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Pediatric + fracture + remodeling

Robert S Runyon, Shevaun M Doyle
PURPOSE OF REVIEW: The purpose of this review is to provide an overview of common pediatric forearm fractures, clarify the descriptions used to identify and thereby appropriately treat them with a splint or cast, and explain osseous remodeling that is unique to the skeletally immature. RECENT FINDINGS: Recent literature addresses the gap in standard treatment protocols. There is variability in the management of pediatric forearm fractures because of the multiple subspecialty physicians that care for children's fractures and a lack of well established guidelines...
February 2017: Current Opinion in Pediatrics
Brandon Scott, Brandon Taylor, Joseph R Shung, Prasit Nimityongskul
Femoral neck and pelvic fractures are rarely encountered in the pediatric population secondary to the resilient nature of the immature skeleton. Both fracture types usually result from high-energy blunt trauma including motor vehicle collisions, motor vehicle-pedestrian accidents, and falls from height. Considerable studies have been published on the natural history, management, and complications of pediatric pelvis and femoral neck fractures. However, few case reports have documented both fracture types in the same patient...
August 4, 2016: Journal of Pediatric Orthopedics. Part B
Christiane G Kruppa, Justin D Khoriaty, Debra L Sietsema, Marcel Dudda, Thomas A Schildhauer, Clifford B Jones
INTRODUCTION: With an incidence of less than 0.2% of all pediatric fractures, pelvic ring injuries are rare. Historically they were conservatively treated, but because malunion and long-term morbidity are associated with unstable injuries, a trend towards operative treatment can be observed. The purpose was to determine clinical and radiographic outcomes following these complex pediatric pelvic ring injuries. PATIENTS AND METHODS: This Level IV retrospective analysis was completed at a private orthopaedic practice in association with a Level One teaching trauma center...
October 2016: Injury
Yanhua Xu, Siew-Ging Gong, Fangyong Zhu, Ming Li, Xu Biao
INTRODUCTION: Management of mandibular condylar fractures is difficult in children with their inherently dynamic and unstable deciduous and mixed dentitions. We present a variation of the conservative fixed orthodontic approach that was used as an adjunct to aid in the reduction of a bilateral condylar fracture in a pediatric patient. METHODS: A boy, aged 10 years 9 months, came with clinical signs and symptoms of mandibular fracture after being involved in a motor vehicle accident...
July 2016: American Journal of Orthodontics and Dentofacial Orthopedics
Audrey Angelliaume, Anne-Laure Simon, Louis Boissière, Aurore Bouty, Jérôme Sales de Gauzy, Jean-Marc Vital, Olivier Gille, Clément Tournier, Stéphane Aunoble, Jean-Roger Pontailler, Yan Lefèvre
To assess sagittal plane spinopelvic balance and functional outcomes in a pediatric cohort of patients with a thoracic and/or a lumbar fracture treated conservatively. A multicentric study retrospectively reviewed radiological and functional outcomes (mean follow-up 49 months) of 48 patients (mean age 12 years) with thoracic and/or lumbar spinal fractures that occurred between 1996 and 2014. Demographic data and radiological spinopelvic parameters were analyzed. Functional outcome was evaluated by a telephone interview...
January 2017: Journal of Pediatric Orthopedics. Part B
E F Garcés Iñigo, M Guasp Vizcaíno, J Gómez Fernández-Montes
A high percentage of the pediatric imaging studies requested during calls are related to musculoskeletal disease. Since bones and joints in children are immature, constantly growing and remodeling, they have physiological and anatomical peculiarities that make it necessary to use an approach specific for pediatric patients. In this article, we use three clinical scenarios (limping, fractures, and musculoskeletal infections) to summarize and transmit the concepts that are essential in emergency musculoskeletal imaging in children...
May 2016: Radiología
Shingo Hama, Ichiro Tonogai, Toshinori Sakai, Yuichiro Goda, Fumitake Tezuka, Tetsuya Matsuura, Naoto Suzue, Rui Takahashi, Tomoya Terai, Kosaku Higashino, Shoji Fukuta, Akihiro Nagamachi, Koichi Sairyo
The pathogenesis of slippage in pediatric spondylolisthesis is still unclear, although epiphyseal injury may account for many cases based on preclinical studies. However, no reports have described a pediatric case of isthmic spondylolisthesis showing radiologic evidence of epiphyseal injury. We report such evidence in a 13-year-old boy with low-back pain. Radiography revealed rounding of the S1 surface, a fracture line below the S1 endplate surface, and a bone marrow lesion in addition to slippage. Slippage and the rounding deformity were partially reversed (from 20 to 14% and from 42 to 27%, respectively) with conservative treatment and natural bone remodeling...
March 4, 2016: Journal of Pediatric Orthopedics. Part B
Yavuz Yildirim, Eugene E Keller
Treatment of condylar fractures is variable and controversial. Treatment options for management of condylar fractures include surgical and nonsurgical methods, and if a nonsurgical method is as effective as a surgical method, the former is preferred. Although plain film radiographs and functional outcomes attained through nonsurgical treatment are well established in literature, evidence of the remodeling process through detailed, high-quality imaging is lacking. The purpose of this case series is to describe and illustrate two adults and one pediatric patient with significantly displaced condylar fractures treated nonsurgically with excellent clinical results...
December 2015: Craniomaxillofacial Trauma & Reconstruction
Yang Wu, Xing Long, Mohong Deng, Hengxing Cai, Qinggong Meng, Bo Li
OBJECTIVE: To evaluate the effectiveness of the screw-based intermaxillary traction combined with occlusal splint in the treatment of pediatric mandibular condylar fracture. METHODS: Between June 2005 and December 2013, 35 pediatric patients with 49 mandibular condylar fractures were treated, and the clinical data were retrospectively reviewed. There were 25 boys and 10 girls, aged 3-13 years (mean, 7.3 years). The injury causes included falling (18 cases), traffic accident (14 cases), and violence (3 cases)...
