Journal of pediatric orthopedics
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Osteochondritis dissecans of the knee is an increasingly frequent diagnosis in the skeletally immature, in whom it is known as juvenile osteochondritis dissecans (JOCD). Although many stable lesions heal with nonoperative treatment, surgical management may be necessary when this treatment fails. Our objective is to determine if extraarticular drilling is an effective treatment for JOCD. ⋯ Level IV case series.
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All-terrain vehicle (ATV) accidents are considerable sources of morbidity and mortality for children and adolescents. This study was done to investigate the types and severity of injuries and the role of age and body mass index on the types of fractures sustained in children younger than 16 years. ⋯ Level IV.
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A full-length standing anteroposterior radiograph of the entire lower extremity has become the standard imaging modality for assessing lower limb alignment. Although reference values of frontal plane deformity parameters based on adult subjects have been established, such values may not be applicable to the pediatric population. The purpose of our study was to establish the reference values of frontal plane alignment and joint orientation angles in children based on a standing full-length radiograph. ⋯ The change in alignment of the lower limb from 1 to 4 years of life from varus to valgus is primarily related to a progressive decrease in varus orientation of the distal femur. In children younger than 7 years old, age-specific reference values for joint orientation angles of the lower extremity should be used instead of values derived from adult subjects.
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The selection of fusion levels continues to be controversial in adolescent idiopathic scoliosis (AIS). The classifications of King and Lenke remain the most widely used, but recent studies have demonstrated their shortcomings, including poor interobserver reproducibility. We propose a method of preoperative planning that is independent of anatomical classifications, based on the anticipated effect of curve reduction. The objectives of this preoperative strategy are (1) to achieve satisfactory T1 tilt and shoulder balance and (2) to restore balance in the coronal and sagittal planes. The purpose of the present study was to evaluate the results of our strategy of deciding the proximal level of arthrodesis in Lenke types 1 and 2 AIS. ⋯ The results of the present preoperative strategy, to which we adhered in 97% of cases, are encouraging and show that the systematic instrumentation of the entire proximal curvature is not justified in Lenke type 2 curves. However, long-term consequences of the residual T1 tilt need to be studied further.
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Correcting multiplanar lower-limb pediatric deformities requires complex and, in many cases, staged procedures. The Taylor-Spatial Frame (TSF) is a sophisticated external fixator system that can be used to treat simple to complex multiplanar and multiapical skeletal deformities. We describe its use in 53 children during the last 7 years in a variety of pathologies and demonstrate its ease of use and versatility. ⋯ We demonstrate its ease of use for both surgeon and patient and its versatility in a variety of pathologies. The advantages of the TSF system are many. It is a simple frame construct, and application is easy. The plan and execution are structured with precise end points; it is a single-stage correction and thus avoids frame modifications. Any residual deformity can be further corrected by use of the same frame. We conclude that the TSF is an effective and efficient way to correct a wide variety of simple and complex often obstinate pediatric limb deformities.