Session 4: Pediatrics
Onsdag den 23. oktober
11:00 - 12:00
Lokale: Centersal
Chairmen: Martin Gottliebsen og Ole Rahbek
Christian Færgemann
Department of Orthopedics and Traumatology, Odense University Hospital
Background: Generally, children in Denmark live a safe life. The incidence of severe injuries in children is low. However, each year a number of Danish children are severely injured and some die from their injuries. The epidemiology of severe injuries in Danish children is largely unknown and is important information in prevention and for hospital resource planning.
Purpose / Aim of Study: To describe the epidemiology of severely injured children admitted to a Danish trauma centre.
Materials and Methods: A descriptive study including all severely injured (ISS>15) children aged 0-15 years admitted to the university level trauma centre at Odense University Hospital 2002-2018. Data was extracted from the multiple trauma register and medical records. Data analyses were made stratified by age groups (0 2018. Data was extracted from the multiple trauma register and medical records. Data analyses were made stratified by age groups (0-4, 5-10, and 11-15 years).
Findings / Results: Overall152 children were included as 62 % were primarily admitted and 38 % were transferred from another hospital. The median number of cases each year was 8. Overall 58 % were boys. The median age was 11 (0-15) years. Accidents accounted for 99 % and in two cases (1 %) the injuries were inflicted by violence. Overall half of the injuries were traffic related and accounted for 22 %, 55 %, and 60 % in the age groups 0-4, 5-10, and 11-15 years respectively. Among the traffic injured children 50 % were injured in a car crash and 38 % as a pedestrian in the youngest age group. In the eldest age group 46 % were injured riding a bicycle and 22 % in a car crash. Injuries in domestic areas accounted for 51 %, 24 %, and 11 % in the different age groups with falls from heights as the dominating trauma mechanism. The overall median ISS was 25 (16-75) with no differences between age groups. Overall 39 (25 %) children died. The mortality in the age groups was 24 %, 15 %, and 30 %. Overall 89 % had injuries in the head/face, 57 % had limb injuries, 36 % had injuries in the thorax, 25 % had abdominal injuries, and 11 % had spinal injuries.
Conclusions: The study describes the epidemiology of severely injured children by including several aspects regarding injury pattern and severity, which may be useful in a population for risk identification, prevention of accidents among specific subgroups, and for hospital resource planning.
Department of Orthopedics and Traumatology, Odense University Hospital
Background: Generally, children in Denmark live a safe life. The incidence of severe injuries in children is low. However, each year a number of Danish children are severely injured and some die from their injuries. The epidemiology of severe injuries in Danish children is largely unknown and is important information in prevention and for hospital resource planning.
Purpose / Aim of Study: To describe the epidemiology of severely injured children admitted to a Danish trauma centre.
Materials and Methods: A descriptive study including all severely injured (ISS>15) children aged 0-15 years admitted to the university level trauma centre at Odense University Hospital 2002-2018. Data was extracted from the multiple trauma register and medical records. Data analyses were made stratified by age groups (0 2018. Data was extracted from the multiple trauma register and medical records. Data analyses were made stratified by age groups (0-4, 5-10, and 11-15 years).
Findings / Results: Overall152 children were included as 62 % were primarily admitted and 38 % were transferred from another hospital. The median number of cases each year was 8. Overall 58 % were boys. The median age was 11 (0-15) years. Accidents accounted for 99 % and in two cases (1 %) the injuries were inflicted by violence. Overall half of the injuries were traffic related and accounted for 22 %, 55 %, and 60 % in the age groups 0-4, 5-10, and 11-15 years respectively. Among the traffic injured children 50 % were injured in a car crash and 38 % as a pedestrian in the youngest age group. In the eldest age group 46 % were injured riding a bicycle and 22 % in a car crash. Injuries in domestic areas accounted for 51 %, 24 %, and 11 % in the different age groups with falls from heights as the dominating trauma mechanism. The overall median ISS was 25 (16-75) with no differences between age groups. Overall 39 (25 %) children died. The mortality in the age groups was 24 %, 15 %, and 30 %. Overall 89 % had injuries in the head/face, 57 % had limb injuries, 36 % had injuries in the thorax, 25 % had abdominal injuries, and 11 % had spinal injuries.
