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James R. Kasser, MD
First Session
Moderator: James R. Kasser, MD

Bojan B. Zoric, MD Thomas J. Gill, MD
Transphyseal ACL Reconstruction in Skeletally Immature Patients
Bojan B. Zoric, MD
Discussor: Thomas J. Gill, MD
Advisor: Mininder Kocher, MD, MPH

Management of ACL injuries in skeletally immature patients is controversial. Conventional adult reconstruction techniques risk potential iatrogenic growth disturbance due to physeal damage. Dr. Zoric summarized his study of “adult” type ACL reconstructions performed in adolescent patients in whom a reconstruction that violated the physis has formerly been considered too risky. He reported transphyseal ACL reconstruction using autogenous quadrupled hamstring tendon grafts in 59 skeletally immature pubescent adolescents that demonstrated no cases of angular deformity or lower extremity length discrepancy. He concluded that by carefully minimizing trauma to the physis, the ACL can be reconstructed without producing a measurable longitudinal growth arrest or angular deformity.

Dr. Kasser asked how it could be possible that a well-fixed graft could cross a growing physis without stretching over time. Dr. Zoric and his advisor Dr. Kocher responded that they plan to follow up on some of their preliminary data that shows that these grafts seem to grow or at least remodel to a longer stable length over time.

Andrew Jawa, MD Timothy Bhattacharyya, MD
Wound Complications in Pilon, Ankle and Talus Fractures: A prospective study Evaluating Transcutaneous Oxygen Measurements
Andrew Jawa, MD
Discussor: Timothy Bhattacharyya, MD
Advisor: Mark Vrahas, MD

High rates of postoperative wound complications accompany open reduction and internal fixation of pilon, talus and ankle fractures despite delayed surgery and surgeon experience. There are few objective criteria that define the optimal timing of surgery. Transcutaneous oxygen measurements have been used to predict wound healing for amputation levels in vascular disease and for diabetic ulcers, but is has not been used in the evaluation of trauma. Dr. Jawa presented an original, prospective study in ankle and related fractures, attempting to correlate local oxygen tension measured at the planned operative site and subsequent skin healing.

His study is on-going, but to date preoperative transcutaneous oxygen measurements did not predict surgical incision complications around the ankle. The only predictor of complication in his series was a higher energy fracture classification. Dr. Kellam explained that he had once conducted an almost identical study with a similar, negative result, and that he’d never been able to get it published. Only half-joking, he suggested there should be a “Journal of Negative Results” in orthopaedics to share that type of information.