Hemiepiphysiodesis via the Bowen Method for Genu Valgum in Adolescents

Surgical techniques using bone blocks, screws, plates and staples have been described to biologically manipulate the growth plate to correct leg length inequality, genu varum and genu valgum.

Leg length inequality and its relationship with injuries incidence of young basketball players: an observational study.

Introduction: The leg length inequality (LLI) creates postural changes collaborating with the emergence of functional limitations and musculoskeletal disorders. In a sport like basketball inequality of the lower limbs may be added to the demands of the sport and generate an increase in the incidence of injuries. Objective: The aim of this study was to identify young basketball players from with structural or functional LLI and its influence in injury incidence in a period of 6 months. Methods: 18 players were followed with an average age of 14.50 ± 1.86 of a basketball team from the city of Sorocaba for a period of 6 months. At the beginning and end of that period were applied tests from the Morbidity Survey Report modified for basketball to obtain data such as physical characteristics, training time, incidence of injuries, quantitative and qualitative measurement of the length of the lower limbs. Results: 72.2% of players had LLI and 50% had some kind of injury during this period, among the most common, sprains and muscle strains. Conclusions: There was a high rate of players with LLI and a positive relationship between this inequality with the incidence of injury.

Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails

Background and objectives: Pediatric tibial shaft fractures often have satisfactory outcomes after closed reduction and casting. However, surgical treatment may be required in unstable or open fractures. Titanium elastic nails (TENs) are a good option for the surgical treatment of pediatric tibial fractures due to their advantages such as short hospitalization periods, easy applicability, early weight bearing, and early union. In this study, we evaluated radiological and functional outcomes in pediatric patients with tibial shaft fractures that underwent fixation with TENs. Materials and methods: A total of twenty tibial shaft fractures that were treated with TENs in our clinic between 2013 and 2017 were retrospectively reviewed. The mean age at injury was 8.9 ± 2.78 (range of 3–14) years. Seven (35%) out of 20 fractures were open fractures, of which one fracture was classified as Grade I and six fractures were classified as Grade II. In each patient, antegrade nailing was performed by inserting a TEN in the medial and another TEN in the lateral side of the proximal metaphysis. Clinical outcomes including union, alignment, leg-length inequality, and complications were evaluated using modified Flynn’s criteria. Results: The mean time to union was 10.85 ± 3.39 (range of 6–20) weeks. No patient had a sagittal or coronal angulation of over 10°. One patient had a leg-length inequality of 10 mm. Among three patients with open fractures, two of them had superficial wound infections and the other patient had a deep wound infection. All the infections were successfully treated with appropriate antibiotic therapies. Four other patients had pin tract irritation that required no intervention. No significant difference was observed between patients with open and closed fractures with regard to the clinical and radiological findings although patients with open fractures had a significantly higher complication rate compared to patients with closed fractures (p < 0.05). No patient had a restricted range of motion of the ankle and knee joints. Twelve (60%) patients had an excellent outcome, and eight (40%) patients had a satisfactory outcome. Conclusions: Intramedullary fixation with TENs provides favorable outcomes and reduced complication rates in the treatment of unstable pediatric tibial shaft fractures that cannot be reduced with conservative treatment modalities or cannot be casted due to the presence of an edema or open wound.

Finite Element Analysis on Pelvis With Leg Length Inequality

Leg length inequality, also known as leg length discrepancy (LLD) is a condition which the left and right legs of an individual are noticeably different in length. When the level of LLD is high, such as those of 20 mm and above, it would disturb the wellbeing of an individual in terms of gait, and also causes them to experience higher stress in their pelvis compared to individual without LLD. In order to study load due to LLD had affects human bones such as the pelvic bone, finite element analysis (FEA) approach is usually used as it allows limitless attempt to investigate the stress-strain response on human bones and is far more practical than experimenting on real bones, therefore FEA was done with by using ANSYS 15.0. From the data obtained via FEA, the risk of fracture can be calculated, which gives us an insight on how would LLD affects the risk of bone fracture. In this study the effect of pelvic tilt caused by LLD has been studied, along with how loads at various LLD level affects the pelvic bone. The verdict from the study is the pelvic tilt caused by LLD amplifies the maximum stress and strain on the pelvic bone. The analysis using hip load due to LLD shows a downtrend for the maximum stress caused by the longer limb as the level of LLD increases, while the maximum stress caused by the shorter limb shows an uptrend with the increment of LLD. The maximum stress and strain observed are usually distributed around the sacroiliac joint. It is also observed that the higher the level of LLD is, the higher the maximum stress on pelvic bone will become, hence the higher the fracture risk.

Revision surgery for leg length inequality after primary hip replacement

Background: We discuss the surgical results of revision surgery for patients with refractory symptomatic leg length inequality (LLI) after primary hip replacement. Methods: This is a retrospective review of 21 patients who underwent revision for LLI after primary total hip replacement. All of them were referred to a tertiary clinic between 2006 and 2015. Leg length was measured, to the nearest mm, using Woolson’s validated X-ray technique which references to centre of femoral rotation, the acetabular teardrop and the midpoint of the lesser trochanter. The post-operative clinical assessment using a modified D’Aubigne and Postel scoring system investigated the pain, function, and satisfaction after surgery. Results: The mean pre-revision LLI was 16.2 mm (8–30 mm). The mean post revision operation leg length inequality was 2.0 mm (12 mm short to 9 mm long). The mean post-operative D’Aubigne and Postel scores, achieved at a mean 12 months (6–30 months), were; pain 5.2 (3–6), function 4.6 (3–6) and satisfaction 4.4 (3–5). Following revision surgery 20 out of 21 (95%) patients were satisfied with the improvement in LLI. Conclusion: Revision surgery for LLI, while it may not resolve all of the pain that the patient presents with, it is a successful treatment for patients who do not respond to conservative management of their LLI.