Journal of pediatric orthopedics
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Rectus femoris transfer (RFT) is a treatment option for children with cerebral palsy (CP) who exhibit a stiff-knee gait pattern. The rectus femoris muscle is transferred to different sites to overcome problems such as tripping and falling. Indications for RFT often include preoperative decreased knee range of motion (KROM) during swing phase, reduced peak knee flexion in swing (PKFSW), abnormal rectus femoris firing patterns on electromyography recordings, and a positive Duncan-Ely test. This study investigated the effect of different RFT sites on kinematic outcome variables and evaluated the relationship between commonly used preoperative surgical indicators and postoperative changes in kinematics. ⋯ Level 3.
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Staphylococcus aureus remains the most common etiologic agent of acute osteomyelitis in children. Recently, methicillin-resistant S. aureus (MRSA) has emerged as a major pathogen. ⋯ Methicillin-resistant S. aureus was isolated more frequently in the second study period and was associated with worse clinical outcomes.
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Congenital thoracic scoliosis is associated with diminished pulmonary function. Early posterior thoracic spinal fusion surgery may additionally impact pulmonary function beyond the natural history of the disease by further inhibiting thoracic growth. The primary study aim is to determine if early thoracic spine fusion patients have diminished pulmonary function versus untreated patients at a similar age. The secondary study aim is to determine how plain radiographic measurements of thoracic deformity change over time and correlate to pulmonary function in these patients. ⋯ Early posterior spinal fusion decreases radiographic measures of thoracic growth over time, but pulmonary function was similar to untreated patients at 10.5 years of age. The data suggest pulmonary function and thoracic size as measured on plain radiographs correlate directly. Therefore, pulmonary function testing at the end of growth should be performed to determine the ultimate pulmonary consequences of early surgery.
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In skeletally immature children, it can often be difficult to differentiate occult Salter-Harris I fibula fractures from ankle sprains based on physical examination, and often, initial radiographs in both conditions are only notable for soft tissue swelling. The likelihood of a child having subsequent plain radiographic evidence of a fracture in this setting and the likelihood of subsequent fracture displacement have not been previously reported. The purpose of our study was to determine the incidence of occult fracture in these patients and the risk of fracture displacement. ⋯ This is the first investigation reporting the frequency of plain radiographic evidence of occult distal fibula fractures in children. This study finds that 7 (18%) of 38 acute ankle injuries in children presenting with distal fibula tenderness and normal radiographs show evidence of periosteal new bone formation on follow-up radiographs, implying the presence of an occult fracture. There was no evidence of fracture displacement during treatment, and no fracture demonstrated greater than 1 mm of periosteal new bone.
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Comparative Study
Three lateral divergent or parallel pin fixations for the treatment of displaced supracondylar humerus fractures in children.
To evaluate the efficacy of lateral or parallel pin fixation using 3 smooth Kirschner wires (K-wires) or smooth Steinmann pins for the operative management of displaced supracondylar humeral fracture in a consecutive series of children. ⋯ Therapeutic study, level III.