摘要:

SummaryAnterior release and fusion, combined with tong gravity traction and second stage L-rod instrumentation, establishes correctability and accomplishes circumferential arthrodesis of the spine in neuromuscular scoliosis. From March 1979 through April 1982, nine patients with neuromuscular scoliosis, with an average age of 16.4 years, underwent this two-stage surgical procedure. The parameters investigated included correction of scoliotic deformity, correction of pelvic decompensation, and spinal arthrodesis. The preoperative scoliotic curvature measured 81° and the postoperative curve measured 29.3°, an average correction of 63.8%. Pelvic obliquity was significant in five of nine patients, averaging 36.2° preoperatively. Postoperatively the pelvic obliquity averaged 11.8°, an average correction of 67.4%. One of two pelvic fixation rods rotated out of the pelvis of one patient; roentgenographically he appears to have fused without loss of correction. A second patient has a poor fusion mass by roentgenographic criteria, although she has lost no correction and has had no pain. This technique offers results comparable to other series reporting arthrodesis for neuromuscular scoliosis. It has the advantages of requiring no anterior instrumentation and no postoperative immobilization.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

SummaryOperative treatment of failed scoliosis surgery requires an instrumentation that is readily adaptable to the multiple causes and sequelae of failed spinal surgery. A “modified L-rod” technique is described for segmental spinal instrumentation to treat failed scoliosis surgery. Nine patients underwent 10 scoliosis revision operations, with an average follow-up of 37.1 months. Three neuromuscular, five idiopathic, and one congenital scoliosis were revised. The average blood loss for the L-rod instrumentation was 2,960 ml, and the average operative time was 6.2 h. Four patients had attempted correction of their deformities, with 21.2% improvement. Five cases had triangular base-transverse bar pelvic fixation. None of the 10 revisions had pseudarthrosis at follow-up. No postoperative immobilization was used. Complications included one fracture of a fusion mass below the L-rods, penetration of the skin by a prominent wire with subsequent infection, minimal loss of correction in one case, and one broken wire without loss of correction.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

SummarySeventy-two children and adolescents, 5–19 years of age, sustaining femoral fractures were treated with immediate cast bracing at Oklahoma Children's Memorial Hospital. Ambulation was started an average of 3 days after fracture when there were no associated injuries. The average length of hospitalization was 18.7 days; the average length of immobilization in plaster was 67.4 days. Results were generally comparable to those of more standard methods of treating a fractured femur in this age group. Proximal as well as middle and distal fractures were treated, but varus and anterior angulation was not well controlled in proximal fractures. No patient had a clinically significant deformity. Sixty-one percent of the entire group healed with less than 6 mm discrepancy. Middle-third fractures showed more tendency toward shortening. All six fractures that healed with more than 1.5 cm of shortening were middle third. No injured femur was longer than the uninjured femur at a 6-month follow-up. Immediate cast bracing can provide an opportunity for early ambulation and avoid the sequelae of immobilization. Weekly assessment for the first 4 weeks is mandatory to monitor length and angulation. The adolescent male with a midshaft fracture was most difficult to manage, and in this situation, closed intramedullary nailing is recommended.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

SummaryAnalysis of 80 femoral fracture episodes in children under 4 years of age revealed that 8.5% were due to violent trauma, 12.5% were “pathologic” fractures, 30% were related to child abuse, and 49% resulted from normal trauma to normal children. Child abuse as a cause of femoral fracture is more common in children under 1 year of age, first-born children, those with preexisting brain damage, and those with bilateral fractures. The fracture configuration was not usually pathognomonic of abuse, although fractures at the subtrochanteric level and chip fracture of the distal metaphysis were more common in abused children. This study suggests that if there is a reasonable history of cause of fracture, appropriate timing in seeking medical care, and no evidence of additional trauma, further evaluation will not be likely to provide evidence of abuse. If any of these criteria is lacking, a skeletal survey and further evaluation are indicated.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

SummaryPertrochanteric fractures in children and adolescents are very rare, accounting for only 1% of these injuries. Most of the patients can be treated nonoperatively with traction, depending on age, in flexion or extension and abduction. Bryant's traction is preferable for very young children, whereas for slightly older children traction on the Weber rack is indicated. Very young children with a pertrochanteric fissure can be treated with bedrest alone. In older children and adolescents, the indicated fracture treatment is traction in extension and abduction. In polytrauma patients, operative treatment with cancellous bone screws or Kirschner wires and cerclage may be necessary. Conservative treatment with the aid of a hip spica is to be avoided, because it may cause serious complications. Fortunately, complications in fracture healing are rare in children and adolescents with pertrochanteric fractures; they are usually malunion or growth disturbances.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

SummaryOsteotomies of the hip fixed with the Coventry lag screw were performed in 29 patients (38 hips) from May 1976 to June 1981. The ages of the children ranged from 24 months to 15 years, with an average of 7.3 years. There were 15 boys and 14 girls. Follow-up averaged 24 months, with a range of 11 to 67 months, and all patients were followed to union. The osteotomies were most commonly indicated for hip deformities associated with cerebral palsy, congenital deformities of the hip, congenital dislocation of the hip, neuromuscular abnormalities, post-traumatic deformities, and other miscellaneous conditions. Results were analyzed according to the bone disorder. All of the osteotomies united, averaging 10.5 weeks to union. Complications included one nonunion which required grafting before the osteotomy united, and two malunions. Following union, there was one fracture distal to the plate, and subcutaneous prominence of the screw developed in three patients. The Coventry lag screw is technically easy to use, is tolerated well, and produced satisfactory fixation in the majority of the patients in this study.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

SummaryThe trochlear epiphysis is subject to an osteochondritic process which has a natural history similar to that affecting other sites. This report deals with three patients in whom radiological signs of fragmentation, fissuring, and increased density of the ossific nucleus occurred in conjunction with mild symptoms which gradually resolved within 1 year to 18 months.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

SummaryA 13-year-old boy is reported with osteomyelitis of the greater trochanter caused by a facultative anaerobic organism (Capnocytophaga ochracea) not known to cause infections in normal immunocompetent individuals, nor implicated in bone or joint infections even in compromised hosts. There remains a need to consider unusual organisms and to obtain accurate bacteriologic data in all cases of osteomyelitis.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

SummaryBecause of the information it provides, computerized tomography has gained wide acceptance. However, the radiation delivered is considerable, and the gonads cannot be shielded effectively. Transaxial tomography also produces a cross-sectional image. While the image has less resolution, it is obtained at a fraction of the exposure. The use of transaxial tomography in several clinical situations is outlined here.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

SummaryTo help severely physically handicapped children with cerebral palsy gain some independent mobility, a special walking frame of great stability has been evolved. It incorporates a variable-resistance roller and automatic reversing brake, and can be folded.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID