Journal of pediatric orthopedics. Part B
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Review Case Reports
Valgus slipped capital femoral epiphysis: report of two cases and a comprehensive review of literature.
Valgus slip of the capital femoral epiphysis is a known but extremely rare form of a slipped capital femoral epiphysis. After the first report in 1926 up to the present, approximately 44 cases have been reported. We report two cases of valgus slip of the capital femoral epiphysis with a comprehensive review of the existing literature and the precautions that are needed while planning surgical management of these patients. Awareness of this condition is essential to make a prompt diagnosis and plan the appropriate management.
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The objective of this retrospective study was to explore, which radiographic parameters, immediately after posterior spinal fusion with pedicle screw fixation for adolescent idiopathic scoliosis (AIS), best correlate with subjacent disc wedging at a minimum of 2-year follow-up. Sixty-four consecutive AIS patients who underwent posterior pedicle screw-only instrumentation were studied. Preoperative and postoperative radiographs were obtained to measure various parameters regarding global coronal, shoulder, sagittal, and regional balance. ⋯ Two-year postoperative disc wedging, LIV tilt, and LIV translation occurred most often when disc wedging and LIV deviation or obliquity existed immediately postoperatively. This study identified a potential indicator for AIS repair. Preoperative surgical planning and intraoperative correction are important for avoiding subjacent regional imbalance after scoliosis fusion.
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Proximal radioulnar translocation associated with posterior dislocation of the elbow is an extremely rare combination of trauma to the elbow in children. We report on the successful and sequential closed reduction of both these dislocations in a 10-year-old girl in which the translocation of the forearm bones was initially missed. A concomitant fracture would have probably precluded an ideal outcome as we note from the literature review on this problem.
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The management of a persistent pink pulseless hand after a satisfactory closed reduction in a pediatric supracondylar fracture of the humerus is controversial. Several recent publications have recommended vascular exploration in contrast to a more conservative approach accepted traditionally. We report the results of seven patients with a mean follow-up of 36.6 months with a persistent pulseless, but well-perfused hand postreduction. ⋯ A palpable return of the radial pulse was seen in six patients at 3 weeks and at 6 weeks follow-up in the other patient with no long-term dysfunction. We believe that the management of a persistent pink pulseless hand remains a 'watchful expectancy'. Surgical exploration should be recommended only if there is either severe pain in the forearm persisting for more than 12 h after the injury or if there are signs of a deteriorating neurological function.
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Case Reports
Intracranial subdural hematoma and pneumocephalus after spinal instrumentation of myelodysplastic scoliosis.
To report a case of acute intracranial subdural hematoma, pneumocephalus, and pneumorachis, which occurred because of cerebrospinal fluid (CSF) leak caused by a malpositioned transpedicular screw during spinal surgery for severe myelodysplastic scoliosis accompanied with hydrocephalus. Intracranial hemorrhage may occur as a consequence of dural sac penetration and CSF leakage after various medical procedures at the spinal level. The awareness of this severe complication is especially important during spinal instrumentation procedures in which inadvertent dural sac violation and CSF loss may be overlooked. ⋯ The final outcome was an uneventful complete recovery. The increasing use of pedicular screws in spinal surgery carries a potential risk of occult dural sac violation with subsequent CSF leakage, intracranial hypotension, and the possibility of intracranial bleeding and pneumocephalus remote from the surgical site. This potentially fatal complication should always be considered after spinal surgery in the presence of early signs of neurological deterioration and necessitates an urgent cranial and spinal imaging to confirm the diagnosis and to make adequate treatment decisions.