Conclusions: The study describes the epidemiology of severely injured children by including several aspects regarding injury pattern and severity, which may be useful in a population for risk identification, prevention of accidents among specific subgroups, and for hospital resource planning.
Martin Gottliebsen, Ole Rahbek, Mathias Bunger, Bjarne Moller-Madsen
Orthopaedics, Aarhus University Hospital; Orthopaedics, Aarhus University Hospital; Orthopaedics, Children's Hospital Westmead, Sydney; Orthopaedics, Aarhus University Hospital
Background: Slipped Capital Femoral Epiphysis (SCFE) is a condition that affects the hips in older children and adolescents. Current treatment is primarily based on in situ fixation using a single cannulated screw. Anatomical re-alignment using surgical dislocation of the affected hip joint is gaining increasing acceptance. The procedure is technically demanding and carries a risk for inducing avascular necrosis (AVN) of the femoral head. Based on experience from an international high volume centre we have established a setup where we use a intracranial pressure (ICP) monitoring probe to monitor perfusion of the femoral head during surgery.
Purpose / Aim of Study: To present our experience with treating severe SCFE using surgical dislocation technique guided by monitoring of femoral head perfusion.
Materials and Methods: From March 2016 to March 2019 a total of 16 children underwent surgical dislocation for severe SCFE at Aarhus University Hospital. The group consisted of 11 girls and 5 boys with median age 13 year (range 10 - 16 year). Median slip angle before surgery was 63,5 deg (range 44 - 77). 5 children had unstable SCFE at the time of admission. Intraoperative monitoring of perfusion in the femoral head was performed using a Codman ICP probe.
Findings / Results: All children had perfused femoral heads postoperatively on SPECT (Bonescan). AVN was not detected during follow-up (range 6w - 2y). Median correction of deformity was 51.5 deg (range 30 - 65). Prophylactic fixation of the contralateral hip was performed in 8 cases.
Conclusions: We present 16 consecutive cases of open reduction for severe SCFE using a new surgical procedure. AVN was not observed in any cases. Avoiding this devastating complication is the most important step to improve the outcome by performing anatomical realignment in severe SCFE.
Orthopaedics, Aarhus University Hospital; Orthopaedics, Aarhus University Hospital; Orthopaedics, Children's Hospital Westmead, Sydney; Orthopaedics, Aarhus University Hospital
Background: Slipped Capital Femoral Epiphysis (SCFE) is a condition that affects the hips in older children and adolescents. Current treatment is primarily based on in situ fixation using a single cannulated screw. Anatomical re-alignment using surgical dislocation of the affected hip joint is gaining increasing acceptance. The procedure is technically demanding and carries a risk for inducing avascular necrosis (AVN) of the femoral head. Based on experience from an international high volume centre we have established a setup where we use a intracranial pressure (ICP) monitoring probe to monitor perfusion of the femoral head during surgery.
Purpose / Aim of Study: To present our experience with treating severe SCFE using surgical dislocation technique guided by monitoring of femoral head perfusion.
Materials and Methods: From March 2016 to March 2019 a total of 16 children underwent surgical dislocation for severe SCFE at Aarhus University Hospital. The group consisted of 11 girls and 5 boys with median age 13 year (range 10 - 16 year). Median slip angle before surgery was 63,5 deg (range 44 - 77). 5 children had unstable SCFE at the time of admission. Intraoperative monitoring of perfusion in the femoral head was performed using a Codman ICP probe.
Findings / Results: All children had perfused femoral heads postoperatively on SPECT (Bonescan). AVN was not detected during follow-up (range 6w - 2y). Median correction of deformity was 51.5 deg (range 30 - 65). Prophylactic fixation of the contralateral hip was performed in 8 cases.
