Journal of pediatric orthopedics. Part B
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Fractures of the radial head or neck in children may lead to radial head deformity and loss of pronation and supination. Trauma may not only be caused by the injury itself, but also may occur secondarily to surgical reduction and manipulation of fracture fragments. Thirty-eight children with displaced radial neck fractures were investigated 2 to 20 years after the initial accident. ⋯ These children had either developed secondary growth disturbances, which had led to a radioulnar synostosis in one case, or they had been treated by open surgical reduction. On follow-up radiographs, all conservatively treated fractures with angulation up to 50 degrees had corrected themselves spontaneously. The high complication rate after open reduction and the poor functional results and inconvenience for the pediatric patient makes conservative treatment of radial neck fractures in children preferable.
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Concerns about the transmission of the human immunodeficiency virus (HIV) have driven the evolution of surgical transfusion practices including the use of preoperative erythropoietin (rhEPO). Although there is significant experience documenting the efficacy of preoperative rhEPO in reducing transfusion requirements for adult patients, there is little experience in the pediatric population. With 178 pediatric patients who underwent surgery for spinal deformity, a retrospective cohort study was performed using patient charts, administrative records, and blood bank computer data. ⋯ Use of preoperative erythropoietin in pediatric patients undergoing scoliosis surgery resulted in higher preoperative hematocrit levels. Significantly lower rates of transfusion were noted only in the idiopathic group, however. Although there is a possibility of erythropoietin "resistance" in the neuromuscular and congenital patients, alternative explanations for the lack of effect on transfusion rates may include underdosing and biases existent in this nonrandomized retrospective study.