Journal of pediatric orthopedics
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Randomized Controlled Trial Comparative Study Clinical Trial
Evaluation of the role of comparison radiographs in the diagnosis of traumatic elbow injuries.
This study attempted to determine whether comparison radiographic views of the uninjured elbow result in increased diagnostic accuracy. Physicians (one junior and one senior orthopaedic resident and an orthopaedic surgeon) were provided with a short clinical summary and asked to interpret radiographs of the injured elbow (IE) or both the injured and uninjured elbow (UE) in a randomized fashion from 25 children with elbow injuries. The overall percentage of correct diagnoses (one vs. two elbow radiographs) were as follows: orthopaedic surgeon, 80 versus 96%; for junior resident, 80 versus 84%; and for senior resident, 84 versus 88% (p > 0.05). ⋯ Incorrect radiograph interpretations were due to false positives in 39 of 40 cases. Comparison radiographs of the UE were not useful in improving diagnostic accuracy in elbow trauma. However, although they may be necessary in some instances, routine radiographic examination of the UE is not warranted.
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Comparative Study
Clinical evaluation of crossed-pin versus lateral-pin fixation in displaced supracondylar humerus fractures.
The radiographs and patient charts of 47 children treated with closed reduction and percutaneous pin fixation of displaced supracondylar humerus fractures were reviewed. Twenty-seven fractures were fixed with crossed medial and lateral pins. Twenty fractures were treated with two parallel laterally placed pins. ⋯ No statistically significant differences regarding maintenance of reduction were found when comparing the two fixation groups. There were two complications in the medial pin group (one cubitus varus and one ulnar nerve injury) and none in the lateral-pin group. We conclude that crossed-pin fixation offers no clinically significant advantage over two laterally placed pins in the treatment of supracondylar humerus fractures.
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A retrospective analysis of 30 consecutive fractures of the distal femoral epiphyseal plate showed the best results occurred when fractures were anatomically reduced and fixed with pins. No fractures with internal fixation displaced, whereas 43% of fractures reduced without fixation displaced during cast treatment. Complications were more frequent in displaced than nondisplaced fractures. We were unable to demonstrate that gentle reduction under general anesthesia offered protection against subsequent physeal arrest when compared with closed reduction in the emergency room; however, reductions in the operating room were more likely to be anatomic.
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Acute annular ligament interposition into the radiocapitellar joint in children (nursemaid's elbow).
Acute annular ligament interposition into the radiocapitellar joint ("nursemaid's elbow") is a common injury in children younger than 5 years. The injury occurs when axial traction is applied to an extended, pronated arm. There are no abnormal radiographic findings associated with this condition. We recommend that children with a classic history and clinical presentation of an acute annular ligament interposition into the radiocapitellar joint be treated without obtaining radiographs.