Showing papers in "Journal of Pediatric Orthopaedics in 2003"
TL;DR: Fracture angulation and outcome were associated with the patient's weight and size of the nails implanted, and technical pitfalls exist with this implant can be minimized by leaving less than 2.5 cm of nail out of the femur and by using the largest nail sizes possible.
Abstract: Limited data exist about complications of titanium elastic nails (TNs) for femur fracture management in pediatric patients. Thirty-nine patients with 43 femoral shaft fractures were identified whose average age was 6.0 years. There were 21 complications (1 intraoperative, 20 postoperative) in 43 fe mur fractures (49%). There were two major postoperative complications: one septic arthritis after nail removal and one hy pertrophic nonunion. Minor postoperative complications were pain at the nails in 13 extremities, nail erosion through the skin in 4, and one delayed union. There was an association between the prominence of TNs and nail pain or skin erosion. Fracture angulation and outcome were associated with the patient's weight and size of the nails implanted. Technical pitfalls exist with this implant and can be minimized by leaving less than 2.5 cm of nail out of the femur and by using the largest nail sizes possible.
204Â citations
TL;DR: A visual gait analysis score for use in cerebral palsy has been developed that demonstrated good intraobserver and interobserver reliability and was able to detect postoperative change.
Abstract: Complex gait analysis systems are not generally available worldwide, and no simple system of assessing gait by observation has been validated specifically for use in patients with cerebral palsy. The authors have developed a visual gait analysis score for use in cerebral palsy. Videotaped sequences of patients were recorded before and after surgery as part of a three-dimensional gait study using a Vicon (Oxford, U.K.) gait analysis system. The score demonstrated good intraobserver and interobserver reliability. The numeric values of the score elements correlated well with the measurements obtained from instrumented gait analysis for the same patients, and the score was able to detect postoperative change.
187Â citations
168Â citations
TL;DR: The incidence and predictors of premature physeal closure (PPC) after pediatric distal tibial fractures were investigated, suggesting that open reduction and removal of the entrapped periosteum may be beneficial.
Abstract: The incidence and predictors of premature physeal closure (PPC) after pediatric distal tibial fractures were investigated. PPC was defined as evidence of growth plate disturbance on the injured side compared with the uninjured side. Ninety-two fractures were reviewed with at least 1 year of follow-up, or until physiologic closure of the growth plates. Twenty-five fractures (27.2%) were complicated by PPC, as confirmed by CT scan in most cases. Salter-Harris III and IV (medial malleolar type) fractures resulted in the highest percentage of PPC by fracture type (38%). Salter-Harris I and II fractures resulted in PPC in 36% of cases, followed by triplane fractures (21%) and Tillaux fractures (0%). Initial displacement, number of reduction attempts, or treatment method did not significantly affect the incidence of PPC. More anatomic reductions resulted in a statistically significant decrease in PPC rates. Residual physeal gap (>3 mm) following reduction was determined from radiographs in Salter-Harris I and II fractures. If a residual gap was seen on the radiograph, the incidence of PPC increased to 60%; if no gap was present, the incidence decreased to 17%. Open reduction was performed in five Salter-Harris II fractures that had a residual gap. Periosteum was entrapped in the physis in all of these cases. Residual gaps in the physis following closed reduction may represent entrapped periosteum in Salter-Harris I and II fractures. This can lead to a higher incidence of PPC, suggesting that open reduction and removal of the entrapped periosteum may be beneficial.
168Â citations
TL;DR: Six-axis deformity analysis and the Taylor Spatial Frame provide accurate and safe correction of infantile and adolescent tibia vara.
