GRs improve trunk height and the space-available-for-lung ratio while controlling curve and pelvic obliquity in young patients with SMA with severe scoliosis, but they do not halt rib collapse. For patients with SMA, hospital stays were longer than those for patients with IIS/JIS, whereas the rate of major complications was lower.

Objective: To evaluate image quality and interobserver reliability of a novel cone-beam CT (CBCT) scanner in comparison with plain radiography for assessment of fracture healing in the presence of metal hardware. Methods: In this prospective institutional review boardapproved Health Insurance Portability and Accountability Act of 1996-complaint study, written informed consent was obtained from 27 patients (10 females and 17 males; mean age 44 years, age range 21-83 years) with either upper or lower extremity fractures, and with metal hardware, who underwent CBCT scans and had a clinical radiograph of the affected part. Images were assessed by two independent observers for quality and interobserver reliability for seven visualization tasks. Visual grading characteristic (VGC) curve analysis determined the differences in image quality between CBCT and plain radiography.Interobserver agreement was calculated using Pearson's correlation coefficient. Results: VGC results displayed preference of CBCT images to plain radiographs in terms of visualizing (1) cortical and (2) trabecular bones; (3) fracture line; (4) callus formation; (5) bridging ossification; and (6) screw thread-bone interface and its inferiority to plain radiograph in the visualization of (7) large metallic side plate contour with strong interobserver correlation (p-value , 0.05), except for visualizing large metallic side plate contour. Conclusion: For evaluation of fracture healing in the presence of metal hardware, CBCT image quality is preferable to plain radiograph for all visualization tasks, except for large metallic side plate contours. Advances in knowledge: CBCT has the potential to be a good diagnostic alternative to plain radiographs in evaluation of fracture healing in the presence of metal hardware.

Management of pediatric femoral fractures is dependent on patient age and injury pattern. For length-stable femoral shaft fractures in school-age children (5 to 11 years of age), flexible intramedullary nailing (IMN) is a popular treatment method. However, for fracture patterns that are length-unstable or involve the proximal or distal third of the femur, flexible IMN has a higher rate of postoperative complications. Use of a submuscular bridge plate has been shown to be an effective alternative to IMN for these injuries. Because this long plate is inserted with a minimally invasive technique and indirect reduction, it acts as an internal type of "external fixator," thereby avoiding soft-tissue stripping at the fracture site and decreasing strain across the fracture site.Step 1: Position the patient supine on a radiolucent table with a bump under the ipsilateral hip.Step 2: Lay a 4.5-mm narrow stainless-steel plate over the injured thigh and use fluoroscopy to determine the appropriate length for this plate. Contour the plate as needed.Step 3: Make a lateral, longitudinal incision of 2 to 3 cm at the proximal or distal part of the femur through the iliotibial band. Elevate the vastus lateralis extraperiosteally from the femur using a Cobb elevator. Pass the plate through this plane proximally or distally while maintaining contact between the plate and the femur.Step 4: Adjust the plate position using fluoroscopy. Obtain fracture reduction using closed techniques and secure the plate temporarily with Kirschner wires through the most proximal and distal holes.Step 5: Place the first screw near the end of the plate under direct visualization. Place the second screw using a percutaneous technique and insert it immediately proximal or distal to the fracture site where the femur is farthest from the plate. The drilling and length measurement of this screw are fluoroscopically aided and will bring the plate down into contact with the femoral cortex.Step 6: Place the remaining screws in a similar fashion; 3 screws proximal and distal to the fracture site provide adequate stability. Locking screws or lag screws are typically not necessary in this construct. Obtain final radiographs to ensure appropriate reduction length, alignment, and rotation.Postoperatively, patients begin hip and knee range-of-motion exercises without immobilization. Touch-down weight-bearing with crutches is used until callus formation is seen on radiographs, usually in 6 to 8 weeks. The plate can be removed 6 months after the index surgery.

Pathological bone resorption is a source of significant morbidity in diseases affecting the skeleton such as rheumatoid arthritis, periodontitis, and cancer metastasis to bone. Evidence indicates that elevated levels of inflammatory mediators such as IL-1, IL-6, and TNF-α play a role in this process by promoting the formation of bone-resorbing osteoclasts. Additionally, current studies have identified inflammatory chemokines of the macrophage inflammatory protein (MIP) family as potential mediators of pathological bone resorption, where both MIP-1α and -3α have been shown to enhance osteoclast (OCL) development. In this study we provide evidence that MIP-1δ, whose expression is associated with renal cell carcinoma bone metastasis and rheumatoid arthritis, enhances OCL formation in vitro via a direct effect on OCL precursors. Consistent with this ability, exposure of OCL precursors to MIP-1δ resulted in the activation of PLCγ2 and NF-κB, two signaling pathways known to regulate OCL differentiation. Moreover, MIP-1δ induced expression and nuclear translocation of NFATc1, a master regulator of osteoclastogenesis, which was dependent on activation of both the PLCγ2 and NFκB signaling pathways. Lastly, consistent with in vitro studies, in vivo administration of MIP-1δ significantly increased OCL number and resorption area as determined using a murine calvarial bone resorption model. Taken together, these data highlight the potential of MIP-1δ as a mediator of pathological bone resorption and provide insight into the molecular mechanism through which MIP-1δ enhances osteoclastogenesis.