Conclusions: We present 16 consecutive cases of open reduction for severe SCFE using a new surgical procedure. AVN was not observed in any cases. Avoiding this devastating complication is the most important step to improve the outcome by performing anatomical realignment in severe SCFE.
Vilhelm Engell, Mathias Bünger, Ole Rahbek, Søren Qwist
Ortopædkirurgisk, Århus Universitets Hospital; Ortopædkirurgisk, Århus Universitets Hospital; Ortopædkirurgisk, Århus Universitets Hospital; Ortopædkirurgisk, Århus Universitets Hospital
Background: The Ponseti method is the gold standard in the treatment of Congenital Clubfoot due to its efficacy and good long term results. The standard Ponseti method entails weekly manipulation and plaster casting in order to correct all components of the clubfoot.In order to reduce the duration of the initial correction plaster casting intervals have been reduced with comparebly good results in several accelerated series.
Purpose / Aim of Study: We report our results and experience with accelerated Ponseti method in a consecutive prospective series of clubfeet.
Materials and Methods: In this consecutive prospective series we included all children with congenital idiopathic clubfoot treated in the department in 2016. They were treated using an accelerated Ponseti method with manipulation and casting twice a week. Controls were all children with congenital idiopathic clubfoot treated in the department in 2015 using the standard Ponseti method. All patients in both groups had follow-up at two years. A p-value of < 0.05 was considered statistically significant.
Findings / Results: During follow-up we had relapse in two feet (7%) in PM and four feet (14%) in APM (p=0,41). All were treated with (re)casting + second TAL. APM reduced the correction time by 40 % from 32 to 19 days (p=0,0002).
Conclusions: Eventhough not statistically significant there were increased relapse in APM compared to PM. One of the feet in the APM was non-compliant with the FAB. A longer follow-up will further assess the relapse rate. We found that APM reduced the correction time by 40 %.
Ortopædkirurgisk, Århus Universitets Hospital; Ortopædkirurgisk, Århus Universitets Hospital; Ortopædkirurgisk, Århus Universitets Hospital; Ortopædkirurgisk, Århus Universitets Hospital
Background: The Ponseti method is the gold standard in the treatment of Congenital Clubfoot due to its efficacy and good long term results. The standard Ponseti method entails weekly manipulation and plaster casting in order to correct all components of the clubfoot.In order to reduce the duration of the initial correction plaster casting intervals have been reduced with comparebly good results in several accelerated series.
Purpose / Aim of Study: We report our results and experience with accelerated Ponseti method in a consecutive prospective series of clubfeet.
Materials and Methods: In this consecutive prospective series we included all children with congenital idiopathic clubfoot treated in the department in 2016. They were treated using an accelerated Ponseti method with manipulation and casting twice a week. Controls were all children with congenital idiopathic clubfoot treated in the department in 2015 using the standard Ponseti method. All patients in both groups had follow-up at two years. A p-value of < 0.05 was considered statistically significant.
Findings / Results: During follow-up we had relapse in two feet (7%) in PM and four feet (14%) in APM (p=0,41). All were treated with (re)casting + second TAL. APM reduced the correction time by 40 % from 32 to 19 days (p=0,0002).
Conclusions: Eventhough not statistically significant there were increased relapse in APM compared to PM. One of the feet in the APM was non-compliant with the FAB. A longer follow-up will further assess the relapse rate. We found that APM reduced the correction time by 40 %.
Ole Rahbek, Martin Gottliebsen, Bjarne Møller-Madsen, Michel Bach Hellfritzsch
Children´s Orthopedics, Aarhus University Hospital; Children´s Orthopedics, Aarhus University Hospital; Children´s Orthopedics, Aarhus University Hospital; Department of Radiology, Aarhus University Hospital
Background: MRI may have a role in the assessment of acetabular dysplasia. MRI provides information on Cartilaginous Acetabular Index (CAI) as well as the Osseous Acetabular Index (OAI). OAI decreases until the age of 10-12 years. CAI remains stable from 2 years of age and may therefore be a predictor for acetabular roof development.
