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Catena N, Baldrighi C, Jester A, Soldado F, Farr S. Microsurgery in pediatric upper limb reconstructions: An overview. J Child Orthop 2022; 16:241-255. [PMID: 35992521 PMCID: PMC9382710 DOI: 10.1177/18632521221106390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/13/2022] [Indexed: 02/03/2023] Open
Abstract
The use of microsurgery has spread during the last decades, making resolvable many complex defects considered hitherto inapproachable. Although the small vessel diameter in children was initially considered a technical limitation, the increase in microsurgical expertise over the past three decades allowed us to manage many pediatric conditions by means of free tissue transfers. Pediatric microsurgery has been shown to be feasible, gaining a prominent place in the treatment of children affected by limb malformations, tumors, nerve injuries, and post-traumatic defects. The aim of this current concepts review is to describe the more frequent pediatric upper limb conditions in which the use of microsurgical reconstructions should be considered in the range of treatment options.
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Affiliation(s)
- Nunzio Catena
- Reconstructive Surgery and Hand Surgery
Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy,Nunzio Catena, Reconstructive Surgery and
Hand Surgery Unit, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini 5, 16121
Genova, Italy.
| | - Carla Baldrighi
- Children’s Hand and Upper Limb Service,
Department of Plastic Surgery, Birmingham Children’s Hospital NHS Foundation Trust,
Birmingham, UK
| | - Andrea Jester
- Children’s Hand and Upper Limb Service,
Department of Plastic Surgery, Birmingham Children’s Hospital NHS Foundation Trust,
Birmingham, UK
| | - Francisco Soldado
- Pediatric Hand, Nerve and Microsurgery
Institute, Vall d’Hebron Instituto de Oncologia, Barcelona, Spain
| | - Sebastian Farr
- Pediatric Orthopedics and Foot and
Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
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Assouto C, Bertoncelli CM, Gauci MO, Monticone M, Bagui S, Rampal V, Solla F. Congenital pseudarthrosis of the clavicle: a systematic review. INTERNATIONAL ORTHOPAEDICS 2022; 46:2577-2583. [PMID: 35701591 DOI: 10.1007/s00264-022-05470-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/03/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE There is no consensus on the type of surgical treatment of congenital pseudarthrosis of the clavicle due to its rarity. The purpose of this study is to provide evidence in favor of a surgical technique and to explore factors correlated with bone consolidation. METHODS Systematic review of the literature and an analysis of the data for each subject, including all available subjects from the published series and clinical cases since 1990. Fisher's exact tests or T-tests were used to evaluate the effect of independent variables (age at surgery and type of treatment) on bone healing. RESULTS The literature search provides 305 articles; 30 were selected, reporting 191 patients and 194 clavicles. One hundred and fifty-one clavicles were operated on at a mean age of nine years and four months (from 8 months to 21 years). Thirteen clavicles (8, 6%) had not consolidated at the last follow-up. Concerning the type of fixation, the rate of healing was similar for plates and pins (p = 0.27). The rate of consolidation was higher with autograft than with allograft, xenograft, or no graft (p = 0.00001), and was 100% for vascularized graft. The mean age at surgery was higher for patients who healed at the last follow-up (118 vs. 61 months, p = 0.001). CONCLUSION In the event of surgical indication for congenital pseudarthrosis of the clavicle, it is recommended to perform autograft and stable fixation (level 4) after seven years old (level 4).
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Affiliation(s)
- Cédric Assouto
- Pediatric Orthopaedic Surgery Unit, Lenval University Children's Hospital, Nice, France
| | - Carlo Mario Bertoncelli
- Pediatric Orthopaedic Surgery Unit, Lenval University Children's Hospital, Nice, France.
- Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, USA.
