Objective To investigate the effectiveness of absorbable pins for reconstructing pelvic stability in Salter innominate osteotomy for treating development dysplasia of the hip (DDH). Methods Between January 2003 and December 2008, 392 patients (440 hips) with DDH underwent a Salter procedure. There were 68 boys (82 hips) and 324 girls (358 hips) with a mean age of 3 years and 3 months (range, 1 year and 6 months-5 years). According to Tonnis classification criteria, 13 hips were rated as grade I, 304 hips as grade II, 82 hips as grade III, and 41 hips as grade IV. Based on the degree of displacement of the femoral head and acetabular index on the anteroposterior pelvic X-ray film, operation method was selected before operation. A total of 341 hips were managed with open reduction and Salter innominate osteotomy, and 99 hips with Salter innominate osteotomy and femoral shortening rotating osteotomy. All cases underwent autologous iliac crest grafting and fixation between osteotomy sites and bone graft with 2 absorbable pins. Results At 1 day after operation, anteroposterior pelvic X-ray examination showed concentric reduction in all hips, having no instability of the joint of the osteotomy sites or bone graft shifting. A total of 368 patients (413 hips) were followed up 1 to 7 years (mean, 3 years and 10 months). At 3 months after operation, no bone graft in stability or shift, and sliding or loosening of pins occurred. At last follow-up, concentric reduction rate was 100%; after hip loading, 358 patients had no claudication and limited hip activities, who had the stability of hips and negative Allis and Ortalani signs. No abnormal height growth was observed in all patients. According to Mckay’s hip function evaluation criteria, the results were excellent in 390 hips, good in 16 hips, and fair in 7 hips, with an excellent and good rate of 98.3%; according to Severin X-ray criteria, the results were excellent in 386 hips, good in 17 hips, and fair in 10 hips, with an excellent and good rate of 97.6%. Conclusion Absorbable pins can replace steel pins for fixation of the osteotomy sites and bone graft in Salter innoninate because of flexible and convenient operation without a need for reoperation of steel pins extraction.
Objective To investigate the operative procedure and the effectiveness of eosinophil ic granuloma (EG) of long bones in children. Methods Between January 2005 and December 2009, 14 patients with EG of long bones were treated. There were 9 boys and 5 girls, aged from 1 to 13 years (mean, 6.5 years). The locations were femur in 5 cases, humerus in 4 cases, tibia in 2 cases, fibula in 1 case, and femur compl icated with tibia in 2 cases. The disease duration was7 days to 10 months (median, 2 months). X-ray films showed that osteolytic destruction had clear boundary, which did notinvolve the epi physeal plate. Of 14 cases, 12 cases of tumor were treated by curettage, autologous il iac bone or combined artificial bone graft repair, and 2 cases were treated by resection, autologous il iac reconstruction, plate and screw fixation. Five cases compl icated with pathological fracture underwent reduction and fixation. Results All cases were diagnosed pathologically as having EG. All incisions healed by first intention. A total of 12 patients were followed up 1 to 4 years (mean, 2 years). The X-ray films showed tumor focus and pathological fracture healed within 3 to 4 months (mean, 3.5 months). Tibial lesion was found in 1 case of femoral tumor after 8 months, and was curred after reoperation. No recurrence occurred in other 11 cases. According to comprehensive assessing standard of X-ray film and joint function, the results of all cases were excellent. Conclusion EG of long bones in children is more common in the femur and humerus. Tumor curettage and autologous il iac bone graft repair is an effective method, and postoperative prognosis is good. There may be multiple lesions, so long-term follow-up is needed.
Objective To investigate the curative effects of open reduction and internal fixation with Kirschner wire for Mason type-II radial head or neck fracture in children. Methods From September 2007 to June 2009, 17 cases of Mason type-II radial head or neck fracture were treated, including 11 males and 6 femals with an average age of 8.5 years (4-11 years).The locations were left side in 5 cases and right side in 12 cases. All fractures were caused by fall ing and classified as Mason type- II fracture. Two cases compl icated by radial nerve deep branch injury. The time from injury to operation was 4 hours to 5 days. All cases received open reduction and internal fixation with Kirschner wire. They were evaluated by anteroposterior and lateral radiographs and functionally by Broberg criteria. Results Wound healed primarily in all patients. According to Métaizeau criteria, the results were excellent in 15 patients and good in 2 patients, who achieved anatomical reduction. Seventeen patients were followed up for a mean time of 14 months (6-25 months). Function returned to normal in 2 cases compl icated by radial nerve deep branch injury after 6 months of operation. No compl ications of infection and nerve injury occurred. The X-ray films showed that bony heal ing was achieved in all cases; the heall ing time was 2.0-3.5 months (mean 3 months). According to Broberg criteria, the outcome was excellent in 11 cases, good in 4 cases, and fair in 2 cases, the excellent and good rate was 88.2%. Conclusion Open reduction and internal fixation with Kirschner wire has good effect, satisfactory functional recovery and less compl ication in the treatment of Mason type-II fracture of radial head or neck in children.
