Journal of pediatric orthopedics
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This study investigates the hypothesis that the integrity of the cartilage hinge at the distal humeral epiphysis determines the stability of fractures of the lateral humeral condyle. Sixteen patients with lateral humeral condyle fractures were studied with radiographs and magnetic resonance imaging (MRI). The clinical course of each patient was compared using these imaging studies to determine whether initial fracture displacement and the integrity of the cartilage hinge correlated with fracture stability. ⋯ None of these displaced during treatment. Two patients had radiographically stable fractures and complete fractures on MRI. One of these fractures displaced, confirming the hypothesis that the stability of lateral humeral condyle fractures is related to the integrity of the cartilage hinge.
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The authors present an original fixation technique for olecranon fractures in children, achievable without opening the fracture site. The standard method of Kirschner wire fixation with tension band wiring is replaced by a threaded pin stabilization with adjustable lock effect. An olecranon fracture model was used to compare the mechanical properties of this new system with the tension band wiring technique, and with a simple pin fixation. No significant difference was found between the two first techniques, whereas the simple pin fixation had much poorer mechanical properties.
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The authors describe four cases of obturator internus muscle (OIM) abscess in children, including their clinical presentations and treatment. This was a retrospective chart review. Children and adolescents younger than 18 years discharged between July 1, 1985, and September 30, 1998, from Brenner Children's Hospital with the diagnosis of muscle abscess or pelvic abscess were identified. ⋯ The presentation of OIM pyomyositis is similar to that of psoas muscle pyomyositis and other infectious processes of the pelvis and hip. The S. aureus is the most common etiologic agent but not the only one reported. Most patients can be managed without open surgical drainage, but needle aspirations may be helpful both therapeutically and diagnostically.
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Forefoot adduction is the most common residual deformity after clubfoot surgery. Surgical treatment of this deformity is often required for moderate and severe cases. ⋯ Clinical and radiographic improvement was seen in all patients, and no complications were seen. Surgery is advocated in children older than age 4, or when the medial cuneiform ossific nucleus is well developed.
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Electrical injuries resulting in physeal injury in children are an uncommon but well-recognized clinical entity. Almost all these injuries are sustained from man-made electrical sources. ⋯ The authors report the case of a 12-year-old girl who survived a lightning strike 2 years ago and who presented with asymmetric growth arrest in both legs. The authors discuss the pathophysiology of lightning strike and consider the evidence for direct electrical injury versus ischemic insult to the physis as explanations for the cause of the growth arrest observed in this patient.