ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

SummaryA computerized MEDLINE search was performed to determine the publication pattern of the abstracts submitted for podium presentation at the 1991–1994 annual meetings of the Pediatric Orthopaedic Society of North America (POSNA). The publication percentage for all papers submitted to the POSNA meetings from 1991 through 1994 was 45%. Fifty-three percent of papers accepted for podium presentation were ultimately published in comparison with 38% of those not accepted for presentation (p< 0.001). The mean time to publication was 29 months and did not differ significantly for the two groups. The majority of papers (65%) were published in eitherJournal of Pediatric Orthopaedics(48%) orThe Journal of Bone and Joint Surgery(American) (17%). The frequency of ultimate publication of abstracts submitted to the annual POSNA meetings compares favorably with the rates for other medical subspecialties.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

SummaryThis is a review of 116 children who had a fracture of the proximal radial head or neck over a 15-year period. Of 33 teenagers with closed physes, 17 (52%) had intraarticular involvement. Of 83 younger children with an open proximal radial physis, six (7%) had an intraarticular fracture (Salter–Harris type III or IV). Of the 17 patients with closed physes and intraarticular fracture, 13 had adequate follow-up. There were eight excellent, three good, one fair, and one poor results. Of the six children with open physes and intraarticular fracture, there were one good and five poor results. This study confirms that intraarticular fracture of the radial head is much more common if the proximal radial physis is closed. In addition, this review indicates that the prognosis is extremely poor for children who have a radial head intraarticular fracture that also involves an open physis (Salter–Harris types III and IV), particularly when the fracture is treated initially nonoperatively. Displaced proximal radial fractures that involve both physeal and articular cartilage may be occult, and as with all physeal and intraarticular fractures, anatomic reduction (open if necessary) is mandatory.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

SummaryAvascular necrosis of the radial head is uncommon. A 20-year review of records at a Pediatric Trauma Center revealed eight cases of avascular necrosis of the radial head in children with an average of 10 years (range, 7–16 years). Symptoms of pain or restriction of elbow motion began at an average of 23 months after trauma in seven cases, and in one case, there was no history of trauma. Of the seven secondary to trauma, six resulted from a fall, and one from a torsional injury. The types of injuries associated with avascular necrosis of the radial head were two supracondylar fractures, a fracture of the lateral condyle, two fractures of the radius, a radial head dislocation that underwent a proximal radial osteotomy, and one with only an elbow contusion. The long-term results of radial head necrosis were poor, with three ultimately requiring radial head resection, and the remainder having considerable limitation of elbow motion. Loss of vascularity to the radial head is very analogous to avascular necrosis of the femoral head, with the late onset of incongruity, osteoarthritis, and hypertrophy of the head. It should be considered in any child with late-onset loss of elbow motion after trauma.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

SummaryThis study reviews all open fractures treated at a tertiary children's hospital from 1990 to 1995 to determine whether delaying surgical debridement influences the rate of infection in the pediatric population. One hundred four open fractures were followed until both clinical and radiographic union was evident. A 1.0% rate of infection requiring surgical drainage, and a 1.0% rate of soft-tissue infection managed with oral antibiotics alone was found. Infection rates for fractures treated within 6 h of injury was 2.5%, and for fractures treated with >6 h delay was 1.6%. No significant statistical difference in infection rate with delay in surgical debridement was found (p= 0.77). Delays of 5 and 16 h were found in the two fractures complicated by infection, compared with an average delay of 12 h for those that healed uneventfully. Our findings suggest that in children given early parenteral antibiotics, operative irrigation and debridement may be delayed >6 h without an increased risk of infection. As this series contains only 18 patients with grade III open fractures and nine patients whose surgery was delayed >24 h, conclusions should not be made in these groups.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

SummaryWe report our 12 years' experience with the treatment of 308 fractures of the long bones in children using theflexiblestableintramedullarypinning technique (FSIMP). This technique is a simple, rapid, and reliable procedure with minimal complications. It assures correct reposition and sufficient stable fixation of fragments, needs only small incisions, and most of all, allowed early mobilization of a child, thus avoiding long hospitalization and permitting his rapid normal activity and return to the school. The results are very encouraging for children up to age 5 years. The age limit is caused by the volume of the intramedullary space.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