Purpose / Aim of Study: To compare findings from standard pelvic radiographs (XR) and coronal MRI images in acetabular residual DDH. Primary aim was to establish the reliability of OAI and CAI. Secondary aim was to estimate feasibility of MRI examination and compare findings of MRI with XR in a retrospective cohort with age between 4-12 years of age.
Materials and Methods: Booking lists were searched for patients with coronal MRIs. OAI, CAI and descriptions were obtained from MRI and XR radiological reports. Blinded measurements where repeated. Bias and limits of agreement (LOA) were calculated for intra- and interrater agreement (Bland Altman). Agreements and correlation (Pearson) between MRI and PR were established. Bias was compared (F-test, T-test).
Findings / Results: 15 (1 male) patients (30 hips) with coronal MRIs and prior XRs were obtained. Mean age was 5 (range 4-12) years. MRIs were performed without sedation. Most XRs were with tilted pelvis (13 of 15). Mean interval between XR and MRI was 134 (range 14-300) days. CAI had the best intra- and interrater agreement (Bias -0, LOA -4.1,4.1; Bias 0.2, LOA -4.5,5.2) compared to OAI (XR and MRI). OAI (MRI) correlated slightly better with OAI (XR) than CAI (r=0.73 vs r=0.68). Agreement for OAI (XR) and OAI (MRI) was established (Bias 1.2, LOA -6.0,8.4). In 2 of 15 of MRIs ischiofemoral impingement was suspected. Other MRI findings were joint effusion (2 hips), ganglion (1 hip), labrum abnormality (4 hips) and bilateral bone marrow edema at the ischio-pubic synchondrosis (1 patient).
Conclusions: CAI is a more reliable measurement compared to OAI (MRI or XR). Additional valuable information from MRI was gained in 8 of 15 patients. MRI is feasible from the age of 4 years without sedation. MRI should be considered as a routine examination in pediatric acetabular dysplasia.
Children´s Orthopedics, Aarhus University Hospital; Children´s Orthopedics, Aarhus University Hospital; Children´s Orthopedics, Aarhus University Hospital; Department of Radiology, Aarhus University Hospital
Background: MRI may have a role in the assessment of acetabular dysplasia. MRI provides information on Cartilaginous Acetabular Index (CAI) as well as the Osseous Acetabular Index (OAI). OAI decreases until the age of 10-12 years. CAI remains stable from 2 years of age and may therefore be a predictor for acetabular roof development.
Purpose / Aim of Study: To compare findings from standard pelvic radiographs (XR) and coronal MRI images in acetabular residual DDH. Primary aim was to establish the reliability of OAI and CAI. Secondary aim was to estimate feasibility of MRI examination and compare findings of MRI with XR in a retrospective cohort with age between 4-12 years of age.
Materials and Methods: Booking lists were searched for patients with coronal MRIs. OAI, CAI and descriptions were obtained from MRI and XR radiological reports. Blinded measurements where repeated. Bias and limits of agreement (LOA) were calculated for intra- and interrater agreement (Bland Altman). Agreements and correlation (Pearson) between MRI and PR were established. Bias was compared (F-test, T-test).
Findings / Results: 15 (1 male) patients (30 hips) with coronal MRIs and prior XRs were obtained. Mean age was 5 (range 4-12) years. MRIs were performed without sedation. Most XRs were with tilted pelvis (13 of 15). Mean interval between XR and MRI was 134 (range 14-300) days. CAI had the best intra- and interrater agreement (Bias -0, LOA -4.1,4.1; Bias 0.2, LOA -4.5,5.2) compared to OAI (XR and MRI). OAI (MRI) correlated slightly better with OAI (XR) than CAI (r=0.73 vs r=0.68). Agreement for OAI (XR) and OAI (MRI) was established (Bias 1.2, LOA -6.0,8.4). In 2 of 15 of MRIs ischiofemoral impingement was suspected. Other MRI findings were joint effusion (2 hips), ganglion (1 hip), labrum abnormality (4 hips) and bilateral bone marrow edema at the ischio-pubic synchondrosis (1 patient).
