Purpose: To investigate robot-assisted percutaneous cannulated screw fixation for treating slipped capital femoral epiphysis, including acute, chronic, and acute-on-chronic slips. Our study included all stable and unstable slips. Methods: Thirty-one children with unilateral SCFE were treated from October 2019 to October 2021. All 31 patients were followed up for 12–36 months, with an average follow-up time of 24.56 ± 6.73 months. The femoral epiphysis was fixed with a percutaneous cannulated screw assisted by a surgical robot. Results: All 31 femoral head epiphyses underwent successful fixation in one attempt. The average operation time and bleeding were 98.25 ± 15.13 min and 21.65 ± 11.25 ml, respectively. The average distance between the actual and planned entry points was 1.13 ± 0.58 mm and 0.91 ± 0.72 mm in the anteroposterior (AP) and lateral views, respectively. The actual insertion trajectory deviated from the planned position by 3.61 ± 1.34° and 2.33 ± 1.32° in the AP and lateral views, respectively. The average fluoroscopy time was 6.56 ± 3.23 times per screw. The Non-Arthritic Hip Score improved from 28.53 ± 9.17 preoperatively to 67.34 ± 6.21 at the last follow-up ( P < 0.05), and the Harris hip score improved from 46.47 ± 15.34 to 89.63 ± 7.52 ( P < 0.05). The wounds healed without avascular necrosis or chondrolysis of the femoral head. Conclusion: Robot-assisted percutaneous cannulated screw fixation is effective for treating pediatric SCFE. Screw fixation was accurate and safe, and clinical outcomes were satisfactory. Level of Evidence: Level 4, Case Series.

Objective: Closed or open reduction and spica casting are common treatments for children aged 6 to 18 months, as well as infants aged 0 to 6 months whose harness treatment for developmental dysplasia of the hip (DDH) was unsuccessful. The study aimed to quantify the distance between the femoral head and the acetabulum after closed or open reduction and evaluate the dynamic docking progression of the femoral head using serial hip medical ultrasound. Methods: We retrospectively reviewed the medical records and hip medial ultrasound images of a consecutive series of patients with DDH who underwent spica casting after reduction and compared images obtained immediately after reduction and at follow-up. The first cast (stage I) was maintained for 2 to 3 months and scheduled for outpatient repeat ultrasound in 4 to 8 weeks. Then the second cast was placed (stage II), lasting for another 2 to 3 months. The triradiate cartilage-femoral head distance (TFD) was measured in the acetabulum coronal mid-sectional plane. The Wilcoxon signed-rank test was used to compare the TFD values. Results: This study included 49 patients. All patients underwent hip medial ultrasound 0 to 3 days after stage I (time 1) and 4 to 8 weeks (time 2) postoperatively, with 24 patients reviewed again 0 to 7 days after stage II. The TFD values in time 1 and time 2 were 6.0 (5.0, 9.0) mm and 5.0 (3.6, 7.0) mm, respectively. There was a statistically significant difference between times 1 and 2 regarding TFD values in 49 close-reduction hips (6.0 vs 5.0 mm, P < 0.001). Similar findings were also observed in 13 open-reduction hips (6.0 vs 5.0 mm, P = 0.023). Conclusions: Hip medial ultrasonography during the period of cast immobilization after reduction in children with DDH can objectively and quantitatively show the dynamic change of the distance between the femoral head and the acetabulum, and can be used to assess reduction of the hip and progression of femoral head docking.

