Journal of pediatric orthopedics. Part B
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The etiology of Legg-Calvé-Perthes disease is poorly understood. An association has been found in the past between Legg-Calvé-Perthes disease and smoking as well as low socio-economic status. ⋯ The presence of second-hand smoke seems to be a significant risk factor in the development of Legg-Calvé-Perthes disease. The presence of second-hand smoke may represent the 'unknown industrial factor' that has been discussed.
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The incidence of pyomyositis is on the increase worldwide among children and adults. When it involves muscles about the hip it needs to be differentiated from septic arthritis and transient synovitis among other diseases. ⋯ We present one case of pyomyositis of the gluteus maximus and another rarer case of obturator internus pyomyositis that posed difficulties in initial diagnosis. While magnetic resonance imaging remains the imaging method of choice, we highlight important physical signs in the examination of patients presenting with a painful hip, which should raise suspicion of pyomyositis.
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Case Reports Comparative Study
Reduction versus remodeling in pediatric distal forearm fractures: a preliminary cost analysis.
The inherent ability of pediatric metaphyseal radius fractures to heal and remodel made us question the need for immediate anatomic reduction under conscious sedation. We believe that isolated closed distal radius fractures with 15 degrees of angulation and 1 cm of shortening will heal well and remodel completely without clinical or functional sequelae. Time and expense can be decreased by splinting and follow-up without the need for immediate anatomic reduction in the emergency room. ⋯ The average time in the emergency room was 2 h less with no reduction. The cost of the emergency room visit with attempted reduction was 50% more than splinting with early referral (US dollars 536 versus US dollars 270). None of our patients had significant clinical deformities or residual functional deficits.
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Review Case Reports
Osteogenesis imperfecta and hyperplastic callus formation in a family: a report of three cases and a review of the literature.
Osteogenesis imperfecta is one of the most common groups of inherited disorders of connective tissue. Hyperplastic callus formation in patients with osteogenesis imperfecta after fracture or surgery is a rare occurrence that has often been misdiagnosed as osteosarcoma. ⋯ An association between osteogenesis imperfecta type IV and hyperplastic callus formation is unclear. This association might, however, be a separate, specific subtype of osteogenesis imperfecta, with an unknown inheritance pattern.
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This report highlights the difficulties associated with diagnosing cervical spine injuries in children especially as the history and mechanism of injury may often be unclear and the normal variations in roentgenographic appearance may be confusing. As far as we are aware this is only the second case of traumatic Hangman's fracture in a child under the age of 3 years and the only case where there is a strong probability of child abuse. A female child aged 23 months was admitted with a 5-day history of irritability and general malaise. ⋯ Hangman's fracture is very rare in children under 3 years and the considerable normal variations further complicate diagnosis. Swischuk described the posterior cervical line connecting the spinous process of C1-C3 vertebrae on the lateral projection to differentiate a true fracture dislocation from physiological anterior displacement. A detailed history, roentgenograms, bone scans, CT scans and MRI scans are often required for accurate diagnosis.