Journal of pediatric orthopedics. Part B
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Review Case Reports
Anterolateral tibial bowing and duplication of the hallux: a rare but distinct entity with good prognosis.
Congenital anterolateral bowing of the lower leg usually is a symptom of (impending) fracture because of congenital pseudarthrosis. This article reports a case of anterolateral bowing of the lower leg that is characterized by spontaneous correction and combination with duplication of the hallux. A review of the literature showed 10 comparable cases. This article is the first report on the magnetic imaging of this entity and describes its differentiation from congenital pseudarthrosis.
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Fractures of the lateral humeral condyle in children may cause difficulties in diagnosis and treatment. The fracture line involves the cartilaginous trochlea, which cannot be visualized on conventional radiographs. Therefore, a differentiation is not possible between the conservatively treated stable and the surgically treated unstable fracture, which involves the joint surface but is not dislocated primarily. ⋯ In the remaining four children, ultrasonography was able to rule out joint involvement, thus classifying the fracture as stable. Conservative treatment was started, and the sonographic findings were confirmed by radiographs 4 days after the trauma to rule out secondary displacement. High-resolution ultrasonography is able to diagnose fracture involvement of the joint forming cartilaginous trochlea humeri in children, thus making further invasive or costly investigations such as magnetic resonance imaging unnecessary.
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We studied 28 displaced (Jacob types II and III) fractures of the lateral humeral condyle in 28 children. There were only two Milch type I fractures. Twenty-one fractures were treated by open reduction and internal fixation with K-wires, Palmer nails, or sutures. ⋯ Two patients developed avascular necrosis of the trochlea. One of these had a concomitant fracture of the medial humeral epicondyle, and the other suffered a lateral condylar fracture preceded by a supracondylar fracture. We conclude that a reduced growth potential at the trochlear groove is a regular complication of the Milch type II fracture, and that the Jacobs classification is the most useful in the assessment of the method of treatment.