Abstract Background Developmental dysplasia of the hip (DDH) is the most common hip abnormality in children. Closed or open reduction and cast immobilization are the most commonly used treatments for patients aged 6 to 18 months with dislocation; they are also used in children younger than 6 months when brace treatment is not effective. During cast immobilization, surgeons need reliable and timely imaging methods to assess the status of hip reduction to ensure successful treatment and avoid complications. Several methods are used, but they have disadvantages. We developed and, in this study, evaluated a hip medial ultrasound method to evaluate the status of hip reduction in children treated with a spica cast. Question/purpose Is hip medial ultrasound more accurate than radiography for determining the status of hip reduction in children treated with a spica cast? Methods Between November 2017 and December 2020, we treated 136 patients with closed or open reduction and spica casting for DDH in our department. These children were 3 to 18 months old at the time of surgical reduction and had a specific medical history, physical examination findings, or AP radiographic evidence of unilateral or bilateral DDH. None had a concomitant femoral/acetabular osteotomy procedure in these hips. All patients underwent hip medial ultrasound, AP radiography, and MRI under sedation within 2 to 7 days after open or closed reduction. The examination time was from the second day after reduction to enable the patient to recover from anesthesia. MRI was performed within 7 days after reduction because of a few long appointment times, and ultrasound and AP radiography were always performed 1 or 2 days before MRI. Based on that, 65% (88 of 136 [88 hips]) of patients were excluded due to the absence of MRI, ultrasound, or AP radiography; 3% (4 of 136 [4 hips]) of patients were excluded because of concurrent congenital spina bifida, Larson syndrome, or Prader-Willi syndrome; and 1% (1 of 136 [1 hip]) of patients were excluded because the patient underwent MRI before ultrasound. A total of 32% (43 of 136 [43 hips]) of patients were eligible for analysis in this cross-sectional diagnostic study, and these 43 patients underwent AP radiography, ultrasound, and MRI. In this retrospective study, the mean age at the time of surgery was 10 ± 4 months (male:female ratio 5:38; unilateral DDH: 34; bilateral DDH: 9). To ensure the independence of the results, the study was limited to one hip per patient (in patients with bilateral DDH, the right hip was evaluated). The reduction of 43 hips (left:right ratio 26:17; closed:open reduction ratio 30:13) was evaluated by MRI, hip medial ultrasound, and radiography. Children with spica casts were placed in the supine position, which is necessary to expose the perineum for ultrasound. We used a broad-spectrum, microconvex, and intracavitary probe. The acetabular medial wall was identified by the triradiate cartilage of the ischial tuberosity and the pubis superior, and the femoral head was identified by the femoral neck. Then, the acetabulum coronal midsectional plane was used to determine the positions of the femoral head and acetabulum and to measure the triradiate cartilage–femoral distance. MRI examinations were performed using a 1.5-T MRI system with an eight-channel body coil. Each reviewer evaluated each reduction independently. Additionally, to further assess the hip medial ultrasound method’s reliability and reproducibility, we investigated the interobserver and intraobserver agreement in evaluating the reduction using hip medial ultrasound. Using ultrasound or radiography, the reviewers classified hips as reduced, uncertain status, or dislocated. MRI was considered the gold standard for assessing hip reduction, and the reviewers classified hips as reduced or dislocated by MRI. Patients with hips with an uncertain reduction status according to ultrasound or radiography were retained in the analysis. Thus, the test results of radiography and ultrasound were classified into three classifications (positive, negative, or uncertain) in the present study. The test was considered positive or negative when patients were assessed with dislocation or without dislocation, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasound and radiography were calculated and compared. We combined uncertain and positive into the positive classification to be conservative in the statistical choices. The specificity, sensitivity, PPV, and NPV were analyzed based on this premise. Furthermore, a subgroup analysis was conducted by sex. MRI evaluation revealed that 41 hips were reduced and two hips were dislocated. Results The sensitivity, specificity, PPV, and NPV of ultrasound were 100% (95% CI 16% to 100%), 95% (95% CI 84% to 99%), 50% (95% CI 7% to 93%), and 100% (95% CI 91% to 100%), respectively. The sensitivity, specificity, PPV, and NPV of radiography were 50% (95% CI 1% to 99%), 68% (95% CI 52% to 82%), 7% (95% CI 0% to 34%), and 97% (95% CI 82% to 100%), respectively. Ultrasound showed a higher specificity (95% versus 68%; p < 0.001) and PPV (50% versus 7%; p = 0.02) than radiography. The sensitivity, specificity, PPV, and NPV of ultrasound were 100% (95% CI 16% to 100%), 94% (95% CI 81% to 99%), 50% (95% CI 7% to 93%), and 100% (95% CI 90% to 100%), respectively, for female patients (with only five male patients, we could not perform these analyses in this group). The sensitivity, specificity, PPV, and NPV of radiography were 50% (95% CI 1% to 99%), 64% (95% CI 46% to 79%), 7% (95% CI 0% to 34%), and 96% (95% CI 79% to 100%), respectively, for female patients. The κ values for intra- and interobserver reliability both were 1.0. Conclusion Hip medial ultrasound can directly visualize the femoral head and acetabulum. Hip medial ultrasound is more reliable than radiography as a preliminary evaluation method and does not involve irradiation. We recommend using hip medial ultrasound during outpatient follow-up visits for patients younger than 2 years treated with hip reduction and cast immobilization. Level of Evidence Level III, diagnostic study.

