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This study reported guided growth for caput valgum deformity and subsequent hip development. Ten children with unilateral hip dysplasia had guided growth by one eccentric transphyseal screw at age 9.1 years with minimum 2 years of follow-up. The first change was decreasing articulotrochanteric distance and then increasing physis tilt angle and head-shaft angle by 1.5 years. The center edge angle that was significantly less than the normal side (18.3 vs. 24.8°) preoperatively became comparable between both the hips 2 years later. Rebounding of physis inclination after screw back out suggested mechanical tethering, rather than permanent physis closure, resulted in morphologic changes in the femur., Level of Evidence: Therapeutic study, level IV.

Background: Guided growth by 1 eccentric transphyseal screw has been used to correct lower limb deformities. Pilot animal studies showed encouraging results in producing varus deformity in the proximal femur. The purpose of this study was to report the preliminary results of guided growth surgery to treat spastic hip displacement., Methods: This case series study included consecutive patients who received soft-tissue release and guided growth at the proximal femur from January 2004 to May 2012 with minimal 2-year follow-up. Surgical indications were children with spastic cerebral palsy aged 4 to 10 years, a gross motor function classification system level IV or V, and hip displacement on 1 or both sides. Study outcomes were Reimer's migration percentage (MP) and the head-shaft angle (HSA)., Results: Nine children with 13 spastic displaced hips received surgery at the age of 6.2 years and were followed up for a mean of 45.6 months. The mean MP improved significantly from 52.2% preoperatively to 45.8% at 3 months, 40.3% at 1 year, and 37.1% at 2 years after operation. HSA was unchanged in the first 3 months, and deceased from 173.3 to 166.4 degrees at 1 year (P<0.01) and to 162.7 degrees at 2 years postoperatively. The screw was usually backed out from the femoral epiphysis in the second postoperative year, and no radiologic bony bar or other surgical complications occurred., Conclusions: The immediate postoperative improvement of MP was the result of soft-tissue release. From postoperative 3 months to 2 years, the HSA was reduced by 10.6 degrees and the MP further improved by 8.7%. Less surgical dissection, faster recovery of motion, and less comorbidity than varus osteotomy make guided growth surgery a treatment option for coxa valga in spastic hip displacement in nonambulant cerebral palsy children., Level of Evidence: Level IV-therapeutic, case series.

Posterior short-segment instrumentation for thoracolumbar burst fracture is known for a high implant failure rate because of the lack of anterior support. Anterior body augmentation by transpedicular bone grafting has been developed as an alternative to overcome this failure. However, the efficacy of transpedicular bone grafting remains debatable. Between August 2002 and August 2006, 31 patients with a single-level thoracolumbar fracture underwent insertion of posterior short-segment pedicle screws and transpedicular bone grafting. Twenty-one men and 10 women had a mean age of 39.7 years at the time of surgery. All patients were followed up for at least 2 years; the mean follow-up period was 52.7 months. Preoperative computed tomography showed that the mean canal encroachment was 48.1%. The kyphotic angle improved from 20.9 degrees to 3.7 degrees immediately postoperatively. Loss of kyphosis correction was 2.7 degrees before implant removal and 6.2 degrees at final follow-up. The anterior body height was corrected from 50.9% to 86.9% by surgery, but collapsed to 82.2% before implant removal and became 78.1% at final follow-up. The failure of the surgery was defined as an increase of >10 degrees in local kyphosis and/or implant breakage. At last follow-up, no implants had failed, but 3 patients had a loss of correction >10 degrees ; the failure rate was 9.7%. According to the Dennis functional scales, the mean pain score was 1.7, and the mean work score was 2.2 at final follow-up. All 8 patients with partial neurological deficit initially had improvement. Analysis of the results indicated that this technique effectively corrects deformities, restores vertebral height, prevents early implant failure, and provides satisfactory clinical results.