Journal of pediatric orthopedics
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Callotasis lengthening is an established method, but few cases of metacarpal lengthening have been reported. The authors performed callotasis lengthening to treat brachymetacarpia in six digits in three patients. The patient age at the time of distraction ranged from 10 to 19 years. ⋯ There were no serious complications. In four digits, the range of flexion of the metacarpophalangeal joint was increased after lengthening, and this enabled the patient to use the digit easily in a palmar grasp. Brachymetacarpia is an appropriate indication for callotasis lengthening in congenital deformities of the upper extremities.
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Thirty-four consecutive patients with displaced supracondylar humerus fractures were treated with reduction and percutaneous pinning. The precise location of the ulnar nerve to the medial pin was determined by intraoperative nerve stimulation. In 22 of the 34 patients, the authors attempted to predict the location of the ulnar nerve by palpation and placing a mark on the skin. ⋯ However, clinically they were fairly close in their prediction and documented safe insertion and distance from the nerve. Intraoperative nerve stimulation may assist in localizing the nerve prior to placement of the medial pin. Stimulation of the pin itself following insertion is another technique to ensure safe pin placement and decrease the risk of injury.
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Four new cases of carpal scaphoid nonunion in children are presented. This rare injury is characterized by delay in treatment of the scaphoid fracture or incorrect immobilization. ⋯ No complications occurred and there was no significantly limited mobility. The author speculates about the posibility of partial or complete consolidation of the scaphoid fracture without treatment as a part of the natural history of this fracture in children.
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Comparative Study
Changing patterns of pediatric pelvic fractures with skeletal maturation: implications for classification and management.
Orthopaedic traumatologists have recognized the unique fracture patterns and injury constellations of pediatric pelvic fractures. However, an understanding of the effect of advancing skeletal maturation is needed to avoid applying adult classifications and management. The authors determined how pelvic fracture patterns and management change with advancing skeletal maturity. ⋯ The incidences of specific pelvic fracture patterns between the two groups were statistically different. Management of fractures to the immature pelvis should focus on associated injuries. Once the triradiate cartilage has closed, adult pelvic fracture classifications and management principles should be used.
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A retrospective study of 21 medial condylar fractures revealed that the complication rate for these rare fractures was 33%. Most of the minimally displaced fractures healed uneventfully with immobilization; however, one patient developed avascular necrosis of the trochlea, and one patient developed a nonunion. Operative treatment was performed if there was >2 mm of displacement at the fracture site. ⋯ Medial condylar fractures may be difficult to diagnose in younger children and should be considered when there is a history of trauma and medial-sided elbow pain. Oblique views, arthrography, or magnetic resonance imaging can be helpful in confirming the diagnosis. Management of this rare fracture must include adequate stabilization of the fracture and immobilization until there is radiographic evidence of healing.