儿童急性血源性骨髓炎( acute hematogenous osteomyelitis, AHO)是儿童最常见的骨骼感染.年幼儿童长骨干骺端的独特解剖特征和血液供应特点,使得AHO在临床上成为常见疾病.如果感染破坏了关节软骨和骺板,可导致关节功能受损或肢体不对称生长,出现严重的肢体功能障碍.有研究将急性感染定义为症状持续2周;亚急性感染定义为症状持续2 周至3 个月;慢性感染定义为症状持续3个月以上[1].北美儿科传染病学会和美国传染病学会指南小组使用了不同的分期[2] ,将急性骨髓炎定义为在以前未受感染的骨骼出现临床症状或体征后4周内的感染;慢性骨髓炎定义为一种更持久的、通常是间断的疾病过程.复发可表现为间歇性反复疼痛、肿胀、窦道.

目的 探讨弹性髓内针固定联合人工骨注射治疗儿童肱骨单纯性骨囊肿的疗效.方法 2015年6月～2019年6月,对31例儿童肱骨单纯性骨囊肿,在C臂机透视下,在肱骨内、外上髁分别做1 cm切口,由肱骨远端向近端置入2枚弹性髓内针固定,经皮穿刺注射人工骨填充病灶.结果 手术时间60～95 min,(68.0±10.5)min;术中出血量20～50 ml,(34.7±8.7)ml.31例随访36～65个月,(49.6±10.8)月.按改良Neer标准,Ⅰ级(愈合)22例,Ⅱ级(部分愈合)8例,Ⅲ级(持续存在)1例,无Ⅳ级(复发),治疗有效率96.8％(30/31).无感染、病理性骨折.结论 采用弹性髓内针固定联合经皮穿刺人工骨注射治疗儿童肱骨单纯性骨囊肿疗效满意.

目的:观察色努支具治疗青少年特发性脊柱侧凸的疗效,探究影响疗效的相关因素.方法:2016年1月～2018年6月采用色努支具治疗的青少年特发性脊柱侧凸患者49例,其中女性46例,男性3例,治疗初始年龄12.6±1.3岁(10～15岁),初始主弯Cobb角32.5°±6.9°(20°～45°),初始Risser征2.2±1.6.收集患者的临床资料:年龄、每日佩戴时间等信息;影像学资料:初始、佩戴支具即刻和随访的系列脊柱全长X线片.通过佩戴支具即刻X线片计算初始支具矫正率.评估治疗后结果:Cobb角减少≥6.定义为"改善",Cobb角变化5°以内定义为"稳定",Cobb角增大≥6°定义为"进展",前两者为治疗成功.观察初始支具矫正率在各组结果中的差异;分析畸形进展的患者相关因素:畸形严重程度(20°～29°,30°～39°及40°～45°三组)、Risser征(0～4)和侧凸类型(胸弯、胸腰弯/腰弯、双主弯三种类型);并分析影响初始支具矫正率的可能因素.结果:49例患者平均治疗2.0±1.0年,所有患儿每天支具佩戴时间在18～20h以上,依从性良好.随访2.0±1.0年(1～5年),末次随访时年龄14.6±1.4岁,Risser征4.2±0.6,末次随访Cobb角28.5°±9.6°;其中畸形改善31例,畸形稳定14例,支具治疗的总体成功率为91.8％(45/49);畸形进展4例,其中3例畸形超过45°.初始支具矫正率平均(64.9±23.6)％,其在改善组、稳定组和进展组分别为(69.5±23.2)％、(61.5±23.7)％和(42.5±10.0)％,初始支具矫形率和各组结果存在中等强度相关性(相关系数0.318,P=0.026);有序多分类Logistic回归显示支具矫正率对结果存在正向影响,差异有统计学意义(P=0.045).分析畸形进展的患者相关因素发现;畸形严重和骨骼成熟度低是畸形进展的危险因素(P=0.016和P=0.010),不同侧凸类型的畸形进展率没有统计学差异(P=0.124),但4例进展患儿均发生在胸段侧凸(3例胸弯,1例双主弯),胸腰弯/腰弯无进展病例.多因素分析显示,畸形程度越低,初始支具矫正率越高(P=0.001);侧凸类型和Risser征对矫正率无显著影响(P＞0.05).结论:色努支具是治疗青少年特发性脊柱侧凸的有效方法,初始支具矫正率是影响结果的重要因素,初始支具矫正率越高治疗效果越优;畸形程度严重(＞40°)和骨骼成熟度低(Risser 0)的胸段侧凸患儿,畸形进展的可能性更大.