Abstract: Operative correction for infantile and adolescent tibia vara has been described using both external and internal fixation. Gradual correction using a circular fixator offers the advantage of accurate coronal, sagittal, and axial plane correction without significant soft tissue dissection. This study evaluated the use of six-axis deformity analysis and the Taylor Spatial Frame (TSF) for the correction of tibia vara. Nineteen patients (22 tibias), 6 with infantile and 13 with adolescent tibia vara, underwent correction with TSF. On the basis of mechanical axis correction, 21 of 22 tibias were corrected within 3 degrees of normal. Using Schoenecker's criteria, all patients achieved good results (no pain, <5 degrees difference in tibial-femoral angle from the normal side). Complications included one intractable pin-site infection, two superficial pin-site infections, and one delayed union. Six-axis deformity analysis and TSF provide accurate and safe correction of infantile and adolescent tibia vara.
130Â citations
TL;DR: There was a doubled risk of fracture in boys aged 13 to 15 compared with their female peers and to make fracture prevention more efficient, it should be targeted at this risk group and these high-risk activities.
Abstract: In 1998 the authors conducted a prospective registration of children younger than 16 presenting with a new traumatic fracture in the city of Bergen, Norway In this epidemiologic study, the authors registered a total of 1725 fractures in children; the fracture incidence was 245 per 10,000 children below the age of 16 One fifth needed reduction, and the distal radius was the most common fracture site (27%) Activities associated with fracture were mostly soccer and bicycling, but compared with the total number of injuries associated with each activity, we found a doubled risk of fractures during rollerblading/skating or snowboarding (60%) compared with playing soccer (38%) or bicycling (33%) Scaphoid fracture, an infrequent fracture in children, was seen in 9% of all fractures due to rollerblading/skating There was a doubled risk of fracture in boys aged 13 to 15 compared with their female peers To make fracture prevention more efficient, it should be targeted at this risk group and these high-risk activities Protection of the wrist region might prevent the most common fractures
116Â citations
TL;DR: The value of gait analysis for decision-making in cerebral palsy is confirmed, suggesting that clinical evaluation of torsional problems was fairly reliable.
Abstract: This study was designed to assess the impact of gait analysis on the treatment of patients with cerebral palsy. One hundred two ambulant patients with cerebral palsy were assessed clinically and with gait analysis. Separate treatment proposals for each patient were recorded after clinical examination and after gait analysis. The results of the two methods of assessment were compared. After clinical assessment, 71 of the 102 patients evaluated were recommended for a surgical procedure and 31 for nonoperative treatment. After gait analysis, the indications for treatment were confirmed in 91 cases (89%). Clinical assessment by the same orthopedic surgeon was in close agreement with gait analysis in identifying an indication for surgery. There was less agreement in the type or level of operation recommended. Gait analysis altered the decision in 106 of 267 operations (40%). There was good agreement for bone surgery, suggesting that clinical evaluation of torsional problems was fairly reliable. The poorer agreement seen for soft tissue operations probably reflects the difficulties in assessing tone-related problems in these patients clinically. This study confirms the value of gait analysis for decision-making in cerebral palsy.
113Â citations
TL;DR: Girls were more likely to have patellofemoral pathology; boys were morelikely to have ACL and meniscal tears; girls were more than twice as likely to be diagnosed with anterior cruciate ligament injuries.
Abstract: A prospective analysis was completed during a 6-month period to identify all patients, age 18 years or younger, who presented for evaluation of their knee effusion. There were 44 injured knees in 44 patients. There were a total of 55 diagnoses: 16 (29%) anterior cruciate ligament (ACL) injuries, 16 (29%) meniscal tears, 14 (25%) patellofemoral subluxations or dislocations, 3 (5%) medial collateral ligament sprains, 2 (4%) patellar osteochondral fractures, 2 (4%) retinacular injuries, 1 (2%) posterior cruciate ligament rupture, and 1 (2%) tibial eminence fracture. Girls had 11 of the 14 patellofemoral injuries; 58% of the girls had effusions secondary to patellofemoral pathology compared with 12% of the boys. Boys had 10 of the 16 meniscal tears and 13 of the 16 ACL tears. Fifty-two percent of boys had an injury to the ACL and 44% had an injury to a meniscus. In contrast, 16% of girls had an ACL injury and 32% had meniscal tears. ACL injuries, meniscal tears, and patellofemoral pathology accounted for 87% (48/55) of the diagnoses. Girls were more likely to have patellofemoral pathology; boys were more likely to have ACL and meniscal tears.
