Journal of pediatric orthopedics
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Ten patients with neuromuscular scoliosis and pelvic obliquity had segmental spinal instrumentation using a unit Luque rod with sublaminar wires and fixation into the pelvis. Nine of the 10 patients also had anterior spinal fusion without instrumentation before the posterior procedure. Average preoperative pelvic obliquity was 42 degrees which was corrected to 6 degrees (82% correction). ⋯ Complications included a wound hematoma in one patient and a superficial wound dehiscence in another. There have been no pseudarthroses or hardware failures to date. Excellent correction of the pelvic obliquity and the spinal curve in neuromuscular scoliosis can be obtained with use of a unit rod and without use of anterior instrumentation.
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Pelvic fractures are uncommon in children, yet they rank second to those of the skull in terms of complications. Thirty-six pediatric patients who sustained pelvic fractures were retrospectively studied, and a recent follow-up examination was conducted in 29 of the patients. ⋯ Associated injuries occurred in 67% of the patients, with long-term morbidity or mortality in 30%. The high probability of associated injuries must be appreciated, as even minimal bony injury may be associated with life-threatening visceral injuries and morbidity.
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Metaphyseal distraction with the Orthofix apparatus was performed on 10 patients (five femora and five tibiae). A retrospective review is presented. The follow-up time was 10-38 months. ⋯ All patients showed solid bony fusion at follow-up. Pin tract infections in seven patients resolved under antibiotic treatment. Problems of pin loosening and mechanical weakness of the distraction device are discussed.
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Reangulation and displacement after closed reduction of pediatric forearm fractures were reviewed in 90 patients treated with 1978-1984. All fractures were remanipulated and followed to union. ⋯ Nonepiphyseal fractures were safely remanipulated up to 24 days postfracture, with the majority at 1-2 weeks. We conclude that 7% of pediatric forearm fractures treated by closed reduction are subject to reangulation and/or displacement following routine acceptable primary treatment, and that remanipulation provides a safe, effective means to obtain and maintain reduction.
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The case of an 11-year-old boy with an ischemic contracture of the forearm and hand, initiated by a minor injury, is reported. Awareness of the syndrome, careful examination, and observation are emphasized. The decompression must include opening of all the tight fascial envelopes.