Journal of pediatric orthopedics
-
We studied 12 children who had minimally displaced lateral humeral condyle fractures. Bony gaps at the fracture site were <2 mm on the anteroposterior view of plain radiographs. To determine the stability of the fractures, we used a magnetic resonance imaging (MRI) study of the distal humerus and elbow joint. ⋯ Type I showed that the line coursed from the lateral metaphysis to the growth plate but not through it. In type II, the line crossed the growth plate to enter the joint space. We concluded that the MRI study distinguished the potentially unstable fracture (type II) from the minimally displaced fracture and recommend the use of a percutaneous pin fixation for the expected unstable fracture.
-
The control of postoperative pain in the pediatric orthopaedic patient is a challenging endeavor. Several studies have shown the efficacy of ketorolac tromethamine in the pediatric general surgical population, but its efficacy in the pediatric orthopaedic population remains unproven. Twenty-seven consecutive patients (age 6 months to 18 years) who underwent long-bone osteotomies or foot procedures by a group of three pediatric orthopaedic surgeons were given a ketorolac protocol (1 mg/kg loading, 0.5 mg/kg every 6 h for 24 h). ⋯ Finally, the patients in the ketorolac group had a significantly shorter length of stay (3.63 +/- 1.64 days vs. 4.74 +/- 1.76 days; p < 0.05). There were no bleeding complications in either group. Ketorolac is thus a safe and effective means of controlling postoperative pain in the pediatric orthopaedic population while avoiding the troubling maleffects seen with the exclusive use of morphine.