Journal of pediatric orthopedics. Part B
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Our objectives were to determine the treatment outcome of trigger thumb and to identify its possible cause. One hundred and thirty-eight thumbs from 115 children were reviewed. ⋯ Our results suggest that a more conservative approach to this problem should be adopted. Our data also suggest that this condition may be acquired rather than congenital.
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Review Case Reports
Anterolateral tibial bowing and duplication of the hallux: a rare but distinct entity with good prognosis.
Congenital anterolateral bowing of the lower leg usually is a symptom of (impending) fracture because of congenital pseudarthrosis. This article reports a case of anterolateral bowing of the lower leg that is characterized by spontaneous correction and combination with duplication of the hallux. A review of the literature showed 10 comparable cases. This article is the first report on the magnetic imaging of this entity and describes its differentiation from congenital pseudarthrosis.
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Fractures of the lateral humeral condyle in children may cause difficulties in diagnosis and treatment. The fracture line involves the cartilaginous trochlea, which cannot be visualized on conventional radiographs. Therefore, a differentiation is not possible between the conservatively treated stable and the surgically treated unstable fracture, which involves the joint surface but is not dislocated primarily. ⋯ In the remaining four children, ultrasonography was able to rule out joint involvement, thus classifying the fracture as stable. Conservative treatment was started, and the sonographic findings were confirmed by radiographs 4 days after the trauma to rule out secondary displacement. High-resolution ultrasonography is able to diagnose fracture involvement of the joint forming cartilaginous trochlea humeri in children, thus making further invasive or costly investigations such as magnetic resonance imaging unnecessary.
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We studied 28 displaced (Jacob types II and III) fractures of the lateral humeral condyle in 28 children. There were only two Milch type I fractures. Twenty-one fractures were treated by open reduction and internal fixation with K-wires, Palmer nails, or sutures. ⋯ Two patients developed avascular necrosis of the trochlea. One of these had a concomitant fracture of the medial humeral epicondyle, and the other suffered a lateral condylar fracture preceded by a supracondylar fracture. We conclude that a reduced growth potential at the trochlear groove is a regular complication of the Milch type II fracture, and that the Jacobs classification is the most useful in the assessment of the method of treatment.
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Neuromuscular scoliosis concerns a wide variety of disorders, all with a different approach to surgical intervention. The impact of these disorders on a patient is discussed in terms of pulmonary, cardiac, bowel and bladder function and complications in the perioperative and postoperative period such as gastric ulcers, pathologic fractures, wound healing, and nutrition is described. ⋯ Items on preoperative clinical and radiological examination are provided, as well as points of special attention in perioperative care. Early detection, decision-making and intervention makes it possible to correct and stabilize the spine in these children with a short stay in hospital and a quick recovery.