Latest journal articles on pediatric orthopaedics and conditions from Journal of Pediatric Orthopaedics, Journal of Children's Orthopaedics, The Bone & Joint Journal, Journal of Bone and Joint Surgery, Clinical Orthopaedics and Related Research, Acta Orthopaedica, Orthopedic Clinics of North, America, Journal of Orthopaedic Surgery and Research, Orthopedics
By Stephanie Mayer, MD; Jay C. Albright, MD; Jason W. Stoneback, MD Given the high incidence of vascular and neurologic injury associated with pediatric knee dislocations and displaced physeal injuries about the knee, a thorough understanding of the clinical and radiographic signs associated with these injuries, relevant anatomy, workup, reduction techniques, and surgical management is crucial. A higher incidence of these injuries in children is anticipated because of increased participation in high-energy activities that result in contact or collision during sports or recreation. Complications, such as vascular and nerve injuries and compartment syndrome, can be diagnosed early in the workup to prevent catastrophic outcomes. The clinical examination should include evaluation of the motor and sensory status of the limb, palpation of pulses, and measurement of ankle brachial indices.
By Editor-in-Chief Your doctor will want to see how your child stands up from a sitting position on the floor. Because of weak leg muscles, children with DMD stand up in a unique way that has been termed the Gower's maneuver. They start out on their hands and feet, planting their feet widely apart and pushing up their bottom first. Then they use their hands to push up on their knees and thighs.
Your doctor will also watch your child walk. He or she may carefully test your child's muscles and nervous system.
By Editor-in-Chief Metatarsus adductus improves by itself most of the time, usually over the first 4 to 6 months of life. Babies aged 6 to 9 months with severe deformity or feet that are very rigid may be treated with casts or special shoes with a high rate of success. Surgery to straighten the foot is seldom required.
Metatarsus adductus is a different condition than clubfoot, which is a more severe foot deformity that requires treatment soon after birth. Learn more about ClubfootClubfoot (topic.cfm?topic=A00255)
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Confirmed Specific Ultrasonographic Findings of Pulled Elbow.
J Pediatr Orthop. 2013 Aug 29;
Authors: Dohi D
Abstract
BACKGROUND:: Pulled elbow is a disorder commonly observed in children in routine medical practice; however, when the circumstances involved in the injury are unknown, difficulty has been encountered in differential diagnosis whether it is a bone fracture or pulled elbow. One of the reasons involved has been the unavailability of diagnostic imaging in confirming the diagnosis of the pulled elbow. Therefore, the author had performed ultrasonography for the pulled elbow and studied the specific ultrasonographic findings of the same.
METHODS:: Using as subjects a total of 70 cases of pulled elbow, with their age ranging from 4 months to 6 years, ultrasonography was performed from September 2010 to February 2013 with the use of Hitachi EUB 7500 ultrasonographic apparatus with a 12 MHz transducer. Careful observation was made of the specific ultrasonographic images of anterior long-axis view of the radiohumeral joint before and after the manipulation.
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Reliability and necessity of computed tomography in distal tibial physeal injuries.
J Pediatr Orthop. 2013 Mar;33(2):e18
Authors: Strohm PC, Hauschild O
PMID: 23389581 [PubMed - indexed for MEDLINE]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23389581?dopt=Abstract
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Oblique in situ screw fixation of stable slipped capital femoral epiphysis.
J Pediatr Orthop. 2013 Mar;33(2):135-8
Authors: Gourineni P
Abstract
BACKGROUND: Percutaneous in situ single screw fixation is the preferred treatment for stable slipped capital femoral epiphysis. The recommended screw placement is in the center of the epiphysis and perpendicular to the physis. We reviewed the results of in situ fixation with the screw placed oblique to the physis.
METHODS: Thirty-six stable slips were treated with a modified technique. The screw was started as close to the mid lateral cortex of the proximal femur as possible while maintaining the screw anterior to the posterior cortex of the femoral neck and ending at the apex of the epiphysis ignoring the resultant angle to the physis. Thirty-five of these hips were followed till physeal closure.
RESULTS: Thirty-five of the 36 hips showed physeal closure at an average of 5 months. There were no screw-related complications or symptoms. The oblique screw path allowed for an extra screw thread to be placed in the epiphysis and also allowed adequate femoral neck osteoplasty.
CONCLUSIONS: Oblique placement of the screw for in situ fixation in stable slipped capital femoral epiphysis did not cause any deleterious effects and offered several potential advantages.
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The value of hip aspiration in pediatric transient synovitis.
J Pediatr Orthop. 2013 Mar;33(2):124-7
Authors: Liberman B, Herman A, Schindler A, Sherr-Lurie N, Ganel A, Givon U
Abstract
INTRODUCTION: Hip transient synovitis (TS) is a common pediatric orthopaedic problem. Although a self-limiting illness, it often makes the patient temporarily disabled and poses a diagnostic difficulty because of its similarity to septic arthritis in clinical manifestations. The aim of this study was to evaluate the use of a single ultrasound-guided hip aspiration as a treatment modality for TS.
METHODS: Between the years 1984 and 1989, 112 children with TS were treated through bed rest and using nonsteroidal anti-inflammatory drugs (group 1). Between the years 1990 and 1999, 119 children diagnosed with TS were treated using hip aspiration, bed rest, and nonsteroidal anti-inflammatory drugs (group 2). Recovery parameters were compared between these patient groups.
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Legg-Calvé-Perthes: interobserver and intraobserver reliability of the modified Herring lateral pillar classification.
J Pediatr Orthop. 2013 Mar;33(2):120-3
Authors: Rajan R, Chandrasenan J, Price K, Konstantoulakis C, Metcalfe J, Jones S
Abstract
BACKGROUND: The purpose of our study was to independently assess the reliability of the modified Herring lateral pillar classification.
METHODS: Thirty-five standardized true anteroposterior radiographs of children in the fragmentation phase were independently assessed by 6 senior observers on 2 separate occasions (6 wk apart). The κ analysis was used to assess the interobserver and intraobserver agreement.
RESULTS: Intraobserver analysis revealed at best only moderate agreement for 2 observers. Three observers showed fair consistency, whereas 1 remaining observer showed poor consistency between repeated observations (P < 0.01). The highest scores for interobserver agreement varying between moderate to good could only be established between 2 observers. For the remaining observers results were just fair (P < 0.01).
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Is There Still a Place for Cast Wedging in Pediatric Forearm Fractures?
J Pediatr Orthop. 2013 Sep 15;
Authors: Samora JB, Klingele KE, Beebe AC, Kean JR, Klamar J, Beran MC, Willis LM, Yin H, Samora WP
Abstract
BACKGROUND:: Forearm fractures are common skeletal injuries in childhood and can usually be treated nonoperatively with closed reduction and casting. Trends toward increasing operative treatment of these fractures have emerged. We aim to demonstrate the safety and efficacy of cast wedging for treatment of pediatric forearm fractures.
METHODS:: We performed a prospective chart review of patients with forearm fractures, including distal radius (DR) fractures, treated with cast wedging at a single large pediatric hospital from June 2011 to September 2012. Inclusion criteria specified open distal radial physis, closed injury, loss of acceptable reduction, and availability of clinical and radiographic data from injury to cast removal. Exclusion criteria included pathologic fractures, neurovascular injury, fracture dislocations, open fractures, and closed DR physis. Reductions were performed and patients followed according to standard protocol at our institution, including placement into long-arm casts, initial follow-up visit within 5 to 10 days postinjury, and weekly visits for 2 weeks thereafter. If alignment were deemed unacceptable within 3 weeks of injury, cast wedging was utilized. Radiographic measurements of alignment included both radius and ulna on the injury film, postreduction, prewedge, postwedge, and final films. Radiographic technique was standardized, with repeatability testing demonstrating a precision of ±2 degrees.
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