摘要:

The operative treatment of 37 patients with unicameral bone cysts was compared with the newer method of steroid injection in 20 patients whose cysts were similarly predisposed with respect to mode of presentation, location, age, and sex. In the surgical group the average operative time was 100 min. with a mean estimated blood loss of 300 ml. The recurrence rate was 409?, rising to 88% in patients under the age of 10 years with active cysts (less than 1 cm from the physis). Major complications occurred in 15% and included infection, refracture, coxa vara. extremity shortening, and physeal damage. A minimum follow-up of 2 years was necessary to rule out recurrence. In contrast, the steroid-injected group had a recurrence rate of 5%, although 50% required more than one injection for maximum obliteration. The average operative time was 30 min, with negligible blood loss and a minimum hospital stay and rehabilitation. The only complications were a mild steroid Hush in one patient and extremity shortening due to preexisting fracture in another. The end point of healing was reconstitution of cortical thickness, rather than total obliteration at the cyst. No secondary fractures were encountered. Both operative treatment and percutaneous steroid injection exhibited a high rate of recurrence or persistence. The greater simplicity and lesser morbidity associated with the steroid technique favored it as the method of choice.

ISSN:0271-6798    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A series of 58 traumatic dislocations of the elbow observed over a 5-year period is reported. Average age of the children was 12 years old (range, 6 to 15 years). All dislocations were posterior. Neurovascular complications were few and transient in all cases. Associated fractures were present in 64% of the cases. In six cases (10%) closed reduction of the dislocation failed. Nineteen children (33%) were operated on in most cases because of an associated fracture of the medial epicondyle. Results were the following: 21 excellent, 12 good, four fair, and two poor. Functional impairment was present only in the two cases with poor results. These occurred in patients in whom an associated fracture of the neck of the radius was present and were due to radioulnar synostosis.

ISSN:0271-6798    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

We evaluated the results of the operative treatment of a difficult supracondylar fracture of the elbow. A series of 45 consecutive children, the majority presenting initially with a complete dislocation of the humerus, was reexamined. Thirty-two of the patients had undergone an early operation applying the anterior cubital approach and 13 patients had been treated by traction. The lengths of the follow-up periods were 3.1 ± 1.5 and 8.8 ± 2.6 years, respectively. Normal range of extension-flexion and rotation movements was preserved almost invariably by either modality of therapy, whereas the carrying angle of the elbow was reduced significantly more often in the group treated by traction. None of the patients presented with permanent nerve dysfunction, keloid formation, or myositis ossificans. The two preventable early complications, slipping of the osteosynthesis and entrapment of the ulnar nerve, were related to the fixation of the fracture. There were no early or late infectious complications. When the anterior approach was used, operative reduction and fixation of a difficult supracondylar fracture of the humerus proved to be both safe and timesaving. Anatomical results of operation were superior to those attained by traction therapy in our series.

ISSN:0271-6798    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Twenty-six children with fractures of the femur were entered into a prospective study to determine the efficacy of treating certain of these fractures by early spica cast immobilization. They were compared with 50 consecutive patients with similar fractures who were treated prior to the study to determine the potential cost savings and decrease in patient days in hospital. The clinical results of treatment were compared with results from the literature and the previous group where applicable. Our conclusion from this study is that most femoral shaft fractures in children under 10 years of age can be treated by closed reduction and early spica cast immobilization with results that are at least as good as those achieved by conventional methods, and with a 70% savings in hospital cost. Factors such as obesity, swelling, shortening, comminution, and fracture type can all combine to give relative contraindications for the use of this technique.

ISSN:0271-6798    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Prevention of fractures in the patient with myelodysplasia is aided by minimizing disuse osteoporosis by continuing weight-bearing whenever possible. The presentation and treatment of lower extremity fractures in the postoperative myelodysplasic patient have been reviewed. After these fractures severe systemic dysfunction can occur. A clinical situation involving hypovolemia and suggestive of fat embolism has responded well to immobilization in the posterior half of the spica cast and to fluid replacement.

ISSN:0271-6798    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A study of 16 patients with myelomeningocele who sustained 37 fractures revealed that children with diaphyseal and metaphyseal fractures presented with local warmth, redness, swelling, and increased general body temperature, leukocytosis, and sedimentation rate. These fractures were the result of a single stress or trauma and healed uneventfully by splinting for approximately 4 weeks. In physeal injuries, which probably resulted from repetitive stresses, the systemic response was less pronounced. These injuries had to be immobilized more rigidly in plaster casts for a minimum of 8 weeks.

ISSN:0271-6798    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Of a group of 79 patients (45 males, 34 females) with myelomeningocele (MMC), 52 had associated hydrocephalus. Three of the hydrocephalic patients (two arrested and one shunted) were found to have precocious sexual development. Endocrine investigations confirmed true isosexual precocity. Hydrocephalus is known to be associated with precocious puberty, but the occurrence of sexual precocity in patients with hydrocephalus in conjunction with MMC has not been described to date. As the clinical diagnosis of hydrocephalus in a young child is often unreliable, routine computerized tomographic scans of all MMC patients is advised, and even patients with arrested hydrocephalus should be followed carefully for signs of precocious puberty. In addition, a high incidence (15%) of cryptorchidism was found in the group of MMC patients reviewed.

ISSN:0271-6798    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

This is a review of 55 metatarsal osteotomies for hallux valgus and metatarsus primus varus in patients under 15 years of age. The results were analysed after the patients were reviewed clinically and radiologically. Complications of the osteotomies and the factors that caused them are discussed. Poor results, irrespective of the type of osteotomy, were due to excessive shortening of the first metatarsal and/or dorsal tilting of the metatarsal head. In both instances there was persistent metatarsalgia.

ISSN:0271-6798    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The results of bunion surgery on 50 feet in 31 adolescents are reviewed. Average follow-up was 3 years 2 months. The failure rate was WA. Fifty-one percent of the children had hypermobile flatfeet, and 32% had a long first ray. The recurrence rate in these groups was 56 and 50% respectively. There were 20 reoperations for either recurrence (12) or hardware removal (eight). Elective bunion surgery in adolescents should only be performed in the face of progressive, painful deformity where both the patient and the patient's parents fully understand the goals and risks of surgery.

ISSN:0271-6798    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Modifications to the original Mitchell osteotomy of the first meta-tarsal for bunions in children are described. The reasons for these modifications are stressed, and the results of the modified version of the operation in 45 feet are discussed. Long-term cosmetic and functional results with this operation have been excellent in growing children.

ISSN:0271-6798    

出版商:OVID    

年代:1984

数据来源: OVID