113Â citations
TL;DR: The timing of epiphyseal extrusion, metaphYseal widening, and the appearance of adverse metaphyseal and acetabular changes suggest that femoral head deformation occurs by stage IIIa in untreated hips, Hence, if containment were to succeed, it should be achieved before this stage.
Abstract: Records and 2,634 pairs of radiographs (anteroposterior and lateral) of 610 patients with Perthes disease were reviewed. The evolution of the disease was divided into seven stages (stages Ia, Ib, IIa, IIb, IIIa, IIIb, and IV) based on plain radiographic appearances. Intraobserver and interobserver reproducibility of this new classification system was assessed. The duration of each stage of the disease was noted. The stages at which epiphyseal extrusion and widening of the metaphysis occurred and the stages at which metaphyseal and acetabular changes appeared were identified. The shape and the size of the femoral head, the extent of trochanteric overgrowth, and the radius of the acetabulum were assessed in hips that had healed. The new classification system of the evolution of Perthes disease was reproducible and helped to identify when crucial events occur during the course of the disease. The median duration of each stage varied between 95 and 335 days. Epiphyseal extrusion and metaphyseal widening was modest in stages Ia, Ib, and IIa but increased dramatically after stage IIb. More than 20% extrusion occurred in 70% of the hips by stage IIIa. Metaphyseal changes were most frequently encountered in stage IIb, while acetabular changes were most prevalent in stage IIIa. At healing, only 24% of untreated patients had spherical femoral heads, while 52% had irregular femoral heads. The timing of epiphyseal extrusion, metaphyseal widening, and the appearance of adverse metaphyseal and acetabular changes suggest that femoral head deformation occurs by stage IIIa in untreated hips. Hence, if containment were to succeed, it should be achieved before this stage.
103Â citations
TL;DR: The analysis found that isolated impairment measures of motion and spasticity were only weakly related to motor function in cerebral palsy and even when averaged across multiple joints yielded no more than a fair correlation with functional scores, nor did a combination of impairments emerge that could predict substantial variance in motor function.
Abstract: Orthopedic surgery for patients with cerebral palsy addresses motion impairments, assuming that this will improve motor function. This study evaluates the relationships among clinical impairment measures with standardized assessments of function and disability as an initial step in testing this assumption. A total of 129 ambulatory children and adolescents across six institutions participated in a prospective evaluation that consisted of passive motion and spasticity examination of the lower extremities, three-dimensional gait temporal-spatial and kinematic analysis, and administration of the Gross Motor Function Measure (GMFM) and the Pediatric Outcomes Data Collection Instrument (PODCI). The analysis found that isolated impairment measures of motion and spasticity were only weakly related to motor function in cerebral palsy and even when averaged across multiple joints yielded no more than a fair correlation with functional scores, nor did a combination of impairments emerge that could predict substantial variance in motor function. These findings suggest that caution should be exercised when anticipating functional change through the treatment of isolated impairment and that addressing multiple impairments may be needed to produce appreciable effects.
101Â citations
TL;DR: Containment surgery aimed at preventing femoral head deformation in Perthes disease should be performed before the advanced stage of fragmentation, according to the outcomes following femoral osteotomy of 97 children.
Abstract: To identify the optimal timing for containment surgery for Perthes disease, the outcomes following femoral osteotomy of 97 children were analyzed. Univariate and multivariate analyses were employed to identify variables that influenced the shape and size of the femoral head at healing. The timing of surgery was an important variable that had a bearing on the outcome. The chances of retaining a spherical femoral head were much higher in children operated on either during the stage of avascular necrosis or in the early part of the fragmentation stage than in those operated later. The authors conclude that containment surgery aimed at preventing femoral head deformation in Perthes disease should be performed before the advanced stage of fragmentation. Further, any study on the outcome of containment treatment of Perthes disease must consider the timing of containment as a variable that influences the outcome while interpreting the results.