Conclusions: CAI is a more reliable measurement compared to OAI (MRI or XR). Additional valuable information from MRI was gained in 8 of 15 patients. MRI is feasible from the age of 4 years without sedation. MRI should be considered as a routine examination in pediatric acetabular dysplasia.
Cecilie Schmidt Østergaard, Nanna Sofie Astrup Pedersen, Anne Thomasen, Inger Mechlenburg, Kirsten Nordbye-Nielsen
Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital
Background: Experienced pain and affected gross motor functioning in children diagnosed with cerebral palsy (CP), might influence children’s participation in physical leisure activities. These factors may also influence children’s development of social skills, the feeling of being part of community and limit the child’s experienced quality of life.
Purpose / Aim of Study: The aim was to investigate the prevalence of pain among children with CP. Furthermore, to investigate the association between reporting pain and participation in physical leisure activities and the association between gross motor functioning and participation in in physical leisure activities.
Materials and Methods: This is a cross sectional study based on data from the National Danish Clinical Quality Database on children diagnosed with CP or symptoms similar to CP. The study population consisted of 960 children aged between 2-11 years across all Gross Motor Function Classification System levels (GMFCS levels), registered in the database by physiotherapists at regular visits in 2016 or 2017. We had information about participation in physical leisure activities for 845 children and information on pain for 817 children. The associations were estimated as odds ratios (OR) by logistic regression, adjusted for age.
Findings / Results: 36% of the children had pain. Children who reported pain, had a statistically significant lower participation in physical leisure activities, compared to children who did not report pain (p=0.03). Children with the lowest GMFCS level I, had a higher participation in physical leisure activities than children with a higher GMFCS level V (p<0.01).
Conclusions: Our study shows that a large part of children with CP report to have pain. Moreover, the study indicates that pain is associated with the level of participation in physical leisure activities in children with CP. Furthermore, children’s gross motor functioning is significantly associated with participation in physical leisure activities.
Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital
Background: Experienced pain and affected gross motor functioning in children diagnosed with cerebral palsy (CP), might influence children’s participation in physical leisure activities. These factors may also influence children’s development of social skills, the feeling of being part of community and limit the child’s experienced quality of life.
Purpose / Aim of Study: The aim was to investigate the prevalence of pain among children with CP. Furthermore, to investigate the association between reporting pain and participation in physical leisure activities and the association between gross motor functioning and participation in in physical leisure activities.
Materials and Methods: This is a cross sectional study based on data from the National Danish Clinical Quality Database on children diagnosed with CP or symptoms similar to CP. The study population consisted of 960 children aged between 2-11 years across all Gross Motor Function Classification System levels (GMFCS levels), registered in the database by physiotherapists at regular visits in 2016 or 2017. We had information about participation in physical leisure activities for 845 children and information on pain for 817 children. The associations were estimated as odds ratios (OR) by logistic regression, adjusted for age.
Findings / Results: 36% of the children had pain. Children who reported pain, had a statistically significant lower participation in physical leisure activities, compared to children who did not report pain (p=0.03). Children with the lowest GMFCS level I, had a higher participation in physical leisure activities than children with a higher GMFCS level V (p<0.01).
Conclusions: Our study shows that a large part of children with CP report to have pain. Moreover, the study indicates that pain is associated with the level of participation in physical leisure activities in children with CP. Furthermore, children’s gross motor functioning is significantly associated with participation in physical leisure activities.
Line Kjeldgard Pedersen, Ole Rahbek, Bjarne Møller-Madsen
Department of Children's Orthopedics, Aarhus University Hospital; Department of Children's Orthopedics, Aarhus University Hospital; Department of Children's Orthopedics, Aarhus University Hospital
Background: The lateral femoral cutaneous nerve (LFCN) has several anatomical variations. Iatrogenic damage in relation to surgery might cause painful meralgia paresthetica. A metaanalysis of adult cadaveric dissection and ultrasound imaging studies of LFCN report that 87% of nerves exits medial to the anterior superior iliac spine (ASIS) and under the inguinal ligament (IL) with a mean distance of 19 mm to the ASIS. A single nerve was the far most common branching pattern. No anatomic studies of the LFCN in a pediatric population has been reported.