Objective? To investigate the pathogenesis, diagnosis, and treatment of unilateral gluteal muscle contracture. Methods Between January 1990 and September 2009, 41 patients with unilateral gluteal muscle contracture were treated and the cl inical data were retrospectively analysed. Among them, 24 were male and 17 were female with an age range from 6 to 29 years (mean, 12 years). Thirty-nine patients had a definite history of repeat intragluteal injection. The locations were the left side in 9 cases and the right side in 32 cases. The main cl inical manifestations included lameness and abnormal gait. The medical examination showed pelvic obl ique and relative inequal ity of lower l imbs with a mean difference of 2.1 cm (range, 1.2-3.8 cm) in the distance form navel to malleolus medials. The X-ray films of pelvis showed outpouching trochanter of femur and pelvic obl ique. The CT scans showed no abnormal finding except pelvic obl ique and gluteal muscle contracture. The arc longitudinal incision was made into the posterolateral area nearby the greater trochanter and then lysis of the gluteal muscles was performed, followed by the skin traction of both legs and rehabil itation exercise. Results All incisions healed by first intention. Forty-one patients were followed up 1-20 years (mean, 5 years), and the signs of gluteal muscle contracture disappeared. After 1 year of operation, 34 patients had equal leg length, 5 patients had mild pelvic obl ique, and 2 patients had obvious pelvic obl ique. According to LIU Guohui et al. evaluation standard, the results were excellent in 33 cases, good in 6 cases, and poor in 2 cases with an excellent and good rate of 95.12% at 1 year after operation. Conclusion Unilateral gluteal muscle contracture leads to pelvic obl ique and inequal ity of lower l imbs, and it can be cured with the surgical release of the gluteal muscle contracture by the arc longitudinal incision into the posterolateral area nearby the greater trochanter, combined with postoperative skin traction and rehabil itation exercises.
Objective To investigate the operative procedure and the therapeutic effects of minimally invasive incision and percutaneous pinning in operative treatment of Gartland type III humeral supracondylar fracture in children. Methods From September 2002 to July 2009, 189 patients with Gartland type III humeral supracondylar fracture were treated with minimally invasive incision and percutaneous pinning. There were 137 males and 52 females, aged from 1 to 13 years (6.2 years on average). Injury was caused by sports in 173 cases, by traffic accident in 9 cases, by fall ing from height in 5 cases, and by earthquake in 2 cases. All fractures were closed fractures, compl icating others fracture in 11 cases, radial nerve injury in 36 cases, median nerve injury in 5 cases, ulnar nerve injury in 2 cases, and brachial artery injuryin 2 cases. The time from injury to hospital ization was 1 hour to 10 days. Neurovascular repair was performed at the same period. Results All incisions healed by first intention, no related compl ications occurred. A total of 143 patients were followed up 5 months to 5 years (12 months on average). X-ray films showed fracture healed within 2-4 months (2.5 months on average). Cubitus varus occurred in 6 cases, but the functions of elbow flexion and extension were good; 2 cases were given distal humeral wedge osteotomy and 4 cases continued keeping the functional training. According to the Flynn et al criteria, the results were excellent in 121 cases, good in 15 cases, and fair in 7 cases; the excellent and good rate was 95.1%. Only a small incision scar was found, the function returned to normal in the cases compl icated by nerve and blood vessel injury. Conclusion Minimally invasive incision and percutaneous pinning for operative treatment of Gartland type III humeral supracondylar fracture in children is a safe and effective surgical procedure, which has minimal trauma, short surgery time, quick recovery, simple operation, and can be effective in reducing the compl ications.