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Journal of Children's Orthopaedics

M Prod'homme, M Sans-Merce, N Pitteloud, J Damet, P Lascombes
Purpose: Exposure to ionizing radiation is a concern for children during intraoperative imaging. We aimed to assess the radiation exposure to the paediatric patient with 2D and 3D imaging. Methods: To evaluate the radiation exposure, patient absorbed doses to the organs were measured in an anthropomorphic phantom representing a five-year-old child, using thermoluminescent dosimeters. For comparative purposes, organ doses were measured using a C-arm for one minute of fluoroscopy and one acquisition with an O-arm...
October 1, 2018: Journal of Children's Orthopaedics
J A van der Sluijs, M J van der Sluijs, F van de Bunt, W J R van Ouwerkerk
Purpose: As in other neuromuscular disorders, both denervation and muscle paresis/imbalance are implicated as aetiological factors for contractures in children with a Brachial Plexus Birth Injury (BPBI). Although both factors are related, it is unclear which factor is dominant. The aim of this study is to assess whether contracture formation in children is predominantly related to denervation or to residual muscle function/imbalance. This might be relevant for understanding contracture formation in other neuromuscular disorders...
October 1, 2018: Journal of Children's Orthopaedics
G A Villamor, L M Andras, P Chan, H Jalloh, A E Sanders, J Yang, P D Choi, V T Tolo, D L Skaggs
Purpose: There have been no prospective studies investigating gastrointestinal (GI) symptoms of patients with adolescent idiopathic scoliosis (AIS) following posterior spinal fusion (PSF). The purpose of this study was to evaluate the incidence and severity of self-reported GI symptoms following PSF. Methods: In all, 40 AIS patients undergoing PSF were prospectively enrolled between March 2015 and October 2016. Patients completed a survey on each postoperative, inpatient day regarding nausea, emesis, constipation, abdominal pain and back pain, rating their pain on a scale of 1 to 10...
October 1, 2018: Journal of Children's Orthopaedics
A Johansson, Y Aurell, B Romanus
Purpose: Previous ultrasound studies of clubfeet have mainly focused on the first year of life. The purpose of this study was to improve the evaluation of the talo-navicular and calcaneo-cuboid joints by adding new variables, evaluating the repeatability of ultrasound measurements for normal feet and clubfeet and establishing values for normal feet up to four years of age. Methods: A control group of 105 children divided into ten age groups, and 71 clubfeet in 46 children were examined...
October 1, 2018: Journal of Children's Orthopaedics
C N Steiger, U Lenze, A H Krieg
Purpose: Intramedullary lengthening nails are an accepted alternative to external fixators but are limited by anatomical preconditions. Therefore, to date the use of external fixators is sometimes inevitable. We report on a new technique for correction of combined limb length discrepancies and complex axis deformities using solely internal devices - a lengthening nail and a locking plate. Methods: Between October 2008 and November 2011 five patients (two femora, three tibias) with a mean leg length discrepancy of 36 mm (25 to 50) and a complex angular deformity were treated with a fully implantable motorized lengthening nail (Fitbone) and a locking plate...
October 1, 2018: Journal of Children's Orthopaedics
M Troy, B Shore, P Miller, S Mahan, D Hedequist, B Heyworth, J Kasser, S Spencer, M Glotzbecker
Purpose: To compare two common surgical techniques of epiphysiodesis: drill/curettage epiphysiodesis (PDED) versus cross screw epiphysiodesis (PETS). The hypothesis is that the two techniques have similar efficacy but demonstrate differences in length of hospital stay (LOS), time to return to activity and complication rates. Methods: A retrospective review of growing children and adolescents less than 18 years old who required an epiphysiodesis with leg-length discrepancy (LLD) of 2 cm to 6 cm with minimum two years of follow-up was conducted...
October 1, 2018: Journal of Children's Orthopaedics
R M Thompson, E W Hubbard, M Elliott, A I Riccio, D J Sucato
Purpose: Postoperative protocols following surgical management of supracondylar humerus fractures (SCFs) are often based upon surgeon preference rather than clinical merit. The purpose of this study is to determine the utility of early clinical and radiographic follow-up. Methods: A retrospective review of patients who underwent closed reduction and percutaneous pinning (CRPP) for SCF between 2009 and 2015 was performed using a database of prospectively-collected consecutive patient data...