Purpose / Aim of Study: To report in vivo anatomical variations of the LFCN in a pediatric population.
Materials and Methods: Thirty-one children (15 boys, 16 girls) aged 4-14 years undergoing pelvic osteotomy (three bilateral) were included in a prospective study. Standardized peroperative photography of the LFCN was performed. The outcome parameters were pelvic exit, distance from exit to ASIS, branching patterns, LFCN width and appearance.
Findings / Results: Of the 34 LFCN’s in this study, 31 nerves (91%) exited the pelvis medial to the ASIS and under the Sartorius muscle, one nerve (3%) exited the pelvis medial to the ASIS but through the IL, one nerve (3%) exited through the ASIS and one nerve (3%) exited lateral to the ASIS. The mean distance from the pelvic exit to the ASIS was 17 mm. Nine nerves (26%) showed no branching, one nerve had a bifurcation within the pelvis (3%), 12 nerves (35%) showed bifurcation in the IL area, seven nerves (20%) showed trifurcation, two nerves (6%) showed quadrification and three nerves (9%) had a branching pattern of more than four. Nine nerves (26%) had a curved appearance and 25 nerves (74%) had a straight appearance.
Conclusions: Present study indicates that in a pediatric population, the LFCN exits the pelvis medial to the ASIS more frequently than in adults with a mean distance to the ASIS similar to adults even though not corrected for body size. Furthermore, the LFCN exhibits markedly higher number of branches in children compared to adults. The pediatric surgeon need to be aware hereof to avoid iatrogenic injury to the LFCN.
Department of Children's Orthopedics, Aarhus University Hospital; Department of Children's Orthopedics, Aarhus University Hospital; Department of Children's Orthopedics, Aarhus University Hospital
Background: The lateral femoral cutaneous nerve (LFCN) has several anatomical variations. Iatrogenic damage in relation to surgery might cause painful meralgia paresthetica. A metaanalysis of adult cadaveric dissection and ultrasound imaging studies of LFCN report that 87% of nerves exits medial to the anterior superior iliac spine (ASIS) and under the inguinal ligament (IL) with a mean distance of 19 mm to the ASIS. A single nerve was the far most common branching pattern. No anatomic studies of the LFCN in a pediatric population has been reported.
Purpose / Aim of Study: To report in vivo anatomical variations of the LFCN in a pediatric population.
Materials and Methods: Thirty-one children (15 boys, 16 girls) aged 4-14 years undergoing pelvic osteotomy (three bilateral) were included in a prospective study. Standardized peroperative photography of the LFCN was performed. The outcome parameters were pelvic exit, distance from exit to ASIS, branching patterns, LFCN width and appearance.
Findings / Results: Of the 34 LFCN’s in this study, 31 nerves (91%) exited the pelvis medial to the ASIS and under the Sartorius muscle, one nerve (3%) exited the pelvis medial to the ASIS but through the IL, one nerve (3%) exited through the ASIS and one nerve (3%) exited lateral to the ASIS. The mean distance from the pelvic exit to the ASIS was 17 mm. Nine nerves (26%) showed no branching, one nerve had a bifurcation within the pelvis (3%), 12 nerves (35%) showed bifurcation in the IL area, seven nerves (20%) showed trifurcation, two nerves (6%) showed quadrification and three nerves (9%) had a branching pattern of more than four. Nine nerves (26%) had a curved appearance and 25 nerves (74%) had a straight appearance.
Conclusions: Present study indicates that in a pediatric population, the LFCN exits the pelvis medial to the ASIS more frequently than in adults with a mean distance to the ASIS similar to adults even though not corrected for body size. Furthermore, the LFCN exhibits markedly higher number of branches in children compared to adults. The pediatric surgeon need to be aware hereof to avoid iatrogenic injury to the LFCN.
