Journal of pediatric orthopedics. Part B
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Expansion thoracoplasty and vertical expandable prosthetic titanium rib (VEPTR; Synthes Spine Co., West Chester, Pennsylvania, USA) implantation is a new method for the treatment of thoracic insufficiency syndrome and congenital spinal deformity in children. The longitudinal rib implant expands the thorax and indirectly corrects spinal deformity, thus allowing spinal, thoracic and probably lung growth. VEPTR has been used since 1989 in San Antonio, USA, and was introduced to Europe in 2002. ⋯ After VEPTR implantation, families and patients reported improvement of the thoracic insufficiency syndrome and better sitting abilities in the neuromuscular patients, as well as radical cosmetic improvement. There were three complications (skin breakage, lumbar hook displacement, rib fracture) after performing fifteen primary VEPTR implantations and 13 expansion surgeries in eight patients. Our experience suggests that expansion thoracoplasty and VEPTR implantation is a safe and efficient method for the treatment of thoracic insufficiency syndrome in young children with severe scoliosis.
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Gowers' sign is pathognomonic in patients with Duchenne muscular dystrophy. These patients, when rising, 'climb up' their thighs using their hands in order to overcome the weakness of the pelvic girdle and paravertebral muscles. ⋯ We therefore conclude that the presence of Gowers' sign in small children must alert the examiner to the possibility of infection in the lumbar spine. These children use this maneuver in order to avoid painful motion of the lumbar spine.
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Comparative Study
Magnetic resonance imaging in diagnosis and follow-up of impending spondylolysis in children and adolescents: early treatment may prevent pars defects.
The lumbar spine was assessed by magnetic resonance imaging (MRI) in 14 children (mean age 12.4 years) with unspecific activity-related low back pain for more than 3 weeks presenting with normal plain radiographs. Impending spondylolysis was diagnosed when typical signal abnormalities were confined to the pars interarticularis without signs of thinning or fragmentation. ⋯ MRI showed promising results in detecting and monitoring the early onset of spondylolysis. Bracing and avoiding strenuous activities prevented the formation of pars defects in all our patients.
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Parents use the Internet increasingly for information about their children's medical problems. There is no quality control for medical information content. The goals of our study were to assess Internet awareness by families seen in paediatric orthopaedic outpatients departments and the type, quality and reliability of information available, using clubfoot as an example. ⋯ Parents frequently use the Internet for information about paediatric orthopaedic consultations, prior to consultation. The quality of clubfoot information on the Internet is variable. The development of academic-based websites should be encouraged, as these offer the most useful information.
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Review Case Reports
Osteomyelitis of the rib due to Streptococcus pneumoniae: a very rare condition in children.
Rib osteomyelitis is a rare disease. We present a previously unreported case of Streptococcus pneumoniae osteomyelitis of the rib. A 4-month-old-infant presented with fever, irritability and abdominal tenderness. ⋯ A review of the pertinent literature was made. This case demonstrates that the spectrum of pathogens potentially responsible for rib osteomyelitis may be broader than previously reported. The management and outcome are similar to rib osteomyelitis due to any other bacteria.