior pelvic radiographs alone to judge hip reduction might result in misdiagnosis and missed diagnosis. MRI could be alternatively used to detect hip reduction after conservative treatment, especially when the doctor was not familiar with ultrasound in the presence of plaster.
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