摘要:

Posttraumatic tibial pseudarthrosis is a relatively uncommon complication of tibia fractures in children. Although reported as a successful method of treating tibial nonunions in adults, distraction osteogenesis through a nonunion site via ring external fixation has not been described in children. The authors report three consecutive cases of distraction through an angulated, shortened, hypertrophic, posttraumatic nonunion to achieve successful union and concurrent correction of deformity. Distraction was carried out using a ring fixator with computer-guided correction. Union was achieved in each of the three patients with complete correction of deformity and length. Lengthening of 8 to 31 mm was achieved. The length of time in the external fixator ranged from 7 to 27 weeks. Pin tract infections developed in all patients; they were treated successfully using oral antibiotics. No deep infections or other significant complications developed. Each patient was followed up for at least 1 year.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Flexible nailing of pediatric femoral shaft fractures is based on the principle of using two C-shaped nails to create six points of fixation. However, clinical studies using various nail combinations demonstrate similar outcomes. This study aimed to compare the mechanical properties of different nail combinations by testing them in a model of a child's midshaft femoral fracture. The two C-shaped nails were compared with two straight nails and with paired S- and C-shaped nails. The constructs were tested in four-point bending and torsion. Graphs of the data were produced, from which the bending and torsional stiffness of the constructs was calculated. The results showed that there was no significant difference between the mechanical properties of the three different constructs. The conclusion is that any of the tested nail combinations can be used to treat a midshaft fracture of the femur in a child.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

External fixation of pediatric femoral shaft fractures has the advantages of minimal dissection and early weight bearing. However, it is associated with slow healing and potential for refracture. Some surgeons have proposed that axial dynamization may improve the speed and strength of callus formation. to test this hypothesis, we performed a randomized controlled trial using 53 femur fractures in 52 patients between 1995 and 1999. Patients were randomized to receive dynamic or static fixation. Average time until early callus formation was 23.2 days for dynamic fixation and 24.9 days for static fixation (P= 0.627). Average time until complete radiographic healing was 70.1 days for dynamic fixation and 63.1 days for static fixation (P= 0.370). Similarly, the differences in time to fixator removal and to full weight bearing did not reach statistical significance. The conclusion was that axial dynamization of external fixation for pediatric femur fractures has no significant effect on time to healing or frequency of complications.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This study evaluated forearm compartment pressures in 29 children with supracondylar humerus fractures. Pressures were measured before and after reduction in the dorsal, superficial volar, and deep volar compartments at the proximal 1/6th and proximal 1/3rd forearm. Pressures in the deep volar compartment were significantly elevated compared with pressures in other compartments. There were also significantly higher pressures closer to the elbow within each compartment. Fracture reduction did not have a consistent immediate effect on pressures. The effect of elbow flexion on post-reduction pressures was also evaluated; flexion beyond 90° produced significant pressure elevation. We conclude that forearm pressures after supracondylar fracture are greatest in the deep volar compartment and closer to the fracture site. Pressures greater than 30 mm Hg may exist without clinical evidence of compartment syndrome. To avoid unnecessary elevation of pressures, elbows should not be immobilized in >90° of flexion after these injuries.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Supracondylar humerus fractures are a common childhood occurrence. Displaced fractures are typically treated with closed reduction and percutaneous pinning. Controversy continues over the appropriateness of various pinning techniques. The most common include crossed or lateral pins. A biomechanical comparison of crossed pins, “parallel” lateral pins, and “divergent” lateral pins was performed using a pediatric synthetic bone model. Mechanical testing of each pin configuration was performed in extension, varus, valgus, internal rotation, and external rotation. The divergent configuration provided statistically greater stability than parallel pins under varus and valgus loading. Divergent pins had similar stability compared with crossed pins in extension, varus, and valgus testing. In axial rotation testing, crossed pins were more stable. If the surgeon feels confident in the ability of lateral pins to provide satisfactory fracture stability, divergent lateral pins provide greater stability than parallel lateral pins while avoiding ulnar nerve injury (associated with crossed pins).