遗传性多发性骨软骨瘤(hereditary multiple exostoses,HME),又叫骨软骨瘤病,是一种较为罕见的常染色体显性遗传疾病,其特征为中轴骨及四肢骨多发的骨疣生长,顶覆软骨[12];因其干扰骺板生长,常可引起肢体不等长,前臂畸形,膝外翻等多种肢体畸形[3].患者多在10岁前因无痛性肢体肿物而就诊,经体检和特征X线表现而确诊[1,3-4].由于该病涉及基因突变,无有效药物,治疗以手术切除为主,包括切除肿瘤改善外观,解除肿瘤对临近神经、血管的压迫和矫正肢体畸形[5-8].2019年12月北京积水潭医院收治1例遗传性多发性骨软骨瘤案例,手术切除该患者来源于足舟骨的骨软骨瘤,归纳该案例临床特点并复习相关文献,现报告如下.

Objective:To investigate the surgical treatment, clinical effect and revision reasons of children with proximal femoral fibrous dysplasia(FD).Methods:The clinical data of 26 children with polyostotic FD of proximal femur who underwent surgery at Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital from June 2016 to June 2018 were retrospectively analyzed. There were 18 males and 8 females with a mean age of 9.2 years (range:5 to 16 years).One of them was McCune Albright syndrome. Fifteen cases were in first operation and 11 cases were in revision operation. The operation methods and results were reviewed,and the causes of revision were analyzed.Results:Among the 15 children who underwent the first operation,13 cases underwent osteotomy or fracture reduction and interlocking intramedullary nail(IMN) fixation;One case underwent valgus osteotomy and pediatric hip plate(PHP)internal fixation;One case underwent valgus osteotomy+lesion curettage+allogeneic bone graft+PHP fixation. Among the 11 children who underwent revision surgery,9 cases were treated with IMN fixation,1 case with PHP fixation,and 1 case with PHP fixation+allogeneic bone graft. The causes of revision included distal fixation failed in 6 cases,proximal fixation failed in 3 cases,plate fixation failed in 5 cases,and recurrence occurred after curettage and artificial bone graft in 2 cases. Patients were followed up for 1.4 years(range:1.0 to 3.5 years) after recent operation. The osteotomy or fracture healed well with good deformity correction. Postoperative complications included infection in 1 case and local bone partial resorption in 1 case.Conclusions:Osteotomy combined with rigid internal fixation is an effective surgical treatment for fibrous dysplasia of proximal femur in children. Internal fixation should cover the whole length of lesion. Intramedullary nail is the most common choice. Because the growth of height and the progress of the disease itself,this deformity is prone to recur in children,needing closely follow-up after operation.

OBJECTIVE:To review the outcomes of surgical management in the pediatric patients with extremity chondroblastoma. Especially the risk factors of recurrence and growth disorder. And discuss a potential method to decrease the rate of growth disorder by preventing the premature physeal closure. METHODS:Fifteen girls and twenty-seven boys aged from two to 14 years (mean, 11 years) with histologically proven chondroblastoma, who presented from January 2011 to June 2018 at our Hospital, were retrospectively reviewed. Clinical data, radiographic images, histological findings, treatment, functional outcomes, and local recurrence rate were analyzed. Surgical treatment included complete curettage of the tumor and the walls of the lesion followed by bone grafting, No adjuvant methods were used. Recurrence was defined as a return of symptoms and an expansion radiolucency at the operated site. It was confirmed by the histopathological analysis. When recurrence was diagnosed, the medical data were analyzed to detect the effect of different factors on local recurrence. Functional outcome was measured according to Sailhan's functional criteria, designed to provide a standardized method of assessing pediatric chondroblastoma patient postoperatively. RESULTS:The proximal part of the femur was the most frequently involved site. All the patients had at least 24 months of follow-up; mean duration was 30 months (range, 24-60 months). The local recurrence rate was 9.5%. Three resolved after repeat surgeries without further recurrence, one had a second recurrence and received another more aggressive curettage. Local recurrence of chondroblastoma was associated with age (P < 0.05), while not associated with sex, tumor location, the radiological character of the lesion or the grafting method (P > 0.05). No pulmonary metastasis was noted at latest follow-up. Five patients suffered from premature closure of physis due to physis injury. Thirty-one patients (73.8%) had a good outcome, and all returned to normal unrestricted activities. Six patients (14.3%) had a fair outcome due to occasional pain, asymmetric range of motion, or radiographic joint changes without arthritis. And five patients (11.9%) had a poor outcome because of chronic pain, loss of joint motion impairing normal life activities, or a limb-length discrepancy and limp. CONCLUSIONS:Aggressive curettage and bone grafting resulted in local control and good outcomes in most pediatric patients. Being less than 12 years of age was the risk factor for recurrence. For those growing patients, premature physeal closure was observed after the curettage, interpositional technique with PMMA would be a good choice for prevention.

AIMS:The objective of this study was to evaluate the clinical and radiological outcomes of patients younger than six months of age with developmental dysplasia of the hip (DDH) managed by either a Pavlik harness or Tübingen hip flexion splint.METHODS:Records of 251 consecutive infants with a mean age of 89 days (SD 47), diagnosed with DDH between January 2015 and December 2018, were retrospectively reviewed. Inclusion criteria for patients with DDH were: younger than 180 days at the time of diagnosis; ultrasound Graf classification of IIc or greater; treatment by Pavlik harness or Tübingen splint; and no prior treatment history. All patients underwent hip ultrasound every seven days during the first three weeks of treatment and subsequently every three to four weeks until completion of treatment. If no signs of improvement were found after three weeks, the Pavlik harness or Tübingen splint was discontinued. Statistical analysis was performed.RESULTS:The study included 251 patients with Graf grades IIc to IV in 18 males and 233 females with DDH. Mean follow-up time was 22 months (SD 10). A total of 116 hips were graded as Graf IIc (39.1%), nine as grade D (3.0%), 100 as grade III (33.7%), and 72 as grade IV (24.2%). There were 109 patients (128 hips) in the Pavlik group and 142 patients (169 hips) in the Tübingen group (p = 0.227). The Tübingen group showed a 69.8% success rate in Graf III and Graf IV hips while the success rate was significantly lower in the Pavlik group, 53.9% (p = 0.033). For infants older than three months of age, the Tübingen group showed a 71.4% success rate, and the Pavlik group a 54.4% success rate (p = 0.047).CONCLUSION:The Tübingen splint should be the preferred treatment option for children older than three months, and for those with severe forms of DDH such as Graf grade III and IV, who are younger than six months at time of diagnosis. The Tübingen hip flexion splint is a valid alternative to the Pavlik harness for older infants and those with more severe DDH. Cite this article: Bone Joint J 2021;103-B(5):991-998.

Developmental dysplasia of the hip (DDH) is a challenging pediatric condition. This study aimed to investigate the feasibility and the efficacy of Dega osteotomy in combination with pelvic triple osteotomy or periacetabular osteotomy and femoral shortening with derotational osteotomy for the treatment of severe acetabular deformity secondary to DDH in children older than 9 years of age. The clinical data of 22 children treated at our institution were retrospectively collected. Pre- and postoperative hip radiographs were evaluated. Center-edge (CE) angle was measured, and Severin classification and McKay criteria were used to evaluate the final outcome. Twenty-two patients (including 21 female patients) were treated during the study period. The mean age was 10.9 years (range 9.1–14.8). All patients had preoperative Tonnis grades III and IV dislocated hips. Mean follow-up time was 25.7 months (range 14–48). All but three hips underwent open reduction. All had concomitant proximal femoral shortening and derotation osteotomy. At last follow-up visit, all hips remained located and no cases of avascular necrosis were recorded. All patients had Severin grade I–II hips at last follow-up. According to McKay criteria, clinical outcome was excellent in three patients, good in seven, and fair in 12 patients. Acetabuloplasty in combination with periacetabular osteotomy and femoral shortening with derotational osteotomy is a valid and effective treatment for children older than 9 years of age with severe acetabular deformity secondary to DDH. Although the early clinical outcome of the reported procedure is favorable, further studies are necessary to evaluate the long-term effects of the reported technique.

Children younger than 18 mo with developmental dysplasia of the hip (DDH) were treated with reduction and spica cast. X-Ray, computed tomography or magnetic resonance imaging (MRI) was used to evaluate reduction effectiveness. This study explored the hip medial ultrasonography method and anatomic structure sonograms. Twenty-eight children with DDH were enrolled. A total of 51 hips (24 left hips /27 right hips) were measured, including 30 affected hips and 21 normal hips. Various indices, including femoral head diameter (DIA), triradiate cartilage–femoral distance (TFD), acetabular–femoral distance (AFD) and ilium–femoral distance (IFD), were measured in the acetabular median coronal plane of ultrasound and the median coronal plane of MRI. The intra-group correlation coefficients for DIA, TFD, AFD and IFD were 0.968 (95% confidence interval: 0.917–0.985), 0.959 (0.929–0 976), 0.923 (0.869–0.955) and 0.950 (0914–0.971), respectively. Hip medial ultrasound and MRI exhibited good consistency. It is feasible to use hip medial ultrasound to evaluate the reduction of DDH in infants and children after spica cast.

