Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jul 2000
Neurovascular injuries in type III humeral supracondylar fractures in children.
Clinical and radiographic records of 210 consecutive children treated for Type III extension humeral supracondylar fractures during a 66-month period were reviewed retrospectively to determine (1) the incidence of neural and vascular injuries associated with this fracture; (2) the frequency of the type of nerve injured; and (3) the relationship of fracture displacement to neural and vascular compromise. Forty patients (19.1%) had neural compromise, vascular compromise, or both. Nerve injuries occurred in 13.3% of patients, combined nerve and vascular compromise occurred in 2.9%, and vascular compromise occurred in 2.9% of patients. ⋯ Posterolateral fracture displacement was correlated with median nerve and vascular compromise. Posteromedial fracture displacement strongly correlated with radial nerve injury. Recognition of fracture displacement pattern provides a guide to clinical examination to assess associated neural injury, in particular, the anterior interosseous nerve, which may be difficult to evaluate in a child who is uncooperative.
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Clin. Orthop. Relat. Res. · Jul 2000
Changes in canine peripheral nerves during experimental callus distraction.
In 24 beagles, lengthening of the right tibia was performed by callus distraction after osteotomy and application of a ring fixator. Distraction was started the fifth day after surgery with a distraction rate of 0.5 mm twice per day and ended after 25 days. A control group of six additional dogs underwent tibial osteotomy and external fixation without distraction. ⋯ Morphometric analysis of the peroneal nerves revealed a significant increase of fiber density and a reduced mean axon and fiber diameter in the consolidation period (Group B). Similar changes were found in the tibial nerves in Group A and disappeared in the consolidation phase (Group B). These features indicate that callus distraction leads to moderate degenerative changes, followed by repair mechanisms, almost complete recovery, and some nerve fiber growth.
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Clin. Orthop. Relat. Res. · Jul 2000
Compartment syndrome in ipsilateral humerus and forearm fractures in children.
Ipsilateral fractures of the humerus and forearm are uncommon injuries in children. The incidence of compartment syndrome in association with these fractures is controversial. The authors reviewed 978 consecutive children admitted to the hospital with upper extremity long bone fractures during a 13-year period. ⋯ All three cases of compartment syndrome occurred among nine children with ipsilateral displaced extension supracondylar humerus and displaced forearm fractures; the incidence of compartment syndrome was 33% in this group. These findings suggest that children who sustain a displaced extension supracondylar humerus fracture and displaced forearm fracture are at significant risk for compartment syndrome. These children should be monitored closely during the perioperative period for signs and symptoms of increasing intracompartmental pressures in the forearm.
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Clin. Orthop. Relat. Res. · Jul 2000
Immediate hip spica casting for femur fractures in pediatric patients. A review of 175 patients.
Immediate closed reduction and application of a well-molded hip spica cast is a safe and effective treatment option for closed, isolated femur fractures in children who weigh between 10 and 100 pounds. Between 1988 and 1996, 190 immediate hip spica casts were placed on children with isolated femoral shaft fractures who weight between 10 and 100 pounds. Fifteen patients were lost to followup leaving 175 children who were evaluated and followed up for at least 2 years after the hip spica cast was removed (range 2-10 years). ⋯ No significant residual angular deformities were present in any of the children at last followup. None of the children required external shoe lifts, epiphysiodesis, antibiotics, irrigation and debridements, or limb lengthening procedures for leg length inequalities. The authors think that immediate closed reduction and placement of a well-molded hip spica cast is a safe and reliable treatment option for isolated, closed femur fractures in children from birth to 10 years of age who weigh less than 80 pounds.
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Clin. Orthop. Relat. Res. · Jul 2000
Proximal femoral fracture. Range of hip motion as a predictor of fracture type.
A cadaveric study has shown that the femoral neck impinges on the posterior part of the acetabulum at an average of 54.5 degrees external rotation and that an intracapsular fracture can be reproduced by an impact load onto the greater trochanter with the hip in external rotation. A clinical study of hip rotation of the contralateral uninjured hip in 100 patients after proximal femoral fracture was done to compare the degree of external rotation between extracapsular and intracapsular fracture. ⋯ Previous work has suggested that an intracapsular fracture occurs during a fall when external hip rotation thrusts the femoral neck against the posterior margin of the acetabulum. The current investigation would support this hypothesis and suggests that the natural degree of external hip rotation is a predictor of fracture type.