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Thirty-four consecutive patients with displaced supracondylar humerus fractures were treated with reduction and percutaneous pinning. The precise location of the ulnar nerve to the medial pin was determined by intraoperative nerve stimulation. In 22 of the 34 patients, the authors attempted to predict the location of the ulnar nerve by palpation and placing a mark on the skin. They also recorded the ability to feel the anatomic landmarks for pin fixation, including the medial epicondyle and ulnar nerve. The average distance from the medial pin to the predicted location was 9.3 mm, whereas the actual distance measured 7.6 mm, for a significant difference of 1.7 mm. Statistically, the authors could not accurately predict the location of the ulnar nerve prior to blind percutaneous crossed K-wire fixation of supracondylar humerus fractures. However, clinically they were fairly close in their prediction and documented safe insertion and distance from the nerve. Intraoperative nerve stimulation may assist in localizing the nerve prior to placement of the medial pin. Stimulation of the pin itself following insertion is another technique to ensure safe pin placement and decrease the risk of injury.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Four new cases of carpal scaphoid nonunion in children are presented. This rare injury is characterized by delay in treatment of the scaphoid fracture or incorrect immobilization. The Matti-Russe procedure was performed with autograft harvested from the proximal cubitus, achieving complete consolidation in every patient. No complications occurred and there was no significantly limited mobility. The author speculates about the posibility of partial or complete consolidation of the scaphoid fracture without treatment as a part of the natural history of this fracture in children.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Expert opinion regarding experience with the management and complications of pediatric anterior cruciate ligament (ACL) injuries was studied by surveying members of The Herodicus Society and The ACL Study Group. There was large practice variation in initial management and ACL reconstruction technique. There were 15 reported cases of growth disturbance: 8 cases of distal femoral valgus deformity with arrest of the lateral distal femoral physis, 3 cases of tibial recurvatum with arrest of the tibial tubercle apophysis, 2 cases of genu valgum without arrest, and 2 cases of leg length discrepancy. Associated factors included fixation hardware across the lateral distal femoral physis in 3 cases, bone plugs of a patellar tendon graft across the distal femoral physis in 3 cases, large (12 mm) tunnels in 2 cases, fixation hardware across the tibial tubercle apophysis in 3 cases, lateral extra-articular tenodesis in 2 cases, and over-the-top femoral position in 1 case. Based on this experience, we recommend a guarded approach to ACL reconstruction in the skeletally immature patient with careful attention to technique and follow-up.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Most patients who develop Legg-Calve-Perthes disease have unilateral involvement. For those children who do develop bilateral involvement, the disease and its outcome have not been characterized. This study reviewed the records and radiographs of 83 patients (20 girls and 63 boys) with bilateral Legg-Calve-Perthes disease. The patients were then divided into 3 groups based on the Waldenstrom stage at the time of the first radiograph. In Group I (26 patients), both hips were in the same stage. In Group II (45 patients), the hips were in a different stage. In Group III (12 patients), the first hip was well into the remodeling stage by the time the second hip became affected. Twenty of the 83 patients (24%) were girls. There were significantly more lateral pillar group A hips on the second side than the first side in Groups II and III, and only 10 of the 45 patients (22%) in these groups had more severe disease in the second hip. When compared with data from a group of hips with unilateral involvement, there were significantly more hips with a Catterall group I rating in the patients with bilateral involvement. In general, the Stulberg et al. class assigned appeared to be independent of bilaterality. It appears that the development of bilateral disease is an independent event. The data in the present study do not support that onset of disease in one hip leads to disease or causes a more severe disease in the second hip.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The authors reviewed 21 patients who underwent triple pelvic osteotomy for severe Legg-Calvé-Perthes disease to evaluate their clinical, functional, and radiologic results. The mean age at presentation was 7 years 7 months (range 5–11 years). Seventeen hips were Herring group C and 5 were group B. All of them had “at risk” radiologic signs. A new technique of interlocking iliac osteotomy was used to provide extra stability, allow early weight bearing, and prevent inadvertent retroversion. The average period of follow-up was 30 months (range 1–5 years). The average gain in Harris score was 34.3 (range 4–55). The average gain in acetabular head index was 18% and that in center–edge angle was 22°, more than reported for any other single surgical procedure for containment of the subluxed femoral head. Average gains in abduction, internal rotation, and flexion were 17°, 12°, and 28° respectively. Longer follow-up is required to see the results at maturity, but the early results are promising.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID