Journal of pediatric orthopedics. Part B
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Comparative Study
Community-associated, methicillin-susceptible, and methicillin-resistant Staphylococcus aureus bone and joint infections in children: experience from India.
Previously, the treatment of Staphylococcus aureus infections was less complex, as most of those isolated were susceptible to β-lactam antibiotics. In recent years, there has been a marked increase in the incidence of invasive community-acquired (CA) methicillin-resistant S. aureus (MRSA) among children worldwide. However, data on the clinical characteristics and outcomes related to pediatric bone and joint infections caused by CA-S. aureus are very limited in India. ⋯ The morbidity associated with MRSA bone and joint infection in children is significantly higher than that caused by MSSA. Early diagnosis at the primary healthcare level and treatment with appropriate antistaphylococcal therapy are crucial to achieve optimal clinical outcomes. High levels of antimicrobial resistance of both MSSA and MRSA isolates to several classes of antibiotics are a major concern warranting the need for antimicrobial stewardship and ongoing surveillance.
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Comparative Study
Is there a role for Ender's nailing of paediatric femoral fractures in a resource-restricted hospital set-up?
Paediatric femur fractures are managed with the titanium elastic nail system (TENS) in the 5-16-year age group. TENS is costly and not easily available in public hospitals. This study compares TENS nailing with stainless-steel Ender's nail fixation of paediatric femur fractures. ⋯ The union time and time to weight bearing were significantly shorter for Ender's nailing than TENS nailing. The outcome according to Flynn's criteria was significantly better in the Ender's nailing group. The results of Ender's nailing in paediatric femur fractures were comparable with TENS, with a rapid healing time and reduced angular malunion.
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This study investigated the outcome of displaced pediatric radial neck fractures treated by percutaneous leverage reduction and intramedullary fixation using Kirschner wires. Twenty-three patients with displaced radial neck fractures were treated following this technique. Adequate reduction was achieved in each patient. ⋯ Malunion occurred in three patients with an average residual angulation of 7.3°. According to the MEPI, excellent outcome was achieved in 15 patients and good outcome in six. Therefore, this technique is an effective alternative for the treatment of pediatric radial neck fractures.
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In 1954, Norell described the 'fat pad sign' for the first time. This refers to the radiological visualization of the elbow fatty tissue. This is a prospective study with the aim of clarifying the relation between the presence of a positive fat pad sign on the lateral radiograph and the type of injury verified on MRI. From January to December 2010, 31 children were diagnosed primarily with a positive fat pad sign. An above-the-elbow cast was applied and all patients were referred for an MRI within a few days. All patients were recommended a clinical follow-up and informed about the MRI results. After revision, five patients were found to have a negative fat pad sign and were excluded. This resulted in a total of 26 patients, 10 men and 16 women, mean age 10±2.62 years. The time between the injury and the initial radiological examination was 0.8±0.27 days and the MRI was obtained on an average of 6.6±3.84 days. A total of 12 patients had an injury of the left side and 14 of the right side. The MRI showed a posterior positive sign in all except five cases and six occult fractures, which accounts for 23%. Nineteen patients (73%) had a bone bruise. All patients except one had a normal range of movement with no pain on the last clinical examination after 2-3 weeks. The presence of a positive fad pad sign is not synonymous with occult fractures. Finding occult fractures on MRI does not alter the final treatment of these patients. On the basis of this study and review of other similar studies, pediatric patients who presented with elbow effusion verified on conventional radiographs could be treated with a cast for 2-3 weeks and extra clinical or radiological controls did not seem to be indicated. ⋯ Level III, development of diagnostic criteria on the basis of consecutive patients.
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Case Reports
Slipped capital femoral epiphysis following fracture of the femoral neck: a case report.
Reports on cases of femoral neck fracture complicated by a slipped capital femoral epiphysis associated with avascular necrosis and coxa vara deformity in children are extremely rare. In this case report, we describe a patient who had complications of a slipped capital femoral epiphysis with avascular necrosis and coxa vara deformity after a Delbet type III left femoral neck fracture. We also describe the surgical treatment to overcome these complications.