摘要:

Nineteen patients with spinal discontinuity syndromes resulting in paralytic spinal deformity were treated with orthoses to postpone spinal stabilization to allow for vertebral growth. All patients had some degree of sensory deficit under the orthosis. The average period of orthotic treatment for all patients was 54 months (range, 22 to 98). The initial upright curve measurement prior to treatment averaged 43°, the best correction obtained during treatment averaged 26°, and all curves averaged 39° when the brace was discontinued or at most recent follow-up. Although pressure sores occurred, no orthosis was abandoned due to a decubitus problem. Eight patients were successfully braced until maturity, at which time they underwent one stage spinal fusion. Five immature patients are still under active orthotic treatment. Poor compliance with brace wear was documented in the cases in which unacceptable progression occurred, requiring spinal fusion prior to maturity. Successful, technically simpler, one stage stabilization procedures were made possible by the successful long-term control of these difficult spinal deformities afforded by orthotic treatment.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The records for 156 consecutive arthroscopic examinations in children with knee complaints were reviewed. Diagnostic accuracy was based on subsequent arthrotomy and the clinical course in the absence of arthrotomy. All arthroscopies were performed by one person (NCC) between 1975 and 1979. Children under 12 years (most of them aged 6–11 years) accounted for 43 of the patients. The arthroscopic diagnoses were classified into three categories: very useful, useful, and not useful. Arthroscopy was found to be very useful in 30% of children in both age groups, those under and those over 12 years. In all these patients, unnecessary arthrotomies were avoided. Most (63%) of the arthroscopies were found to be useful, since they provided additional findings and biopsies. Only in 5% of cases did the arthroscopy fail to add any information. There were no complications from the procedure. Arthroscopy is an effective diagnostic tool that can be used safely in children.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

We studied 55 consecutive children with hematogenous osteomyelitis and found that 18 (33%) had a subacute course marked by mild pain, few systemic or laboratory signs, and little functional impairment. Radiographic findings frequently suggested a tumor (50%), and the correct diagnosis was delayed an average of 3 months. We therefore suggest a radiographic classification that will help provide more accurate diagnosis of this disorder.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Seventy-five infants and children with suppurative skeletal infections were managed with a sequential parenteral–oral regimen of cephalosporin antibiotic therapy. Initially, parenteral antibiotics (cefamandole for 48 patients and cefuroxime for 27 patients) were given for a median of 5 days. Oral therapy was with large doses of cefaclor (150 mg/kg/day) or cephalexin (100 mg/kg/day). Eight patients (11%) had inadequate serum bactericidal activity with cefaclor. Six of them were successfully managed with alternative oral antibiotics, and parenteral therapy resumed in one patient. Chronic disease developed in a child who was continued on oral cloxacillin therapy in spite of absent serum bactericidal activity. It is concluded that oral therapy can be successful for the majority of patients but that it is hazardous and not indicated if careful laboratory monitoring of compliance and serum bactericidal activity cannot be performed.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Two skeletally immature patients with bipartite patella, a lesion normally classified as a developmental variation, proved to have a symptomatic lesion with a traumatic etiology. In both patients, appropriate treatment resulted in complete subsidence of symptoms; one patient was treated with cast immobilization, while the other eventually required surgical resection. In addition, normal and bipartite patellar specimens from skeletally immature cadavers were histologically and morphologically assessed. These clinical and anatomic studies suggest that in some cases a bipartite patella may be a trau-matically induced, chondroosseous disruption of the superolateral pole of the incompletely ossified patella, analogous to Sinding-Larsen-Johansson disease at the inferior patellar pole or Osgood-Schlatter disease in the tibial tuberosity. The possibility of bipartite patella being such a chronic stress fracture in a symptomatic patient should be considered in order to render appropriate treatment.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

In a prospective study of supination adduction (SA) ankle fractures in children, the post-traumatic growth pattern was registered with a roentgen stereophotogrammetric technique allowing exact determination of the growth rate within 3 months after fracture. It was possible to predict future growth pattern within 6 months. The SA injuries (10 cases) were divided into two stages according to Gerner-Smidt. One Stage I injury (physeal separation through the distal fibula) showed a growth stimulation. Nine Stage II injuries (including a fracture through the medial malleolus) showed four types of growth pattern besides symmetrical growth. The Salter-Harris classification alone showed no obvious correlation to the post-traumatic growth pattern. whereas factors such as age at injury, stage of injury, displacement, and treatment in combination with the Salter-Harris classification contributed to a better prediction of risk of deformity. It was found that displaced Stage II injuries in the younger child had the highest risk of developing a clinically significant varus deformity. Early determination of the post-traumatic growth pattern is of crucial importance in SA injuries with a high risk of growth deformities. Operative treatment in order to restore normal growth can be pet-formed before a severe deformity has developed.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A retrospective review of 67 distal femoral and proximal tibial epiphysiodeses. performed over a 14 year period for correction of leg length inequality, revealed only 22 patients with a final discrepancy of less than 1 cm. Ten of the 45 failures were secondary to inadequate surgical epiphysiodesis. The remaining 35 failures were secondary to errors in timing surgery due to incorrect use of Green and Anderson growth prediction tables. The primary causes of failure would have been decreased by more careful follow-up and the use of the Moseley Graph.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Rickets secondary to hepatobiliary disease is a rare condition; however, the skeletal manifestations are similar to simple nutritional rickets. These skeletal changes include epiphyseal plate abnormalities, pseudofractures, bowing of long bones, scoliosis, and fractures. One-hundred and twelve charts and radiographs of patients with chronic hepatobiliary disease admitted to Children's Hospital of Michigan from 1968 to 1978 were reviewed. Nineteen, or 17% of these patients showed roentgenographie evidence of rickets. Orthopedic management is primarily concerned with the treatment of fractures and prevention or correction of deformities in those children whose longevity justifies treatment.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A case of osteomyelitis of the femur in a 6-year-old boy. which resulted in pathological fracture of the femoral neck, severe coxa vara deformity. and total sequestration of the diaphysis. is reported. Sequestrectomy was intentionally delayed until 10 months had elapsed from the onset of the disease-in order to let an involucrum develop. At removal of the main sequestra, the involucrum was stable and had replaced the necrotic diaphysis. Pseudarthrosis was prevented by the delay of sequestrectomy. During 9 years of growth after the acute stage, the coxa vara deformity spontaneously corrected to a state close to normal anatomy and. at the age of 15 years, the shape of the entire bone was not far from normal. The almost complete restoration to the normal shape of the destroyed femur indicates that both the differentiation capacity of the cells from which it was restored and grew and the guiding forces directing their development had been preserved. Corresponding phenomena, still poorly understood, may play an important role in several pathological conditions of the growing skeleton.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

This paper reports an adolescent male with progressive scoliosis that continued to progress despite a solid bony fusion. The diagnosis of idiopathic juvenile osteoporosis was made retrospectively. The cardinal features of idiopathic juvenile osteoporosis are discussed with particular emphasis on their impact in the management of the scoliosis.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID