The American journal of orthopedics
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of morphine patient-controlled analgesia with and without ketorolac for postoperative analgesia in pediatric orthopedic surgery.
The purpose of this prospective, randomized, double-blind, placebo-controlled clinical study was to determine whether the administration of intravenous ketorolac, coadministered with morphine patient-controlled analgesia (PCA), demonstrates an opioid-sparing effect, provides improved analgesia, and reduces the incidence of opioid-induced side effects in children after orthopedic surgery. The findings of enhanced analgesia with decreased opioid use suggest that coadministration of ketorolac with morphine PCA is beneficial for the treatment of pain in children after orthopedic surgery.
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The characteristic pattern of fusion of distal tibial epiphysis explains the special configuration of the fragments in the triplane fracture and the "juvenile" fracture of Tillaux in adolescents. The application of external rotation force produces Tillaux and triplane fractures of the lateral portion of the distal tibial epiphysis in patients with a mean age of 13.5 years. Eight patients, 13 to 15 years of age, with distal tibial epiphyseal fractures were treated in the last 12 years. ⋯ Objective evaluation included clinical assessment and radiographic evaluation. All patients regained full range of motion and no one complained of pain or joint stiffness. Radiographs confirmed that all fractures have healed without articular incongruity.
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Case Reports
Femoral fracture at the proximal end of an intramedullary supracondylar nail: a case report.
Retrograde intramedullary supracondylar nails have been added to the orthopedic armamentarium for treatment of distal femoral fractures. Major complications of this new technique have not been noted. We report a case of a femoral fracture at the proximal end of a retrograde intramedullary supracondylar nail. We hypothesize that this complication may be due to the proximal end of the nail acting as a stress riser, with the cortical holes drilled for the interlocking screws compounding this effect.
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Twenty children with fractures of both bones in the middle third of the forearm were immobilized in extension after closed reduction. Unlike distal-third fractures, these fractures are prone to develop rotary and angular deformities that may lead to permanent functional impairment and visible deformity. Mid-third forearm fractures with the radius fracture proximal to the ulnar fracture are even more troublesome. ⋯ Extension casting can be used initially for proximal fractures or to salvage forearms that lost reduction in flexed elbow casts. Extension cast application is easy while the reduction is maintained, whereas the problems are often encountered while applying a flexed elbow cast. This unorthodox treatment is safe and effective and may alleviate the need for surgical intervention.