Journal of pediatric orthopedics
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Comparative Study
Eleven years experience in the operative management of pediatric forearm fractures.
There has been a trend toward operative management of pediatric diaphyseal forearm fractures (DFFx). We studied our experience with surgical management of these injuries to assess indications, frequency, outcome, and complications. ⋯ Level III, Retrospective Comparative Study.
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Supracondylar humerus fractures that present with a perfused, viable hand yet no pulse continue to be a source of controversy. The purpose of this study was to conduct a systematic review of the literature and perform a Pediatric Orthopaedic Society of North America (POSNA) opinion poll regarding management of pulseless supracondylar humeral fractures in children. ⋯ Our study revealed that common dogma regarding watchful waiting of pulseless and perfused supracondylar fractures needs to be questioned. In the vast majority of published cases, an absence of pulse is an indicator of arterial injury, even if the hand appears pink and warm, suggesting the need for more aggressive vascular evalvation and vascular exploration and repair in selected cases. Moreover, patency rates for revascularization procedures appear sufficiently high, making this intervention worthwhile.
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The increase in the utilization of fluoroscopy during surgical procedures carries with it an inherent increase in the exposure of both patients and surgical staff to ionizing radiation. The purpose of this study was to examine the ability to reduce radiation doses by the implementation of an intervention program targeted at the staff operating the fluoroscopy machinery and attempting to make a behavioral change in its utilization. ⋯ Level II therapeutic study.
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Comparative Study
Operative versus nonoperative treatment of midshaft clavicle fractures in adolescents.
Midshaft clavicle fractures in adolescents have traditionally been treated nonoperatively. Recent studies in the adult literature have shown a higher prevalence of symptomatic malunion, nonunion, and poor functional outcome after nonoperative treatment of displaced fractures. The purpose of this study was to compare operative versus nonoperative treatment of displaced clavicle fractures in adolescents. ⋯ Therapeutic level III.