Journal of pediatric orthopedics
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Comparative Study
Comparison of titanium elastic nail and plate fixation of pediatric subtrochanteric femur fractures.
Studies have demonstrated a higher risk of complications when children with fractures in the proximal third of the femur and length-unstable fractures are treated with titanium elastic nails. Alternative treatment methods include open plating and submuscular plating. We are not aware of any published studies that directly compare titanium elastic nail and plate fixation of pediatric subtrochanteric femur fractures. The purpose of the present study was to retrospectively compare the outcomes and complications of titanium elastic nail and plate fixation of subtrochanteric femur fractures in children and young adolescents. ⋯ Therapeutic Level III.
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Mechanical low back pain is common in the pediatric population; recent studies have shown that undiagnosed mechanical low back pain (UMLBP) is the most common cause of low back pain presenting in adolescents, accounting for up to 78% of cases. Spondylolysis/spondylolisthesis is the most common cause with diagnosed pathology observed in this age group. The goals of this study are to: determine the natural history of low back pain, evaluate the value of radiographic studies in establishing a diagnosis of spondylolysis, and determine the cost and radiation effective doses (EDs) associated with those studies with the associated risks radiation exposure. ⋯ Mechanical low back pain is common in adolescents and in most cases is undiagnosed; most require no imaging and ≤2 office visits. For spondylolysis, 2-view plain films are often diagnostic and oblique views did not add significant value. Advanced imaging increases diagnostic accuracy, but adds to the cost and considerable radiation exposure. Because diagnosis of spondylolysis rarely changes clinical management, physicians should use ionizing radiation studies sparingly in children.