Journal of Children's Orthopaedics最新文献

{"title":"A protocol for the management of pediatric type I open fractures.","authors":"Christopher A Iobst,&nbsp;Craig Spurdle,&nbsp;Avi C Baitner,&nbsp;Wesley F King,&nbsp;Michael Tidwell,&nbsp;Stephen Swirsky","doi":"10.1007/s11832-014-0554-7","DOIUrl":"https://doi.org/10.1007/s11832-014-0554-7","url":null,"abstract":"<p><strong>Background: </strong>The management of pediatric type I open fractures remains controversial. There has been no consistent protocol established in the literature for the non-operative management of these injuries.</p><p><strong>Methods: </strong>A protocol was developed at our institution for the non-operative management of pediatric type I open forearm fractures. Each patient was given a dose of intravenous antibiotics at the time of the initial evaluation in the emergency department. The wound was then irrigated and a closed reduction performed in the emergency department. The patient was admitted for three doses of intravenous antibiotics (over approximately a 24-h period) and then discharged home without oral antibiotics.</p><p><strong>Results: </strong>In total, 45 consecutive patients were managed with this protocol at our hospital between 2004 and 2008. The average age was 10 (range 4-17) years. The average number of doses of intravenous antibiotics was 4.06 per patient. Thirty patients (67 %) received cefazolin (Ancef®) as the treating medication and 15 patients received clindamycin (33 %). There were no infections in any of the 45 patients.</p><p><strong>Conclusion: </strong>In this study we outline a consistent management protocol for type I open pediatric forearm fractures that has not previously been documented in the literature. Our results corroborate the those reported in the literature that pediatric type I open fractures may be managed safely in a non-operative manner. There were no infections in our prospective series of 45 consecutive type I open pediatric forearm fractures using our protocol. Using a protocol of only four doses of intravenous antibiotics (one in the emergency department and three additional doses during a 24-h hospital admission) is a safe and efficient method for managing routine pediatric type I open fractures non-operatively.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"71-6"},"PeriodicalIF":1.4,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-014-0554-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32084620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decrease in outpatient department visits and operative interventions due to bisphosphonates in children with osteogenesis imperfecta.","authors":"F de Graaff,&nbsp;W Verra,&nbsp;J E H Pruijs,&nbsp;R J B Sakkers","doi":"10.1007/s11832-010-0305-3","DOIUrl":"https://doi.org/10.1007/s11832-010-0305-3","url":null,"abstract":"<p><strong>Introduction: </strong>Bisphosphonates are currently the medical treatment most often used in children with osteogenesis imperfecta (OI). The purpose of this retrospective pre-post study was to evaluate the efficacy of treatment with bisphosphonates. We measured the effect by evaluating the number of outpatient department consultations and operative interventions before and after treatment with bisphosphonates in children with OI.</p><p><strong>Methods and materials: </strong>Outpatient department consultation and operative intervention frequencies before and after treatment with bisphosphonates were registered. Children who had at least 2 years of medical records before treatment and at least 2 years after treatment were used in this study.</p><p><strong>Results: </strong>Of 118 children who were treated with bisphosphonates, 51 (23 boys and 28 girls) fulfilled the inclusion criteria. Statistical analysis revealed a significant decrease in outpatient department consultations (P < 0.000) and operative intervention (P < 0.003) before and after bisphosphonate treatment.</p><p><strong>Conclusion: </strong>The pre-post design of our study shows a significant reduction of the number of outpatient department consultations and operative interventions in patients with OI after treatment with bisphosphonates.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"121-5"},"PeriodicalIF":1.4,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-010-0305-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40093949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison of percutaneous and mini-open techniques of Achilles tenotomy: an experimental study in rats.","authors":"Ahmet Dogan,&nbsp;Onat Uzumcugil,&nbsp;Bartu Sarisozen,&nbsp;Bulent Ozdemir,&nbsp;Y Emre Akman,&nbsp;Ergun Bozdag,&nbsp;Emin Sunbuloglu,&nbsp;Erol Bozkurt","doi":"10.1007/s11832-009-0207-4","DOIUrl":"https://doi.org/10.1007/s11832-009-0207-4","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the effect of Achilles tenotomy performed percutaneously and by mini-open methods on tendon healing and final strength.</p><p><strong>Materials and methods: </strong>In two groups, each consisting of 14 rats, percutaneous and mini-open techniques in Achilles tenotomy were compared in terms of biomechanical, histological and gross properties.