This study compared the radiographic and clinical outcomes of pediatric diaphyseal femur fractures treated by submuscular plating, flexible retrograde intramedullary nailing, or rigid antegrade intramedullary nailing with a trochanteric entry point in skeletally immature patients who were 8 years and older. A retrospective review was conducted of skeletally immature patients 8 years and older who were treated for femur fracture with submuscular plating, flexible intramedullary nailing, or rigid intramedullary nailing from 2001 to 2014 with a minimum 12-week follow-up. Treatment outcomes were compared for statistical significance, including time to union, malunion, nonunion, heterotopic ossification, avascular necrosis, time to full weight bearing, limb length discrepancy, residual limp, painful hardware, and infection. The study identified 198 femur fractures in 196 patients (mean age, 11.9 years). Each femur fracture was treated with submuscular plating (35), flexible intramedullary nailing (61), or rigid intramedullary nailing (102). Mean follow-up across the cohort was 48 weeks, ranging from 12 to 225 weeks. Flexible nailing was associated with an increased incidence of malunion (P<.0001) and hardware irritation (P=.0204) and longer time to full weight bearing (P=.0018). Rigid nailing was associated with an increased incidence of limp at 12-week followup (P=.0412). Additionally, 23.5% of patients who were treated with rigid nailing had heterotopic ossification. Of all surgical methods, submuscular plating allowed for the most rapid return to full weight bearing (mean, 7 weeks) and offered the fastest healing rate (mean, 6 weeks). Submuscular plating resulted in faster times to union and full weight bearing, with minimal complication rates. Rigid intramedullary nailing with trochanteric entry resulted in a lower incidence of malunion and hardware-related complications; however, these patients had an increased incidence of heterotopic ossification and residual limp postoperatively. Flexible retrograde intramedullary nailing resulted in the highest rates of malunion and hardware irritation and the longest time to full weight bearing. [Orthopedics. 2016; 39(6):353-358.].

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When evaluated with CT, custom instrumentation performs similar or better to standard instrumentation in component alignment and accurately templates component size. Tourniquet time was mildly increased for custom compared to standard.

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Background Ranulas are salivary pseudocysts in the floor of the mouth adjacent to damaged salivary glands. Current surgical management is drainage of the ranula with removal of the offending gland. An analogous percutaneous procedure could potentially offer similar treatment efficacy in a more minimally invasive way. Objective To evaluate the outcomes of a cohort of patients with ranulas treated with percutaneous ranula aspiration and chemical ablation of the source salivary gland to see whether this technique could be proposed as a minimally invasive treatment alternative. Materials and methods This retrospective single-center study evaluated 24 patients treated percutaneously for ranulas between January 2004 and December 2014. All patients were treated with percutaneous ranula aspiration and chemical ablation of the offending salivary gland. Treatment success and any complications were recorded. Results Complete ranula eradication was successfully accomplished in 87.5% of the patients with no complications. Conclusion Initial results suggest that our technique of percutaneous aspiration of ranulas and chemical ablation of the source salivary gland is safe and effective.

The treatment of pediatric diaphyseal femur fractures, particularly length-unstable fractures, continues to be an area of controversy in patients from age 6 to skeletal maturity. Submuscular bridge plating is an alternative that allows for stable internal fixation while minimizing soft tissue disruption. We describe a surgical technique that has simplified both implantation and removal. This technique provides a stable construct in comminuted and unstable fracture patterns allowing for early mobilization with minimal complications.

We present a 16-year-old girl with an osteoid osteoma in the vertebral body of C5. Given the difficulty of surgically treating the lesion, radiofrequency ablation was used. Percutaneous needle access to this lesion in the anterior aspect of the cervical vertebral body was limited by the many critical adjacent structures. We present our successful treatment of this lesion utilizing a trans-thyroid needle approach.

Background: Surgical treatment options for addressing recurrent dislocation after total hip arthroplasty (THA) vary. Identifying impingement mechanisms in an unstable THA may be beneficial in determining appropriate treatment. Questions/Purposes: We sought to assess the effectiveness of developing pre-operative plans for treating hip instability after THA. We used advanced imaging and three-dimensional modeling techniques to perform impingement analyses in patients with unstable THA. Methods: We evaluated a series of eight patients who would require revision THA to treat recurrent dislocation. Using a preoperative algorithmic approach, we built patient-specific models and evaluated hip range of motion with computed tomographic scanning and biplanar radiography. This information was used to determine a surgical treatment plan that was then executed intra-operatively. Patients were followed for 2 years to determine whether they experienced another hip dislocation following treatment. Results: Pre-operative kinematic modeling showed four of the eight patients had limited hip range of motion during flexion and internal rotation; a prominent anterior inferior iliac spine (AIIS) was found to limit hip range of motion in some of these cases. In the other four patients, range of motion was acceptable, suggesting soft-tissue causes of dislocation. No patients in this series experienced dislocation after undergoing revision THA. Conclusion: Advanced modeling techniques may be useful for identifying the impingement mechanisms responsible for instability after THA. Once variables contributing to limited hip range of motion are identified, surgeons can develop treatment plans to improve patient outcomes. Resecting a hypertrophic AIIS may improve hip range of motion and may be an important consideration for hip surgeons when revising unstable THAs.