摘要:

Summary:The torsional malalignment of lower limbs in children can be measured by different diagnostic techniques. In this review, clinical examination, radiographic technique, ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) are explained; advantages and disadvantages are described; and recommendations are given for their appropriate application. Clinical determination of femoral and tibial torsion can be applied easily to patients and does not require special equipment. The method is regarded not to be reliable enough for preoperative planning and does not allow a reproducible documentation of results. With standard radiographs, torsional deformities also cannot be measured reliably enough. A further disadvantage is the radiation exposure to the patient. Ultrasonography, as a radiation‐free technique, has shown to produce valid and reliable results in measuring torsion of the lower limbs, but the documentation of results for preoperative considerations is hardly possible. With CT and MRI, sector‐scanning techniques are available for precise and reproducible assessment of post‐traumatic torsional deformities in the femur and tibia of children. Although CT scanning still poses a radiation hazard to the patient, MRI is free of radiation and allows a precise anatomic measurement even in nonossified structures. The comparison of different techniques in a recent investigation has shown a high correlation of results between MRI and CT scanning and between MRI and ultrasonography. Reliability of techniques was high in MRI and CT, but less in ultrasonography and clinical examination. Clinical examination and ultrasound techniques are recommended for screening purposes in post‐traumatic torsional deformities in the lower extremities in children. For operative considerations, the sectorscanning techniques CT and MRI should be used, with priority given to MRI in children.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:Traumatic and pathologic humeral shaft fractures and fractures of the proximal humerus represent approximately 3% of all fracutres in children. Even in severe malalignments, especially in children under the age of 10 to 12 years, growth disturbance is very seldom and there is a wide range of tolerance. As in proximal humerus fractures and humeral shaft fractures, the conservative treatment approach is the method of choice. For diagnosis, radiography in two planes is sufficient. Only a few extremely displaced fracutres have to be treated by intramedullary ascending and descending nailing. Pathologic fractures of the humerus represent 0.2% of fractures in children and are extremely rare. Approximately 50% of pathologic fractures are caused by unicameral bone cysts, and they are best treated by long‐term intermedullary nailing.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:Even today approximately 30% of all dislocations of the radial head associated with fractures of the ulna (Monteggia lesion) are missed. There are two main pitfalls. First, there is not always an obvious fracture of the ulna. Therefore, simple bowing of the ulna may not be considered a signal for a potential dislocation of the radial head. The other pitfall is that the elbow is often not included on radiographs of the forearm. A retrospective study from 1998, including patients from 1980 to 1997, showed that only 4 of 13 patients had objectively good results and 9 of 13 patients had bad results. Decreased range of motion over 20° in any plane compared with the opposite elbow or redislocation or subluxation were rated as bad results. This disastrous experience forced us to reflect again on the issues of late missed Monteggia fractures.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:Supracondylar fractures of the humerus in children may be associated with difficulties in diagnosis and treatment. One of the major problems is malrotation of the distal fragment, which has to be reduced. On clinical examination, as well as radiography, the initial malrotation cannot be assessed. In the authors' experiments, they were able to show that malrotation only became visible when greater than 40° as a ventral spur on the lateral radiographic view. On the other hand, the authors also noticed a linear correlation between the degree of rotation and increasing fracture instability if the center of rotation was in the middle of the fracture. If the center of rotation was located in radial condyle, the contact surface of the fracture remained at 60° with increasing rotation. Based on these findings, the authors started to perform osteosynthesis in supracondylar fractures with a radial external fixator, which guaranteed compression on the radial column. Satisfactory reduction is checked clinically by the range of motion and the arm axis, rather than radiologically. The authors favor this method because the cosmetically disturbing cubitus varus can be avoided, and the removal of the external fixator can be performed without additional anesthesia.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:Of all fractures in childhood, 6% to 8% are of the lower leg. Orthopaedic treatment is the traditional option in these fractures and was practiced in more than 95% of all patients. The results were unsatisfactory in 6%, predominantly found in shaft fractures with more than one reduction or with extension treatment in unstable fractures of the tibia and fibula on the same level. At the ankle joint, osteosynthesis was used more often (28%), and no bad results were stated. Today's treatments of children's fractures must include primary definitive fracture care and a stabilization adequate for children's wishes for freedom of movement. Therefore, unstable fractures, irreducible fractures, and fractures in which maintenance of reduction cannot be guaranteed reliably by a cast should be stabilized during the first anesthesia. Elastic stable intramedullary nailing is the method of choice in closed and grade I open fractures of the midshaft. In higher‐degree open fractures, comminuted fractures, and special metaphyseal fractures, external fixation is preferred. At the ankle joint, the use of compression screws, Kirschner wires, or tension band wiring is still adequate. Elastic stable intramedullary nailing is characterized by two nails in an opposite threepoint spreading, assisting traction and compression forces and eliminating shear forces. Immediate mobilization and early weight bearing is possible, and there is no need for a supplemental cast. In recent years, orthopaedic treatment in shaft fractures was reduced to 83%, and the portion of osteosynthesis increased to 17%. After surgery we found only one unsatisfactory result in a boy with a refracture and later a 1.3‐cm lengthening. Other length discrepancies were less than 1 cm; all malalignments were less than 10°, and no reduction of ankle movement was stated. Orthopaedic treatment lost the dogmatic position to be the first choice in principle. We must select the method of treatment that seems to guarantee the highest effectiveness with the lowest degree of manipulation in a single case.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:The authors present a modified telescopic nailing technique for deformity and fracture treatment in children with osteogenesis imperfecta. Because a threaded portion of the solid nail component can be screwed into cancellous epiphyseal bone without additional arthrotomy, the morbidity associated with nailing is lower than the morbidity associated with conventional techniques.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:After fractures of the proximal radius in children, severe complications, such as loss of elbow motion and cosmetically disturbing radial head deformities, may occur. Controversial management recommendations regarding the acceptability of initial radial head angulation and side‐to‐side displacement, treatment, and posttreatment contribute to a confusing discussion. Two to 20 years after the initial accident, 38 children with displaced proximal radius fractures were studied. Radiologically, radial head deformities were present in 83% of cases, whereas functional disorder was present in only four (11%) children. These patients had been treated by open surgical reduction or had a secondary growth disturbance, which resulted in a radioulnar synostosis in one patient. All conservatively treated radial head angulations up to 60° had corrected themselves spontaneously on follow‐up radiographs. Thus, the poor functional result, the high complication rate after open surgical treatment, and the inconvenience for the pediatric patient make conservative treatment of proximal radius fractures of up to 60° in children younger than age 10 favorable.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:Closed reduction and treatment by immediate spica cast is the preferred method of treatment of femoral shaft fractures in children as old as 4 years of age. Elastic stable intramedullary nailing has proven to be the most advantageous procedure in children between 4 and 14 years of age. Traction methods have a long hospital stay, discomfort, and the risk of overgrowth and malalignment. Plate fixation requires extensive dissection and produces a large scar. Rigid nailing is associated with a small but troublesome risk of avascular head necrosis and valgus deformity as a result of growth plate arrest. External fixation is the preferred method for the rare open and comminuted fractures. Elastic intramedullary fixation with elastic stable intramedullary nailing and Ender nails has a short learning curve for surgeons and a low complication rate. Short hospital stays and low costs of the implants are further advantages. Overgrowth in late controls is lower than that in other types of treatment, with an average of 5 mm.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID