Thoracoplasty has been described as primarily a cosmetic resection of the rib hump. The purpose of our study was to investigate whether removal of a normal spine stabilizer affected the correction of the spine, particularly in the sagittal plane. Thirty-eight adolescent idiopathic scoliosis patients who underwent thoracoplasty were compared with eighteen controls in terms of maintenance of correction and patient satisfaction using the SRS questionnaire. Thoracoplasty had no effect on curve correction in the coronal plane. It did show a significant effect on sagittal plane correction of the thoracic hypokyphosis without any significant detractors in terms of patient outcome

To investigate whether thoracoplasty affected spinal correction. We also compared patient outcomes thoracoplasty patients and controls, as well as long-term curve maintenance.

Thoracoplasty did increase the correction of thoracic hypokyphosis, without any significant detractors in terms of patient outcome.

Current understanding of the scoliotic curve as a three dimensional helix has led to increased recognition of the importance of sagittal contour and balancing the spine’s reciprocal curves to avoid problems such as flat back syndrome. Correction of the scoliotic curve intraoperatively may require the removal of spine stabilizers such as the disc and annulus, posterior facet and capsule, and thoracic cage stabilizers such as the ribs.

Thirty-eight patients who had either concave para-median or convex Steel mid-rib thoracoplasty were reviewed and compared to eighteen controls. Prospective patient outcomes using the Scoliosis Research Society instrument with an average of > one year follow-up were available for thirty patients. Degree of curve settle and maintenance of correction was measured on follow-up radiographs.

Thoracoplasty had no effect on curve correction in the coronal plane. It did show a significant effect on sagittal plane correction of thoracic hypokyphosis. The paramedian group showed a mean increase of tweleve degrees, the Steel group 8.7 degrees, and, the control group 3.1 degrees. No significant difference between pain, satisfaction, function, and self-image was found. Long-term radiographic follow-up (average three years) showed a mean coronal curve settle of 4.6 degrees (thoracoplasty) versus 3.1 degrees (non-thoracoplasty), and an accompanying improvement in sagittal plane correction of 4.2 and 3.0 degrees, respectively.

Supracondylar humeral fractures are the most common elbow injury in children, usually sustained from a fall on the outstretched hand. Iatrogenic ulnarnerve injury is not uncommon following cross K wiring. NNH is the number of cases needed to treat in order to have one adverse outcome. A systemic review was undertaken to calculate relative risks, risk difference and number needed to harm following management of supracon-dylar fractures with cross or lateral K wires. It was found that there was one iatrogenic ulnar nerve injury for every twenty-seven cases that were managed with crossed K wires.

The aim of this study was to calculate the number of cross K wiring of supracondylar fractures of the humerus that would need to be performed for one iatrogenic ulnar nerve injury to occur.

Iatrogenic ulnarnerve injury is not uncommon following cross K wiring of supracondylar fractures of the humerus.

To date there are no clinical trials showing the benefit of cross K wiring over lateral K wiring in the management of supracondylar fractures of the humerus in children. If it can be confirmed that lateral K wiring is as effective as crossed K wiring, iatrogenic ulnar nerve injury can be avoided.

A systematic review of iatrogenic ulnar nerve injuries following management of supracondylar fractures was conducted. The databases MEDLINE 1966 – present, EMBASE 1980 – present, CINAHL 1982 – present, CDSR, and DARE were searched along with a meticulous search of the Journal of Paediatric Orthopaedics from 1998 to 2004. Of the two hundred and forty-eight papers identified, only thirty-six met the inclusion criteria. The papers where both lateral crossed K wires were used as treatment were identified for calculating relative rates, risk difference and number needed to harm.

NNH was 7.69. When a sensitivity analysis removing two studies that had five subjects or fewer and a 100% ulnar nerve injury rate was peformed, the NNH was 27.7. In other words, there was one iatrogenic ulnar nerve injury for every twenty-seven cases that were managed with crossed K wires.

Purpose: The purpose of this study was to assess the clinical, radiological, and functional outcomes following the treatment of a lumbar Chance fracture and to analyze the spectrum of associated abdominal injuries as seen in the Seat Belt Syndrome.

Methods: All patients diagnosed with L1 to L4 Chance fractures were included in this study. Patient data, injuries, treatment and complications were collected from hospital charts. A review of all available spinal radiology was done to measure pre-treatment, post-treatment and follow-up kyphosis angles. We have also described and calculated a Chance Fracture Deformity Index. Patients were seen in follow-up to assess for range of motion, tenderness and neurological status. A functional outcome questionnaire by the AAOS Pediatric Instruments was completed by the patients.