</p><p><strong>Results: </strong>In the gross evaluation, it was observed that an obvious thickening and adhesion to the subcutaneous tissue of the healing tendon were observed in nearly all rats in which the mini-open technique was performed. In the biomechanical analysis, there was no significant difference between percutaneous and mini-open groups and between operated and intact Achilles tendons in both groups, in terms of tendon strength (P > 0.05). In the histological evaluation, irregularity in the parallel pattern of the collagen fibres, emergence of a non-specific collagenous tissue formation and infiltration of mild mononuclear inflammatory cells were reported. These changes were more marked in the rats in which the percutaneous technique was performed.</p><p><strong>Conclusion: </strong>Mini-open technique for Achilles tenotomy may be considered as an alternative method of treatment to apply the tenotomy technique in a secure way.</p><p><strong>Clinical relevance: </strong>There are two basic advantages of Achilles tenotomy performed by the mini-incision open technique: (1) a complete tenotomy is guaranteed, as it has to be in the original Ponseti technique, (2) iatrogenic neuro-vascular injury risk is nearly completely avoided due to the subparatenon exploration of the tendon and direct visual observation during the transection. The mini-open technique may only be used in cases in which a vascular compromise is clinically suspected or confirmed by Doppler ultrasonography and/or arteriography. On the other hand, the technique may be performed in all cases routinely by the choice of the surgeon.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"485-91"},"PeriodicalIF":1.4,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-009-0207-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40049495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthrogryposis multiplex congenita. Long-term follow-up from birth until skeletal maturity.","authors":"Alice Fassier,&nbsp;Philippe Wicart,&nbsp;Jean Dubousset,&nbsp;Raphaël Seringe","doi":"10.1007/s11832-009-0187-4","DOIUrl":"https://doi.org/10.1007/s11832-009-0187-4","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this retrospective long-term study was to review and present the effects of treatment for 11 children with arthrogryposis multiplex congenital, or amyoplasia, followed from birth until skeletal maturity.</p><p><strong>Methods: </strong>We evaluated walking ability, age of beginning to walk, required ambulatory devices, age of independent walking and muscle strength.</p><p><strong>Results: </strong>Our series showed babies with severe limb involvements without spine abnormalities. Despite the initial severity of involvement, nine patients finally became ambulators with flexion contracture of less than 20 degrees on hips and 15 degrees on knees, and six were independent walkers before the age of 2.5 years. The two non-ambulators presented severe scoliosis at skeletal maturity, which needed spinal fusion.</p><p><strong>Conclusion: </strong>We conclude that long-term ambulatory status at skeletal maturity is not correlated with the severity of condition at birth. A prognosis for ambulation at skeletal maturity will be done before 2.5 years of age. We believe that early aggressive management of children with severe arthrogryposis is warranted and justified.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"383-90"},"PeriodicalIF":1.4,"publicationDate":"2009-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-009-0187-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40024319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The results of downgrading moderate and severe slipped capital femoral epiphysis by an early Imhauser femur osteotomy.","authors":"Melinda M E H Witbreuk,&nbsp;M Bolkenbaas,&nbsp;M G Mullender,&nbsp;I N Sierevelt,&nbsp;P P Besselaar","doi":"10.1007/s11832-009-0204-7","DOIUrl":"https://doi.org/10.1007/s11832-009-0204-7","url":null,"abstract":"<p><strong>Purpose: </strong>Patients with moderate and severe slipped capital femoral epiphysis (SCFE) develop osteoarthritis earlier in life in association with mechanical impingement.</p><p><strong>Methods: </strong>To correct deformity and diminish impingement, we performed epiphysiodesis combined with an Imhauser intertrochanteric osteotomy (ITO) in moderate and severe slipped capital femoral epiphysis. We downgraded the angle of the head relative to the acetabulum into an angle corresponding to a mild slip or even an anatomical position. Our hypothesis is that the avoidance of anterior impingement at an early stage can prevent the development of osteoarthritis.</p><p><strong>Results: </strong>The results of 28 patients (32 hips) were evaluated. Outcome parameters were SF-36, Harris Hip Score, range of motion, Kellgren-Lawrence score, chondrolysis and avascular necrosis. After a median follow-up of 8 (range 2-25) years, the group was clinically, functionally and socially performing well. Radiologically, there was no sign of chondrolysis or avascular necrosis, and more than 80% of the patients did not show any signs of osteoarthritis.</p><p><strong>Conclusions: </strong>Based on these results, we conclude that a one-stage Imhauser ITO combined with epiphysiodesis performed on patients with moderate and severe SFCE gives satisfactory results.