Percutaneous Retrograde Extraphyseal screw fixation for Type II and III Anterior Tibial Spine Avulsion Fractures: A Technical Note

Volume 8 | Issue 2 | May-August 2022 | Page: 16-19 | R M Chandak, Mohit Sharma, Amit Nemade

DOI- https://doi.org/10.13107/ijpo.2022.v08i02.140

Authors: R M Chandak [1], Mohit Sharma [1], Amit Nemade [2]

[1] Department of Orthopedics & Trauma, Chandak Nursing Home, Nagpur, Maharashtra, India.
[2] Department of Orthopedics, Kids Orth Clinic, Nagpur, Maharashtra, India.

Address of Correspondence
Dr. Amit Nemade,
Consultant Pediatric Orthopedic Surgeon, Kids Orth Clinic, Nagpur, Maharashtra, India.
E-mail: kidsorth@gmail.com

Abstract

Introduction: Anterior tibial spine avulsion (ATSA) fractures are uncommon intra-articular knee injuries in children. They are common in adolescents. Treatment for displaced ATSA fracture is fixation. Various methods of fixation are documented, most common being arthroscopic assisted fixation using various sutures or anchors. Antegrade screw fixation is also an accepted method of treatment but is associated with implant back out and impingement. We describe our technique of retrograde extraphyseal percutaneous fixation for type II and III ATSA fractures.
Method: Under image intensifier (IITV) guidance, fracture reduction was achieved and fixed with a specially designed, short-threaded, 4mm cannulated screw. The screw was inserted in retrograde fashion proximal to the proximal tibial physis. The patient was immobilized in a cylinder cast and was allowed weight bearing as tolerated. Cast was removed at 6 weeks and range of movement exercises started.
Result: Our technique of percutaneous retrograde extraphyseal screw fixation for ATSA fracture is simple. The learning curve is less and can be used in selected case. In resource-limited situations where facilities for arthroscopy are not readily available, our technique can provide good results
Keywords: Anterior tibial spine avulsion, Percutaneous fixation, Retrograde, extraphyseal.

References

[1] Adams AJ, Talathi NS, Gandhi JS, Patel NM, Ganley TJ. Tibial Spine Fractures in Children: Evaluation, Management, and Future Directions. J Knee Surg. 2018;31(5):374–81.
[2] MEYERS MH, McKEEVER FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am. 1959 Mar;41-A(2):202–9.
[3] Hallam PJB, Fazal MA, Ashwood N, Ware HE, Glasgow MMS, Powell JM. An alternative to fixation of displaced fractures of the anterior intercondylar eminence in children. J Bone Jt Surg – Ser B. 2002;84(4):579–82.
[4] Furlan D, Pogorelić Z, Biočić M, Jurić I, Meštrović J. Pediatric tibial eminence fractures: Arthroscopic treatment using K-wire. Scand J Surg. 2010;99(1):38–44.
[5] Jochymek J, Ondruš Š, Škvařil J. Fraktura interkondylické eminence v dětském věku. Výsledky dlouhodobého sledování. Acta Chir Orthop Traumatol Cech. 2012;79(5):442–6.
[6] Vega JR, Irribarra LA, Baar AK, Iñiguez M, Salgado M, Gana N. Arthroscopic Fixation of Displaced Tibial Eminence Fractures: A New Growth Plate-Sparing Method. Arthrosc – J Arthrosc Relat Surg. 2008;24(11):1239–43.
[7] Louis M-L, Guillaume J-M, Toth C, Launay F, Jouve J-L, Bollini G. Fracture de l’éminence intercondylienne du tibia de type II chez l’enfant. Rev Chir Orthop Reparatrice Appar Mot. 2007;93(1):56–62.
[8] Mann MA, Desy NM, Martineau PA. A new procedure for tibial spine avulsion fracture fixation. 2012;2395–8.
[9] Reynders P, Reynders K, Broos P. Pediatric and adolescent tibial eminence fractures: Arthroscopic cannulated screw fixation. J Trauma. 2002;53(1):49–54.
[10] Herman MJ, Martinek MA, Abzug JM. Complications of tibial eminence and diaphyseal fractures in children: prevention and treatment. Instr Course Lect. 2015;64:471–82.
[11] Ando T, Nishihara K. Arthroscopic internal fixation of fractures of the intercondylar eminence of the tibia. Arthroscopy. 1996;12(5):616–22.
[12] Xu X, Liu Z, Wen H, Pan X. Arthroscopic fixation of pediatric tibial eminence fractures using suture anchors: a mid-term follow-up. Arch Orthop Trauma Surg. 2017;137(10):1409–16.
[13] Xu P, Liu LC, Chen QJ, Yang P, Chen X Bin, Xie XP. The clinical effect and safety of the treatment of tibia intercondylar eminence fracture with cannulated screw and suture fixation under arthroscope: Protocol for a systematic review and meta-analysis of randomized controlled trials. Med (United States). 2020;99(23).
[14] Watts CD, Larson AN, Milbrandt TA. Open versus arthroscopic reduction for Tibial eminence fracture fixation in children. J Pediatr Orthop. 2016;36(5):437–9.
[15] Shin CH, Lee DJ, Choi IH, Cho TJ, Yoo WJ. Clinical and radiological outcomes of arthroscopically assisted cannulated screw fixation for tibial eminence fracture in children and adolescents. BMC Musculoskelet Disord. 2018;19(1):1–9.