TL;DR: It is concluded that substantial variations in raw data exist when the same cerebral palsy patient is evaluated at different gait centers, and these data do not yield the same treatment recommendations in the majority of patients.
Abstract: In this study 11 ambulatory patients (mean 10.8 years) with spastic cerebral palsy were each evaluated with instrumented gait analysis at four different centers. After review of the data, each medical director chose from a list of treatment options. The average variability in static range of motion from physical examination ranged from 25 degrees to 50 degrees. Hip and knee sagittal motion had the best relative variability of 20 degrees to 24%. Via gait analysis, the average variability in sagittal, coronal, and transverse plane kinematic motions averaged 12, degrees 7 degrees, and 20 degrees, respectively. Increased variability was noted in transverse (worst) to coronal and finally sagittal (best) plane motion. Only two mildly affected patients had similar, but not exact, treatment recommendations. The authors conclude that substantial variations in raw data exist when the same cerebral palsy patient is evaluated at different gait centers. These data do not yield the same treatment recommendations in the majority of patients.
TL;DR: The authors conclude that the independent multivariate predictors are effective indices for the differential diagnosis of acute septic coxitis and transient synovitis.
Abstract: Although significant differences exist in the methods of treatment and prognoses of septic coxitis and transient synovitis in children complaining of acute hip pain, similar symptoms are present in these two diseases at the early stages, and differential diagnosis is difficult To differentiate between these two diseases, the authors evaluated the clinical, serologic, and radiologic findings and tried to determine factors that could be used as diagnostic criteria The authors performed a retrospective study by evaluating medical records, plain hip radiographs, and clinical findings in 97 patients with transient synovitis and 27 patients with septic arthritis Univariate analysis showed significant differences in body temperature, serum WBC count, and ESR and CRP levels of the two patient groups Plain radiographs showed a displacement or blurring of periarticular fat pads in all patients with acute septic arthritis, and multivariate regression analysis showed that body temperature >37 degrees C, ESR >20 mm/h, CRP >1 mg/dL, WBC >11,000/mL, and an increased hip joint space of >2 mm were independent multivariate predictors of acute septic arthritis The authors conclude that the independent multivariate predictors are effective indices for the differential diagnosis of acute septic coxitis and transient synovitis
TL;DR: C-reactive protein is a better negative predictor than a positive predictor of disease and compares with erythrocyte sedimentation rate (ESR) in the diagnosis of septic arthritis in children.
Abstract: The purpose of this study was to determine the test characteristics of C-reactive protein (CRP) in the diagnosis of septic arthritis in children and to compare with erythrocyte sedimentation rate (ESR). The authors reviewed patients with synovial fluid aspiration sent for culture and Gram stain for whom a CRP was drawn within 24 hours of presentation. Descriptive statistics and univariate analyses were performed. Results for CRP were compared with ESR. Thirty-nine of 133 patients had septic arthritis. Sensitivity of CRP ranged from 41% to 90%, specificity from 29% to 85%. Positive predictive values ranged from 34% to 53%, negative predictive values from 78% to 87%. In comparison to ESR, CRP is a better independent predictor of disease. CRP is a better negative predictor than a positive predictor of disease. Indeed, if the CRP is <1.0 mg/dL, the probability that the patient does not have septic arthritis is 87%.
TL;DR: Although no single factor was uniformly predictive of successful nonoperative treatment of juvenile OCD lesions, younger, skeletally immature patients with no MRI criteria of instability were most amenable toNonoperative treatment.
