摘要:

We reviewed 19 children and adolescents with cervical spine congenital synostosis as in KlippelFeil syndrome (KFS), with an average follow-up of 12.5 years. We paid particular attention to neurologic complications associated with cervical spine abnormalities. Five patients were affected by neurologic complications; four underwent a surgical procedure; and 14 had no neurologic finding. Two had hypermobility at one level, and one had hypermobility at two levels. We found that the more numerous the occipito-Cl abnormalities, the more significant the neurologic risk. In contrast, this risk was not related to the number of “mobile blocks” or to age. Various mechanisms of neural complications have been studied in the literature: medullary abnormality, spinal instability, narrowing of the cervical canal, and vascular dysfunction. Surgery is usually thought to be required in cases with neurologic complications. The indication for surgery is, however, less clear in cases of pure instability without neurologic involvement because surgery is likely to increase the future risks at mobile disks either above or below the fuse level. Careful clinical and radiologic observation is necessary in such patients. Magnetic resonance imaging (MRI) with lateral views in flexion and extension seem to be the best method for detecting impingement of the spine on the cord.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Analysis of 100 consecutive femoral fractures admitted to our institution revealed an incidence of about 1 fracture per 2,000 children per year. Epidemiologic data may help to promote prevention. Initial treatment was performed by many doctors, thus rendering guidelines to safe and cost-effective management indispensable. In the last decade, growing concern to reduce hospital stays and costs led to new approaches that replaced traction as a therapeutic principle. Today. we consider immediate spica casting a good option for the group 0–5 years old, whereas in the age group 5–12 years old elastic stable intramedullary nailing (ESIN) produces reliably good results. Minor complications were common and could be avoided partially, but they did not affect the good final outcome.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Ten patients with Laurence-Moon-Biedl-Bardet syndrome were investigated. They all belonged to one large family within which several intermarriages had taken place. We found that, apart from the already described abnormalities, these patients suffered from dysgenesis of the following epiphyses: vertebrae, proximal femur, proximal tibia, capitellum, tarsal navicular, and the distal epiphysis of the first metatarsal. The degree of polydactyly, a prominent feature of this syndrome, varied from patient to patient, ranging from a wide fifth metatarsal or metacarpal to a complete sixth digit. As in other epiphyseal dysgenesis, a pseudoepiphysis of the distal first metacarpal was present. One patient (the eldest) was tetraparetic due to severe spinal stenosis.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The disease course of six tibial lesions in five patients with osteofibrous dysplasia who were followed longer than 10 years (average: 16.8 years) was analyzed retrospectively. Three patients had a lesion of the unilateral tibia; one patient had lesions of the unilateral tibia and fibula; and one patient had lesions of the bilateral tibiae and ulnae. Curettage and autogeneic bone graft were performed on two lesions, which then healed. Of four lesions on which curettage and xenogeneic bone grafts were performed, three lesions healed, and one developed local recurrence. Curettage and xenogeneic bone graft were performed on the recurrent lesion, which finally healed and the deformity stopped. Three lesions healed without surgical treatment. During the long-term follow-up, this disease showed a clear tendency of healing. Surgical treatment should be considered in patients with disease uncontrollable by conservative treatment or those who have a high possibility of impending fracture and progressing deformity.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Concerns about the transmission of the human immunodeficiency virus (HIV) have driven the evolution of surgical transfusion practices including the use of preoperative erythropoietin (rhEPO). Although there is significant experience documenting the efficacy of preoperative rhEPO in reducing transfusion requirements for adult patients, there is little experience in the pediatric population. With 178 pediatric patients who underwent surgery for spinal deformity, a retrospective cohort study was performed using patient charts, administrative records, and blood bank computer data. Of these patients, 44% received erythropoietin and 55% did not. From the entire population, 17.5% were in the rhEPO treatment group that received homologous blood transfusion compared with 30.6% in the untreated group (p < 0.05). Among the children with idiopathic scoliosis, this effect was more pronounced, with 3.9% of rhEPO patients receiving blood transfusion compared with 23.5% of nontreated patients (p = 0.006). Additionally, rhEPO treatment was associated with a significantly decreased length of stay only for patients in the idiopathic group (9.3 vs. 6.7, p = 0.02). Use of preoperative erythropoietin in pediatric patients undergoing scoliosis surgery resulted in higher preoperative hematocrit levels. Significantly lower rates of transfusion were noted only in the idiopathic group, however. Although there is a possibility of erythropoietin “resistance” in the neuromuscular and congenital patients, alternative explanations for the lack of effect on transfusion rates may include underdosing and biases existent in this nonrandomized retrospective study.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The results of three different surgical procedures for the correction of bunions on 25 adolescent feet (distal soft-tissue procedure, proximal closing-wedge osteotomy of the first metatarsal with distal soft-tissue procedure, and proximal phalangeal osteotomy) are reviewed. The results with an average follow-up of 3.5 years were excellent or good in 21 cases, and fair or poor in 4.The average correction of the metatarsophalangeal angle, the intermetatarsal angle, and the hallux valgus interphalangeus angle was, respectively, 9.88, 3.11, and 0.0 degrees for the first procedure, 21.0, 6.87, and 0.0 degrees for the second, and 11.0, 0.9. and 22.5 degrees for the third. We conclude that distal soft-tissue reconstruction allows only mild to moderate correction of the metatarsophalangeal and intermetatarsal angles, and the association of a proximal osteotomy of the first metatarsal produces an statistically significant better correction (p < 0.05). Hallux valgus interphalangeus deformities are corrected only by proximal phalanx osteotomies. The selection of a particular procedure should therefore be based on an appropriate preoperative planification.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Fractures of the radial head or neck in children may lead to radial head deformity and loss of pronation and supination. Trauma may not only be caused by the injury itself, but also may occur secondarily to surgical reduction and manipulation of fracture fragments. Thirty-eight children with displaced radial neck fractures were investigated 2 to 20 years after the initial accident. Whereas radial head deformity was present in 83% of cases, functional disorder was found in only four children (11%). These children had either developed secondary growth disturbances, which had led to a radioulnar synostosis in one case, or they had been treated by open surgical reduction. On follow-up radiographs, all conservatively treated fractures with angulation up to 50 degrees had corrected themselves spontaneously. The high complication rate after open reduction and the poor functional results and inconvenience for the pediatric patient makes conservative treatment of radial neck fractures in children preferable.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The method of skin closure in using the Cincinnati incision for clubfoot surgery may influence the quality of the scar obtained and the postoperative outcome. We retrospectively reviewed two groups of patients who underwent either primary skin closure (14 feet in 11 patients) or partial wound closure and healing by secondary intention (15 feet in 11 patients). The quality of the scars from both of these methods were equally acceptable cosmetically, and neither technique predisposed the patient to any long-term wound complications. In addition, we noted that closing the skin may act as a soft tissue tether, and that the initial position of the postoperative splinting of the foot may influence the surgical outcome. Both of these factors may contribute to the recurrence of equinovarus deformity.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A long-term follow-up of 49 patients with an average age of 38 years (range: 25–67 years) who had experienced infantile Blount's disease was done. Thirty-seven patients had bilateral disease, giving a total of 86 affected knees. Thirty-eight knees had conservative or no treatment during childhood; 13 were treated by epiphysiodesis, and 35 by osteotomy. At follow-up, 11 knees showed arthrosis, and 9 were graded as mild. Ten knees had been surgically treated by medial meniscectomy at an average age of 29 years (range: 19–45 years), after the diagnosis of Blount's disease. Four of the knees showed arthrosis. Most of the patients had a straight leg and mild or no pain from their knee. It is concluded that most children with infantile Blount's disease will, at the age of 40 years, have a straight leg without arthrosis and that one third can reach this result without any treatment.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Perthes disease has an incidence of 1 in 4,750 live births (1 in 3,000 boys, but only 1 in 11,800 girls). Although there is evidence for a genetic predisposition to Perthes disease, more than two family members are rarely affected. We report the first recorded case of Perthes disease affecting three female first-degree relatives.

ISSN:0271-6798    

出版商:OVID    

年代:1998

数据来源: OVID