ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Physeal fractures and the formation of physeal bars can pose significant problems in skeletal development for the injured, growing child. Regrettably, little experimental attention has been directed toward this clinical disturbance. The current study documents early histologic changes (days 2–6) and subsequent alterations (day 21) following a physeal fracture in the rat proximal tibia model. The fracture plane was usually contained within the physis but could involve many regions of the physis. In some instances, the fracture plane extended to the physeal epiphyseal border. When the fracture was contained within the physis, healing was uneventful. However, when the fracture extended through the physis to the epiphyseal physeal border, there was greater physeal disorganization and formation of vertical septa leading to physeal bars. Physeal bars appeared to form at sites of vertical fibrotic septa into which marrow cells, osteoclasts, and osteoblasts had migrated. Bar formation mediated by primary osteogenesis (rather than by endochondral bone formation) followed. This study examines the changes in the histologic features of the rat proximal tibial physis, epiphysis, and metaphysis after a physeal fracture and identifies key factors associated with physeal bar formation.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This study describes the histologic features of periosteum interposed into a physeal fracture of the rat proximal tibia. Periosteum was introduced into a physeal fracture in two groups of animals: those with an intact physis after fracture, and those with the medial half of the physis surgically ablated. Specimens of the proximal tibia underwent histologic analysis at 2, 4, 6, 10, and 21 days after fracture to determine the histologic features of interposed periosteum in a physeal fracture. In animals with an intact physis, interposed periosteum underwent one of two fates: it was degraded by giant cells in the fracture plane, which allowed cellular infiltration, or if the periosteum was closely surrounded by physeal cartilage, the physis grew around it and appeared to force it toward the metaphysis. In animals whose physis received surgical ablation, physeal bar formation was always present, with poor organization of the remaining lateral growth plate. Histologic evidence from this study also underscores the fact that physeal bar formation occurs from the migration of osteoblasts and osteoclasts along vertical septa.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Thirty adolescents underwent surgery for progressive deformity after posttraumatic distal radial growth arrest at the average age of 14.8 years. Patients underwent ulnar epiphysiodesis (n = 11), ulnar-shortening osteotomy (n = 18), radial osteotomy (n = 7), and combined radial and ulnar epiphysiodesis (n = 3) procedures. A modification of the Mayo Wrist Score (maximum 100) was used to assess functional outcome at an average follow-up of 21 months. Average wrist scores in 24 symptomatic patients improved from 82 to 98 after surgical treatment. All six asymptomatic patients maintained scores of 100. Of 18 patients who underwent ulnar shortening, average ulnar variance was corrected from 4.5-mm positive to neutral. Complications included one case of radial osteotomy displacement and two cases of continued ulnar overgrowth. Surgery for posttraumatic distal radial growth arrest can improve pain and loss of motion in symptomatic adolescents and prevent symptoms in asymptomatic patients with progressive deformity.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The purpose of this study is to analyze how fractures are managed in children with associated acute burns. A retrospective review of 20 years of experience at a major U.S. burn center was undertaken. A total of 28 fractures in 18 patients were identified during this time period. Variables studied included mechanism of the burn, fracture location, associated injuries, and type of fracture. The fractures were then analyzed according to management, healing times, and complication rates. Of the 24 available fractures, 22 went on to union in an appropriate amount of time. The average rate to union was 9.9 weeks and average follow-up was 32.5 months. There were five infectious complications, one loss of reduction, one knee instability, and one malunion requiring additional surgery. This study supports early definitive fracture treatment in the burned child. If internal fixation is chosen, it can be safely performed if performed within the first 48 hours after the burn. External fixation is also a viable alternative. High rates of union are possible.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Three cases of sternal segment dislocation in children are described. The primary mechanisms were direct blow in a 4-year-old boy, indirect forces in a 3-year-old boy, and osteomyelitis in a 10-year-old boy. The two former cases were dislocated at the junction of the manubrium with the sternal body, and the latter case was at the junction of the first and second sternal segments. The dislocated segments were gradually rotated for approximately 2 weeks and were finally stabilized after rotation. While in the dislocated state, the patients were observed conservatively, although all the dislocated segments were remodeled. Surgical treatment of sternal segment dislocation is not inevitable.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

In young children, methods of primary flexor tendon repair in the digital canal are controversial. The authors reviewed 12 children younger than age 6 years with zone 2 flexor tendon repairs. The mean follow-up period was 8 years. In all cases, the flexor digitorum profundus tendons were repaired according to the Kessler modified technique and the hands were immobilized by an above-elbow cast. As for postoperative complications, there were no fingers with tendon rupture and two fingers with tendon adhesion. One finger needed tenolysis. The total active motion (TAM) in the interphalangeal joints evaluated with the Strickland formula averaged 155°, and the TAM percentage averaged 89% (range 74%–100%). Eleven patients had an excellent result and one had a good result. The percentage phalangeal length averaged 99% (range 96%–100%). Functional motion and nearly normal growth of the finger can be expected after primary zone 2 flexor tendon repairs in children younger than age 6 years.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Between 1980 and 2000, 15 children (14 boys and 1 girl) underwent surgical treatment of a fractured clavicle at the authors' hospital. Eight patients were treated for midshaft fracture, two had medial fractures, and five had fractures to the lateral end, one of which occurred in combination with true disruption of the acromioclavicular joint. The indications for operative treatment of clavicle fractures are rare, in some cases debatable, and surgery is usually necessary only in older children. If surgically treated, the results are satisfactory without major complications. In the authors' experience intramedullary stabilization with elastic nails is the method of choice in most cases.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The medical records of all children less than 1 year of age presenting to the Accident and Emergency Department over a 5-year period (1995–1999) with a fracture were retrospectively reviewed for possible abuse. Seventy-four children presented with fractures during the study period, with a mean age at presentation of 5 months (range 2 weeks to 1 year). Of these children, 46 had skull fractures and 28 had long bone fractures. Children were classified into one of seven categories: definite abuse, likely abuse, suspicious, likely accident, definite accident, neglect, or unknown cause. A three-tier system of grading for possible abuse was then used to analyze variance. The first tier consisted of the initial assessment by staff clinicians, the second retrospectively by an orthopaedic registrar, and the third retrospectively by a designated doctor in child protection (consultant pediatrician), all using the same information from the case notes. The use of the three-tier system of grading demonstrated a variance in the diagnosis of nonaccidental injury. The possibility of abuse was underestimated at the time of the original injury in over a quarter of cases (28.4%) when compared with the assessment by the consultant pediatrician. In 34 children (46%), there was no written documentation that nonaccidental injury was ever considered. While management depends on local guidelines and arrangements, the authors would advise that all children under 1 year of age with a fracture should be admitted to the hospital and referred to a pediatrician for child protection assessment.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The authors reviewed 17 fractures of the olecranon apophysis in 10 children with mild osteogenesis imperfecta (OI). Seven of the 10 patients sustained the same injury to the opposite extremity 1 to 70 months (mean 15.1) after their initial fracture. Four fractures were initially treated by cast immobilization alone. Two of these eventually required operative treatment because of refracture or late displacement. In all, 15 fractures were treated operatively. All had healed at the time the cast was removed; however, two refractured. At latest follow-up (mean 53 months), no patient reported pain or limited function. Children with OI may be prone to this injury. Cast immobilization with careful follow-up may be used for minimally displaced fractures, but operative treatment is recommended for displaced fractures. The high rate of bilateral injury (70%) suggests that children with OI who sustain this fracture should be counseled regarding the risk of injury to the opposite extremity.

ISSN:0271-6798    

出版商:OVID    

年代:2002

数据来源: OVID