SummaryThe evaluation and management of acute spondylolysis remains unclear in part because of outcome data that are primarily subjective. The aim of this study was to evaluate and monitor these patients objectively using quantitative single-photon emission computed tomography (SPECT). Thirty-four patients were so observed clinically between 1987 and 1996 and were studied with an initial and at least one follow-up SPECT scintigram. Initial radiographs and planar bone scans failed to demonstrate the pars lesion in 53 and 19% of the patients, respectively. The average SPECT ratio before brace treatment was 1.45. After treatment, this ratio significantly decreased to 1.27 (p= 0.03). A subset of patients remained symptomatic at follow-up. Their reduction in SPECT ratio averaged only 2.8% as compared with 13% for the remainder of the patients (p= 0.01). Patients diagnosed and braced in the early, more active stage of the condition (with greater intensity on SPECT) had more predictable symptom relief. An initial SPECT ratio of >1.5 was associated with complete symptom resolution after brace treatment. Patients treated with activity restriction only (>3 months) before bracing were more likely to have persistent symptoms and more modest improvement on SPECT (p= 0.01). These data, which use SPECT scintigraphy, support prompt treatment with brace immobilization for acute spondylolysis in children and adolescents.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

SummaryThe clinical presentation and management of 19 children who sustained injuries by stationary exercise bicycles were reviewed retrospectively. These injuries represented 32 traumatized digits with a minimum of 2-year follow-up. The index and long fingers were most commonly involved. Wheel-spoke injuries typically produced repairable nerve and tendon lacerations, and full functional recovery in these cases was common. The chain/sprocket injury involved a crushing mechanism and frequently produced severe injury including amputations that were not salvageable. Stationary exercise bicycles represented a predictable source of severe hand injury in children between the ages of 18 months and 5 years. Adult supervision was not reliable in preventing contact between an operating exercycle and a child's hand. We recommend that children not be allowed access to any stationary exercycle machinery, whether it is in use or not. Safety design considerations should focus on not only shielding the wheel spokes, but also (and perhaps even more important) on enclosing the entire chain axis and gear interface. In addition to these design considerations, public education will be critical in reducing the incidence of injury.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

SummarySixty-six patients admitted to our institution over an 8-year period with the diagnosis of osteomyelitis were analyzed to determine the incidence of adjacent joint involvement. Patients with osteomyelitis of the hand, foot, spine, and extraarticular pelvis were excluded from this study. The average age was 5.8 years (range, 1 month to 17 years). Forty-two percent of our patients who had osteomyelitis had evidence of adjacent joint involvement (either septic or nonseptic). One third of our patients had evidence of septic joint involvement. The most commonly involved joint was the knee. There was no difference in the incidence of adjacent joint involvement in those patients who were younger than 18 months compared with the incidence in older children. Our study suggests that the incidence of adjacent joint involvement in children who have osteomyelitis is higher than that suggested in the literature. We believe that careful evaluation of the adjacent joint should be an important part of the evaluation of any child who has osteomyelitis.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

SummaryWe reviewed 20 consecutive patients with a culture-proven acute septic arthritis of the hip who were treated with a shortened course of parenteral antibiotic therapy after a surgical drainage. Patients were switched over to an oral antibiotic when they showed clinical improvement. Sixteen of the 20 patients had parenteral antibiotic therapy of <10 days, whereas nine of these patients received <7 days of parenteral therapy (mean, 8.2 days). No recurrence of infection, readmission, or osteomyelitis was observed after the discharge. At the follow-up interview (mean, 32 months), 18 patients were completely asymptomatic, and two patients had occasional hip pain with activity but no physical limitations. All 20 patients had normal hip range of motion and gait. Their latest radiographs (mean, 26 months) revealed 11 patients with normal findings, six patients with mild coxa magna, and three patients with a smaller ossific nucleus compared with the unaffected side. We conclude that a community-acquired, acute gram-positive septic arthritis of the hip can be managed safely with a surgical drainage and a shortened course of parenteral antibiotic therapy, which can be switched over to an oral therapy based on the patient's response to the therapy.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID