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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
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.
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.
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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These pubmed results were generated on 2013/11/30
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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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Central Polydactyly of the Foot: Surgical Management With Plantar and Dorsal Advancement Flaps.
J Pediatr Orthop. 2013 Sep 15;
Authors: Osborn EJ, Davids JR, Leffler LC, Gibson TW, Pugh LI
Abstract
BACKGROUND:: Central polydactyly is the least common form of foot polydactyly, and the intercalary location of the duplicated ray makes the surgical exposure, excision, and closure more complex. For these reasons there is little consensus concerning the optimal technique for surgical management.
METHODS:: A retrospective case series of 22 patients with 27 feet with central polydactyly, treated surgically by the dorsal and plantar advancement flap technique, was performed. Change in width of the forefoot was measured from radiographs by the metatarsal gap ratio. Functional outcomes were assessed by the Foot and Ankle Ability Measure.
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Safety and Efficacy of Instrumented Convex Growth Arrest in Treatment of Congenital Scoliosis.
J Pediatr Orthop. 2013 Sep 15;
Authors: Demirkiran G, Yilmaz G, Kaymaz B, Akel I, Ayvaz M, Acaroglu E, Alanay A, Yazici M
Abstract
BACKGROUND:: Anterior and posterior convex hemiepiphysiodesis is a widely used surgical alternative in the treatment of congenital scoliosis. This procedure has the disadvantage of the need for both anterior and posterior approaches. Furthermore, outcomes may be unpredictable. Posterior convex growth arrest (CGA) with pedicle screws at each segment on the convex side may obviate the need for anterior surgery and provides more predictable outcomes. This study retrospectively evaluates the safety and efficacy of instrumented posterior CGA in congenital scoliosis.
METHODS:: Patients who had posterior CGA with convex pedicle screw instrumentation for congenital scoliosis were evaluated retrospectively. Thirteen patients (6 male, 7 female) were included in the study. Preoperative, early postoperative, and last follow-up standing posteroanterior and lateral x-rays were evaluated. Cobb angles were recorded for the instrumented segment (main curve). Global thoracic kyphosis was measured between T2 and T12 on sagittal plane. These values were compared preoperatively, postoperatively, and at last follow-up. The T1-S1 vertical height and the height between the concave side pedicles of the upper and lower end vertebra of the main curve was also determined and recorded as the concave height.
RESULTS:: The average follow-up was 56.1±10 months (range, 36 to 74 mo) and the average age of the patients at the time of operation was
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Management of Pediatric Type III Supracondylar Humerus Fractures in the United States: Results of a National Survey of Pediatric Orthopaedic Surgeons.
J Pediatr Orthop. 2013 Oct-Nov;33(7):750-4
Authors: Carter CT, Bertrand SL, Cearley DM
Abstract
BACKGROUND: Supracondylar humerus fractures are common injuries in the pediatric population. The most severe, type III injuries, have seen the most debate on treatment regimens. Traditionally, these fractures were treated as surgical emergencies, most often fixed with percutaneous pinning in a cross-pin configuration. The recent literature shows that delayed fixation is comparable to emergent fixation as long as there is no vascular compromise with the injury.
METHODS: A short survey was sent to Pediatric Orthopaedic Society of North America (POSNA) members using an online survey and questionnaire service. The purpose of the survey was to establish an overview of current practices in the United States concerning treatment of type III supracondylar humerus fractures and the influence of the recent literature on the management of these injuries.
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Submuscular Bridge Plating for Length-Unstable, Pediatric Femur Fractures.
J Pediatr Orthop. 2013 Sep 6;
Authors: Samora WP, Guerriero M, Willis L, Klingele KE
Abstract
BACKGROUND:: Submuscular bridge plating has become an acceptable method of treatment for pediatric femur fractures. The purpose of our study was to describe a technique for submuscular bridge plating and review a series of consecutive, length-unstable, pediatric femur fractures treated at a single institution with this technique.
METHODS:: We performed a query of hospital records from January 4, 2006, to May 10, 2011, to identify length-unstable femur fractures treated with submuscular bridge plating by 5 pediatric surgeons. Included were patients treated with submuscular bridge plating for a femur fracture. Excluded were patients with incomplete medical records, inadequate radiographs, or follow-up <6 months duration. Fifty-one patients met diagnostic criteria; 19 patients were excluded due to incomplete medical records and/or radiographs.
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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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