Objective: To evaluate the effects of treatment of post-traumatic distal radius partial physeal arrest with physeal bar resection. Methods: From February 2007 to November 2017, 11 children with distal radius physeal arrest received physeal bar resection in the Department of Pediatric Orthopedics, Beijing Jishuitan Hospital. There were 2 females and 9 males. The average age of the patients was (10.1±1.8) years (range,7-13 years). All cases had previous history of distal radius trauma. The average duration from the previous fracture to the physeal bar resection operation was (22.8±3.2) months (range,22 to 41 months). Clinical and radiological evidence of distal radius physeal arrest were suggested in all patients. A CT or MRI scan was performed preoperatively to assess the size of the physeal bridge. Inclusion criteria were patients with a physeal bridge<30% of the physeal area,and with at least 2 years of growth remaining. The physeal bar resection operation was performed with the assistance of either fluoroscopy (5 cases) or intraoperative three dimensional navigation (6 cases). After resection, the void was then filled with bone wax in all cases and distal ulnar epiphysiodesis was conducted in 5 cases. The mean follow-up duration was (3.7±1.6) years (range,1-9 years). The clinical examination data and X ray were obtained during the follow up. Results: Four cases obtained fully recovery from the operation and the deformity got fully correction. The X ray showed no bone bridge recurred. The deformity did not aggravate in 1 case. The deformity aggravated and subsequent osteotomy was conducted in the left 6 cases. Three cases in the navigation group obtained fully recovery. One case in the fluoroscopy group obtained fully recovery. Conclusions: The intraoperative three dimensional navigation can precisely locate the bone bridge. The physeal bar resection is an effective technique in some post-traumatic distal radius partial physeal arrest.

Children presenting with partial physeal arrest and significant remaining growth may benefit from physeal bar resection, although the operation is a technique demanding procedure. This study evaluates the treatment of post-traumatic pediatric ankle varus deformity using physeal bar resection and hemi-epiphysiodesis with the assistance of two operative methods. Forty-five patients presenting with a distal tibial medial physeal bridge as well as ankle varus deformity following traumatic ankle physeal injury between 2009 and 2017 were followed. These patients were treated with physeal bar resection and hemi-epiphysiodesis, with the assistance of either fluoroscopy (10 cases) or intraoperative three-dimensional navigation (35 cases). Of the 45 cases, the median age was 9.0 years (range: 3–14 years) with 28 male and 17 female patients. The median of pre-operation ankle varus angle was 20 degrees (IQR 15–25) and 5 degrees (IQR 0–20) at the time of final follow up, representing a statistically significant difference (P<0.05). No differences were observed with regards to age, gender, and surgical history between effective group and ineffective group (P>0.05). The median of pre-operative ankle varus angles of the navigation and fluoroscopy groups were both 20 degrees (P>0.05). The median correction angle of the navigation and fluoroscopy groups was 10 and 15 degrees, respectively (P>0.05). Our results indicate that physeal bar resection and hemiepiphysiodesis are effective treatments for correcting ankle varus deformity due to traumatic medial physeal arrest of the distal tibia. We observe no difference in outcome between fluoroscopy group and three-dimensional navigation group during the procedures.

Objective To explore the possibility and early outcome of the combined procedure of ace -tabularplasty and periacetabular osteotomy in treatment of developmental dysplasia of the hip in older children . Mtehods Seven cases from Oct 2010 through Jan 2016 who underwent the combined procedure were reviewed . The detailed surgical method was introduced and the indication for the procedure was analysed .We used modi-fied McKay classification and Severin grade system to evaluate the function and radiographic outcome of the hip . Results Average age, 9.9 years (range, 9-11 years)old, all cases were female, average follow up duration, sixteen months(6-67 months),six cases were performed the combined procedure and the proximal femoral os-teotomy( PFO) , only one case was performed the combined procedure in the acetabular side without PFO .No femoral head redislocation or avascular necrosis of the femoral head in the study group up to the latest follow up date.The function the hip according to McKay classification system , one excellent,2 good, and 4 fair.The ra-diographic outcome of the hip according to Severin grade system , all cases achieved grade Ⅱ.Conclusion The combined procedure of acetabularplasty and periacetabular osteotomy could be considered as an option when the severe acetabular pathology in older children need to be solved .In the early follow up ,the function of the hip could achieve fair and above and the radiographic outcome was good .