Uggi Balle, Christian Færgemann
Orthopedic Department, Odense University Hospital; Orthopedic Department , Odense University hospital
Background: Bone lengthening with an intramedullary magnetic nail has become first choice of treatment in both adults and old children with lower limb length discrepancy (LLD). Studies have described the procedure as a safe method. Since 2015 the method has been the standard treatment at Odense University Hospital.
Purpose / Aim of Study: To describe the outcome with focus on intra- and postoperative complications to intramedullary bone lengthening with Precise® magnetic nails.
Materials and Methods: A descriptive study of all patients with LLD who underwent limb lengthening surgery with Precise® magnetic intramedullary nail at OUH 2015-2018. Data on all patients were extracted from medical records.
Findings / Results: Overall 12 patients were included. The median age was 26 (14-49) years. The median LLD was 35 (18-90) mm. A femoral anterograde technique was used in 9 cases, a femoral retrograde technique in two cases in order to correct a simultaneously distal angular deformity, and a tibial anterograde technique was used in one case. No patients had intraoperative complications. All patients had continuous regional analgesic treatment postoperatively and discharged after 3-9 days. All patients were mobilized with restricted weight bearing (¡Ü 20 kg). So far no postoperative infection or bleeding has been observed. Eight patients had the LLD fully corrected (¡À5 mm). Two patients were corrected according to the preoperative ambition leaving a rest-LLD of 10 mm and 30 mm. Two patients did not receive the planned full correction because of complications. One patient with hypothyroidism required secondary auto-transplant and intramedullary nailing of tibia due to lack of bone formation. The LLD was partly corrected. One patient with cerebral palsy had the lengthening prematurely terminated after 20 mm of lengthening (35mm intended) because of contracture of the knee. One person had a fracture through the callus 205 days postoperatively due to too early return to sports. After a year all three patients were fully mobilized with no sequelae.
Conclusions: Based on a limited number of cases intramedullary bone lengthening with Precise® magnetic nail seems to be a safe procedure. However, continuously monitoring of complications is important.
Orthopedic Department, Odense University Hospital; Orthopedic Department , Odense University hospital
Background: Bone lengthening with an intramedullary magnetic nail has become first choice of treatment in both adults and old children with lower limb length discrepancy (LLD). Studies have described the procedure as a safe method. Since 2015 the method has been the standard treatment at Odense University Hospital.
Purpose / Aim of Study: To describe the outcome with focus on intra- and postoperative complications to intramedullary bone lengthening with Precise® magnetic nails.
Materials and Methods: A descriptive study of all patients with LLD who underwent limb lengthening surgery with Precise® magnetic intramedullary nail at OUH 2015-2018. Data on all patients were extracted from medical records.
Findings / Results: Overall 12 patients were included. The median age was 26 (14-49) years. The median LLD was 35 (18-90) mm. A femoral anterograde technique was used in 9 cases, a femoral retrograde technique in two cases in order to correct a simultaneously distal angular deformity, and a tibial anterograde technique was used in one case. No patients had intraoperative complications. All patients had continuous regional analgesic treatment postoperatively and discharged after 3-9 days. All patients were mobilized with restricted weight bearing (¡Ü 20 kg). So far no postoperative infection or bleeding has been observed. Eight patients had the LLD fully corrected (¡À5 mm). Two patients were corrected according to the preoperative ambition leaving a rest-LLD of 10 mm and 30 mm. Two patients did not receive the planned full correction because of complications. One patient with hypothyroidism required secondary auto-transplant and intramedullary nailing of tibia due to lack of bone formation. The LLD was partly corrected. One patient with cerebral palsy had the lengthening prematurely terminated after 20 mm of lengthening (35mm intended) because of contracture of the knee. One person had a fracture through the callus 205 days postoperatively due to too early return to sports. After a year all three patients were fully mobilized with no sequelae.
Conclusions: Based on a limited number of cases intramedullary bone lengthening with Precise® magnetic nail seems to be a safe procedure. However, continuously monitoring of complications is important.