Journal of pediatric orthopedics
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Comparative Study
Treatment of the collapsed femoral head by containment in Legg-Calve-Perthes disease.
One hundred ninety-seven patients with unilateral Legg-Calve-Perthes disease (LCPD) were followed-up to skeletal maturity. According to the lateral pillar classification, 142 hips were classified as group B and 55 hips as group C. Radiographs were evaluated for percent of collapse of the femoral head, Waldenstrom stage of disease at diagnosis, Mose sphericity, hinge abduction, lateral acetabular shape, and limb-length discrepancy. ⋯ Analyses revealed statistically significant differences between group B versus group C with regard to the classifications of Stulberg et al. and Mose, lateral acetabular shape, age at onset, and limb-length discrepancy. There was no significant statistical difference with regard to the types of treatment. Containment treatment of a deformed femoral head from LCPD improves the sphericity of the hip and gives 63% satisfactory results according to the Mose classification and 74% satisfactory results according to the Stulberg et al. classification.
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Comparative Study
Lyme arthritis presenting as acute septic arthritis in children.
There is considerable overlap in the initial clinical and laboratory presentations of acute septic arthritis and Lyme arthritis. The authors present a consecutive case series of 10 children with acute arthritis consistent with septic arthritis who ultimately were diagnosed with Lyme disease. Fifty percent presented with a fever of 38 degrees C or higher. ⋯ Seven patients in this series underwent emergent joint irrigation and debridement for presumed septic arthritis. The authors suggest that in regions where Lyme disease is endemic, children who present with presumed septic arthritis should also be evaluated for Lyme disease. The authors also present a protocol for evaluation and management of these diagnostically challenging cases.
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Fractures of the anterior superior iliac spine (ASIS) in adolescents are usually due to avulsion of the sartorius origin from the ASIS; however, the authors here report a second type due to avulsion of the tensor fascia lata origin. Eight patients were identified with ASIS avulsion fractures. Type II sartorius avulsion fracture was due to sprinting in various sports (n = 6). ⋯ Type II tensor fascia lata avulsion fractures were due to swinging a baseball bat. The two muscular males were both injured during the initial phase of batting. The bony fragment was much larger and displaced laterally as confirmed by three-dimensional computed tomography scans.
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The purpose of this study was to determine the role of magnetic resonance imaging (MRI) in the evaluation of children with suspected cervical spine injury (CSI). The authors studied 237 consecutive children, 74 of whom were evaluated by MRI based on a trauma protocol of the authors' institution. ⋯ MRI confirmed the plain radiography diagnosis in 66% of children and altered the diagnosis in 34%. MRI is valuable in the evaluation of potential CSI, especially in obtunded children or children with equivocal plain radiographs.