October 1, 2018: Journal of Children's Orthopaedics
C A Perkins, M T Busch, M A Christino, J Axelrod, D P Devito, J A Fabregas, J C Flanagan, J Murphy, D Olszewski, M L Schmitz, T Schrader, S C Willimon
Purpose: Open reduction and internal fixation with a tension band construct is the standard treatment for displaced transverse intra-articular olecranon fractures. The purpose of this study is to describe the outcomes of tension band fixation of olecranon fractures in children, specifically assessing the need for revision fixation and hardware removal. Methods: Patients less than 18 years of age diagnosed with a displaced transverse intra-articular olecranon fracture and treated with tension band fixation between 2008 and 2017 were retrospectively enrolled...
October 1, 2018: Journal of Children's Orthopaedics
G Nelson, C Brown, R W Liu
Purpose: Proximal humerus fractures in adults are approached with a high suspicion for potential associated glenohumeral dislocation. Axillary views of the shoulder can be painful and possibly even lead to dynamic angulation of the proximal humerus fracture. The incidence of associated glenohumeral dislocation in the paediatric population is unclear and it would be useful to determine whether children with proximal humerus fracture require specific axillary view imaging to rule out dislocation...
October 1, 2018: Journal of Children's Orthopaedics
L-K Chen, B T Sullivan, P D Sponseller
Purpose: To compare patient characteristics, operative time, estimated blood loss (EBL), postoperative length of hospital stay (LOS) and complications after insertion and removal of submuscular plates (SMPs) versus flexible nails (FNs) for paediatric diaphyseal femur fractures. Methods: We reviewed records of 58 children (mean age, 7.7 years SD 2.0) with diaphyseal femur fractures who underwent treatment with SMPs (n = 30) or FNs (n = 28) from 2005 to 2017 (mean follow-up, 22 months SD 28)...
October 1, 2018: Journal of Children's Orthopaedics
K B L Lim, T Laine, J Y Chooi, W K Lye, B J Y Lee, U G Narayanan
Purpose: Acute compartment syndrome (ACS) requires urgent fasciotomy to decompress the relevant muscle compartment/s prior to onset of irreversible myonecrosis and nerve injury. A fasciotomy is not a benign procedure. This study aims to describe and quantify early morbidity directly associated with fasciotomies for ACS in children. Methods: Clinical charts of 104 children who underwent 112 fasciotomies over a 13-year period at a tertiary children's hospital were reviewed...
October 1, 2018: Journal of Children's Orthopaedics
N M Jandl, T Schmidt, M Schulz, W Rüther, M H F Stuecker
Purpose: The containment orientated treatment of Legg-Calvé-Perthes disease (LCPD) affected hip joints is broadly accepted in the literature. The prerequisite is early recognition of loss of containment. An often-used quantitative MRI containment parameter is the cartilaginous acetabulum-head-index (CAHI). Based on ultrasound (US), we analyzed the newly created 'femoral head extrusion angle' (HA) as a containment parameter in comparison with the CAHI in severe LCPD. Methods: In a prospective study with 40 children (mean age 5...
October 1, 2018: Journal of Children's Orthopaedics
J Murar, L S Dias, V T Swaroop
Purpose: A San Diego pelvic osteotomy is frequently used as part of the surgical treatment of neuromuscular patients with hip displacement. This short-term follow-up study assesses the effectiveness of this osteotomy in patients with closed triradiate cartilage compared with open triradiates. Methods: Retrospective review of 43 patients (44 hips) with neuromuscular hip disease who underwent a San Diego pelvic osteotomy to correct hip displacement. In all 24 hips had open triradiate cartilage at the time of surgery and 20 hips were closed...
