Journal of pediatric orthopedics. Part B
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Child abuse is a serious problem affecting the pediatric population, which has tremendous medical and social implications. There exists no gold standard test to diagnose child abuse, and as a result, clinicians are often in a difficult position of both protecting the child adequately, and respecting the rights and privacy of families. Upper extremity fractures are also common injuries seen in the emergency room, and a need exists to differentiate accidental from nonaccidental etiologies in young children. ⋯ Univariate analysis found that location of fracture, polytrauma, age, prior injury, and history were factors that are important in the diagnosis of child abuse. Our multivariate analysis found that age above 18 months, physical and/or radiographic evidence of prior injury, and suspicious history were found in greater frequency in the group of patients experiencing abusive humerus fractures. In conclusion, based on our statistical analysis and earlier studies we developed an algorithm that clinicians can use to guide judgment and refer to social services when encountered with a young child presenting to the emergency room with a humerus fracture.
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Review Case Reports
Concurrent bilateral patellar tendon rupture in a preadolescent athlete: a case report and review of the literature.
Concurrent bilateral patellar tendon rupture in preadolescence is a very rare condition. It is mostly associated with systemic disease or steroid use in adults. We report a case of 12-year-old boy, who had bilateral patellar tendon rupture, treated with nonabsorbable synthetic suturing with titanium osseous anchors. Moreover, we discuss the causes of patellar tendon rupture, diagnostic clues and surgical options.
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Comparative Study
Cortical bone fenestrations with continuous antibiotic irrigation to mediate hematogenous tibial osteomyelitis in children.
The objective of this study was to evaluate the results of drainage and continuous antibiotic irrigation of the medullary canal to mediate hematogenous osteomyelitis of the tibia in children. Data were analyzed from 376 patients (388 tibiae) treated from January 1982 to December 2004. The average age at the time of surgery was 5 years and 9 months. ⋯ In group II, there were good results in 77.9%, fair results in 21.4%, and poor results in 0.7% tibiae with the development of chronic osteomyelitis and without pathologic fracture. In conclusion, this technique is generally safe and effective. We suggest that similar management might also be applied for hematogenous osteomyelitis of femur and humerus.
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Case Reports
An elbow dislocation in a child with missed medial epicondyle fracture and late ulnar nerve palsy.
Elbow dislocations associated with a medial epicondyle fracture and ulnar nerve palsy are uncommon injuries. We present the case of an 11-year-old girl with an elbow dislocation treated by closed manual reduction. ⋯ Removal of the bony fragment relieved her symptoms and she returned to normal activities at 1 year follow-up. We would like to highlight this rare occurrence and present the detailed history and management of this case.
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This study sought to evaluate the incidence of neurologic injury in children referred for manipulation in our hospital. A retrospective chart analysis of the first 100 children to be referred with a fracture of any segment of the radius and/or ulna was performed. ⋯ Clinicians require a high index of suspicion when evaluating forearm fractures. If neurologic injury is missed at initial assessment, the child may not receive a prompt reduction, thus increasing the likelihood of long-term sequelae.