Results: Between December 1984 and February 2001, 27 patients aged 3 to 17 were treated for lumbar Chance fractures. The mean age at injury was 11.1 years. There were 17 females and 8 males. All injuries occurred as a result of a motor vehicle accident. Of the 25 patients, 17 were treated surgically. 12 patients had abdominal injuries. 3 cases involved abdominal arterial vascular trauma. Significant improvement in intra-vertebral kyphosis, segmental kyphosis, and vertebral kyphosis redmodelling (6.5 vs. 4 degrees) was noted in the operative group compared to the non-operative group. The disease specific AAOS Lumbar Spine Questionnaire scores were poor for pain and disability, 29.22, (26.41–31.98), but the SF-36 scores for both MCS and PCS were within the normal range, 47.79 (44.03–51.54) and 47.71 (42.59–52.82), respectively.

Conclusions: An abdominal and spinal CT must be taken when presented with a Chance fracture with abdominal symptoms. Injury type and kyphosis angle are the main factors that aid in treatment planning in paediatric lumbar chance fractures. A purely soft-tissue injury or a kyphosis angle greater than 20 requires surgical intervention.

This study examined clinical and radiological outcomes following video assisted thoracoscopic surgery (VATS) for anterior release and fusion in the correction of paediatric scoliotic deformities. Nineteen patients who underwent VATS were compared with nineteen open thoracotomy patients to compare degree of correction and perioperative morbidity. Demographic parameters were similar between the groups and there was no significant difference in operative time or total blood loss. VATS offered the same degree of correction as open thoracotomies and has the potential to decrease post-operative morbidity while still allowing the same degree of correction as traditional open thoracotomies.

To compare the peri-operative parameters and outcomes of video-assisted thoracoscopic surgery (VATS) with open thoracotomy for anterior release and fusion in the treatment of paediatric spinal deformities.

VATS is a good alternative to open thoracotomy.

VATS has the potential to decrease post-operative morbidity while still allowing the same degree of correction as traditional open thoracotomies.

There were nineteen patients in each group, seventeen with idiopathic scoliosis in the VATS group and sixteen in the open group. Mean age, weight at surgery and pre-operative Cobb angle were similar (p=1.000, 0.8277, 0.0636, respectively). There was no significant difference in operative time per level between the VATS group and the open group (37.2 vs. 34.5 min, p= 0.2254) or total blood loss (908 vs. 823 ml, p= 0.4953). There were no major complications encountered in the VATS group, one patient in the open group experienced atelectasis and subsequent lower lobe collapse.

A detailed chart and radiographic review was undertaken to determine degree of correction, perioperative morbidity and complications, if any, of patients who underwent VATS between 1997 and 2004 at the author’s institution. A control group of patients who underwent open thoracotomy was used to determine if is there a significant difference in correction (Cobb angle) or in perioperative morbidity when using VATS versus open thoracotomy for anterior release and fusion in the correction of scoliotic deformities.

It appears that VATS offers the same degree of correction as open thoracotomies.

Introduction and Aims: Pivotal to most clubfoot management protocols is Achilles tendon lengthening or tenotomy to address hindfoot deformity. The effectiveness of Botulinum A toxin (BTX-A) in defunctioning the triceps surae muscle complex as an alternative to tenotomy was investigated.

Method: Newborns, infants and children referred for suspected clubfoot deformity to the authors’ institution from September 1, 2000 to September 17, 2003 were reviewed consecutively for inclusion in this prospective study. Patients underwent manipulation and castings (above knee casts) emulating Ponseti’s principles until hindfoot stall was encountered. In order to defunction the triceps surae muscle complex, BTX-A at 10 IU per kilogram was injected into this muscle complex. Outcome measures included surgical rate, Pirani clubfoot score, ankle dorsiflexion with knee in flexion and extension, and recurrences. Patients were divided according to age: Group I (< 30 days old) and Group II (> 30 days and < 8 month old).

Results: Fifty-one patients with 73 feet met the criteria for inclusion in the study with 29 patients in Group I and 22 in Group II. Mean age of Group I was 16 months (2.5–33 months) and average follow-up was nine months post-BTX-A injection (1 week-27 months post-injection). Mean age of Group II was 23.5 months (3.8–44.6 months) and average follow-up was 15 months post BTX-A injection (1 week–27 months post-injection). Ankle dorsiflexion in knee flexion and extension remained above 20/15 degrees, respectively, and Pirani scores below 0.5 following BTX-A injection for both groups. All but one patient (one foot) who reached the point of hindfoot stall during the protocol of manipulations and castings had successful defunctioning of the triceps surae complex using a single BTX-A injection. This one patient out of 51 (1.9% of patients and 1.3% of feet) did not respond to the protocol. Of the 50 patients who responded to the protocol, nine patients lost some degree of dorsiflexion due to non-compliance with boots and bars, with fitting problems accounting for two cases. All these patients have corrected with either a return to manipulations and casting alone (one patient), or a combination of repeated BTX-A injection and further manipulations and castings (eight patients)

Conclusion: These results are comparable to those reported in the literature using Ponseti’s method or the physical therapy method and were achieved without the need of tenotomy or more frequent manipulations. The use of BTX-A as an adjunctive therapy in the non-invasive approach of manipulation and casting in idiopathic clubfoot is an effective and safe alternative and one that may be preferable to parents.

