Journal of pediatric orthopedics
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Clinical Trial
Popliteal fossa block for postoperative analgesia after foot surgery in infants and children.
The efficacy of a popliteal fossa block (PFB) was evaluated after foot and ankle surgery in children. With the child still anesthetized, a PFB was performed with 0.75 ml/kg of 0.2% ropivacaine. Postoperative analgesia was assessed by using an objective pain score, assigned at 2-h intervals. ⋯ Eight patients required no analgesic agents during the first 12 postoperative hours. The duration of the analgesia varied from 8 to 12 hours. PFB provides effective analgesia after foot and ankle surgery in children.
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The diagnosis of traumatic dislocation of the radial head, either isolated or as part of a Monteggia fracture-dislocation, was delayed in 10 of the 110 children treated with these injuries during the study period. In eight children, the dislocation was overlooked on the initial radiographs. ⋯ The most likely explanation is that the radial head dislocated at the time of impact, spontaneously reduced by the time the first radiographs were obtained, and redislocated while the arm was in a cast. We conclude that radiographic assessments of the radiocapitellar joint, by using the radiocapitellar line, are required in children with elbow and forearm injuries at presentation and when the cast is removed.
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Pediatric femoral neck fracture is rare and known to be associated with a high complication rate. The effect of early decompression and operative fixation is not frequently reported in the literature. This is a retrospective study of 14 patients younger than 16 years with traumatic fractures of the femoral neck and intertrochanteric region over a 10-year period with a follow-up of 2-11 years (mean, 4.6 years). ⋯ Complete fracture healing and functional recovery was achieved in 13 patients with only one delayed union. No patient had radiographic evidence of avascular necrosis. When compared with earlier studies, the current aggressive management protocol for displaced fracture significantly minimized the complications of avascular necrosis, non-union, delayed union, and premature physeal closure.
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Case Reports
Estimation of the lumbar curve magnitude with correction of the right thoracic curve in idiopathic scoliosis.
A simple formula was proposed to estimate the magnitude of the postoperative uninstrumented lumbar curve with correction of the right thoracic curve in idiopathic scoliosis. This formula is as follows: PLC < or = LC - 0.5(TC - BTC) (PLC, predicted postoperative standing lumbar Cobb angle; LC, preoperative standing lumbar Cobb angle; TC, preoperative standing thoracic Cobb angle; BTC, preoperative supine lateral bending thoracic Cobb angle). Sixty-five patients' preoperative and postoperative radiographic measurements were taken, and of these 45 had measurements taken after > or = 12 months of follow-up. Multiple regression (R) value for the proposed formula postoperatively was 0.8048 and at > or = 1 year follow-up was 0.6869.
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Review Case Reports
Fracture of the cuboid in children: case report and review of the literature.
Although fractures of the cuboid are rare, they can be very disabling. The diagnosis is often missed, and overlooked cuboid fractures can lead to severe alterations in foot mechanics and function. ⋯ Cuboid fractures should be considered in the differential diagnosis of limping toddlers. Children seen with pain, swelling, and inability to bear weight on the lateral aspect of the foot require proper evaluation and treatment.