Journal of pediatric orthopedics
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Since 1978 we have examined 3,500 infant hips by ultrasonography. We classified these hips into four basic categories: (a) normal, according to age; (b) delayed ossification (dysplasia); (c) partial dislocation (subluxation); and (d) dislocation (total luxation). Ultrasound provides no exposure to radiation and can differentiate soft tissue much better than radiography. It clearly offers a new tool for infant screening with the potential for widespread application.
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Sixteen cases of dislocation and ligamentous disruptions of the cervical spine in children are reported. In five cases resulting from injury to the upper cervical spine, the roentgenographical features of the instability at the C1-C2 level are documented and their therapeutic orientation is defined. ⋯ Diagnosis of serious ligamentous disruptions was based on precise radiographic criteria: increase of the interspinous distance, loss of parallelism between the articular processes, and posterior widening of the disc space. The indications for surgical fixations in serious ligamentous disruptions depend on persistence of the clinical and radiological signs after a long orthopedic immobilization.
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Anterior release and fusion, combined with tong gravity traction and second stage L-rod instrumentation, establishes correctability and accomplishes circumferential arthrodesis of the spine in neuromuscular scoliosis. From March 1979 through April 1982, nine patients with neuromuscular scoliosis, with an average age of 16.4 years, underwent this two-stage surgical procedure. The parameters investigated included correction of scoliotic deformity, correction of pelvic decompensation, and spinal arthrodesis. ⋯ A second patient has a poor fusion mass by roentgenographic criteria, although she has lost no correction and has had no pain. This technique offers results comparable to other series reporting arthrodesis for neuromuscular scoliosis. It has the advantages of requiring no anterior instrumentation and no postoperative immobilization.
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Railyard or train-related accidents are a common cause of traumatic amputations in children. Four consecutive children with traumatic lower extremity amputations due to railyard amputation seen between 1975 and 1980 demonstrated: a common mechanism of injury--all were attempting to obtain rides on slow-moving trains near their homes or school; similar lower extremity amputation patterns--four right below knee and two left Syme's amputations; and distinctively abnormal psychosocial backgrounds. The psychosocial abnormalities have been demonstrated to be unique in children sustaining traumatic railyard amputations and are probably contributory. Awareness of these factors is important when considering surgical intervention and in planning for long-term rehabilitation.
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Entrapment of the median nerve in the elbow joint is an uncommon complication of dislocation of the elbow in children. Delay in diagnosis has been common. ⋯ If the nerve is intact and one can obtain electrical conduction across the entrapped segment, freeing the nerve and neurolysis should result in recovery. On the other hand, if the nerve is replaced by scar, and there is no conduction across the elbow joint, resection of the damaged segment and reanastomosis is indicated, and has resulted in very good nerve function.