Journal of pediatric orthopedics. Part B
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Comparative Study
Comparison of compression plate and flexible intramedullary nail fixation in pediatric femoral shaft fractures.
The purpose of this study was to compare the results of compression plating and flexible intramedullary nailing for pediatric femoral shaft fractures. Thirty-eight consecutive patients with 40 femoral shaft fractures were evaluated. Twenty-two femoral segments were treated with a compression plate and 18 femoral segments were treated with flexible intramedullary nailing. ⋯ The average operation time was statistically significantly shorter in the nailing group (P=0.039). Four implant failures occurred in the compression plate group whereas one non-union was observed in the flexible nailing group. Flexible intramedullary nailing seems to provide a high union rate with a shorter operation time when compared with plate fixation.
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Delay in diagnosis of slipped capital femoral epiphysis has important implications with regard to slip severity and long-term hip outcomes. The aims of this review were to identify the incidence of delayed diagnosis of slipped capital femoral epiphysis in the hospital to which the authors are affiliated, and the causes for such delays. A retrospective review was conducted of all patients admitted to the Women's and Children's Hospital in Adelaide between January 1997 and October 2004 with a diagnosis of slipped capital femoral epiphysis. ⋯ An increasing presentation of adolescents with this disorder to allied health professionals for initial management warrants a broader education strategy than has been previously advocated. Slipped capital femoral epiphysis remains an enigmatic disorder; consequently delayed diagnosis of this condition is not likely to disappear. Despite this, the medical community must strive toward early diagnosis through continued education and vigilance.
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Case Reports
Recurrent migratory sympathetically maintained pain syndrome in a child: a case report.
A 10-year-old boy presented with pain and swelling of short duration in his right hand. A traumatic cause was ruled out. He had clinical features suggestive of sympathetic overactivity in the form of hyperesthesia, edema and dry skin. ⋯ Again the clinical features were consistent with SMPS. His response to a lumbar sympathetic block was again dramatic. This case illustrates that the diagnosis of SMPS is essentially clinical and that prompt diagnosis and treatment with sympathetic blocks can be very rewarding.
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Out of 210 children suffering from severely displaced supracondylar fractures, 76 (36%) presented with immediate neurovascular complications: 47 (22%) were neurological, 16 (8%) vascular and 13 (6%) both. Injury to two nerves simultaneously was observed in six patients. The median nerve was affected in 28 cases, the ulnar nerve in 25 and the radial nerve in 13. ⋯ A conservative therapeutic approach is customary in the majority of neurovascular complications. Prognosis is generally excellent. Ischaemia of the limb and total ruptures of the nerve are very rare.
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This manuscript will review the literature and focus on the present controversies regarding natural history, microsurgical treatment, and secondary shoulder reconstructive surgery in infants with brachial plexus birth palsies. Surgical indications, expected outcomes and complications will be addressed. ⋯ The developments in assessment and care of glenohumeral deformity with magnetic resonance imaging scans, arthroscopic and open reductions, and tendon transfers about the shoulder will be discussed. Recommendations for microsurgery and shoulder reconstruction will be based on the present evidence from the literature.