10.3969/j.issn.2095-4344.2013.23.003

Objective: To investigate the early clinical outcomes of hip anterior short incision and open reduction and internal fixation for the treatment of children with Delbet Ⅱ femoral neck fracture. Methods: A retrospective analysis of 12 children with DelbetⅡ femoral neck fractures was performed with the anterior short incision approach at Department of Pediatric Orthopaedic, Children′s Hospital, Nanjing Medical University from January 2014 to August 2016. There were 7 males and 5 females including 8 cases at left side and 4 cases at right side,aged (11.5±0.8) years (range: 8-14 years).Patients underwent surgery in (12.0±0.9) hours (range: 6-20 hours) after the injury. Displaced fractures were treated by open reduction if closed reduction failed.The surgical incision was performed with the anterior inferior iliac spine centered on, extending along the groin crease, and the length was 3 to 4 cm. The interval between the sartorius and the tensor fascia latae was applied, and the direct and indirect head of rectus femoris were resected to visualize the hip joint capsule. T-shaped incision was made in the capsule. After the reduction was obtained, two or three compression canulated screws were used to fix the fracture site. The healing time, complications and corresponding record outcome by X-ray and clinical examination were recorded. At the latest follow-up,the results were analyzed using the Ratliff criteria and clinical outcomes were assessed by pain, restrictive hip movement, normal activity or the avoidance of games, and the femoral neck in the radiograph. Results: Twelve patients had been followed-up for (30.0±4.1)months(range: 24-36 months). X-ray showed the fractures′ healing time was (8.0±0.4) weeks(range: 7-9 weeks). Ten of the 12 fractures healed after one operation and were associated with no evidence of osteonecrosis of the femoral head. One case occurred premature physeal closure. There were no cases with fracture relocation, coaxvara, delayed union and nonunion or any significant postoperative complications. There was no infection, flexible internal fixation or ruptures. According to Ratliff grade, 9 cases of 12 patients were fine and 3 cases was acceptable. Conclusions Satisfactory short-term effects can be achieved by a mini-incision on the anterior hip for Delbet Ⅱ pediatric femur neck fractures. The anterior incision has the advantage of less trauma, smaller incision scar, better fracture reduction and fixation, and less wound complications.

Objective To investigate the feasibility and clinical effectiveness of fixation with Kirschner wires plus pediatric hip plate (PHP) for femoral neck fracture combined with avulsion fracture of the greater trochanter in children.Methods Between February 2014 and February 2016,6 children were treated by fixation with Kirschner wires plus PHP for femoral neck fracture combined with avulsion fracture of the greater trochanter at Department of Pediatric Orthopaedics,Children's Hospital,Nanjing Medical University.They were 4 boys and 2 girls,aged from 3.5 to 11.1 years (mean,7.2 years).By the Delbet's classification,all the fractures were of type Ⅲ.Clinical efficacy was evaluated according to the Ratliff scoring system at the last follow-ups.Results The intraoperative bleeding ranged from 20 to 50 mL (average,30 mL);the operation time ranged from 45 to 60 min (average,55 min).All the patients were followed up for 12 to 36 months (average,26 months).Bony union was obtained in all cases after an average time of 7 weeks (from 5 to 8 weeks).The Ratliff scores at the last follow-ups showed 5 good and one acceptable cases.No neurovascular lesion or incision infection was observed in the children.Anatomical reduction of the greater trochanter fracture was not achieved in one child but led to no adverse effect.Conclusion Fixation with Kirschner wires plus PHP can successfully treat femoral neck fracture combined with avulsion fracture of the greater trochanter in children.

Objective:To investigate the feasibility and clinical efficacy of limited open reduction and transepiphyseal intramedullary kirschner wiring for treatment of irreducible fracture of the distal radius diaphysis-epiphysis junction in older children.Methods:A retrospective study was conducted to analyze the data of 17 children with fracture of the distal radius diaphysis-epiphysis junction who had been admitted to Department of Orthopedics, Children's Hospital of Nanjing Medical University from January 2018 to December 2019. All were male. Ten fractures were on the left side and 7 on the right side, all caused by indirect violent falls. The time from injury to operation was (3.1±0.8) d. After a limited incision, about 2 to 4 cm in length, was made with the fracture ends as the center, a single Kirschner wire was used for transepiphyseal and intramedullary fixation. Postoperative imaging results, incisions, forearm soft tissue, and complications were recorded. The forearm function was evaluated at 24 months after operation by the grading system proposed by Price et al.Results:All the 17 patients were followed up for (25.8±2.3) months. In all patients, operation time was 25 (20, 50) min, incision length (2.4±0.6) cm, postoperative angular deformity of the radius 0° (0°, 0°), and postoperative displacement of the radius (1.5±1.1) mm. Incisions healed well 2 weeks after operation with no vascular or neurological complications. Skin irritation of Kirschner wire appeared in 1 case. Fractures healed after 5.0 (4.0, 5.5) weeks. The forearm function evaluated by the Price grading at 24 months after operation was excellent in 15 cases and good in 2 cases.Conclusion:Limited open reduction and transepiphyseal intramedullary kirschner wiring is effective for treatment of irreducible fracture of the distal radius diaphysis-epiphysis junction in older children.