Objective To retrospectively analyze the clinical characteristics and curative results of 16 children with Meyer dysplasia. Methods From 2008 to 2014, 16 children ( 22 hips ) with Meyer dysplasia were treated in our hospital, whose clinical data were retrospectively analyzed. There was 1 female and 15 male patients in the study, including 6 patients ( 38% ) with both sides affected. Their mean age was 3.1 years old ( range: 1.5 - 5 years ) at the first hospital visit. They were followed up for a mean period of 2.8 years ( range: 2 - 6 years ). The diagnosis criteria were:( 1 ) Younger than 5 years; ( 2 ) The clinical symptoms were mild pain and limping at the first hospital visit, and the symptoms got resolved after rest; ( 3 ) There was no or only mild limitation in hip motion, and the physical examination showed positive signs; ( 4 ) The X-ray showed smaller or delayed ossification centers in the proximal femoral epiphysis, or a small epiphyseal nucleus composed of multiple independent bony foci, but no subchondral fracture, epiphysis condensation or subluxation of hip; ( 5 ) No abnormal finding in MRI; ( 6 ) The other skeleton dysplasia was excluded;( 7 ) No congenital metabolic abnormality. After the first hospital visit, the treatment of all children was observation only with no weight-bearing for 3 months. During the follow-up after 3 months, if the clinical symptoms got resolved, and the X-ray did not show subchondral fracture, epiphysis fragmentation or condensation, or subluxation, the children were allowed to weight-bearing, and had regular follow-up. Results All children had no symptom and no motion limitation at the latest follow-up. The X-ray showed proximal femoral epiphysis became enlarged and gradual recovery to a normal or nearly normal contour of the femoral head ( class I and II in Stulberg classification ). Conclusions Meyer dysplasia is a rare condition, but could be easily mistaken with Legg-Calve-Perthes disease ( LCPD ), leading to unnecessary diagnostic procedures and treatments. To those with smaller or delayed ossification centers in the proximal femoral epiphysis and younger than 5 years, Meyer dysplasia should be considered. For favorable prognosis, an early and correct diagnosis should be made, so as to avoid unnecessary treatments.

目的 探讨重度股骨头骺滑脱的手术治疗.方法 回顾性分析2006年1月至2014年12月北京积水潭医院小儿骨科手术治疗并获得随访的重度股骨头骺滑脱患者45例.其中男37例,女8例;平均年龄11.9岁(7～18岁);非稳定型15例,稳定型30例;急性6例,慢性26例,慢性病程急性发作13例.根据术前患者病程的长短、影像学表现和术者对手术方法的熟悉程度,采取了不同的手术治疗方法.切开复位空心钉固定11例(包括牵引无效之后的切开复位4例),牵引后空心钉固定21例,直接空心钉固定13例.平均随访33.4(18 ～75)个月.随访时X线观察股骨头骺的转归和固定情况,并根据Harris髋关节评分对髋关节功能进行评估.结果 末次随访时,所有患者均可无需拄拐行走,Harris髋关节评分为86～100分,平均96.1分.在切开复位加空心钉固定的11例中,X线显示4例出现股骨头缺血坏死,2例术后出现半脱位,经过治疗后,半脱位得以恢复.在非切开复位空心钉固定的34例中,10例出现凸轮畸形,2例出现股骨头缺血坏死,2例出现牵引处的皮肤激惹.所有病例均未出现滑脱加重、软骨溶解.结论 重度股骨头骺滑脱的治疗充满挑战,非切开复位空心钉固定出现股骨头缺血坏死的风险相对较低,但是残余畸形可能需要进一步治疗.切开复位空心钉固定能恢复股骨头颈的正常解剖形态,但是出现并发症的风险较高,需要较长的学习曲线.