October 1, 2018: Journal of Children's Orthopaedics
J Balch Samora, B Adler, S Druhan, S A Brown, J Erickson, W P Samora, K E Klingele
Purpose: Early diagnosis and treatment of slipped capital femoral epiphysis (SCFE) is important to prevent slip progression and avoid complications. We sought to determine if MRI findings in patients with unilateral SCFE could indicate 'pre-slip' or predict future SCFE in the contralateral hip. Methods: A prospective study evaluated patients with unilateral SCFE over a two-year period. MRI of the asymptomatic hip was performed within the perioperative period. Patients were followed with radiographs until a contralateral slip occurred or until physeal closure...
October 1, 2018: Journal of Children's Orthopaedics
D A Maranho, A Davila-Parrilla, P E Miller, Y-J Kim, E N Novais, M B Millis
Purpose: To investigate changes in acetabular morphology during the follow-up of slipped capital femoral epiphysis (SCFE) and search for factors associated with acetabular dysplasia at skeletal maturity. Methods: We evaluated 108 patients with unilateral SCFE (mean age at slip, 12.3 years sd 1.7) to skeletal maturity, with a minimum follow-up of two years (median 4.5 years; interquartile range 3.2 to 6.2). Acetabular parameters obtained from initial and most recent radiographs included the lateral centre-edge angle (LCEA), Tönnis angle (TA) and acetabular depth-width ratio (ADR)...
October 1, 2018: Journal of Children's Orthopaedics
B Herngren, M Stenmarker, K Enskär, G Hägglund
Purpose: To evaluate outcomes three years after treatment for slipped capital femoral epiphysis (SCFE): development of avascular necrosis (AVN), subsequent surgery, hip function and the contralateral hip. Methods: This prospective cohort study included a total national population of 379 children treated for SCFE between 2007 and 2013. A total of 449 hips treated for SCFE and 151 hips treated with a prophylactic fixation were identified. The Barnhöft questionnaire, a valid patient-reported outcome measure (PROM), was used...
October 1, 2018: Journal of Children's Orthopaedics
I M Gutman, S R Gilbert
Purpose: Slipped capital femoral epiphysis (SCFE) is an adolescent hip condition with a high risk of complication. The purpose of this study was to evaluate trends in treatment using a prospectively collected paediatric nationally representative database. Methods: A total of 9034 patients undergoing treatment for idiopathic SCFE were selected by querying the Healthcare Cost and Utilization Project's Kids' Inpatient Database for the years 1997, 2000, 2003, 2006, 2009 and 2012...
October 1, 2018: Journal of Children's Orthopaedics
K K Wang, M E Munger, B P-J Chen, T F Novacheck
Background: Selective dorsal rhizotomy (SDR) is a surgical procedure for treating spasticity in ambulant children with cerebral palsy (CP). However, controversies remain regarding indications, techniques and outcomes. Current evidence summary: Because SDR is an irreversible procedure, careful patient selection, a multi-disciplinary approach in assessment and management and division of the appropriate proportion of dorsal rootlets are felt to be paramount for maximizing safety...
October 1, 2018: Journal of Children's Orthopaedics
A Grzywna, A McClung, J Sanders, P Sturm, L Karlin, M Glotzbecker, Children's Spine Study Group, Growing Spine Study Group
Purpose: To investigate paediatric orthopaedists' cast practices for early onset scoliosis regarding patient selection, cast application, radiographic evaluation, treatment cessation and adjunctive bracing. Methods: A casting survey was distributed to all paediatric orthopaedists in Children's Spine and Growing Spine Study Groups (n = 92). Questions included physician and patient characteristics, technique, treatment, outcomes, radiographic measurements and comparison to other treatments...
August 1, 2018: Journal of Children's Orthopaedics
P D Mitchell, A Viswanath, N Obi, A Littlewood, M Latimer
Purpose: To determine if the detection of musculoskeletal pathology in children with a limp or acute limb disuse can be optimized by screening with blood tests for raised inflammatory markers, followed by MRI. Methods: This was a prospective observational study. Entry criteria were children (0 to 16 years of age) presenting to our emergency department with a non-traumatic limp or pseudoparalysis of a limb, and no abnormality on plain radiographs. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) blood tests were performed...
August 1, 2018: Journal of Children's Orthopaedics
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