Journal of pediatric orthopedics. Part B
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The authors report a case of abscess in the obturator internus muscle, which is a rare occurrence. It was managed with antibiotics and surgical intervention was not necessary. Pyomyositis involving the muscles around the hip needs to be differentiated from septic arthritis and transient synovitis of the hip because these pathologies more commonly afflict this joint. ⋯ Only rarely is the obturator internus involved by the abscess. Magnetic resonance imaging is the imaging modality of choice to image the obturator internus and to ascertain the diagnosis. Lack of awareness of the existence of this condition leads to a delay in the correct diagnosis.
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Measurement of capillary refill time (CRT) is thought of as a fast and inexpensive tool for assessing perfusion to an extremity or digit. CRT is frequently relied upon by orthopedic surgeons, especially in the postoperative period when pulses may be inaccessible owing to casts or dressings. Yet to our knowledge, no study has attempted to correlate CRT with other indices of perfusion to the extremity. ⋯ A lack of correlation was found between arterial flow and CRT (r=0.02, P=0.93). Though the study has its weaknesses, the results caution the use of CRT as a solitary measure of perfusion in children. This was a level 1 diagnostic study.
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Literature, describing scoliosis in patients of osteogenesis imperfecta (OI), favors operative treatment as soon as possible in the form of fixation with instrumentation and fusion to prevent curve progress and pulmonary function deterioration. There are various complications associated with the treatment of scoliosis in OI before, during, and after surgery because of poor bone quality in such patients. ⋯ Owing to unusual symptoms and continuous dull pain in her back, the diagnosis was delayed during which the conditions made her life miserable. This report also suggests that a stress fracture should be on high suspicion in OI patients when they present with minor difference in the nature of pain.
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Comparative Study
Incidence and risk factors of prolonged mechanical ventilation in neuromuscular scoliosis surgery.
Patients with neuromuscular scoliosis (NMS) are frequently considered at high risk for postoperative complications based on their underlying disease and comorbidities. Postoperative complications include prolonged mechanical ventilation (MV), defined longer than 72 h, at the paediatric intensive care unit. The objectives of this retrospective study were to assess the incidence of prolonged MV in patients with NMS following scoliosis surgery and to identify predictive risk factors. ⋯ The only risk factor for prolonged MV was a decreased preoperative pulmonary function. Forced expired volume in 1 s and vital capacity were significantly decreased in patients with MV >72 h compared with patients with MV <72 h. Routine preoperative pulmonary function testing may reveal important information with regard to restrictive lung disease in the preoperative assessment of patients with NMS and predict the early postoperative clinical course.
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The results of closed and open reduction via posterior approach with percutaneous pinning of posteromedial displaced supracondylar humerus fractures in children were evaluated. Fifty-five consecutive patients with Gartland type III fractures were reviewed. The mean follow-up period was 22 months (12-48 months). ⋯ In comparison with closed reduction, despite the fact that better bone alignment was obtained with open reduction, longer union time (7 vs. 5.8 weeks), significantly reduced range of motion of the elbow (12.3 degrees vs. 3.8 degrees), poorer functional outcomes and bad cosmetics because of hypertrophic scar tissue of the skin were found. The patients were analyzed according to their Bauman angle and Flynn criteria: good or excellent functional and cosmetic results were 91% in the closed reduction group but 52% in the open reduction group. On the basis of results of this study, closed reduction and percutaneous fixation of the posteromedial totally displaced fractures are preferable to open reduction with posterior approach.