Introduction and Aims: The aims of this study were to assess the clinical and functional outcomes following the treatment of a lumbar Chance fracture and to analyse the spectrum of associated abdominal injuries as seen in the Seat Belt Syndrome.

Method: All patients diagnosed with L1 to L4 Chance fractures at the British Columbia Children’s Hospital were included in this study. Patient data, injuries, treatment and complications were collected from hospital charts. A review of all available spinal radiology including pre-treatment, post-treatment and follow-up x-rays, CTs and MRIs was done to measure pre-treatment, post-treatment and follow-up kyphosis angles, as well as to help classify the Chance fracture. Patients were seen in follow-up to assess for range of motion, tenderness and neurological status. Furthermore, a functional outcome questionnaire by the American Academy of Orthopaedic Surgeons Pediatric Instruments was completed by the patients.

Results: Between December 1984 and February 2001, 27 patients aged three to 17 were treated for lumbar Chance fractures. The mean age at injury was 11.1 years. There were 18 females and nine males. All injuries occurred as a result of a motor vehicle accident. Nineteen were rear-seat passengers and eight were front-seat passengers. Of the 27 patients, 19 were treated surgically. Of these 19, nine were treated with either pedicle screws or laminar hooks and rods, four with intersegmental spinous process (ISP) wires alone, two with sublaminar wires and four with a combination of screws/hooks, rods and ISP wires. One patient had a post-operative urinary tract infection. Of the eight patients treated conservatively, four were treated with a hyperextension cast and four were treated with a hyperextension brace. Neurological impairment was seen in seven of the 19 surgical patients pre-operatively. Post-operatively impairment was impoved in two of the seven patients. One of the eight patients treated conservatively had neurological impairment which spontaneously resolved. A total of 13 patients underwent surgery for an associated abdominal injury. Three cases involved abdominal arterial vascular trauma and 12 involved small bowel injury.

Conclusion: An abdominal and spinal CT must be taken when presented with a Chance fracture with abdominal symptoms. Injury type and kyphosis angle are the main factors that aid in treatment planning in paediatric lumbar chance fractures. A purely soft-tissue injury or a kyphosis angle greater than 20 requires surgical intervention.

Introduction and Aims: The aims of this study were to compare the over-the-top and four-strand techniques of paediatric anterior cruciate ligament reconstruction. An age and sex-matched control study of these two different ACL reconstructive techniques was done to determine if there are differences in instability, functional outcomes and growth plate-related problems.

Method: Injuries, treatment and associated complications were collected from hospital charts. Pre-operative x-rays were used to determine growth plate status both at the distal femur and the proximal tibia. Pre-operative MRIs were studied to assess the position and nature of mid-substance ACL tear and any associated meniscal tear or pathology. Follow-up included examination as per International Knee Documentation Committee guidelines, including patient history and a clinical examination assessing the degree of anterior draw, presence and quality of a pivot shift test and pivot glide, and arthrometric measurements using the KT-1000 Arthrometer for anterior translational distance in millimetres. The Lysholm questionnaire was completed by all patients.

Results: Thirty-nine paediatric patients were reviewed for anterior cruciate ligament injuries requiring reconstruction at the authors’ institution. Data collected included background information on the injury, including mechanism and age at injury and surgical information including age at surgery, surgical procedure, and technique. Surgical follow-up information was also collected including wound problems, re-ruptures, or growth arrests. The mean age at injury was 14.3 years. The predominant mechanism of injury was twist and turn with 21 reports. The average age at surgery was 15.2 years, with 20 patients undergoing reconstruction of their ACL alone and 19 patients repair of their ACL and menisci. Fourteen patients were treated using the four-strand technique, while 25 patients were treated using the over-the-top method. We have an average follow-up of 1.9 years post-surgery. Three patients in the over-the-top group had wound infections. There were no known growth arrests or re-ruptures in this patient group based on this limited follow-up. Fifty-five percent of patients had meniscal involvement. Those with a meniscal tear were older than those without (14.5 years versus 11.5 years; p< 0.05).

Conclusion: Once rare, injuries of the anterior cruciate ligament in skeletally immature patients have become a common clinical presentation. It is important to have a documentation of the amount of pathologic laxity of the knee joint. Instrumented measurements can show the success of an ACL reconstruction in restoring the patient’s knee to normal joint kinetics.