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"405-10"},"PeriodicalIF":1.4,"publicationDate":"2009-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-009-0204-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40038371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of femur fractures in children with cerebral palsy.","authors":"Arabella I Leet,&nbsp;Eric D Shirley,&nbsp;Chris Barker,&nbsp;Franck Launay,&nbsp;Paul D Sponseller","doi":"10.1007/s11832-009-0191-8","DOIUrl":"https://doi.org/10.1007/s11832-009-0191-8","url":null,"abstract":"<p><strong>Purpose: </strong>Children with cerebral palsy may have low bone density stemming from various etiologies and are, thereby, at risk for fractures. The treatment of femur fractures in children with cerebral palsy may need to be tailored to address the management of spastic muscle tone and multiple medical co-morbidities.</p><p><strong>Methods: </strong>Our study is a retrospective review that evaluates the treatment of 47 femur fractures in children with cerebral palsy in both ambulatory and non-ambulatory patients.</p><p><strong>Results: </strong>Thirty-two fractures in non-ambulators were treated non-operatively, 11 of which resulted in malunions and five developed pressure sores. Six fractures in non-ambulators were treated operatively, one of which resulted in a malunion. In ambulators, five fractures were treated non-operatively; one of these fractures lost reduction after 2 weeks and required surgical intervention. One of four fractures in ambulators treated operatively developed a malunion.</p><p><strong>Conclusion: </strong>Our study results suggest that femur fractures in children with cerebral palsy can be treated non-operatively; however, because of the high risk of malunion in this patient population, fracture alignment needs to be followed closely during healing. Careful attention during casting is necessary to prevent pressure sores. Strong consideration should be given to initial operative treatment in ambulatory patients in order to preserve function.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"253-8"},"PeriodicalIF":1.4,"publicationDate":"2009-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-009-0191-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40009317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of surgical treatment for type III supracondylar humerus fractures in pediatric patients.","authors":"Ahmet Ozgur Yildirim,&nbsp;Vuslat Sema Unal,&nbsp;Ozdamar Fuad Oken,&nbsp;Murat Gulcek,&nbsp;Metin Ozsular,&nbsp;Ahmet Ucaner","doi":"10.1007/s11832-009-0189-2","DOIUrl":"https://doi.org/10.1007/s11832-009-0189-2","url":null,"abstract":"<p><strong>Background: </strong>Type III supracondylar humeral fracture is a common cause of emergency hospitalization among children requiring surgical treatment. The configuration of the internal fixation material, surgical technique, and optimal timing of surgery (TS) have always been popular topics of debate. The TS in uncomplicated cases is usually determined by surgeons.</p><p><strong>Methods: </strong>In this study, we prospectively followed children with type III supracondylar fractures. We aimed to clarify the effects of injury side, gender, and post-injury delay on switching to open surgery and the ease of the reduction.</p><p><strong>Results: </strong>Based on our results, the probability of switching to open surgery increased by a factor of 4 every 5 h beginning 15 h after injury. Open surgery was necessary after 32 h.</p><p><strong>Conclusion: </strong>Reduction became technically more difficult as TS increased.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"265-9"},"PeriodicalIF":1.4,"publicationDate":"2009-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-009-0189-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40006737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determination of hip reduction in spica cast treatment for DDH: a comparison of radiography and ultrasound.","authors":"Oliver Eberhardt,&nbsp;Michael Zieger,&nbsp;Michael Langendoerfer,&nbsp;Thomas Wirth,&nbsp;Francisco F Fernandez","doi":"10.1007/s11832-009-0194-5","DOIUrl":"https://doi.org/10.1007/s11832-009-0194-5","url":null,"abstract":"<p><strong>Purpose: </strong>In this retrospective study we compared the efficacy of ultrasound and radiography for determining the position of the femoral head after closed or open reduction in DDH.</p><p><strong>Materials and methods: </strong>The ultrasound was performed using the van Douveren technique by a transinguinal approach through a perineal window of the spica cast. Sixty-eight a.p. radiographs of the pelvis were correlated to 68 ultrasound images.</p><p><strong>Results: </strong>Thirty-two radiographs were not useful for precisely determining the femoral head position, whereas the criteria described by van Douveren et al. could be identified in all ultrasound images. All ultrasound images in the study were useful and gave reliable information about the position of the femoral head.</p><p><strong>Conclusion: </strong>Consequently, standard radiographic documentation is no longer used as a standard in our clinic. MRI and CT are reserved for special cases. We recommend transinguinal ultrasound as a standard diagnostic method to determine the position of the femoral head in hip spica casts safely and reliably.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"313-8"},"PeriodicalIF":1.4,"publicationDate":"2009-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-009-0194-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40014199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}