Journal of pediatric orthopedics
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Despite a tendency for rotational abnormalities of the lower leg in children to improve spontaneously over time, some fail to correct and require corrective derotation osteotomy. In this retrospective study, we report the technique and results of the distal transverse tibial and fibular derotation osteotomy with Kirschner-wire fixation performed in 63 limbs of children with cerebral palsy, clubfoot, idiopathic tibial torsion, and myelomeningocele, as well as other less common conditions. ⋯ There were three (4.8%) complications, including late fracture (one), cross-union (one), and distal physeal closure (one). We conclude that transverse, same-level, distal tibial and fibular osteotomy fixated with crossed Kirschner wires is a safe, efficient, and effective surgical approach to the treatment of children with tibial torsion in a variety of clinical conditions.
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Modification of the original Luque technique in the treatment of Duchenne's neuromuscular scoliosis.
Luque segmental instrumentation with Galveston technique for pelvic fixation is generally used in the correction of Duchenne's neuromuscular spinal deformities with pelvic obliquity. Particularly difficult is the control of the lumbopelvic junction. Instrumentation failures and only mediocre correction of pelvic obliquity are reported. ⋯ At the last examination (mean follow-up, 36 months), mean spinal curvature was 18 degrees (range, 3-37 degrees), and pelvic obliquity was always <15 degrees (range, 0-15 degrees) with mean correction of 75%. No instrumentation failure or loss of correction >3 degrees could be observed in the entire series. In every patient, a good sitting balance could be restored after surgery.
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Over a 3-year period, in 36,075 general anesthetic anesthesia procedures done at our institution, 21 patients had type I (anaphylactic) intraoperative reactions to latex (phase 1). We subsequently established a system for classification of at-risk patients with a corresponding regimen for prophylaxis used prospectively between January 1992 and July 1994 (phase II). Three groups of patients at risk for type I hypersensitivity reaction were identified, and a regimen for prophylaxis developed (based in part on protocols used in preparing patients who are allergic to radiocontrast media). ⋯ During phase 2, 34,513 patients received a general anesthetic in the operating room, and there have been three cases of suspected intraoperative latex anaphylaxis; two of these three patients did not meet any of the risk criteria and therefore did not receive preoperative prophylaxis or avoidance of latex. Of these 34,513 patients, 86 at-risk patients received prophylaxis. A prospective study is needed to determine whether the pharmacologic prophylaxis is needed in addition to a latex-free environment.
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Osteomyelitis of the clavicle is a rare condition that is difficult to diagnose. We have reviewed five cases of acute staphylococcal osteomyelitis of the clavicle that have been collected over a 3-year period in our center. All patients had pain, fever, and swelling over the clavicle. ⋯ This behaves very differently from chronic sclerosing osteomyelitis and tuberculous osteomyelitis of the clavicle, which are more commonly reported. Our impression is that early treatment with high-dose intravenous antistaphylococcal antibiotics helps avoid the complication of pathologic fracture. The functional result after resorption of the medial clavicle is very good in the short term.
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Thirteen (3.2%) of 410 patients seen in British Columbia's Children's Hospital in Vancouver from January 1984 to September 1992 with supracondylar fractures did so with an absence of a radial pulse in an otherwise well perfused hand. A combination of segmental pressure monitoring, color-flow duplex scanning, and magnetic resonance angiography (MRA) appears to be a valid, noninvasive, and safe technique in evaluating patency of the brachial artery and collateral circulation across the elbow. Based on this study, early revascularization of a pulseless otherwise well-perfused hand in children with type 3 supracondylar fractures, although technically feasible and safe, has a high rate of asymptomatic reocclusion and residual stenoses of the brachial artery. Therefore a period of close observation with frequent neurovascular checks should be completed before more invasive correction of this problem is contemplated.