Journal of pediatric orthopedics
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Clinical Trial
Evaluating blood loss in children's orthopaedic surgery: a simplified method of photometric analysis of eluted swabs.
Assessment of intraoperative blood loss by the traditional method of weighing swabs (4 x 4-in. gauze) is propounded to estimate approximately 75% of total loss, although many believe this still underestimates actual loss. The various components of this technique were studied by using the method of colorimetric analysis of eluted swabs, but utilising a modern spectrophotometer. ⋯ Weighing swabs was found to estimate only approximately 50% of total loss, and this was supported in the pilot clinical study by a postoperative decrease in haemoglobin of 8-17%, despite transfusion, when transfusion was based on the traditional "75%" rule. Because it is impractical to elute theatre apparel and instruments to increase the accuracy of the elution method in the perioperative time scale necessary, a compromise may be to use the new "50%" rule as a better estimate of total blood loss when calculating transfusion requirements.
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Review Case Reports
Fracture of the cuboid in children: case report and review of the literature.
Although fractures of the cuboid are rare, they can be very disabling. The diagnosis is often missed, and overlooked cuboid fractures can lead to severe alterations in foot mechanics and function. ⋯ Cuboid fractures should be considered in the differential diagnosis of limping toddlers. Children seen with pain, swelling, and inability to bear weight on the lateral aspect of the foot require proper evaluation and treatment.
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Calcaneal fractures are rare in children but frequent in adults. We report 18 cases (20 feet) of pediatric calcaneal fractures before the distal tibial growth line closed to assess the characteristics of pediatric calcaneal fractures and reveal differences in treatment and prognosis between children and adults. ⋯ The outcome was good, including the surgical cases. One of the reasons that calcaneal fractures are considered rare in children is that they are missed, and thus care is required in making the diagnosis.
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Comparative Study Clinical Trial
The effect of elbow position on the radial pulse measured by Doppler ultrasonography after surgical treatment of supracondylar elbow fractures in children.
We performed a prospective study of 20 patients with displaced extension supracondylar humerus fractures and evaluated the effect of elbow flexion, forearm supination, and forearm pronation on blood flow to the injured arm after closed reduction and Kirschner wire fixation. Ten patients had a Gartland type II fracture and 10 patients had a Gartland type III fracture. After closed reduction and percutaneous pinning, the radial pulse was examined with Doppler ultrasonography starting with the elbow in extension. ⋯ Supination allowed > or = 5 degrees of elbow flexion prior to radial pulse ablation in six Gartland type II and four Gartland type III fractures. We concluded that after closed reduction and percutaneous Kirschner wire fixation of displaced extension supracondylar fractures, vascular safety is enhanced by extending the elbow and supinating the forearm. The ideal position of elbow immobilization depends on the amount of swelling and the presence of a radial pulse.
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Clinical Trial
Ultrasonography: can it differentiate between vasoocclusive crisis and acute osteomyelitis in sickle cell disease?
We prospectively evaluated the results of ultrasonography in 53 patients of sickle cell disease suspected to have vasoocclusive crisis/acute hematogenous osteomyelitis. The average age was 8.4 +/- 3.40 years (range, 1-14). Twenty-six children were boys and 27 were girls. ⋯ All patients with vasoocclusive crisis were treated with analgesics and intravenous fluids and did not require any further treatment. In patients with acute osteomyelitis, the treatment was incision, drainage and drilling of bone, and antibiotic therapy. We conclude that ultrasonography clearly and decisively differentiated acute osteomyelitis from vasoocclusive crisis in patients with sickle cell disease.