Abstract: Magnetic resonance imaging (MRI) offers promise as a noninvasive method to determine the potential of an osteochondritis dissecans (OCD) lesion to heal without surgical intervention. The purpose of this study was to compare the value of MRI, plain radiographs, and clinical findings in predicting the success of nonoperative treatment of juvenile OCD lesions. Twenty-seven lesions in 24 patients (mean age 12.2 y) with OCD of the distal femur diagnosed based on MRI were identified. A radiologist or orthopaedist, blinded to the clinical status of the patients, correlated the MRIs with patient outcome. MRIs were assessed for lesion size, location, and four criteria evaluating signal intensity changes and articular surface defects to determine lesion stability. Older, more skeletally mature patients with at least one sign of instability on MRI were most likely to have nonoperative treatment fail. Nonoperative treatment failed most often in patients with large lesions in weightbearing areas, as seen on lateral radiographs. However, location based on anteroposterior radiographs was not statistically significant for predicting treatment outcome. Although no single factor was uniformly predictive of successful nonoperative treatment, younger, skeletally immature patients with no MRI criteria of instability were most amenable to nonoperative treatment.
TL;DR: Compression plate fixation is a safe and effective treatment in children with both isolated femoral shaft fractures and those associated with multiple injuries, compared favorably to the literature of other treatment options.
Abstract: The authors conducted a retrospective review of 60 children under the age of 16 years with femoral shaft fractures treated with compression plate fixation. All patients were followed to hardware removal. The 100% union rate and low complication rate after compression plate fixation of pediatric femur fractures compared favorably to the literature of other treatment options. Compression plate fixation is a safe and effective treatment in children with both isolated femoral shaft fractures and those associated with multiple injuries.
TL;DR: Twenty-three patients who had obstetric brachial plexus palsy and shoulder subluxation or dislocation that required open reduction and tendon lengthening were entered into a prospective study to evaluate glenoid version after surgery and the mean glenoids retroversion for the dislocated shoulder progressively decreased.
Abstract: Twenty-three patients who had obstetric brachial plexus palsy and shoulder subluxation or dislocation that required open reduction and tendon lengthening were entered into a prospective study to evaluate glenoid version after surgery. All the patients had a preoperative computerized axial tomograph and postoperative computed tomography scan of both shoulders at approximately yearly intervals to assess the degree of congruity of the glenohumeral joint and glenoid version. Surgery was performed between 1988 and 1997. There were 11 girls and 12 boys. The mean age was 2 years 5 months (range 8 months-6 years 7 months). The left shoulder was affected in 12 patients and the right shoulder was affected in 11 patients. At mean follow-up of 3 years 7 months, the mean glenoid retroversion for the dislocated shoulder progressively decreased. The difference in glenoid version between the dislocated and the normal side decreased. The angle of glenoid retroversion in the affected shoulders decreased by a mean of 31% after open reduction, and the retroversion continued to imorove at 9% per vear.
TL;DR: Lesions in group I and II patients had a considerable potential for spontaneous healing and Group III patients had the worst prognosis, while current chemotherapy protocols have a high morbidity and produce a variable response.
Abstract: The purpose of this paper was to analyze the orthopaedic aspects of Langerhans cell histiocytosis and to assess the outcome after treatment. Fifty-six patients with Langerhans cell histiocytosis involving the bone were retrospectively studied. Three groups were identified with regard to the type of bone involvement. Group I patients (n = 26) had a solitary bone lesion, with no systemic involvement. No treatment was given in 22 patients and curettage was done in 4 patients. At last follow-up, complete or partial healing was observed in 25 patients. Group II patients (n = 13) had multiple bone lesions, with no systemic involvement. Clinical and radiographic pictures as well as the outcome after treatment were similar to those in group I. Group III patients (n = 17) had bone and systemic involvement. Chemotherapy was used in all group III patients, with adjuvant radiotherapy in seven patients. Recurrence or new lesions were observed in 11 patients. Complications of treatment were observed in 14 patients. Lesions in group I and II patients had a considerable potential for spontaneous healing. Group III patients had the worst prognosis. Current chemotherapy protocols have a high morbidity and produce a variable response.
TL;DR: In this paper, the complication rates and results of 27 proximal (intertrochanteric) and 51 distal femoral rotational osteotomies in 48 patients with static encephalopathy were compared.
