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  • ISSN: 2373-9290
    Volume 3, Issue 2


    Research Article
    Evgeny Dyskin* and Michael Ferrick
    Developmental dysplasia of the hip [DDH] is a common pediatric condition, treated successfully in 80.2 to 96.7% cases by nonrigid bracing (e.g. Pavlik harness). If treatment fails patients usually undergo closed reduction and hip spica casting under anesthesia. Less invasive therapeutic options are being investigated. This study assessed outcomes of treatment of mild to moderate DDH with semirigid plastic abduction orthosis after initial failure of bracing with Pavlik harness in infants younger than 6 months.
    Charts, sonograms and X-rays of 9 patients with 14 hips affected by DDH were retrospectively reviewed. 9 hips were unstable, but reducible, 5 hips were stable; however, remained severely dysplastic at the presentation. All patients were initially placed in Pavlik harness at median age 11 days (3 - 138). All patients were switched to plastic hip abduction orthosis after 30 (21 - 109) days of bracing with Pavlik harness, due to lack of clinical and/or sonographic improvement. After 63 (35 - 124) days spent full time and 245 (64 - 315) days spent part time in semirigid plastic hip abduction orthosis all patients demonstrated full clinical and sonographic recovery after 3 (2 - 5) years of follow up; however, 50% of the hips remained mildly dysplastic radiographically. Minor complications (superficial skin breakdowns at the edges of the brace) were noted in 4 cases.
    This study demonstrated that semirigid plastic hip abduction orthosis is a safe and effective treatment option for the infant with developmental dysplasia and a reducible hip, resistant to bracing with a Pavlik harness; however, close monitoring is warranted to address frequent skin complications and residual radiographic dysplasia.
    Reiner Josef Wirbel1*, Christina Vrabac2, Tim Pohlemann2 and Sascha Hopp2
    Abstract: The AO / ASIF classification of tibial plateau fractures is based on radiographic morphological criteria, the classification according to Moore considers also functional criteria. The aim of this study was to compare the interobserver reliability and the intraobserver reproducibility of both calssification systems.
    Plain film radiographs and computed tomographs of 25 tibial plateau fractures were presented to 16 observers. There were three groups of observers with regard to their clinical expertise. Assessments were repeated 3 months later. The inter- and intraobserver reliability were evaluated by the kappa coefficients.
    The interobserver reliability and the intraobserver reproducibility for both classification systems showed only fair to moderate agreement with kappa values ranged between 0.17 and 0.46. There were no considerably differences between the two classification systems. The experience of the observers did not influence the agreement at all. Even special training of the low experienced observers before the second assessment could not improve the interobserver agreement.
    Reliability of the AO / ASIF and Moore classifications for tibial plateau fracture is challenging. Tibial plateau fractures are difficult to classify. Additional criteria have to be developed for reliable and reproducible classification. The results of clinical studies about tibial plateau fractures have to be analysed critically.
    Case Report
    Claudia Kallfelz1, Reiner Wirbel2*, Merten Kriewitz3, Alexander Stolben4 and Lutz von Laer5
    Abstract: The rare case of an acute haematogenous osteomyelitis of the patella in a 9-year old boy is presented. Primarily, the symptoms were misinterpreted as tonsillitis or acute rheumatoid arthritis. MRI was helpful to confirm the correct diagnosis. Sequestration of the patella required surgical debridment. Recurrence after seven weeks could be cured by renewed sequestrectomy. The actual examination after two years did not present signs of relapse.
    Presenting an updated algorithm, the problems of the diagnostic and therapeutic process in acute haematogenous osteomyelitis in childhood are discussed.
    Review Article
    Molina RA, Bohlen H*, Kwiat D, Leasure J, Buckley JM and Lattanza L
    Background: Posterolateral rotatory instability (PLRI) of the elbow requires surgical reconstruction. A docking technique with a tendon graft is traditionally used; however, the techniques for lateral ulnar collateral ligament (LUCL) reconstruction have evolved with attempts to increase the effectiveness of the surgery. The purpose of our study is to biomechanically compare a docking technique to an interference screw fixation technique for LUCL reconstruction.
    Methods: Six matched pairs of cadaveric elbows underwent biomechanical testing. The first group used two 4.5 x 15 mm soft tissue interference screws (Arthrex PEEK) to secure the graft. The second group used a docking technique. Palmaris tendons were harvested from each arm. The elbows were cyclically loaded using 0.5 Nm supination torque with 70N of axial compression for 50 cycles at 0.1Hz, and then loaded to failure.
    Results: The average stiffness and ultimate torque for the interference screw fixation group were not significantly different from reconstructed elbows using a docking technique. In cyclical loading testing, the conditional relaxation did not show any difference between the two groups as well.
    Discussion and Conclusion: The interference screw reconstruction technique was biomechanically equivalent to the docking technique in this model. However, we chose a smaller screw so that tendon graft size was equal in the two groups. In a patient setting, the screw and graft size can be increased, likely leading to an even stronger construct. In addition, reduced soft tissue stripping and increased precision provided by the interference screw technique may make it the superior option for LUCL reconstruction. Level of Evidence: Basic Science, Biomechanics, Cadaver Model.
    Letter to Editor
    Iraj Salehi-Abari*
    Scleroderma is divided into localized and systemic. Localized Scleroderma is a cutaneous disease with only sclerosis of one or more skin area without Raynaud's phenomenon and visceral involvement, but systemic Scleroderma [or systemic sclerosis] is a chronic autoimmune multisystem disorder with overproduction of collagen fibers; presented as a combination of thickened/sclerotic skin involvement and visceral organ fibrosis along with Raynaud's phenomenon. The pathogenesis of this disease is unknown but upon a genetic background, environmental trigger factors can initiate the pathophysiology of it. Its pathophysiology has three axises:Vascular events including Raynaud's phenomenon and endothelial injury, immunological events and activated fibrogenic fibroblast. When complex interplay between basal vasculopathy and autoimmunity affectsfibrogenic fibroblasts, it initiates and amplifies the fibrotic process and in this stage the disorder will be irreversible/progressive and it is not curable or even, treatable. So, we need to diagnose the state before the start of fibrosis of skin and viscera. This state can be called as pre-scleroderma state. In this letter, the corresponding author wants to deliver a diagnostic criteria for pre-scleroderma state. If in this step, the problems can be detected, it may be prevented, but after establishment of scleroderma, it cannot be curable o treatable.
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