Journal of pediatric orthopedics
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Pediatric patients with congenital thoracic scoliosis often have restrictive lung disease and low body weight for age. In other patients with respiratory disorders, the work of breathing can increase basal metabolic demands and predispose patients to cachexia. The primary study aim was to determine if severity of restrictive lung disease, as measured by pulmonary spirometry, correlates to decreased body mass index (BMI) in patients with congenital thoracic scoliosis. A secondary study aim was to determine what patient factors and radiographic measures correlate to low BMI. ⋯ Prognostic case-control study, level III.
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Hinge abduction is widely accepted as a poor prognostic factor in Legg-Calvé-Perthes disease (LCPD), whereas the exact definition of hinge abduction remains ill defined. The purpose of this diagnostic study was to refine the definition of hinge abduction in LCPD using conventional hip arthrography under general anesthesia. ⋯ Level II (diagnostic study, development of diagnostic criteria on the basis of consecutive patients).
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Controlled Clinical Trial
The impact of intrathecal baclofen on the natural history of scoliosis in cerebral palsy.
Intrathecal baclofen (ITB) is an effective treatment of spasticity in patients with cerebral palsy. However, several recent reports have raised concerns that the treatment may be associated with a rapid progression of scoliosis. The objective of this study was to further examine the effect of ITB treatment on the progression of scoliosis in patients with cerebral palsy. ⋯ Level III.
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To better understand anatomical and functional outcomes of coxa vara in chondrodysplasia according to the initial presenting hip morphology, disease type, and impact of surgery. ⋯ Coxa vara with physeal and epiphyseal involvement and severe impairment of the articular cartilage has a poor prognosis even after reconstructive surgery. In coxa vara with an abnormal physis, there were numerous postsurgical recurrences of the deformity during growth if the physis was not stabilized at the time of valgus osteotomy. In these cases, we should delay osteotomy until an HEA greater than 60 degrees. Coxa vara in which only the metaphysis of the femoral neck is involved, the deformity is milder and often requires no treatment. Indications for surgery in this group are increasing coxa vara, Trendelenburg gait, or an HEA greater than 60 degrees.
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Salter-Harris type III and IV medial malleolar fractures (MacFarland fracture) is a joint fracture of the ankle in children. The fracture line passes through the medial part of the lower epiphyseal disk of the tibia. Prognosis is dominated by later risk of misalignment and osteoarthritis. ⋯ Surgical treatment was arthrotomy in all cases to achieve anatomical reduction under direct view, followed by osteosynthesis. We believe that it is difficult to evaluate if the reduction is perfect under the control of the intensifier screen alone. Arthrotomy did not lead to ankle stiffness, in any of our patients at longest follow-up.