Abstract: This study compares the complication rates and results of 27 proximal (intertrochanteric) and 51 distal femoral rotational osteotomies in 48 patients with static encephalopathy. There was no significant difference between the 14% rate of orthopaedic complications in the intertrochanteric osteotomy (ITO) group and the 10% rate in the distal osteotomy (DO) group. Loss of fixation occurred in three of 51 limbs (6%) in the DO group and in none of 27 limbs in the ITO group. If the results of one surgeon are excluded, fixation loss occurred in one of the 49 remaining DO cases (2%). There was one delayed union in the study population (1/27 limbs [4%] in the ITO group). Of the 33 limbs studied with postoperative gait analysis, overcorrection was present in two limbs (6%): one of 10 limbs (10%) in the ITO group and one of 23 (4%) in the DO group. Static and dynamic measures of femoral rotation improved in both groups, and no statistically significant differences were present between the two groups. Though variable, the mean change in dynamic and static measurements postoperatively was approximately 40% less than the amount of derotation reported at surgery.
TL;DR: Skeletally immature patients may expect excellent functional outcomes following surgery for posterior SCJ dislocations or posteriorly displaced physeal fractures of the medial clavicle after undergoing ligament repair and suture stabilization.
Abstract: Posterior sternoclavicular joint (SCJ) dislocations and posteriorly displaced physeal fractures of the medial clavicle require prompt diagnosis and treatment to prevent persistent symptoms, recurrent instability, and potential complications. The purpose of this investigation was to review one institution's experience with these injuries. A retrospective review of 13 patients with posterior SCJ fracture-dislocations was performed. Average patient age was 14.6 years, and 85% of injuries were sustained during sporting activities. Patients with posterior dislocations underwent ligament repair and those with posteriorly displaced medial clavicular physeal fractures had open reduction and suture stabilization. At an average of 22.2 months follow-up, all patients had excellent functional outcomes. There were no respiratory or neurovascular complications. Skeletally immature patients may expect excellent functional outcomes following surgery for posterior SCJ dislocations or posteriorly displaced physeal fractures of the medial clavicle.
TL;DR: Osteochondritis dissecans of the talus is rare in children and the etiology is unknown, although trauma has been implicated, particularly in lateral lesions.
Abstract: Osteochondritis dissecans (OCD) of the talus is rare in children. The lesion is encountered on either the medial or lateral surface of the talar dome. The etiology is unknown, although trauma has been implicated, particularly in lateral lesions. Since 1983, 24 children have been treated for OCD of the talus at a major Canadian pediatric referral center. Two children had bilateral involvement, for a total of 26 lesions. There were 10 boys and 14 girls. The average age at initial presentation was 13 years 4 months (range 6 years 7 months to 17 years 1 month). The lesion involved the medial aspect of the talus in 19, the lateral in 5, and the central talar dome in 3. Magnetic resonance imaging was very useful in preoperative assessment in six cases. Surgical intervention was required in 15 (58%) ankles. The results at the most recent follow-up revealed resolution or decreased symptoms in 25 (96%) and no change in 1 (4%).
TL;DR: In this paper, a review of 32 patients who had medial open reduction of 40 hips were reviewed at an average of 10.3 years follow-up (range 2.5-18.6 y). Center-edge angles and acetabular indices were measured on preoperative, postoperative, and final radiographs.
Abstract: Thirty-two patients who had medial open reduction of 40 hips were reviewed at an average of 10.3 years follow-up (range 2.5-18.6 y). Center-edge angles and acetabular indices were measured on preoperative, postoperative, and final radiographs. The presence of AVN was noted. The final radiograph was assigned a Severin grade. One hip re-dislocated. Eight (20%) have required subsequent pelvic osteotomies. AVN developed in 11 hips (27.5%). Of the 11, five were classified as type I, defined as temporary irregular ossification of the femoral head. Bilateral dislocations and age older than 1 year at surgery correlated with greater likelihood of AVN ( < 0.05), whereas absence of the ossific nucleus did not. Thirty hips were classified as Severin 1 or 2, six were rated Severin 3, and three were Severin 4. Nineteen patients completed gait analysis. Normal motion was documented in 12 of 14 unilateral patients. Significant hip flexor and extensor isokinetic weakness was seen. In conclusion, medial open reduction yielded satisfactory results in 75% of hips. Although iliopsoas weakness is common, gait is usually normal.
