The Masquelet technique, also known as the ‘induced membrane technique’ has been utilised in adult reconstruction with varied success. However, there is limited literature on its use in children and this study aims to share our experience. Between 2014 and 2022, 7 children underwent bone defect/infection reconstruction using Masquelet technique, four for complications of Congenital Pseudoarthrosis of Tibia (CPT) treatment, two with chronic osteomyelitis and one for Osteogenesis imperfecta with infected nonunion. The length of the defect relative to the length of the bone (index of reconstruction expressed as a percentage), time to union and complications were evaluated with standard radiographs and from electronic medical records. The mean age was 11 years and the procedure was done in five tibiae, one femur and a metatarsal. The mean time interval was 7.1 weeks between the first and second stage surgery. The mean index of reconstruction was 25.8% and the mean follow up period was 17 months. Though six patients achieved union with a mean time to union of 6.5 months (range 4.5 to 10), two patients with multiple previous surgeries for CPT decided to have ablation despite union. The interosseous Masquelet technique of cross synostosis between the tibia and fibula is being highlighted.Materials & Methods
Results
Aim of this study was to review a single surgeon series and analyse the results of hip reconstruction and compare them to an historical cohort. Retrospective review from a prospective database was undertaken of 113 CFD children since 1999. 31 of these patients had hip reconstruction with combined soft tissue and bony procedures akin to the Superhip. This cohort was compared to the results of the previous series using deformity planning methods on radiographic imaging, quantification of acetabular and femoral geometry, focussing upon the effects and results of hip reconstruction and lengthening. Compared to the previous series, this cohort achieved greater objective increases in length and significantly fewer complications involving the hip joint during the process.11 hips out of 45 (24.4%) that were treated in the previous cohort subluxed during lengthening. Since 1999 there were no subluxations with improved hip geometry. Primary difference between the cohorts was the recent group's preparatory hip surgery before the commencement of any lengthening even for borderline dysplasias. This had not been the case for all children in the previous cohort. This indicates a steep learning curve in the last 3 decades concerning the importance of primary hip reconstruction as a preparatory stage of treatment before lengthening in CFD with almost normalised acetabulae.Introduction
Methods and results
Surgical correction of upper limb deformities in severe osteogenesis imperfecta (OI) is technically difficult and less absolving, hence we aimed to analyse the surgical complications of rodding the humeri in severe OI. Retrospective analysis was carried out for consecutive humeral roddings for severe OI in last 3 years. Surgical technique for all humeri included retrograde telescopic nailing (female or both of FD or TST rods) with entry from olecranon fossa, exploration of radial nerve followed by osteotomies. Deformities were quantified and sub-classified as per level of deformity). Variables such as number of osteotomies, radiological union, intraoperative and postoperative complications, improvement in ROM and subjective patient satisfaction were recorded. Total 18 humeri in 12 patients with type III OI (except 1) with mean age of 8.9 years underwent nailing. All patients achieved radiological union at 6–10 weeks. Total 8 complications (44.4 %) were reported within mean 8.4 months follow up. Four segments (22.2 %) had intraoperative fractures at distal third of the humerus while negotiating the nail. Significantly higher intraoperative complications were encountered in humeri fixed with both components combined and upper third level deformities, deformities > 900 and more than 2 osteotomies. Other complications were prominent implant at upper end (2) with growth and one each of contralateral fracture and distal humeral varus. All patients reported improvement in ROM and functional status.Purpose
Methods and results
