Journal of pediatric orthopedics
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Comparative Study
Pediatric olecranon fractures: open reduction and internal fixation with removable Kirschner wires and absorbable sutures.
The authors present an original fixation technique for pediatric olecranon fractures that avoids reoperation to remove hardware as compared with the standard fixation technique with Kirschner wires and tension band wiring as advocated by the AO technique. The authors' technique uses two percutaneously placed Kirschner wires to fixate displaced transverse and oblique olecranon fractures. Prior to the insertion of the wires, the fracture is reduced through a standard open approach. ⋯ No immediate complications have been noted; one patient has a loss of extension of 10 degrees at the elbow. Radiographic results are good, with no loss of reduction. This technique avoids the need for reoperation for hardware removal without compromising the quality of reduction.
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Comparative Study
The use of conscious sedation for pain control during forearm fracture reduction in children: does race matter?
Recent reports in the medical literature indicate that certain racial disparities have been identified in healthcare. The authors sought to identify the potential relationship between the use of pain medications in African-American and Caucasian children undergoing forearm fracture reduction. This retrospective cohort study was performed at a university-affiliated tertiary care children's hospital emergency department. ⋯ Multivariate statistical analysis revealed that higher amounts of fracture translation (P < 0.0001) and angulation (P < 0.0027) and younger age of the patient (P = 0.0059) were significant predictors of conscious sedation use. Race was not found to be significantly associated with the use of conscious sedation (P = 0.0606 in univariate analysis, P = 0.1678 in multivariate analysis). The authors found that the decision to use conscious sedation for pediatric forearm fractures was not influenced by race, but was influenced by certain fracture characteristics and patient age.
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The purpose of this prospective clinical study was to identify the true incidence, pattern, and location of the injury and nature of fracture after hand injuries in different pediatric age groups attending a hand unit. Three hundred sixty children (237 boys, 123 girls) under 16 years of age who presented with hand injuries between April 1, 2000, and Sept. 30, 2000, were included in the study. Bony injuries accounted for 65.5% (236 injuries); 33.3% (120 injuries) were soft tissue injuries. ⋯ Diaphyseal fractures (46%) were more common in the metacarpals, and basal fractures (51%) were common in the phalanges. At discharge more than 80% of the patients felt that they were cured or significantly better. This paper highlights the changing pattern and the different varieties of hand injuries in different pediatric age groups.
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Placement of an intrathecal baclofen pump is a common treatment of spasticity in cerebral palsy patients. Though effective, the hardware is prone to malfunction, and multiple revisions are often necessary. Additional complications have also been described, including infection and drug toxicity or withdrawal. ⋯ A retrospective chart review was performed on four patients who showed accelerated scoliotic progression after intrathecal baclofen pump insertion for treatment of spasticity. Cobb angles were measured from preoperative and postoperative radiographs to determine the rate of scoliotic degeneration both before and after pump insertion. Although there may not be a direct correlation between intrathecal baclofen and scoliosis, the authors consider the issue important enough to warrant discussion with any patient considering intrathecal baclofen.