Journal of pediatric orthopedics
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The radiocapitellar line (RCL) has long been used for the radiographic evaluation of elbow alignment. In children, the capitellar ossific nucleus serves as a proxy for the entire capitellum, but this substitution has not been verified. Using magnetic resonance imaging (MRI), we sought to understand how maturation of the ossific nucleus of the capitellum affects the utility of RCL throughout skeletal maturation of the elbow. ⋯ Eccentric ossification of the capitellum explains RCL variability in young children. The RCL does not reliably intersect the central third of the ossified capitellum until ages 10 years in girls and 11 years in boys in the sagittal plane. The RCL should be used within its limitations in skeletally immature children and should be combined with advanced imaging if necessary.
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One of the main goals of scoliosis surgery is to obtain a balanced fused spine. Although preoperative planning remains essential, intraoperative posteroanterior radiographs are the only available tool during the procedure to verify shoulder and coronal spinal balance and, if necessary, adjust the construct. The aim of this study was to quantify the direct influence of intraoperative radiographs on the surgical procedure itself during correction of adolescent idiopathic scoliosis. ⋯ Intraoperative radiographs remain necessary to ensure compensation of the shortcomings of the modern preoperative planification method.
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Randomized Controlled Trial Pragmatic Clinical Trial
Treatment of Calcaneal Apophysitis: Wait and See Versus Orthotic Device Versus Physical Therapy: A Pragmatic Therapeutic Randomized Clinical Trial.
Calcaneal apophysitis is a frequent cause of heel pain in children and is known to have a significant negative effect on the quality of life in affected children. The most effective treatment is currently unknown. The purpose of this study is to evaluate 3 frequently used conventional treatment modalities for calcaneal apophysitis. ⋯ Treatment with wait and see, a heel raise inlay, or physical therapy each resulted in a clinical relevant and statistical significant reduction of heel pain due to calcaneal apophysitis. No significant difference in heel pain reduction was found between individual treatment regimes. Calcaneal apophysitis is effectively treated by the evaluated regimes. Physicians should deliberate with patients and parents regarding the preferred treatment.
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Randomized Controlled Trial
Does Topical Anesthetic Reduce Pain During Intraosseous Pin Removal in Children? A Randomized Controlled Trial.
The purpose of this study was to determine the effectiveness of topical liposomal lidocaine in reducing the pain perceived by children undergoing percutaneous intraosseous pin (PP) removal in the outpatient orthopaedic clinic. ⋯ Topically applied liposomal lidocaine was not effective in reducing pain during this procedure, compared with a placebo. However, this study demonstrates that PP removal is a painful procedure in children. Given the large volume of patients who undergo this procedure and the long-term consequences of experiencing painful procedures in childhood, it is important to find safe and fast-acting methods to decrease procedural pain associated with PP removal.
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Previous literature has underreported radiation exposure with the use of mini C-arm during pediatric forearm fracture reductions. The purpose of this study is to report an accurate amount of radiation exposure during fracture reductions using a mini C-arm that records the amount of kilovolts, milliamps, and the number of seconds of foot pedal use. ⋯ Radiation exposure when using the mini C-arm for reduction of pediatric fractures has been underestimated in previous literature. Radiation from the mini C-arm exceeded that from conventional radiographs in most cases. We recommend that residents receive training about the use of the mini C-arm before its utilization as an aid to reduce pediatric fractures in the emergency department.