- Hôpital Pour Enfants - E.E.A.P. H. Germain, 337 Chemin Saint Antoine de Ginestiere, 06200, Nice, France.
| | | | - Marco Monticone
- Medical Sciences and Public Health, Physical Medicine and Rehabilitation, University of Cagliari, Cagliari, Italy
- Neuroscience and Rehabilitation, Neurorehabilitation Unit, G. Brotzu Hospital, Cagliari, Italy
| | - Sikha Bagui
- Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, USA
| | - Virginie Rampal
- Pediatric Orthopaedic Surgery Unit, Lenval University Children's Hospital, Nice, France
| | - Federico Solla
- Pediatric Orthopaedic Surgery Unit, Lenval University Children's Hospital, Nice, France
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Congenital hypoplasia and aplasia of the quadriceps: Diagnosis and treatment. Orthop Traumatol Surg Res 2022; 109:103316. [PMID: 35569755 DOI: 10.1016/j.otsr.2022.103316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Congenital absence of the quadriceps is an extremely rare condition whose management is not standardised. The objective of this study was to describe the clinical presentation, treatments, and outcomes of a multicentre cohort. HYPOTHESIS Classification of the type of abnormality at birth helps to guide management decisions. METHODS Fifteen patients (19 knees) were included retrospectively in this multicentre study. Data on joint range-of-motion and management were analysed. We divided the patients into three groups based on whether they had continuous hypoplasia (involving the entire quadriceps), discontinuous hypoplasia (hypoplasia of some of the muscle groups or aplasia of the distal third of the quadriceps), or aplasia (complete absence of the quadriceps with replacement by fat). RESULT Physiotherapy was provided initially to all patients. The main treatment in the 6 patients with continuous hypoplasia was posterior release and biceps femoris lengthening. At last follow-up all 6 patients were able to walk unaided, although 4 of them had persistent knee extension lag. Quadriceps reconstruction and osteotomy to correct knee recurvatum deformity were performed in most of the 11 patients with discontinuous hypoplasia. Among them, 10 were able to walk unaided at last follow-up, and 5 had knee extension lag. The 2 patients with aplasia required knee arthrodesis after multiple surgical procedures. Both were able to walk. DISCUSSION Depending on the classification of the abnormality at birth, different surgical procedures should be considered. Surgery should only be performed after non-operative treatment. The treatment goal is to obtain a normal mechanical axis of the limb with the knee in extension and no extension lag, in order to enable walking. LEVEL OF EVIDENCE IV, retrospective observational study.
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Kamrani RS, Jehanno P, Arabzadeh A, Nabian MH, Farhoud AR. Treatment of Recalcitrant Nonunion of the Radius With Posterior Interosseous Bone Flap in Children. J Pediatr Orthop 2021; 41:472-478. [PMID: 34238866 DOI: 10.1097/bpo.0000000000001891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Forearm nonunion is a rare condition in children, and its treatment is usually successful. However, nontraumatic nonunion can be resistant to treatment. Although the vascularized fibular bone graft has been frequently used for complex forearm nonunion, there is no consensus on the best treatment method. In this study, we aimed to investigate the outcome of the antegrade posterior interosseous bone flap (PIBF) in treating children with complex radius nonunion. METHODS The participants consisted of 3 girls and 1 boy ranging from 31 months to 9 years of age. They were treated with PIBF surgery, and the nonunion of the radius was fixed with a plate or an external fixator. The nonunion was due to congenital pseudoarthrosis, osteogenesis imperfecta, or infantile osteomyelitis. All patients were evaluated for a clinical and radiologic union. RESULTS The radiologic union was achieved 2 to 3 months after the surgery in all cases. The functional recovery of the elbow, forearm, and wrist was satisfactory except for 1 patient who experienced donor site fracture, and finally radioulnar synostosis accompanied by radial head dislocation. CONCLUSION Because of the simplicity of its technique and short duration of surgery, PIBF can be a reliable and less-demanding alternative to vascularized fibular bone graft in the treatment of complex forearm nonunion in children. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Reza S Kamrani
- Department of Orthopedics and Trauma Surgery, Shariati Hospital
| | - Pascal Jehanno
- Department of Pediatric Orthopedics and Pediatric Hand Emergencies, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Aidin Arabzadeh
- Department of Orthopedics and Trauma Surgery, Imam Khomeini Hospital, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Amir R Farhoud
- Department of Orthopedics and Trauma Surgery, Imam Khomeini Hospital, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Solla F, Bertoncelli CM, Rampal V. Does the PROSPERO registration prevent double review on the same topic? BMJ Evid Based Med 2021; 26:140. [PMID: 32054725 DOI: 10.1136/bmjebm-2020-111361] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2020] [Indexed: 11/04/2022]
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Elfatairy KK, Ehrlich L, Porrino J, Wang A. Congenital pseudarthrosis of the forearm as a single manifestation of neurofibromatosis type 1 at birth: A case report. Clin Imaging 2021; 78:214-216. [PMID: 34049141 DOI: 10.1016/j.clinimag.2021.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/10/2021] [Accepted: 04/18/2021] [Indexed: 11/18/2022]
Abstract
Congenital pseudoarthrosis of the forearm is an extremely rare condition. It is most commonly associated with neurofibromatosis type I (NF1). Patients with NF1-associated pseudoarthrosis have complex medical management and often require surgical intervention due to higher failure rates of union. In this case report, we present a unique case of a newborn baby with congenital pseudoarthrosis of both the radius and ulna that was manifested at birth and shortly thereafter, was diagnosed with NF type 1.
