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Birth-related femoral fracture in newborns: risk factors and management.

J Child Orthop. 2012 Jul;6(3):177-80

Authors: Kancherla R, Sankineani SR, Naranje S, Rijal L, Kumar R, Ansari T, Trikha V

Abstract
PURPOSE: Femoral shaft fracture following birth in newborns is a very rare injury. However, the risk factors for, mechanism of and management of these injuries remain a matter of debate. We describe our observations in a tertiary centre.
METHODS: Ten cases of femoral shaft fracture encountered during a study period from January 2005 to December 2009 were evaluated. The demographic details, risk factors during birth, systemic illness, mode of delivery, type of fracture and management used were documented, and an analysis was performed.
RESULTS: Mean gestational age was 37.2 weeks. Mean time to diagnose was 4 days. Two patients had subtrochanteric fracture, and eight patients had mid-shaft fracture. Most patients had breech presentation and had been born by Caesarean section. All patients showed complete union at the end of 4 weeks. No residual angulation or limb length discrepancy was noted after mean follow-up of 5 years.
CONCLUSIONS: Thorough clinical examination and proper orthopaedic consult in the event of doubtful presentation help in early diagnosis and management. These fractures have good prognosis at long-term follow-up.

PMID: 23814617 [PubMed]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23814617?dopt=Abstract

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Reliability of plain radiographic parameters for developmental dysplasia of the hip in children.

J Child Orthop. 2012 Jul;6(3):173-6

Authors: Upasani VV, Bomar JD, Parikh G, Hosalkar H

Abstract
INTRODUCTION: Few studies have evaluated the reliability and reproducibility of the femoral neck-shaft angle (NSA), center-edge angle (CEA), and acetabular index (AI) in young children with developmental dysplasia of the hip (DDH). We wanted to determine whether these parameters could be used reliably by practitioners.
METHODS: Fifty radiographs from 21 children with DDH were reviewed. Analysis was performed by three observers, at two time periods. The intra- and inter-observer reliability for each measure was assessed.

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Hip impingement in slipped capital femoral epiphysis: a changing perspective.

J Child Orthop. 2012 Jul;6(3):161-72

Authors: Hosalkar HS, Pandya NK, Bomar JD, Wenger DR

Abstract
BACKGROUND: Femoroacetabular impingement (FAI) as a result of slipped capital femoral epiphysis (SCFE) has recently gained significant attention. Seen as an intermediate step toward the development of early osteoarthritis, symptomatic FAI develops in SCFE patients who have residual hip deformity characterized by relative posterior and medial displacement of the capital femoral epiphysis, leading to an anterolateral prominence of the metaphysis which abuts on the acetabular rim. This results in a decreased range of hip motion as well as progressive labral damage and articular cartilage injury, which cause symptoms of FAI. All degrees of slips from mild to severe can develop impingement.
METHODS: The existing literature on the subject was thoroughly reviewed and all levels of studies that have made any meaningful changes to clinical practice were considered.
RESULTS: Based on the literature review, current practice trends, and our own institutional practice pattern, all treatment options for SCFE in the impingement era have been presented with an open discussion regarding potential benefits and limitations.

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Localized Acquired Hypertrichosis After Cast Treatment in Pediatric and Adolescent Patients: A Natural History Study.

J Pediatr Orthop. 2013 Jun 26;

Authors: Pfiester MP, Eismann EA, Wilson LM, Parikh SN

Abstract
BACKGROUND:: Localized acquired hypertrichosis (LAH) is a condition characterized by increased hair growth and is frequently seen after cast removal in children and adolescents. The purpose of this study was to examine the natural history of LAH and its potential impact on patients' quality of life.
METHODS:: Patients between the ages of 5 and 16 years, in whom hypertrichosis was detected after the removal of a cast were enrolled in a prospective study. Each patient completed the Children's Dermatology Life Quality Index after cast removal and at follow-up. Each patient was followed up until complete resolution of hypertrichosis. Statistical analyses were performed to determine any relation between the time to resolution of hypertrichosis and potential contributing variables including age, sex, initial diagnosis, type of cast, type of cast liner, and duration of cast.
RESULTS:: Of the 25 enrolled patients, 3 were lost during follow-up and 1 girl was excluded. The mean Children's Dermatology Life Quality Index total score was 1.1±1.4, with the majority of patients (68%) scoring 0 or 1. The hypertrichosis was completely resolved within 6 months in 17 of the 21 patients and within 6 to 12 months in the

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Bipolar Sealer Device Reduces Blood Loss and Transfusion Requirements in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

J Pediatr Orthop. 2013 Jun 26;

Authors: Gordon ZL, Son-Hing JP, Poe-Kochert C, Thompson GH

Abstract
BACKGROUND:: Reducing perioperative blood loss and transfusion requirements is important in the operative treatment of idiopathic scoliosis. This can be achieved with special frames, cell saver systems, pharmacologic aspects, and other techniques. Recently there has been interest in bipolar sealer devices as an adjunct to traditional monopolar electrocautery. However, there is limited information on this device in pediatric spinal deformity surgery. We reviewed our experience with this device in a setting of a standard institutional operative carepath.
METHODS:: Perioperative blood loss and transfusion requirements of 50 consecutive patients with adolescent idiopathic scoliosis undergoing a posterior spinal fusion and segmental spinal instrumentation and who had a bipolar sealer device used during their surgery was compared with a control group of the 50 preceding consecutive patients who did not. Anesthesia, surgical technique, use of intraoperative epsilon aminocaproic acid (Amicar), postoperative protocol, and indications for transfusions (hemoglobin≤7.0 g/dL) were identical in both groups.

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Abduction Bracing for Residual Acetabular Dysplasia in Infantile DDH.

J Pediatr Orthop. 2013 Jun 26;

Authors: Gans I, Flynn JM, Sankar WN

Abstract
BACKGROUND:: Abduction bracing is often used to treat residual acetabular dysplasia in infants whose acetabular indices (AI) exceed 30 degrees after 6 months of age. However, little data exist to support this practice. The purpose of this study was to determine the efficacy of part-time abduction bracing in treating residual acetabular dysplasia by comparing a cohort of braced infants with a cohort of unbraced infants.

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Venous Thromboembolism in Children: Details of 46 Cases based on a Follow-up Survey of POSNA Members.

J Pediatr Orthop. 2013 Jun 26;

Authors: Sabharwal S, Zhao C, Passanante M

Abstract
INTRODUCTION:: On the basis of a recent survey of Pediatric Orthopedic Society of North America members, 59% of the respondents acknowledged having encountered at least 1 child with the diagnosis of venous thromboembolism (VTE). The current survey sought further information including patient demographics, underlying diagnosis, presence of certain risk factors for VTE, and the clinical outcome.
METHODS:: A follow-up web-based questionnaire was sent to 121 active members of Pediatric Orthopedic Society of North America who had provided their contact information in the prior survey. Thirty-eight respondents provided clinical details on 46 children.