Objective:To observe any effect of ankle dorsiflexion angle on the gait of children with cerebral palsy (CP) after Achilles tendon lengthening surgery.Methods:Nine children with CP and equinus foot deformity were given Achilles tendon lengthening surgery. Reconstruction images of their pelvises and lower limbs were collected before the surgery and used to construct OpenSim simulations. Gait analysis data were also recorded before the surgery. The curve of changes to the Achilles tendon insertion was simulated in the software to determine the optimum angle of ankle dorsiflexion, and that guided the Achilles tendon extension surgery. The 3D gait analysis was repeated 12 months after the surgery to compare the spatiotemporal, kinematic and dynamic parameters (especially maximum ground reaction force on the affected side). The maximum dorsiflexion angles of the ankle joint before and after surgery were also recorded.Results:Before the surgery the dorsiflexion angles ranged from 8 to 12°, with an average of (10.1±1.2)°. After the surgery, significant changes were observed in the stride length, rhythm, speed and stride time of the affected side, as well as the maximum forward angle of the supported pelvis, the maximum dorsiflexion angle of the supported ankle and the maximum plantar flexion angle of the swinging ankle. Twelve months after the surgery, no recurrence of horseshoe malformation or over-correction complications were found in any of the 9 patients.Conclusions:3D gait analysis technology combined with OpenSim software can simulate the changes in Achilles tendon length needed by children with cerebral palsy. The optimum ankle dorsiflexion angle can be predicted pre-operatively and the simulation can also guide the operation. This technique also offers pre-and post-operative quantitative evaluation to provide references for subsequent rehabilitation treatment.

Objective To investigate the feasibility and clinical effectiveness of modified humeral supracondy-lar step－cut osteotomy(M－HSSCO)for cubitus varus in children.Methods Between June 2016 and June 2017,the study included 25 children (20 boys and 5 girls)presenting cubitus varus at the age of (8.5 ± 0.3)years old (6－11 years old)in the Children's Hospital of Nanjing Medical University.M－HSSCO was used in the osteotomy operation. The initial osteotomy was performed as a right triangle osteotomy.The inferior margin of this right triangle was outlined parallel to the joint line 0.5－1.0 cm above the olecranon fossa.Then,they were incised from the medial end of this parallel line,which made an angle between the first and second lines equal to the desired corrective humerus elbow－wrist angle.Next,from the lateral end of the second line,the third line perpendicular to the first line was cut.Finally, desired right triangle was outlined and removed.The second right triangle osteotomy from proximal line of osteotomy was similar as the above.The medial cortex and periosteum was used as a hinge and rotated to make two osteotomy parts combined steadily.The Bellemore evaluation system was used to evaluate the difference in carrying angle degree be-tween the affected side and normal side after osteotomy,and the different degree of flexion and extension in the elbow joint between preoperation and post－operation.Residual varus deformity and other complications were also evaluated. Results All patients were followed up for 6－18 months (mean 12 months).The preoperative ipsilateral carrying an-gle was－(15°－30°)[－(22.20 ± 1.40)°],the postoperative was 5°－10°[(7. 60 ± 0.47)°]and the final follow－up was 5°－9°[(7.30 ± 0.40)°].There were statistically significant differences in the flexion angles before surgery and after surgery (t＝23.34,P＝0.000).There were statistically significant differences in the flexion angles before surgery and at final follow－up (t＝23.14,P＝0.000).The mean range of joint motion of the elbow was －5°－130° [(132.5 ± 0.5)°]before surgery,0°－125°[(123.6 ± 1.4)°]after surgery and 0°－130°[(126.8 ± 1.3)°]at fi-nal follow－up.The carrying angle reduced did not happen by the final follow－up.There was no statistically significant difference between the flexion angles before surgery and after surgery or by final follow－up(P＞0. 05).Twenty－three (92.0%)patients got an excellent result,2 cases(18.0%)got a good result and no patient (0)got worse according to the criteria described by Bellemore.The first－class incision healing were achieved in all patients.There was no case with postoperative infection,instabilities,vascular and neural injury or any significant postoperative complications. Conclusions M－HSSCO is an effective osteotomy procedure which shows good feasibility and apparent therapeutic effect in treating cubitus varus in children.