Journal of pediatric orthopedics. Part B
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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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Over the last 40 years, anatomic reduction with plate stabilization has become the standard in adult patients with diaphyseal fractures of the radius and ulna. When operative fixation has been indicated in skeletally immature patients with these fractures, a variety of techniques have been reported, with intramedullary fixation becoming increasingly accepted. There is currently significant variability in the treatment of adolescents with forearm fractures. ⋯ Only three major complications occurred, two refractures and one ulnar hardware migration, and subsequent radius nonunion occurred in the one grade 3b injury. Flexible intramedullary nailing of both bone forearm fractures provides reliable bony union and excellent postoperative clinical results in adolescents. Level of evidence, IV.
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Quantity of citation is often used as a surrogate measurement of an article's importance or relevance in a given field. To date, there has been no study on citation quantity or density in pediatric orthopedics. We present such an analysis. ⋯ We describe the top 50 articles in pediatric orthopedics by citation and citation density. The level of evidence for highly cited papers was low. Although many of these articles were written by the great thinkers of our field, a need exists for more rigorous methodology.
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Pigmented villonodular synovitis is a rare condition in children. We report a case of a 7-year-old girl with pigmented villonodular synovitis in her left hip. The diagnosis was confirmed with an arthroscopic hip biopsy. ⋯ There was, however, joint space narrowing in the affected hip. In addition, there was early closure of the proximal femoral epiphysis in the affected limb, leading to a discrepancy in leg length. This case report suggests that pigmented villonodular synovitis should be considered in children with a painful hip.