Journal of pediatric orthopedics. Part B
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Forty-five children with combined fractures of the proximal end of the radius and ulna were treated in our orthopedic department over a period of 16 years (1984-1999). The age of the patients ranged from 5 to 12 years (mean 8 years) with a peak of 7-8 years. The mechanism of injury was a fall on the outstretched hand with the elbow extended and with a valgus force being applied to the elbow. ⋯ Valgus deformity, restriction in flexion-extension, and pronation-supination were related with the extent of the initial injury but not related with the way of treatment. Overgrowth of the radial head, which had minor impact mainly on the pronation-supination, was found in the majority of cases that underwent surgical treatment. Minor residual abnormalities of the radius, ulna, or both were present without having marked functional influence.
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Comparative Study
A comparison of two different techniques in the surgical treatment of flexible pes planovalgus: calcaneal lengthening and extra-articular subtalar arthrodesis.
The objective of this study was to compare the results of calcaneal lengthening and Dennyson-Fulford extra-articular subtalar arthrodesis operations performed in patients with flexible pes planovalgus owing to various etiologies and to compare their effectiveness in realigning the foot. Two patient groups were retrospectively formed out of the patients in whom calcaneal lengthening (25 feet of 13 patients) and subtalar extra-articular arthrodesis (27 feet of 15 patients) operations were performed. The modified Evans technique for the calcaneal lengthening operation and the Dennyson-Fulford technique for the subtalar extra-articular arthrodesis operation were applied. ⋯ The evaluation of the effectiveness of the surgical technique on the results made by performing repeated measures from general linear models showed significantly better correction in anteroposterior and lateral talocalcaneal angles, anteroposterior and lateral talonavicular angles, and medial longitudinal arc angle in the subtalar extra-articular arthrodesis group (P<0.05). In conclusion, in this study group, the subtalar extra-articular arthrodesis technique was superior in talocalcaneonavicular joint complex reduction and medial longitudinal arc reconstruction in the surgical treatment of flexible pes planovalgus, and calcaneal lengthening provided better correction of calcaneal equinus. Therefore, it is better to use the calcaneal lengthening technique in mild or moderate deformities because of its physiological advantages, and subtalar extra-articular arthrodesis technique in severe and/or rigid deformities because of its superior potential to correct the deformity and stabilize the foot in the corrected position.
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The Vertical Expandable Prosthetic Titanium Rib (VEPTR) is a technique developed for the treatment of progressive early onset scoliosis. This vertically placed device uses distraction to indirectly elongate the spine and chest, stabilizing the progression of the spinal deformity while preserving spinal growth. Thoracic spine and chest wall deformity are usually correlated; therefore, elongation of the chest wall will increase the space available for the lung and improve respiratory mechanics in patients with early onset scoliosis. ⋯ The complication rate was 13%, which includes infection, device migration, and rib fracture. The analysis of the data shows that the natural history of the progressive spinal deformity was improved in all patients. This preliminary report reaffirms that the VEPTR implantation is a safe and efficient method for the treatment of early onset scoliosis.
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Case Reports
Nonunion after fracture of the anterior tibial spine: case report and review of the literature.
Nonunion of anterior tibial spine of tibia in children is quite rare, but it could be associated with significant instability of the knee as it involves the fixation of anterior cruciate ligament. We report one case in which open reduction and internal fixation was carried out with good functional results. A literature review was performed to identify the cases reported of tibial eminence nonunion in children.
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Pediatric orthopedic surgery is rarely done in an outpatient setting because of the postoperative pain. The purpose of this study was to evaluate the children's comfort and parents' satisfaction after ambulatory peripheral pediatric orthopedic surgery performed under general anesthesia combined with regional anesthesia (RA). Sixty consecutive children were enrolled in this prospective study. ⋯ Parents' satisfaction was greater than eight out of 10 in 88.3% of the cases, and 85% of the parents would choose ambulatory surgery in case of a second procedure. RA used with level I or II analgesics is compatible with ambulatory peripheral pediatric orthopedic surgery. Resulting good analgesia and postoperative comfort render the ambulatory mode to be favored by the parents.