Reconstruction of Bone Defects After Osteomyelitis With Nonvascularized Fibular Graft: A Retrospective Study in Twenty-Six Children.

Reconstruction of Bone Defects After Osteomyelitis with Nonvascularized Fibular Graft: A Retrospective Study in Twenty-six Children.

J Bone Joint Surg Am. 2013 May 1; 95(9): e561-6
Patwardhan S, Shyam AK, Mody RA, Sancheti PK, Mehta R, Agrawat H

Persistent infection, soft-tissue fibrosis, and damage to periosteum compound the treatment of children with a bone defect following osteomyelitis. We report on a series of twenty-six patients treated with nonvascularized fibular graft and intramedullary fixation.The series included eleven boys and fifteen girls (mean age, 6.8 years; range, three to twelve years) with gap nonunion after osteomyelitis. Initial treatment involved thorough debridement and sequestrectomy. When the infection was quiescent as indicated by inflammatory parameters, nonvascular fibular grafting with intramedullary Kirschner wire fixation (with or without additional external fixation) was performed. The time to union was noted, and a subgroup analysis was performed to correlate the size of the bone defect with the time to union.The mean duration of follow-up was 3.02 ± 0.74 years (range, 1.3 to 4.2 years), and the mean time to union was 38.76 ± 12.02 weeks (range, fifteen to sixty weeks). There was a weak positive correlation between the time to union and the preoperative bone defect size (Pearson correlation coefficient, 0.699). The mean time to union was 31.7 ± 11.5 weeks for a defect of <4 cm, 36.6 ± 9 weeks for a defect of 4 to 6 cm, and 51 ± 6.7 weeks for a defect of >6 cm. Delayed union was seen at one end of the fibular graft in four (15%) of the patients and was treated with plate fixation. One patient had recurrence of infection. Limb-length discrepancy (range, 2 to 5 cm) was seen in all patients in whom the lower limb was involved and was treated with a shoe lift.This series illustrates the potential benefits of staged sequestrectomy and nonvascular fibular grafting for the treatment of gap nonunion following osteomyelitis in children. The procedure is simple, does not require specialized training or equipment, and has a low complication rate.Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. HubMed – rehab


Comparison of Ultrasound-Guided Intra-articular Injections by Long Axis in Plane Approach on Three Different Sites of the Knee.

Am J Phys Med Rehabil. 2013 Apr 29;
Park KD, Ahn JK, Lee SC, Lee J, Kim J, Park Y

OBJECTIVE: The objective of this study was to examine the accuracy of ultrasound-guided intra-articular (IA) injections on three different sites of the knee using midmedial, midlateral, and superolateral portals. DESIGN: Ultrasound-guided IA injection and a radiographic evaluation were performed on 120 knees with osteoarthritis. Five milliliters of a mixed material consisting of 1% lidocaine (1 ml), 20 mg of triamcinolone (1 ml), and nonionic contrast (3 ml) was injected into the IA space of the knee through three different portals. After each injection, a radiographic evaluation was performed to determine whether the injected material had reached the IA space or infiltrated into the soft tissue. RESULTS: Of 40 injections administered through the midmedial portal, 38 were confirmed as having been placed in the IA space on the first attempt (95% accuracy rate). Thirty-nine of 40 injections administered through the midlateral portal were IA on the first attempt (98.5% accuracy rate), as were 40 of 40 injections administered through a superolateral portal (100% accuracy rate). No significant differences (P > 0.05) were observed in the accuracy rate obtained with placement through the midmedial, midlateral, and superolateral portals. CONCLUSIONS: All three ultrasound-guided IA injections may be used to access the knee joint, with a high rate of accuracy. HubMed – rehab


Ultrasound-Guided vs. Fluoroscopy-Guided Caudal Epidural Steroid Injection for the Treatment of Unilateral Lower Lumbar Radicular Pain: A Prospective, Randomized, Single-Blind Clinical Study.

Am J Phys Med Rehabil. 2013 Apr 29;
Park Y, Lee JH, Park KD, Ahn JK, Park J, Jee H

OBJECTIVE: The aim of this study was to compare the short-term effects and advantages of ultrasound-guided caudal epidural steroid injections with fluoroscopy-guided epidural steroid injections for unilateral radicular pain in the lower lumbar spine. DESIGN: A total of 120 patients with unilateral radicular pain were enrolled and randomly assigned to either the fluoroscopy or the ultrasound group. Complication frequencies during the procedures, treatment effects, functional improvement, and adverse events were compared after the procedures. RESULTS: The verbal numerical rating scale and the Oswestry Disability Index improved 2 and 12 wks after the injections in both groups. Statistical differences were not observed in the verbal numerical rating scale, the Oswestry Disability Index, or the effectiveness of the procedure between the groups. Two cases of intravascular injections were observed in the fluoroscopy group, without the prevalence of complication between the groups. CONCLUSIONS: The ultrasound approach with color Doppler mode may avoid intravascular injection-induced complications. The results showed similar improvements in short-term pain relief, function, and patient satisfaction with both ultrasound and fluoroscopic guidance. HubMed – rehab