Journal of pediatric orthopedics
-
Thirteen (3.2%) of 410 patients seen in British Columbia's Children's Hospital in Vancouver from January 1984 to September 1992 with supracondylar fractures did so with an absence of a radial pulse in an otherwise well perfused hand. A combination of segmental pressure monitoring, color-flow duplex scanning, and magnetic resonance angiography (MRA) appears to be a valid, noninvasive, and safe technique in evaluating patency of the brachial artery and collateral circulation across the elbow. Based on this study, early revascularization of a pulseless otherwise well-perfused hand in children with type 3 supracondylar fractures, although technically feasible and safe, has a high rate of asymptomatic reocclusion and residual stenoses of the brachial artery. Therefore a period of close observation with frequent neurovascular checks should be completed before more invasive correction of this problem is contemplated.
-
We report the retrospective results of 17 displaced radial neck fractures (O'Brien type II-III) in children aged between 6 and 16 years treated with closed intramedullary pinning according to the Metaizeau technique, from 1988 to 1992 in our Pediatric Orthopaedic Service at the Ramón y Cajal Hospital. The average follow-up was 4.1 years. ⋯ Overgrowth of the radial head was present in three cases without functional impairment. We recommend this closed method of treatment because it is simple, easy to perform, and obtains exciting results with few complications.
-
Case Reports
Compartment syndrome associated with bupivacaine and fentanyl epidural analgesia in pediatric orthopaedics.
Two patients had a compartment syndrome after surgery at a remote site performed under a continuous lumbar infusion of a mixture of narcotic (fentanyl) and local anesthetic (bupivacaine 0.1%). Each patient had inadvertent excessive pressure applied to the limb distally and had no perception of pain in the presence of this analgesic combination. After the relief of this pressure from a sling or traction apparatus, each child had signs of a compartment syndrome, and this sensation of pathologic pain was not masked by the epidural infusion. A discussion of the literature questions the benefits of bupivacaine local anesthetic as a routine addition to epidural analgesia for orthopaedic surgery.