Journal of pediatric orthopedics
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Intravenous (i.v.) regional anaesthesia was used in outpatient treatment of 400 upper extremity fractures and dislocations in children ranging in age from 3 to 16 years. All reductions were performed in the emergency department. Good analgesia was achieved in 90% of the patients, and only nine children (2.3%) had unacceptable reductions that required further treatment under general anaesthesia. Intravenous regional anaesthesia is a safe and effective procedure that facilitates outpatient treatment of upper extremity injuries in children.
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Three boys had percutaneous biopsies of pyogenic infections of the spine guided by computed tomography (CT). All had typical features of chronic vertebral osteomyelitis, i.e., narrowing of disc space, destruction of the contiguous vertebral endplates, sclerosis of vertebral bodies, and soft tissue swelling as noted on radiographs, CT, and magnetic resonance imaging (MRI). ⋯ If blood cultures are negative, a biopsy of the vertebral body is recommended in order to determine the activity of the process and the type of organism, and its susceptibility to antibiotics. CT-guided percutaneous biopsy is an alternative to open surgical biopsy.
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This study determined whether a significant difference in response to vibratory stimuli was consistently present in a large group of children with idiopathic scoliosis as compared with age-matched controls. Fifty-eight unselected adolescent females with documented progressive idiopathic scoliosis were studied along with age-matched controls. ⋯ Results indicated that highly significant differences existed between scoliotic children and controls at all sites tested (p less than 0.01), with scoliotic children being more sensitive than controls. The results support the presence of a central aberration in posterior column function that may be a primary etiology of idiopathic scoliosis.
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We have used magnetic resonance imaging (MRI) to evaluate 22 patients with various clinical and/or radiographic findings potentially associated with intraspinal pathology whose evaluation would have necessitated myelography or computed tomography scanning in the past. Ten of these 22 children were diagnosed by MRI to have significant intraspinal lesions: diastematomyelia in four, syringomyelia in four, tethered spinal cord in three, intraspinal lipoma in two, and spinal cord tumor in one. MRI is noninvasive, requires no exposure to ionizing radiation, and provides multiplanar images and three-dimensional reconstruction potential, all with superior soft tissue imaging. In our patient population, it has proven to be a useful diagnostic adjunct.
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Case Reports
Fracture of the distal radial physis complicated by compartment syndrome and premature physeal closure.
Complications after injury to the epiphyseal growth plate of the distal radius are uncommon. An 11-year-8-month-old boy developed two complications--compartment syndrome of the forearm and premature closure of the physis--after a Salter-Harris Type I injury. Treatment included closed reduction, decompression, skin grafting, excision of the physeal bar, and epiphysiodesis of the distal ulna and the remaining open physis of the distal radius.