Pediatric Orthopaedics Journal Scan

Related Articles

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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Management of Legg-Calvé-Perthes disease using an A-frame orthosis and hip range of motion: a 25-year experience.

J Pediatr Orthop. 2013 Mar;33(2):112-9

Authors: Rich MM, Schoenecker PL

Abstract
BACKGROUND: Containment treatment is widely accepted in the management of Legg-Calvé-Perthes disease. Many reports indicate the need to regain hip motion before pelvic or femoral osteotomy, but have not indicated how osteotomy affected motion. Recent studies have suggested that osteotomy treatment of lateral pillar B hips may result in a higher proportion of spherical hips than those managed nonoperatively; however, outcomes for children older than 8 years of age or with pillar C involvement remain unsatisfactory.

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Demographic differences in adolescent-diagnosed and adult-diagnosed acetabular dysplasia compared with infantile developmental dysplasia of the hip.

J Pediatr Orthop. 2013 Mar;33(2):107-11

Authors: Lee CB, Mata-Fink A, Millis MB, Kim YJ

Abstract
BACKGROUND: Acetabular dysplasia is a common cause of hip pain that can lead to premature osteoarthritis. This study explores whether demographic characteristics of patients diagnosed with acetabular dysplasia in adolescence and adulthood [adult-diagnosed dysplasia (AD)] differ from those who are diagnosed with developmental dysplasia of the hip (DDH) in infancy.
METHODS: Database review identified 633 patients undergoing periacetabular osteotomy for dysplasia from August 1991 to January 2008. Excluding patients with syndromal conditions and 80 lacking contact information, 421 patients received a questionnaire regarding birth and family history; 324 (70.3%) completed the survey. Thirteen were excluded because of unrelated hip conditions, leaving 311 patients for analysis.
RESULTS: Respondents were divided into 2 groups according to whether they had a history of DDH in infancy (102 patients) or were diagnosed in adolescence/adulthood (209 patients). Statistically significant differences (P < 0.05) were found in sex distribution (female: DDH = 98.0%, AD = 88.0%), affected limb

Ulnar Nerve Monitoring During Percutaneous Pinning of Supracondylar Fractures in Children.

J Pediatr Orthop. 2013 Aug 20;

Authors: Shtarker H, Elboim-Gabyzon M, Bathish E, Laufer Y, Rahamimov N, Volpin G

Abstract
BACKGROUND:: Supracondylar fractures of the humerus in children are frequently managed by closed reduction and percutaneous pinning. Insertion of medial and lateral pins is more stable than lateral pinning alone, but carries an increased risk for ulnar nerve damage. This study describes the use of electrical stimulation concurrent with medial pin insertion as a monitoring technique for avoiding iatrogenic ulnar nerve injury.
METHODS:: A retrospective review was conducted on 138 children, mean age 5.6 years (SD±2.5), who were admitted to the hospital between 2007 and 2010 with uncomplicated supracondylar fractures, Gartland type II and above, and intact neurovascular presentation. The location of the ulnar nerve was identified and marked preoperatively by observing twitch contractions in response to electrical stimulation. The medial pin served as an active electrode during pin insertion, and repeated stimulation throughout the insertion process ensured no contact with the response of the ulnar nerve. After pin insertion, ulnar nerve stimulation was used again to ensure nerve continuity viability.

Correction of Lower Extremity Angular Deformities in Skeletal Dysplasia With Hemiepiphysiodesis: A Preliminary Report.

J Pediatr Orthop. 2013 Aug 20;

Authors: Yilmaz G, Oto M, Thabet AM, Rogers KJ, Anticevic D, Thacker MM, Mackenzie WG

Abstract
BACKGROUND:: Lower extremity angular deformities are common in children with skeletal dysplasia and can be treated with various surgical options. Both acute correction by osteotomy with internal fixation and gradual correction by external fixation have been used with acceptable results. Recently, the Guided Growth concept using temporary hemiepiphysiodesis for correction of angular deformities in the growing child has been proposed. This study presents the results of temporary hemiepiphysiodesis using eight-Plates and medial malleolus transphyseal screws in children with skeletal dysplasia with lower extremity angular deformities.

Sitting Sagittal Balance is Different From Standing Balance in Children With Scoliosis.

J Pediatr Orthop. 2013 Aug 20;

Authors: Vaughn JJ, Schwend RM

Abstract
BACKGROUND:: Several variables can have effect on sagittal balance. The changes that occur between standing and sitting have been inadequately studied, especially in the, pediatric population.
METHODS:: Preoperative sagittal radiographs were obtained in both standing and sitting positions for 26 patients with idiopathic scoliosis before spinal fusion and instrumentation. Standard measurements of thoracic kyphosis, lumbar lordosis, sacral slope (SS), pelvic incidence, pelvic tilt, and lumbar intervertebral angles were, recorded. Differences were compared between positions using 2-sided paired t tests.
RESULTS:: When moving from standing to a seated position, the spine loses 5-degree thoracic kyphosis (P=0.007), 29-degree lumbar lordosis (P<0.0001), and the sacrum rotates 20 degrees (P<0.0001) to a more vertical position. The greatest change in sitting sagittal balance occurs due to increased pelvic tilt with decreased SS. The next greatest change is increased forward flexion of the lowest 2 lumbar vertebrae, 6.5 degrees between L4-L5 (P<0.0001) and 5.9 degrees between L5-S1 (P<0.0001). Flexion occurs throughout the lumbar spine but its magnitude decreases in the more proximal lumbar segments, 1.6 degrees between L1-L2 (P=0.028). The sagittal vertical axis also moves more anterior by 44 mm (P<0.0001).

Distal Humerus Atrophic Nonunion in a Child With Osteogenesis Imperfecta.

J Pediatr Orthop. 2013 Aug 20;

Authors: Hsiao CM, Mormino MA, Esposito PW, Burke BA

Abstract
Atrophic nonunion of the distal humerus in children with osteogenesis imperfecta is a vexing and disabling problem. Traditional treatments, including casting, intramedullary nailing, plating and bone grafting have not been universally successful. We report on a case of successful treatment of one atrophic nonunion of the distal humerus in ad 2 year 10 month old child with type III OI who had failed more traditional treatments. The treatment used a combination of telescoping intramedullary nails, locking plate fixation and bone morphogenic protein.Level of Evidence: Level IV.

PMID: 23965914 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23965914?dopt=Abstract

Chronic Exertional Compartment Syndrome of the Forearm in Adolescents.

J Pediatr Orthop. 2013 Aug 20;

Authors: García-Mata S

Abstract
PURPOSE:: Chronic exertional compartment syndrome (CECS) is a well-known process, although rare in the forearm. The diagnosis is based on history, clinical examination, and compartment pressure readings. My objective is to present the largest series of CECS of the forearm in adolescents and describe my experience in its management and evolution.
METHODS:: I reviewed 5 patients, 4 male (competing in motorcycling or motocross) and 1 female (CECS in both the legs and forearms), aged between 15 and 18 years. Volar and dorsal compartments were affected in 3 patients and isolated volar in 2 cases. The clinical diagnosis was objectively confirmed by measuring ICP with a low-pressure digital transducer (Stryker).
RESULTS:: Open fasciotomy was carried out in 4 patients. They resumed their athletic activities 6 weeks after surgery without complications, increasing their athletic performance level in line with their preoperative status. All these patients remained asymptomatic, recovering their previous competitive levels. The results were objectively classified as excellent in all 4 cases. After a mean follow-up of 6 years, the condition has not relapsed in any of the patients. Two of the patients agreed to a new ICP measurement 1 year after the surgery, showing normal values.