TL;DR: Achieving and maintaining reduction in Neer grade III/IV proximal humeral epiphyseal fractures can be safely performed and results in excellent long-term shoulder function, of particular significance in the older adolescent who has minimal remodeling potential.
Abstract: The purpose of this study was to document the late outcome of a group of patients with Neer grade III/IV proximal humeral physeal fractures who were treated with reduction of the fracture and maintenance of reduction until fracture consolidation. A total of 28 patients treated between 1984 and 1999 at a large children's hospital were included in this study. Nineteen of the 28 patients were 15 years or older (range 5-16 y). All patients were treated in the operating room with closed reduction followed by immobilization (n = 3), closed reduction and pin fixation (n = 20), open reduction and screw fixation (n = 3), or open reduction and pin fixation (n = 2). Postoperatively, all had Neer grade I or II displacement, which was maintained until fracture union. No operative or postoperative complications occurred. At an average follow-up of 4 years, all patients had near-normal glenohumeral motion and excellent strength and uniformly reported regaining full preinjury functional use of the involved extremity. Achieving and maintaining reduction in Neer grade III/IV proximal humeral epiphyseal fractures can be safely performed and results in excellent long-term shoulder function. This is of particular significance in the older adolescent who has minimal remodeling potential.
TL;DR: This historical review highlights Pavlik's career from the time he worked with Frejka and then later in his own clinic in Olomouc, Czech Republic (1938-1950).
Abstract: Because of the high rate of avascular necrosis, Pavlik developed his harness and method of treating developmental dysplasia of the hip in infants. This historical review highlights Pavlik's career from the time he worked with Frejka and then later in his own clinic in Olomouc, Czech Republic (1938). In the 1950s, he wrote five articles on the results of his harness use in developmental dysplasia of the hip. Subsequently, Pavlik's harness has become the orthosis of choice worldwide for treatment of infants with hip dysplasia because of the principles he espoused.
TL;DR: From 1984 to 1999, the authors treated 64 cases of fracture of the scaphoid in children, most of which were nonunion cases; a major problem is that children are not brought to clinics immediately after injury, so the percentage of nonunion is high.
Abstract: From 1984 to 1999, the authors treated 64 cases of fracture of the scaphoid in children. Causes of injury were sports (n = 27), punching game machines or fighting (n = 22), and traffic accident or other trauma (n = 15). Most (46 cases) were nonunion cases. Eighteen cases were acute. Cast immobilization was performed in 10 acute cases and two nonunion cases. Screw fixation was performed in 52 cases, including 35 cases of bone graft. In 10 of these operated cases, freehand screw insertion was used. Ultimately, good bony fusion was achieved in all cases, but in two nonunion cases a secondary bone graft was necessary. Functional results in all cases were acceptable. A major problem is that children are not brought to clinics immediately after injury, so the percentage of nonunion is high.
TL;DR: Walking speed measured during walks of 10 minutes or more should become an integral part of gait laboratory evaluation, and self-selected walking speed during the 10-minute walk may be more representative of walking speed in the community setting.
Abstract: Self-selected walking speed is being increasingly used as a primary outcome measure in the management of neuromuscular disease. It would be useful if the speed recorded in the gait laboratory represented the child's walking speed in the community. This study investigated the difference in self-selected walking speeds between a 10-meter walk, as measured during instrumented gait analysis, and a 10-minute walk. The authors found that self-selected walking speed during the 10-minute walk was slower than the self-selected walking speed recorded during the 10-meter walk. The former may be more representative of walking speed in the community setting. Walking speed measured during walks of 10 minutes or more should become an integral part of gait laboratory evaluation.
