X-ray at eight months and 45 degree angle
Douglas Armstrong, M.D., Penn State Hershey Bone and Joint Institute, has taken a serious second look at serial casting for infantile scoliosis and found reason to pursue its use for his own patients. “Just ten years ago, the technique was largely rejected by U.S. physicians, who regarded it as ineffective. But patients with early onset scoliosis, meaning those who develop scoliosis before age five, face grim long-term outcomes if not treated.” Serial casting seemed to Armstrong a reasonable option.
“Many surgeons believe that infants with scoliosis onset don’t do well with brace treatment. Apart from casting, the only other option is surgical intervention,” explains Armstrong.
Inadequately corrected infantile scoliosis leads to chest wall deformities, poor lung development, and higher rate of early adulthood mortality; therefore, physicians have begun to use more aggressive treatment approaches. Typically, Armstrong and his Penn State Hershey colleagues may treat twelve or more cases of early onset scoliosis per year.
Open fractures, usually resulting from automobile or motorcycle accidents, are often associated with poor long-term outcomes involving loss of function, amputation and mortality. “To preserve the limb, the most important goals are to stabilize the fracture, decontaminate the wound, and preserve or re-establish the blood supply,” explains Henry Boateng, M.D., Penn State Hershey Bone and Joint Institute. Continue reading
For osteochondritis dissecans (OCD) of the knee, avascular necrosis of subchondral bone can lead to fragmentation of bone and overlying cartilage [Figure 1]; osteochondral loose body formation may occur, leading to pain and further articular damage. According to Kevin Black, M.D., Penn State Hershey Bone and Joint Institute, “The number one goal in treating all patients with OCD is to preserve the articular surface. In skeletally immature children, OCD tends to heal on its own with three to six months of rest and limited activity. In skeletally mature patients, the lesions don’t heal and predictably require surgery.” Continue reading
While open thoracotomy is the traditional approach most often chosen for patients undergoing thoracic spine reconstruction, alternative approaches can be useful in certain situations. Mark Knaub, M.D., Penn State Hershey Bone and Joint Institute, says, “For patients with spinal tumors, osteomyelitis or major trauma, particularly at upper thoracic levels, an open thoracotomy may not offer sufficient access to the surgical site. In these cases, a costotransversectomy approach can be superior. A single surgical approach can be used for both removal of diseased vertebral body tissue and placement of stabilizing hardware.” To minimize complications and optimize reconstruction, Knaub explains, “It’s critical to achieve the proper angle of access and for this it’s necessary to remove approximately five centimeters or more of at least two ribs; in some situations, more rib tissue must be removed. Such removal also involves sacrificing one or two thoracic nerve roots.” Because the nerve roots are sensory in nature and share overlapping fields of innervation, patients may experience postoperative numbness, but there are no functional consequences. There is a small risk of violation of the pleura, as well as major blood vessel injury. These risks can be minimized by staying right against the bone while working in the anterior column. Continue reading
AP X-ray of pelvis in a six-week old child
Developmental dysplasia of the hip (DDH), seen in 2 of every 1000 infants, is present when there is an abnormal relationship between the femoral head and acetabulum, including dislocation, partial-dislocation, and instability. William Hennrikus, M.D., Penn State Hershey Bone and Joint Institute, says, “It’s widely understood that early detection of DDH is important because, if untreated, it can lead to gait anomalies, pain, and arthritis. All babies are universally screened for DDH at well-baby visits using a physical examination. Infants born in the breech position and those with a family history of DDH, however, are at increased risk and require regular examination and monitoring.” Since 2000, the American Academy of Pediatrics (AAP) has recommended targeted hip imaging via ultrasound at six weeks of age for female infants born in the breech position, along with optional hip imaging for boys born in the breech position or girls with a positive family history of DDH [1,2]. Hennrikus notes, “The AAP recommendation assumes that ultrasound is universally available. Our research shows that in Pennsylvania this isn’t the case.” Continue reading
Reverse total shoulder replacement arthroplasty, a technically challenging surgery, is often reserved for patients with serious shoulder pathology that cannot be adequately addressed with more conventional procedures. In patients who present with a massive irreparable rotator cuff tear and arthritis, a reverse total shoulder replacement can dramatically restore function and reduce pain. In the past, there would have been few good options for helping these patients. Nevertheless, according to Hyun-Min (Mike) Kim, M.D., Penn State Hershey Bone and Joint Institute, “Complications are seen in approximately 10 percent of patients who have this procedure done; about half of all complications involve instability. Mechanical impingement between the components and native tissue can contribute to instability and later to scapular notching.” To improve outcomes for these patients, Kim takes specific intra- and post-operative steps aimed at reducing risk of instability. Continue reading