Journal of pediatric orthopedics
-
This article reports a long-term follow-up assessment (10-15 years) of eight children treated with a vascularized rib pedicle graft after an anterior spinal decompression for paralysis resulting from tuberculosis. Neurologic recovery, fusion, and hypertrophy of the rib grafts were noted in all patients. The vascularized rib pedicle grafts were superior to autologous rib grafts in supporting and promoting early fusion of the anterior column in children with kyphosis resulting from tuberculosis.
-
Magnetic resonance imaging (MRI) of acute thoracolumbar spinal injuries allows excellent evaluation of the neurologic and soft tissue structures. Owing to recent advances in imaging techniques that permit greater spatial resolution and more detailed imaging of tissue, MRI now affords effective visualization of injury to the ligaments, intervertebral disk, bones, and spinal cord after spine trauma. ⋯ The value of MRI in evaluating pediatric patients with thoracolumbar injuries or in predicting their clinical outcome has not been assessed. After retrospectively reviewing 19 pediatric thoracolumbar fractures associated with neurologic deficits from three level 1 trauma centers, we conclude that MRI is the imaging modality of choice in these patients because it can accurately classify injury to bones and ligaments and because the cord patterns as determined by MRI have predictive value.
-
Comparative Study
Measurement of vertebral rotation in standing versus supine position in adolescent idiopathic scoliosis.
Thirty-three structural curves of 25 patients with adolescent idiopathic scoliosis were evaluated using computed tomography (CT) scans and plain radiography. The average Cobb angle on standing radiographs was 55.72 degrees and was observed to be corrected spontaneously to 39.42 degrees while the patients were in supine position (29.78% correction). Average apical rotation according to Perdriolle was 22.75 degrees on standing radiographs and 16.78 degrees on supine scanograms. ⋯ If the patient lies supine, the scoliosis curve corrects spontaneously to some degree on both planes. Measurements obtained from the scanograms by the Perdriolle method in the supine position are very similar to those obtained by CT. Perdriolle's is a simple, convenient, and reliable method to measure rotation on standing radiograms.
-
The diagnosis of a toddler's fracture is frequently difficult at the initial evaluation because of negative radiographs. We propose the presumptive diagnosis of toddler's fracture, despite negative radiographs, when the history and physical examination are consistent with the diagnosis. This retrospective study was designed to evaluate how frequently the diagnosis is correct and to determine if there were any differentiating characteristics with respect to history, gait, or physical examination. ⋯ A total of 16 (41%) toddler's fractures was confirmed on follow-up radiographs. Comparing the children who demonstrated a toddler's fracture with those who did not, no particular characteristic was found that could predict the outcome. To avoid delay in the treatment of toddler's fracture, we recommend a long-leg cast on those children with a history of an acute injury, inability to walk or limp, no constitutional signs, and negative radiographs.
-
Stubbing injuries to the great toe can be a cause of occult open fractures and osteomyelitis. Five such patients were identified after conducting a retrospective review of injuries to the hallux between January 1998 and December 1998. The study was conducted to draw attention to the association between this trivial trauma and its possible complications. ⋯ Two of these children experienced a partial growth arrest and two experienced a full growth arrest of the distal phalanx of the great toe, the significance of which is yet unknown. Clinical signs such as bleeding from the eponychium and a laceration proximal to the nail bed should alert physicians to the presence of a possible open fracture. Early detection and treatment of these injuries may reduce or eliminate hospital stays and prolonged intravenous antibiotic treatment for osteomyelitis.