How to Cite this Article:  Chandak RM, Sharma M, Nemade A |  Percutaneous Retrograde Extraphyseal screw fixation for Type II and III Anterior Tibial Spine Avulsion Fractures: A Technical Note | International Journal of Paediatric Orthopaedics | May-August 2022; 8(2): 16-19. https://doi.org/10.13107/ijpo.2022.v08i02.140

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Editorial

Volume 8 | Issue 1 | January-April  2022 | Page: 01 | Jayant  S. Sampat
DOI-10.13107/ijpo.2022.v08i01.126

Authors: Jayant S. Sampath FRCSEd (Tr & Orth) [1]

[1] Department of Orthopaedics, Rainbow Children’s Hospital, Bangalore, Karnataka, India.

Address of Correspondence
Dr. Jayanth S. Sampath,
Rainbow Children’s Hospital, Bangalore, Karnataka, India.
E-mail: editor.posi.ijpo@gmail.com

Dear Friends,
The first issue of IJPO in 2022 features a symposium on current concepts in musculoskeletal infections in children. Our associate editors, Dr Mohan V Belthur and Dr Ashish Ranade were instrumental in producing the symposium, from topic selection to coordinating with individual authors. A wide-ranging array of subjects feature in the symposium including tropical pyomyositis, diagnostic tools in infection, management guidelines for septic arthritis and the role of non-vascularised fibular grafting for post-infection bony defects.
The original article in this issue highlights improvements in the treatment outcomes of lateral condyle fracture of the humerus in children by a simple modification of existing techniques. In addition, there are 3 case reports which will be of interest to readers.
As life returns to normal following the pandemic, orthopaedic surgeons have less spare time to devote to academic pursuits. We appeal to POSI members to maintain the momentum that was created in 2020 by submitting their articles to IJPO on a regular basis. We will provide the necessary editorial assistance so that your ideas and research work can be shared with the global community of orthopaedic surgeons. This will be particularly useful to trainees and first-time authors.
The Editorial Board would like to thank the team of reviewers without whom this journal would not be possible.

Dr Jayanth S Sampath FRCSEd (Tr&Orth)
Editor

editor.ijpo@gmail.com

How to Cite this Article: Sampat JS | Editorial | International Journal of Paediatric Orthopaedics | May-August 2022; 8(1): 01.

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Surgical and Medical Management of Deformity and Non-union with Implant Failure of Femur in OI Type III

Volume 8 | Issue 1 | January-April 2022 | Page: 35-42 | Sanjay Chhawra, Raman Jain, Unus Ahmed, Nimish Agarwal, Rajiv Chaubey, Gaganpreet Singh
DOI-10.13107/ijpo.2022.v08i01.132

Authors: Sanjay Chhawra D Ortho., DNB Ortho. FICS, Raman Jain MS Ortho., Unus Ahmed MS Ortho., Nimish Agarwal MS Ortho., Rajiv Chaubey MS Ortho., Gaganpreet Singh MS Ortho.

[1] Department of Orthopedics, Jaipur Golden Hospital, Rohini, Delhi, India.