TL;DR: The medical records and frog-leg lateral radiographs of 37 children with 46 stable slips treated with in situ single cannulated screw fixation at the Shriners Hospitals for Children, Lexington, from 1990 to 1998 were reviewed and screw advancement until five threads engage the epiphysis appears appropriate.
Abstract: The medical records and frog-leg lateral radiographs of 37 children with 46 stable slips treated with in situ single cannulated screw fixation at the Shriners Hospitals for Children, Lexington, from 1990 to 1998 were reviewed. The first postoperative frog-leg lateral radiograph was used to determine the head-shaft angle, the screw position, and the number of screw threads that engaged the epiphysis. The mean age at surgery was 12.3 years. The mean age when a frog-leg lateral radiograph first demonstrated physeal closure was 14.0 years. Nine slips (20%) demonstrated progression of more than 10 degrees from the first postoperative frog-leg lateral radiograph to the frog-leg lateral radiograph at first physeal closure. Slip progression appears inversely related to the number of screw threads engaging the epiphysis on the postoperative frog-leg lateral radiograph. The nine hips that progressed all had less than five screw threads engaging the epiphysis on the first postoperative frog-leg lateral radiograph. None of the 24 hips with five or more screw threads engaging the epiphysis on the first postoperative frog-leg lateral radiograph demonstrated progression. Slip progression was not related to screw position. Time to physeal closure was not related to screw position or the number of screw threads that engaged the epiphysis on the first postoperative frog-leg lateral radiograph. Screw advancement until five threads engage the epiphysis appears appropriate.
TL;DR: Specific measurements on CT scans of bilateral upper extremities were performed in a population of patients with obstetric brachial plexus palsy before and after reconstruction and showed that the restoration of external rotation and the scapula stabilization procedure correct the inclination of the humeral head, improve the joint congruency significantly, and decrease the winging of theScapula, thus improving the kinetics of the shoulder.
Abstract: Obstetric brachial plexus palsy invariably involves the upper roots. If left untreated, characteristic deformities of the shoulder are common sequelae. The most objective way to investigate these shoulder deformities is computed tomographic (CT) scanning of bilateral upper limbs. In this study, specific measurements on CT scans of bilateral upper extremities were performed in a population of patients with obstetric brachial plexus palsy before and after reconstruction (nerve repairs and secondary procedures). The measurements showed that the restoration of external rotation and the scapula stabilization procedure correct the inclination of the humeral head, improve the joint congruency significantly, and decrease the winging of the scapula, thus improving the kinetics of the shoulder. Periodic CT measurement is an objective method of measuring the changes at the shoulder joint that occur over time during the natural evolution of the obstetric brachial plexus palsy lesion and of documenting the benefits of microsurgical intervention.
TL;DR: Improvement in swing-phase knee flexion and foot clearance after rectus femoris transfer was associated with loss of knee extension at long-term follow-up, and hamstring lengthening in patients who develop excessive stance-phase knees flexion may be necessary.
Abstract: The purpose of this study was to evaluate the long-term results of rectus femoris transfer in cerebral palsy children with stiff-knee gait. Thirty-eight affected limbs in 24 children were evaluated preoperatively and 1 year postoperatively by gait analysis, with 26 limbs in 18 patients having final study, averaging 4.6 years postoperatively. Functional ambulatory status was evaluated based on Hoffer's criteria on ambulation. There were statistically significant improvements of 9.8 degrees in maximum swing-phase knee flexion and 7.0 degrees in total range of knee motion at 1 year, with a small loss of knee extension in stance. At final gait analysis, the improvement in the swing-phase knee flexion was maintained, but improvement in total range of knee motion was decreased. There were no significant changes in temporal parameters. Improvement in swing-phase knee flexion and foot clearance after rectus femoris transfer was associated with loss of knee extension at long-term follow-up. Hamstring lengthening in patients who develop excessive stance-phase knee flexion may be necessary.