Journal of pediatric orthopedics
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Multicenter Study Clinical Trial
Morphological changes during growth in healed childhood spinal tuberculosis: a 15-year prospective study of 61 children treated with ambulatory chemotherapy.
A retrospective clinical study for prognostic purposes. ⋯ Notable morphological changes occurred in both the kyphosis fusion mass and the uninvolved levels above and below the lesion in children with healed spinal tuberculosis. These changes occurred during growth, after complete healing of the disease was achieved, and were responsible for the variability in progression of the deformity during growth seen in these children. Our results imply that all children with spinal tuberculosis must be followed up regularly till the entire growth potential is completed.
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Elastic stable intramedullary nailing (ESIN) has became a well-accepted method of osteosynthesis of diaphyseal fractures in children and adolescents for many reasons including the following: no need for postoperative cast, primary bone union with avoidance of growth plate injury, and minimum invasive surgery. ⋯ The good results of this reliable technique are obtained when surgeons have a good knowledge of it, especially in the understanding of the principle of the correction of the fracture and its stability.
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To determine national trends and putative racial and socioeconomic disparities in health care utilization in pediatric patients with pyogenic arthritis over a 13-year period. ⋯ There was a trend toward decreased health care utilization, but no decrease in charges for pediatric pyogenic arthritis from 1988 to 2000. Racial disparities still exist, with little improvement over time.
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Randomized Controlled Trial
Axillary block for analgesia during manipulation of forearm fractures in the pediatric emergency department a prospective randomized comparative trial.
Our objective was to compare procedural distress during manipulation of forearm fractures in children receiving either axillary (brachial plexus) block regional anesthesia (20 children) or deep sedation with ketamine and midazolam (21 children). This was a prospective randomized unmasked controlled comparative trial conducted in an urban children's hospital emergency department. The 2 groups were similar in age (older than 8 years), fracture types, initial pain scores, narcotic analgesia received, and midazolam doses before fracture manipulation. ⋯ The mean CHEOPS score was 6.4 +/- 2.8 in the group with axillary block and 7.5 +/- 1.6 in those receiving deep sedation; the difference between the CHEOPS scores in the 2 groups was not statistically significant (P = 0.126, 95% CI: 2.5, 0.3). Axillary block was used successfully in 18 (90%) of the 20 children. No patient in either group experienced any adverse events.
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The purpose of this review is to evaluate the safety of regional anesthesia techniques performed for postoperative analgesia in anesthetized children. Pediatric regional anesthesia techniques, such as nerve blocks and neuraxial injections of either local anesthetics or narcotics, can potentially reduce postoperative pain for all children undergoing surgery. However, children may react differently to anesthesia than adults, and they usually cannot tolerate the administration of regional anesthesia unless they are under general anesthesia. ⋯ No complications were noted in patients who received neuraxial injections. This retrospective review indicates that regional anesthesia techniques performed 'under general anesthesia have a low rate of complications in children. A prospective trial is recommended to establish the efficacy and safety of this practice.