Journal of pediatric orthopedics
-
Previous reports of posterolateral fusion for treatment of adolescent spondylolisthesis at L5-S1 suggest that persistent slippage is a significant problem in the postoperative period. Of 40 adolescent patients who underwent posterolateral fusion for L5-S1 spondylolisthesis, 23 demonstrated Grade 3 slip or worse. ⋯ Improvement in results is attributed to the surgical technique and to postoperative casting. The displacement index, a new method to document relative L5-S1 position, is described.
-
We report the incidence of fractures by sex and age based on 851 femoral shaft fractures from specific types of trauma. The maximum incidence occurred between 2 and 3 years of age, and the total incidence was 2.6 times higher in boys than in girls. In 438 cases the fractures were caused by falls and in 413 cases by traffic accidents. ⋯ Because child abuse has been shown to be involved in the majority of such fractures in early infancy, the data demonstrate the possible magnitude of this problem. Traffic accidents were most common in the oldest age groups, reaching 3.7 cases/10,000 population/year in boys 16 and 17 years of age. Although all fractures were more common during the periods of the fastest skeletal growth, the difference in incidence between different causes indicated that environmental factors are more important than endogenous factors for the risk of fracture.
-
Slippage of the upper femoral epiphysis can occur in association with multiple endocrine imbalances. This report documents the second case of primary parathyroid adenoma with hyperparathyroidism and symptomatic concomitant slipped capital femoral epiphyses. In the evaluation of children with slipped capital femoral epiphysis, care must be taken to eliminate other treatable disease states that are known to be associated with this phenomenon. The capital femoral physes in this child with hyperparathyroidism promptly closed following removal of the parathyroid adenoma.
-
Four cases of unusual complications following traumatic dislocation of the hip in children are presented along with a review of the literature. All patients presented with posterior or posterosuperior dislocations, and two had associated pelvic or acetabular fractures. One patient had a small, shallow acetabulum caused by premature closure of the triradiate cartilage and damage to the superior gluteal nerve. ⋯ One patient presented with a previously unrecognized fracture dislocation. Two patients presented with recurrent dislocations, one with a posterior capsular defect indicated by arthrography. The patient with this defect was treated with surgical repair, whereas the other patient was treated nonsurgically.
-
Nonunions after diaphyseal fractures of long bones in children are rare. Thirty diaphyseal nonunions in 30 children are reported. The sites of nonunion were tibia (15), femur (5), ulna (4), humerus (3), radius (2), and fibula (1). ⋯ Treatment of the nonunion must be individualized, but usually requires excision of the nonunion fibrous tissue, bone grafting, and internal fixation. Electrical stimulation was not used. The average time from fracture to union was 14.7 months, and multiple surgical procedures were required.