Journal of children's orthopaedics
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Posterior only approaches for spinal deformity are increasingly popular and posterior spinal release is utilized to gain flexibility for correctional maneuvers. Prior biomechanical data support the use of facetectomy and rib head resection for gaining flexibility in the sagittal and coronal planes but to date there has been no quantification of stiffness reduction provided by these techniques for axial correction through a pedicle screw construct. We sought to determine the contribution of posterior spinal releases (facetectomy, rib head resection) on axial plane stiffness. ⋯ Complete facetectomies (Ponte or Smith-Petersen osteotomies) decrease the force required to rotate spinal segments with respect to the axial plane by approximately one-fifth. Posterior rib head resection should be considered to further loosen the spine if additional axial correction is desired.
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The Scoliosis Research Society-22 (SRS-22) questionnaire is a widely accepted questionnaire used to assess the health-related quality of life for scoliosis patients in the United States. However, its adaptation in other languages is necessary for its multinational use. A cross-sectional study was performed to evaluate the validity and reliability of an adapted Thai version of the SRS-22 questionnaire. ⋯ The Thai version of the SRS-22 outcome instrument has satisfactory internal consistency, excellent reproducibility, and acceptable validity.
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Supraclavicular brachial plexus block is considered to be one of the most effective anesthetic procedures for upper extremity surgeries. Its major drawback is placement of the needle, with inaccurate placement, especially in children, being a risk factor for pneumothorax and vascular puncture and failure of the procedure. Ultrasound-guided needle placement may reduce the risk of complications and increase the accuracy of the block, particularly in pediatric patients. Little has been published on the efficacy and safety of ultrasound-guided supraclavicular block in children based on practical experience, and there has been no published report on its usage in younger children (<6 years old). ⋯ The results of this study demonstrate the efficacy and safety of the ultrasound-guided supraclavicular brachial plexus block for orthopedic upper extremity surgeries in patients less than 6 years of age.
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At Haukeland University Hospital (HUH), we used overhead skeletal traction for displaced supracondylar humerus fractures (SCHF) in children until closed reduction and crossed wire fixation was introduced in the early 1990s. Though there are obvious and well-documented benefits of wire fixation, the aim of this study was to document and compare the results and complication rates for both methods. ⋯ The introduction of crossed wire fixation has significantly reduced the number of days for which patients are hospitalised for SCHF. The rate of nerve injuries in Gartland type 3 fractures is high. Despite the fact that this study includes the first patients to be treated with crossed wire fixation at our institution, no significant increase in the risk of complications could be found compared to skeletal traction.
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To determine the influence of the time from injury to surgery of Type III supracondylar fractures on operative duration and quality of reduction. ⋯ There was no difference in the operative duration demonstrated between IST <8 h and IST >8 h. This failure to demonstrate a difference should not be interpreted as demonstrating equivalence. This study does not conclude that all displaced supracondylar fractures should be delayed, though it does inform the surgeon that, if compelled to delay surgery, this series did not demonstrate an increased risk of complications, nor a worsened quality of reduction.