Address of Correspondence
Dr. Sanjay Chhawra
Department of Orthopedics, Jaipur Golden Hospital, Rohini, Delhi, India.
E-mail: sanjaychhawra@yahoo.com

Abstract

Purpose: Osteogenesis imperfecta (OI) is characterized by increased bone fragility and susceptibility for fracture because of the mutation of genes. A few studies are there for treatment modalities of non-union femur fractures in children with OI. This study on adult OI patients aims to give insight into non-unions and their best treatment reporting the surgical modification by using a humeral nail for femoral fixation options to avert non-union. Best implant in the adolescent OI patients for the surgical reconstruction of the femur for correction of deformity healing non-union.
Methods: This is a retrospective, descriptive study of the OI type III fracture non-union and its treatment modality.
Conclusions: In Adolescent OI patients with the rare percentage of non-union with deformity with implant failure of the femur was fixed with Humerus nail having stable fixation deformity correction by both osteotomy rotational translational and conversion of non-union to union with a better result.
Keywords: Osteogenesis imperfecta (OI), TENS Tensile Elastic Nail System, Adolescent, Humeral nail, Femoral bowing deformity

References

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14. Huang RP et al. Functional Significance of Bone Density Measurements in Children with Osteogenesis Imperfecta. The Journal of Bone and Joint Surgery (American). 2006:88:1324.10.2106/JBJS.E.00333.
15. MaromR, LeeYC, Grafe I & Lee B. Pharmacological and biological therapeutic strategies for osteogenesis imperfecta. American Journal of Medical Genetics Part C: Seminars in MedicalGenetics2016172367–383.10.1002/ajmg.c.31532.
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How to Cite this Article:  Chhawra S, Jain R, Ahmed U, Agarwal N, Chaubey R, Singh G | Surgical and Medical Management of Deformity and Non-union with Implant failure of Femur in OI Type III | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 35-42.

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A Case of Pyomyositis in a Healthy 11-Year Old Boy with Need of Surgical Drainage

Volume 8 | Issue 1 | January-April 2022 | Page: 47-50 | Alina Frolova, Joana Freitas, Rui Martins, Jorge Coutinho

DOI-10.13107/ijpo.2022.v08i01.134

Authors: Alina Frolova MD [1], Joana Freitas MD [1], Rui Martins MD [1], Jorge Coutinho MD [1]

[1] Department of Pediatric Orthopedics, The University Hospital Centre São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto Portugal.

Address of Correspondence

Dr. Alina Frolova,
Department of Pediatric Orthopedics, The University Hospital Centre São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto Portugal.
E-mail: alina.frolova.238@gmail.com

Abstract

Pyomyositis is an uncommon clinical entity affecting predominantly pediatric population. It presents with diffuse muscle involvement, mostly in the lower limb, with occasional abscess formation and need of drainage, coupled to an appropriate antibiotic therapy.
In this article we present a case of a previously healthy 11-year old boy with an acute onset of hip pain and fever, as well as elevation in blood leukocyte count and C-reactive protein. Magnetic resonance imaging showed a gadolinium-enhanced oedema of internal obturator, external obturator, adductors and quadratus femoris, with an intra-muscular abscess of external obturator. After two attempted percutaneous drainages the patient progressed to sepsis, with the need of open surgical drainage through transgluteal approach. Concomitantly, a deep venous thrombosis was also diagnosed.
After the appropriate drainage and a prolonged antibiotic regimen, patient’s condition improved, with full recovery and no sequelae.
Keywords: Pyomyositis, External obturator, Muscle abscess, Transgluteal approach

