Journal of pediatric orthopedics
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Comparative Study
Clinical evaluation of crossed-pin versus lateral-pin fixation in displaced supracondylar humerus fractures.
The radiographs and patient charts of 47 children treated with closed reduction and percutaneous pin fixation of displaced supracondylar humerus fractures were reviewed. Twenty-seven fractures were fixed with crossed medial and lateral pins. Twenty fractures were treated with two parallel laterally placed pins. ⋯ No statistically significant differences regarding maintenance of reduction were found when comparing the two fixation groups. There were two complications in the medial pin group (one cubitus varus and one ulnar nerve injury) and none in the lateral-pin group. We conclude that crossed-pin fixation offers no clinically significant advantage over two laterally placed pins in the treatment of supracondylar humerus fractures.
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A retrospective analysis of 30 consecutive fractures of the distal femoral epiphyseal plate showed the best results occurred when fractures were anatomically reduced and fixed with pins. No fractures with internal fixation displaced, whereas 43% of fractures reduced without fixation displaced during cast treatment. Complications were more frequent in displaced than nondisplaced fractures. We were unable to demonstrate that gentle reduction under general anesthesia offered protection against subsequent physeal arrest when compared with closed reduction in the emergency room; however, reductions in the operating room were more likely to be anatomic.
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Acute annular ligament interposition into the radiocapitellar joint in children (nursemaid's elbow).
Acute annular ligament interposition into the radiocapitellar joint ("nursemaid's elbow") is a common injury in children younger than 5 years. The injury occurs when axial traction is applied to an extended, pronated arm. There are no abnormal radiographic findings associated with this condition. We recommend that children with a classic history and clinical presentation of an acute annular ligament interposition into the radiocapitellar joint be treated without obtaining radiographs.
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Comparative Study Clinical Trial Controlled Clinical Trial
The prevention of skin excoriation under children's hip spica casts using the goretex pantaloon.
The purpose of this study is to determine whether the use of the Goretex Pantaloon cast liner for children's spica casts reduces urine excoriation of the skin under the cast and reduces the incidence of unplanned cast changes necessitated by cast soilage. Between 1988 and 1993, 72 consecutive children who had 147 hip spica casts applied were followed. The first 36 patients had 77 spica casts applied without the Goretex Pantaloon, and the last 36 patients had 70 spica casts with a Goretex liner. ⋯ The incidence of unnecessary cast changes due to soiling of the cast was 14% in the non-Goretex group compared to 2.9% in the Goretex group (p = 0.05). The use of the Goretex liner in our series resulted in a savings of $38 per cast including the cost of the liners ($75). The Goretex Pantaloon cast liner used for children's spica casts prevents urine excoriation of the skin and is cost effective.
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Five cases of anterior cruciate ligament reconstruction, performed for symptomatic episodes of giving way or during surgery for associated injury, were carried out in preepiphyseal closure adolescents (ages 12-15 years), utilising a strip of iliotibial band placed over the top of the lateral femoral condyle in a MacIntosh type repair, and avoiding drilling through epiphyseal plates. At a mean follow-up of 4.4 years, all five were symptomatically satisfactory and all five patients had returned to their preinjury level of sports activity. Although objective assessment revealed that increased laxity, when compared to the normal leg anterior laxity measured by the KT-1000, was within normal limits in four of five patients. Only one patient, who had had a fracture of the contralateral femur, had any leg length discrepancy.