Material and Methods: We reviewed a series of eight cases with standard and modified techniques of plating after lengthening. The amount of lengthening, the period of distraction, the external fixator index and the associated complications were assessed.
Results: The mean lengthening was 5cm, with a range of 3cm to 9cm. The external fixation index, the period of external fixators in days in relation to the length of distraction in cm, was between 18 days/cm to 58 days/cm. One patient with quadriceps contracture, underwent quadriceplasty to improve knee flexion. Three patients with transient knee stiffness had resolution with aggressive physiotherapy. One patient with transient hypoesthesia recovered spontaneously. None of the patients developed joint subluxation, deep infection, re-fracture or implant failures.
Conclusion: Standard and modified techniques of plating after lengthening were safe and required only a short period of external fixation. The modified technique offered an easier way of plate insertion in a deformed bone.
Materials and Methods: From 2010 to 2017, a total of 19 patients with infected tibia non-union and a bone defect less than 3cm, were treated with debridement and a monolateral frame fixation with acute shortening and lengthening. The patients were divided into two groups: one in which no bone graft was used at the docking site during early years of the study; and a later group in which autologous bone graft was used at the acute docking site primarily in addition to compression. Consolidation at the docking site was assessed both radiographically and clinically, and the results were statistically analysed.
Results: There were 12 patients in Group I without bone graft, where consolidation at the docking site was noted after a mean duration of 22.08 ± 3.87 weeks. There were seven patients in Group II with bone graft, where the mean time for docking site consolidation was significantly lower at 16.57 ± 3.82 weeks. No docking site complications were noted in either group.
Conclusion: Primary autologous bone graft enhances docking site consolidation in acute shortening. The routine use of bone graft at the docking site in acute shortening will expedite the docking site union with reduction of treatment time.
OBJECTIVE: This analysis is a subset of a larger systematic review. The objective of this study is to determine the effects of MDO on feeding and GERD.
DATA SOURCES: The databases searched included PubMed, Embase, Scopus, Web of Knowledge and grey literature sources.
STUDY SELECTION: The inclusion criterion included studies in children with clinical evidence of micrognathia/Pierre Robin Sequence (PRS) who have failed conservative treatments, including both syndromic (sMicro) and non-syndromic (iPRS) patients. 21 studies relevant to feeding and 4 studies relevant to GERD outcomes were included. All studies included were case series and case reports.
RESULTS: MDO leads to a significant improvement in feeding, with 82% of children feeding exclusively orally after surgery. The overall percentage of children with iPRS who were feeding orally was 93.7% compared with only 72.9% in the sMicro group (p<0.004). A growth decline within the first six weeks after surgery was observed in multiple studies. Overall, out of 70 patients with pre-operative GERD, only four had evidence of GERD after surgery.
CONCLUSIONS: Considering the limitations of this systematic review, this study found that successful relief of airway obstruction by MDO leads to improvement of feeding and improvement in symptoms of GERD in children with upper airway obstruction secondary to micrognathia. Clinicians need to be aware of the risk of growth decline in the initial post-operative period.