References

1. Maravelas R, Melgar TA, Vos D, Lima N, Sadarangani S. Pyomyositis in the United States 2002-2014. J Infect. 2020 May;80(5):497-503
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4. Moriuchi Y, Fuchigami T, Sugiyama C, Takahashi S, Ohashi Y, Yonezawa R, Mizukoshi W, Morioka I. Obturator pyomyositis and labium majus cellulitis: A case report and literature review. SAGE Open Med Case Rep. 2022 Mar 25
5. Kiran M, Mohamed S, Newton A, George H, Garg N, Bruce C. Pelvic pyomyositis in children: changing trends in occurrence and management. Int Orthop. 2018 May;42(5):1143-1147
6. García-Mata S, Hidalgo-Ovejero A, Esparza-Estaun J. Primary obturator-muscle pyomyositis in immunocompetent children. J Child Orthop. 2012 Jul;6(3):205-15
7. Ovadia D, Ezra E, Ben-Sira L, Kessler A, Bickels J, Keret D, Yaniv M, Wientroub S, Lokiec F. Primary pyomyositis in children: a retrospective analysis of 11 cases. J Pediatr Orthop B. 2007 Mar;16(2):153-9
8. Comegna L, Guidone PI, Prezioso G, Franchini S, Petrosino MI, Di Filippo P, Chiarelli F, Mohn A, Rossi N. Pyomyositis is not only a tropical pathology: a case series. J Med Case Rep. 2016 Dec 21;10(1):372
9. Unnikrishnan PN, Perry DC, George H, Bassi R, Bruce CE. Tropical primary pyomyositis in children of the UK: an emerging medical challenge. Int Orthop. 2010 Feb;34(1):109-13
10. Sánchez-Rodríguez HM, Morales-Ávalos R, Rivera-Zarazúa S, Ramírez-Elizondo MT, Hernández-Rodríguez PA, Vílchez-Cavazos F, Peña-Martínez VM. Piomiositis tropical del músculo ilíaco, obturador interno, piriforme y psoas mayor en un paciente inmunocompetente con claudicación [Tropical pyomyositis of the iliacus, obturator internus, piriformis and psoas major muscles in an immunocompetent patient with claudication]. Acta Ortop Mex. 2021 Jan-Feb;35(1):80-84. Spanish.
11. Tawfik D, Hobson WL. Group A Streptococcal Pyomyositis in a Previously Healthy Six-year-old Girl. Cureus. 2018 Feb 8;10(2):e2168
12. Menge TJ, Cole HA, Mignemi ME, Corn WC, Martus JE, Lovejoy SA, Stutz CM, Mencio GA, Schoenecker JG. Medial approach for drainage of the obturator musculature in children. J Pediatr Orthop. 2014 Apr-May;34(3):307-15
13. White S, Stopka S, Nimityongskul P, Jorgensen D. Transgluteal Approach for Drainage of Obturator Internus Abscess in Pediatric Patients. J Pediatr Orthop. 2017 Jan;37(1):e62-e66

How to Cite this Article:  Frolova A, Freitas J, Martins R, Coutinho J | A Case of Pyomyositis in a Healthy 11-Year Old Boy with Need of Surgical Drainage | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 47-50.

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One-Stage Emergency Surgical Release of Amniotic Constriction Band in Streeter’s Dysplasia with Clubfoot- A Case Report

Volume 8 | Issue 1 | January-April 2022 | Page: 43-46 | Harsharan Singh Oberoi, Baldish Singh Oberoi

DOI-10.13107/ijpo.2022.v08i01.133

Authors: Harsharan Singh Oberoi MS, DNB Ortho [1], Baldish Singh Oberoi MS Ortho, MPH [1]

[1] Department of Orthopaedics, Oberoi Hospital, Jalandhar City, Punjab, India.

Address of Correspondence

Dr. Baldish Singh Oberoi
Orthopaedic Surgeon, Oberoi Hospital, Jalandhar City, Punjab, India.
Email: baldishoberoi@gmail.com

Abstract

Streeter’s dysplasia is a rare condition that occurs in 1 in 1200 to 1 in 15000 live births. Timely intervention is the key in saving the limb in vascular compromised cases. A 7 days old neonate presented with Streeter’s Dysplasia with a grossly swollen, deformed and cyanosed foot. The deformity was a clubfoot deformity. There was a circumferential amniotic constriction band in the lower third left leg, causing a vascular compromise leading to bluish discoloration and gross swelling of the foot and toes. There was another semicircular band in the mid-foot region. One stage urgent circumferential band excision and multiple Z plasties for skin cover were done. The foot and the toes turned pink immediately. The swollen foot was treated by debulking of the foot and the clubfoot deformity by the Ponseti method.
Keywords: Streeter’s dysplasia, Vascular compromise, Constriction ring, One stage release, Clubfoot, Debulking

