Journal of pediatric orthopedics
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Femoral shaft fractures in children: an epidemiological study in a Danish urban population, 1977-86.
We report 144 femoral shaft fractures (FSF) in 138 children less than 15 years old. The boy/girl ratio was 2.8:1. The incidence rate was 28 per 100,000 child-years. ⋯ Involvement of children in traffic accidents and the number of FSFs due to traffic trauma fell significantly during the study period. The resource consumption of FSF was very high compared to other childhood fractures. The mean length of stay for FSF was almost three times that of all other patients seen in the emergency unit.
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One hundred one clinically normal newborn hips showed varying degrees of sonographic hip dysplasia according to the classification of Graf. None were treated, and after +/- 6 months, radiographs showed that only four had definite dysplasia. ⋯ The severity of ultrasound dysplasia at birth was not related to ultimate development of the hip. Our results indicate that ultrasound should not be performed as a general screening procedure in clinically normal newborns.
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Case Reports
Bilateral lower extremity compartment syndromes secondary to intraosseous fluid resuscitation.
Intraosseous infusions are reserved for use in life-threatening hypovolemic or cardiogenic shock when intravenous (i.v.) access cannot be readily established. Although minor fluid extravasation is a common problem with this technique, a fully established compartment syndrome has never been reported. We describe a child with severe compartment syndromes of both lower extremities complicating the use of intraosseous fluid resuscitation.
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Six patients (seven feet) previously treated surgically for clubfoot had a "bean-shaped" foot. Opening wedge medial cuneiform and closing wedge cuboid osteotomies were done, resulting in good resolution of the prominent midfoot supination and forefoot adductus without significant soft tissue dissection and invasion of growing areas in the foot. Cadaver reproductions show that the cuboid closing wedge is responsible for the change in the midfoot, whereas the cuboid and cuneiform osteotomies both contribute to the change in the forefoot.
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A femoral varus osteotomy can be used to contain the femoral head in Legg-Calvé-Perthes (LCP) disease if certain pitfalls can be avoided. We reviewed 74 patients who underwent 79 femoral varus osteotomies. ⋯ It was concluded that the amount of varus angulation should barely position the femoral head beneath the lateral rim of the acetabulum, avoiding varus less than 105 degrees, and that consideration should be given to performing a greater trochanteric epiphysiodesis at the time of initial femoral osteotomy. The short-term results reflect a positive attitude toward femoral varus osteotomy in treatment of LCP if these pitfalls can be avoided.