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Affiliation(s)
- Kareem K Elfatairy
- Department of Radiology, Yale New Haven Health-Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA.
| | - Lauren Ehrlich
- Department of Radiology and Biomedical imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
| | - Jack Porrino
- Department of Radiology and Biomedical imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
| | - Annie Wang
- Department of Radiology and Biomedical imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
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Mohseni AA, Boussetta R, Saied W, Zairi M, Msakni A, Bouchoucha S, Nessib MN. Congenital pseudarthrosis of the forearm treated with induced membrane technique: A case report. Int J Surg Case Rep 2020; 77:584-590. [PMID: 33395851 PMCID: PMC7708772 DOI: 10.1016/j.ijscr.2020.10.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/16/2022] Open
Abstract
Congenital pseudarthrosis of the forearm (CPF) is an uncommon entity frequently described in association with neurofibromatosis type 1. Surgical treatment Is required. This is a challenging pathology in pediatric orthopedic surgery due to the difficulty of achieving a satisfying result in terms of bone defect healing. Many techniques are described such us free vascularized fibula, illizarov and induced membrane. We describe a first case of the forearm non union associated with neurofibromatosis type 1 successfully treated with 2 steps of induced membrane. Whatever the technique selected it's remain challenging problem in pediatric orthopaedic.
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Affiliation(s)
- Ahmed Amine Mohseni
- Children's Hospital Béchir Hamza, Tunis Tunisia Pediatric Orthopedic Surgery Department, Tunisia.
| | - Rim Boussetta
- Children's Hospital Béchir Hamza, Tunis Tunisia Pediatric Orthopedic Surgery Department, Tunisia.
| | - Walid Saied
- Children's Hospital Béchir Hamza, Tunis Tunisia Pediatric Orthopedic Surgery Department, Tunisia.
| | - Mohamed Zairi
- Children's Hospital Béchir Hamza, Tunis Tunisia Pediatric Orthopedic Surgery Department, Tunisia.
| | - Ahmed Msakni
- Children's Hospital Béchir Hamza, Tunis Tunisia Pediatric Orthopedic Surgery Department, Tunisia.
| | - Sami Bouchoucha
- Children's Hospital Béchir Hamza, Tunis Tunisia Pediatric Orthopedic Surgery Department, Tunisia.
| | - Mohamed Nabil Nessib
- Children's Hospital Béchir Hamza, Tunis Tunisia Pediatric Orthopedic Surgery Department, Tunisia.
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Abstract
The one bone forearm is a salvage procedure for treatment of painful, instability of the forearm that results from trauma, congenital deformity, tumor, infection, and failed reconstructive efforts. By creating a stable osseous bridge between the ulnohumeral and radiocarpal joints, one bone forearm addresses defects in the bony architecture of the radius and ulna, their articulations, and their associated ligamentous complexes. Global instability of the forearm is a complex clinical pathology with few other answers. Choice of technique should be dictated by adjacent bone loss. This article presents experience with creating a one bone forearm in patients using synostosis procedures.
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Affiliation(s)
- Brett Schiffman
- Department of Orthopaedics and Sports Medicine, University of Washington, Box 359798, 908 Jefferson Street, Seattle, WA 98104, USA
| | - Douglas Hanel
- Department of Orthopaedics and Sports Medicine, University of Washington, Box 359798, 908 Jefferson Street, Seattle, WA 98104, USA.
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Congenital Forearm Pseudarthrosis: A Systematic Review for a Treatment Algorithm on a Rare Condition. J Pediatr Orthop 2020; 40:259. [PMID: 31876700 DOI: 10.1097/bpo.0000000000001499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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