References

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5. Naqvi ZG, Rao I, Anwer W, Yaseen T. Two-stage release in Streeter’s dysplasia. BMJ Case Rep. 2015 Apr 21;2015:bcr2014207568.
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9. Hata T, Tanaka H, Noguchi J. 3D/4D sonographic evaluation of amniotic band syndrome in early pregnancy: a supplement to 2D ultrasound. J Obstet Gynaecol Res. 2011 Jun;37(6):656-60.
10. Pedersen TK, Thomsen SG. Spontaneous resolution of amniotic bands. Ultrasound Obstet Gynecol. 2001 Dec;18(6):673-4.
11. Alabdrabalnabi FI, Elsaid AS, Alsinan FM, Almushrif HA, Nasr MA, Elashaal E, Aljehani RK. Early release of constricting amniotic band of the lower limb followed by reconstruction using multiple Z-plasty. J Pediatr Surg. Case Rep. 2021 Dec 1;75:102054.
12. Dufournier B, Guero S, de Tienda M, Dana C, Garcelon N, Glorion C, Salon A, Pannier S. One-stage circumferential limb ring constriction release and direct circular skin closure in amniotic band syndrome: a 14-case series. Orthop Traumatol Surg Res. 2020 Nov;106(7):1353-9.
13. Carpiaux AM, Hosseinzadeh P, Muchow RD, Iwinski HJ, Walker JL, Milbrandt TA. The Effectiveness of the Ponseti Method for Treating Clubfoot Associated With Amniotic Band Syndrome. J Pediatr Orthop. 2016 Apr-May;36(3):284-8.
14. Basheer SM, Karashi AR, Abdulbasith M. Single stage release of bilateral amniotic band syndrome. Bahrain Med.Bull. 2019 Mar 1;41(1):38-41.
15. Waiswa G, Nassaazi J, Kajja I. Single stage release surgery for congenital constriction band in a clubfoot patient managed at a Teaching Hospital In Uganda: A case report. East Afr. Orthop J. 2020 Nov 12;14(2):99-101.

How to Cite this Article:  Oberoi HS, Oberoi BS| One-Stage Emergency Surgical Release of Amniotic Constriction Band in Streeter’s Dysplasia with Clubfoot- A Case Report | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 43-46.

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Fixation of Displaced Paediatric Humeral Lateral Condyle Fractures with 3 K-Wires

Volume 8 | Issue 1 | January-April 2022 | Page: 31-34 | Deepak Jain, Tushar Agrawal, Saijyot Raut, Parimal Malviya

DOI-10.13107/ijpo.2022.v08i01.131

Authors: Deepak Jain MS Ortho [1], Tushar Agrawal MS Ortho [2, 3], Saijyot Raut MS Ortho [2],
Parimal Malviya MS Ortho. [2]

[1] Department of Orthopaedics & Spine Surgery Ganga Hospital, Coimbatore, Tamil Nadu, India.
[2] Department of Orthopaedics, MGM Hospital, Navi Mumbai, Maharashtra, India.
[3] Aastha Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Deepak Jain,
Paediatric Orthopaedic Fellow, Department of Orthopaedics & Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
E-mail: deepaksjain1993@gmail.com

Abstract

Background- Management of paediatric humeral lateral condyle fractures by 2 Kirschner wire or screw fixation in parallel or divergent manner remains the treatment of choice and has long remained unchallenged. In this study, we are recommending using a third K wire for fracture fixation technique for the age group less than 10 years which provides a more stable fixation enhances stability and ensures better outcomes without any significant disadvantages.
Materials & Methods- We Present a Cohort of 20 pediatric lateral condyle fractures of Song et al stage 3 and above. Of the 20 patients treated, 12 were male and 8 females. All fractures were fixed using 3 lateral Kirschner wires of size 1.2 or 1.5mm. Out of the 20 fractures, 12 were opened and 8 were fixed percutaneously.
Results- All Patients showed union at 6 weeks. K-wires were removed at 6 weeks. Good radiological and clinical outcomes were noted on the periodical check-up. Hardacre score was used to calculate clinical outcome. None of the patients had any loss of reduction, non-union, or implant-related failure except for pin tract infections in a few patients.
Conclusion- We recommend adding a third wire to the construct for three k wires fixation for lateral condyle humerus fractures in all patients less than 10 years which is useful tool, cost-effective, enhances stability and ensures good outcomes without any significant disadvantages. We found all benefits of the cannulated screws by inserting the third wire and the fracture was found to be biomechanically more stable, none showed loss of reduction, had early union, early mobilization, minimal chances of nonunion, full ROM, no infection with the added advantage of no re-surgery for implant removal
Keywords- Pediatric fractures, Elbow fractures, Lateral condyle fractures, K-wires

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How to Cite this Article:  Jain D, Agrawal T, Raut SJ, Malviya P | Fixation of Displaced Paediatric Humeral Lateral Condyle Fractures with 3 K-Wires | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 31-34.

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