OKOJ, Volume 12, No. 10

Contemporary Management of the Pediatric Patient With Achondroplasia

Achondroplasia is the most common human skeletal dysplasia. Its etiology is usually a single mutation on the gene encoding fibroblast growth factor receptor-3 (FGFR-3), resulting in the inhibition of chondrocyte proliferation at the growth plates of the body's long bones. The clinical manifestations of achondroplasia are diverse, with the classic presentation being short stature with disproportionate shortening of the limbs. Nonorthopaedic manifestations of achondroplasia include hydrocephalus, obstructive sleep apnea, recurrent otitis media, conductive hearing loss, and obesity. Its orthopaedic manifestations include disorders of the spine and extremities. In the pediatric patient with achondroplasia, stenosis of the foramen magnum, with cervicomedullary compression, thoracolumbar kyphosis, and lumbar spinal stenosis, are common conditions and may require surgical management. Limb-lengthening surgery for patients with achondroplasia remains controversial, with unproven clinical outcomes. Care for the child with achondroplasia should be multidisciplinary to ensure that the myriad medical issues that may arise from the condition are adequately addressed.

    • Keywords:
    • achondroplasia

    • skeletal dysplasia

    • lumbar stenosis

    • thoracolumbar kyphosis

    • Subspecialty:
    • Pediatric Orthopaedics

Use of Bone Graft Extenders in Spinal Surgery

Numerous materials have emerged as viable candidates for use as bone graft extenders in the setting of spinal fusion. These materials are intended to be mixed with autologous bone harvested locally (eg, from the lamina or spinous process) or from the iliac crest to reduce the total amount of autogenous bone tissue needed. A trend of decreasing reliance on iliac crest autograft coupled with a higher incidence of complex spinal surgery has driven the development of several categories of bone graft extenders, including demineralized bone matrix, calcium phosphate-based materials, calcium sulfate-based materials, bioactive glasses, and synthetic polymer composites. The goals of this article are to describe the structure, composition, and mechanisms of action of each of these material categories, and to summarize the available clinical and preclinical evidence regarding their efficacy in the setting of spinal fusion.

    • Keywords:
    • bone graft extenders

    • spinal fusion

    • calcium phosphate

    • bioglass

    • demineralized bone matrix

    • Subspecialty:
    • Spine

Direct Posterior Approach for Treatment of Posteromedial Fractures of the Tibial Plateau

Fractures of the tibial plateau that have an associated, displaced posteromedial fracture pattern are difficult to reduce and fix adequately through conventional surgical approaches. The direct posterior approach to posteromedial fractures of the tibial plateau, with the patient in a prone position, has been used to overcome limitations related to conventional posteromedial approaches. The posterior approach allows for fracture reduction by hyperextension of the knee through axial traction over a surgical bump. The technique allows the direct visualization of posteromedial fractures of the tibial plateau without the need for dissection of the neurovascular bundle, and for placement of an antiglide buttress plate at the apex of the posteromedial fracture fragment. Patients undergoing fracture repair through the posterior approach can typically be mobilized on the first day after their surgery with functional rehabilitation and restricted weight bearing for 8 to 10 weeks postoperatively.

      • Subspecialty:
      • Trauma