Objective: To explore the influence of the labro-chondral complex (LLC) on the development of the acetabulum after close reduction in developmental dysplasia of the hip (DDH). Methods: Sixty-one cases (72 hips) with DDH presented in Beijing Jishuitan Hospital were reviewed, all the patients were treated by closed reduction, arthrogram and Spica casting from March 2010 to December 2013. The anterior-posterior pelvic radiography was performed to evaluate the morphology of the labro-chondral complex and reduction of the hip. The cases were divided into Ⅰ, Ⅱ, Ⅲ, Ⅳ four groups according to the shape of the LLC initially, and when performed the secondary Spica cast after 3 months, these cases were divided into 0-0.4, 0.4-0.6, and >0.6, three groups based on the height difference ratio (HDR) of the LLC. The relationship between the shape and HDR of the LLC was analyzed. The AI and CE angle were used to evaluate development of the hip during the latest follow up. The impact of the shape and HDR of the LLC on the development of the acetabulum was explored as well. Results: The HDR was the least in the type Ⅰ hips, all cases were less than 0.6, the AI in this group was significantly lower than the others(24.33°±3.12°), and the CE angle was significantly higher in the type Ⅰ hips(15.22°±3.11°) during the latest follow up. The CE angle was significantly different among the three groups of HDR. The HDR was lower, the CE angle was higher. The AI in 0-0.4 group was significantly lower than the others(14.24°±3.10°). Conclusion: The shape of the LLC is helpful to judge development of the acetabulum when closed reduction was performed in DDH. And the HDR in the secondary cast change could be used as a sensitive index to predict development of the hip.

Objective Few reports of surgical treatment of post-traumatic elbow stiffness can be found in literatur. This study aimed to analyze a consecutive case series of post-traumatic elbow stiffness only in children younger than 14 years old to explore indication, surgical technique, rehabilitation, outcome and complications. Method At a mean follow-up of 25.1 months ( range, 7 - 41 months ), 17 patients with post-traumatic elbow stiffness after open release treatment were evaluated. Pre-operatively, the average flexion was 74.1° ( range, 30° - 110° ), the average limitation of extension was 42.6° ( rang, 0° to 80° ), the average lfexion-extension range of motion was 74.1° ( range, 30° - 110° ). The average ‘Mayo Elbow Performance Score’ ( MEPS ) was 59.7 points ( range, 55 to 75 points ). Most operations were through combined approach of both lateral and medial side. Intraoperatively, we tried our best to preserve the lateral ulnar collateral ligament ( LUCL ) and anterior bundle of medial collateral ligament, which are very important to the stability of the elbow. If the elbow was not stable enough intraoperatively, we applied hinged external ifxator to lateral side of the elbow. Rehabilitation began on day 1 postoperatively.Results No patient complained of pain. They had an average of 115.3° ( rang, 60° to 130° ) of lfexion of elbow and 16.5.° ( range 0° to 40° ) to full extension. ) °, The average lfexion-extension rang of motion was 115.3° ( range, 60° - 130° ). The average MEPS was 87.5 points ( range, 55 to 95 points ).Conclusion On appropriate indication, well performed open release treatment of the elbow can achieve good result in treating post-traumatic elbow stiffness of children.

Objective To explore the injury mechanism,treatment and prognosis of head-neck separation type among Monteggia equivalent fractures in children.Methods A retrospective study was conducted for 15 children of head-neck separation type fractures treated between January 2000 to December 2013.There were 3 boys and 12 girls with an average age of 8.7 (5.1-13) years.The injuries were located at left (n =11) and right (n =4) sides.The lesion was characterized by a fracture of ulnar diaphysis with a separated fracture of radial neck without a dislocation of radial head.And a line appeared through the longitudinal axis of radius off the center of capitellum.The classification was based on the direction of displacement and angulation of fractures.Nine cases belonged to type Ⅰ with an ulnar fracture with ulnar and palmar angulation plus radial neck fracture with ulnar and palmar displacement of distal end.And another 6 cases were classified as type Ⅱ with a direction of fracture displacement was opposite to that of type Ⅰ.The fractures of ulna were fixed with plate,Kirschner wire or elastic stable intramedullary nail.And the fractures of radial neck were fixed with Kirschner wire or elastic stable intramedullary nail.Reduction was evaluated by postoperative radiology and the therapeutic outcomes were assessed by the scheme of Bruce-Harvey-Wilson.Results The average follow-up period was 27 (11-60) months.The postoperative radiographs were used to evaluate the reductions of ulnar fractures.And the outcomes were good (n =13) and fair (n =2).According to the M taizeau criteria,the outcomes of radial neck fracture were good (n =14) and fair (n =1).According to the Bruce-Harvey-Wilson scoring system,the efficacies were excellent (n =13),good (n =1) and fair (n =1) at the last follow-up.Avascular necrosis occurred in 1 case and another case showed bulk formation of proximal metaphysis.Conclusions The head-neck separation type among Monteggia equivalent fractures have unique mechanisms.Timely diagnosis,prompt reduction,rigid fixation of ulnar fracture,anatomical reduction of radial neck fracture and early exercises may achieve a fair prognosis with fewer complications.