April 2015: Chinese Journal of Reparative and Reconstructive Surgery
K Hamoud, J Abbas
A case report and literature review. To present a rare case of facture dislocation of the sacro-coccygeal joint in a 12-year-old boy who was treated conservatively. Fracture dislocations of the sacrum or the sacro-coccygeal joint are infrequent injuries and are rarely reported. The treatment for these disorders is usually conservative. Detailed description of the anterior dislocation (Salter-Harris type I) of the sacro-coccygeal joint in this child and its management are presented, with review of the relevant literature...
November 2015: Orthopaedics & Traumatology, Surgery & Research: OTSR
Georg Singer, Stephan Parzer, Christoph Castellani, Helmut Wegmann, Franz Lindbichler, Holger Till, Robert Eberl
PURPOSE: Different treatment methods including immediate mobilization with or without brace, bed rest or immobilization using thoracolumbosacral orthosis have been applied for stable compression fractures of the pediatric spine. The aim of this study was to evaluate the influence of bracing on the remodeling capacity of pediatric thoracolumbar type A 1.2 impaction fractures. Additionally, the prevalence of pain and functional disabilities were assessed. METHODS: All children treated conservatively between 2000 and 2011 with impaction fractures of the thoracolumbar spine (A 1...
February 2016: European Spine Journal
Mansur Halai, Bilal Jamal, Paul Rea, Mobeen Qureshi, Anand Pillai
BACKGROUND: Injuries around the foot and ankle are challenging. There is a paucity of literature, outside that of specialist orthopedic journals, that focuses on this subject in the pediatric population. DATA SOURCES: In this review, we outline pediatric foot and ankle fractures in an anatomically oriented manner from the current literature. Our aim is to aid the emergency department doctor to manage these challenging injuries more effectively in the acute setting...
February 2015: World Journal of Pediatrics: WJP
Frank Fitoussi, Brice Ilharreborde
BACKGROUND: Resection of primary malignant tumors often creates large bony defects. In children, this creates reconstructive challenges, and many options have been described for limb salvage in this setting. Studies have supported the use of an induced-membrane technique after placement of a cement spacer to aid in restoration of bone anatomy. QUESTIONS/PURPOSES: We asked: (1) What complications are associated with the induced-membrane technique? (2) How often is bone healing achieved after resection greater than 15 cm using this technique? (3) What is the functional outcome of patients treated with this technique? METHODS: We performed a retrospective evaluation of eight patients with a mean age of 13...
June 2015: Clinical Orthopaedics and related Research
Charles A Popkin, William N Levine, Christopher S Ahmad
In the pediatric population, sports participation, falls, and motor vehicle accidents can result in proximal humerus fractures. Because the proximal humeral growth plate is responsible for up to 80% of the growth of the humerus, the remodeling of these fractures in children is tremendous. Most of these injuries can be treated with a sling or hanging arm cast, although older children with decreased remodeling capacity may require surgery. Special considerations should be taken for management of proximal humerus fractures that occur in the context of Little League shoulder, lesser tuerosity avulsion fractures, fracture-dislocations, birth fractures, and fractures associated with cysts...
February 2015: Journal of the American Academy of Orthopaedic Surgeons
Melissa A Pasquale-Styles, Christian M Crowder, Jeannette Fridie, Sarah S Milla
Bilateral symmetric bone nodules were observed in the anterolateral first ribs of an infant with shaking injuries at autopsy. The location prompted diagnostic considerations of healing fractures versus anomalous articulations with pseudarthroses. The forensic pathologist worked with forensic anthropologists and pediatric radiologists to evaluate autopsy findings and compare premortem and postmortem X-rays. Gross examination of the bones by the pathologist and anthropologists confirmed bilateral, callus-like bone nodules in first-rib locations associated with pseudarthroses...
November 2014: Journal of Forensic Sciences
Jing Han, Zhi Li, Haihua Zhou, Rongtao Yang, Guizhong Xiong, Zubing Li
OBJECTIVE: To evaluate the long-term clinical and radiographic outcomes of open and close treatment of condylar fractures of mandible in children. METHODS: A total of 78 cases (105 mandibular condylar fractures) were included in this study. All patients (younger than 12 years at the time of injury were followed up for at least 3 years. According to the classification of the condylar fractures, open or close treatment was chosen. Clinical outcomes were classified as favorable or unfavorable depending on the mouth opening, pattern of mouth opening, occlusion, facial symmetry...
August 2014: Zhonghua Kou Qiang Yi Xue za Zhi, Zhonghua Kouqiang Yixue Zazhi, Chinese Journal of Stomatology
Ila Srinivasan, Naveen Kumar, Udhya Jaganathan, Arihant Bhandari
Osteosynthesis using minimum material in pediatric mandibular fractures is the key, due to the limited space available in the mandible, especially in the mental foramen and apical region. There is an important role of open reduction and rigid internal fixation in re-establishing facial height, width and projection. During the early years of growth and development, there is a high osteogenic potential of the bones. The thick periosteum allows for rapid consolidation and remodeling at the site of fracture. Primary teeth have short, bulbous crowns which compromise stable maxillomandibular fixation during fracture reduction and stabilization using traditional methods...
September 2013: International Journal of Clinical Pediatric Dentistry
Louis F Amorosa, Peter Kloen, David L Helfet
Pediatric pelvic and acetabular fractures are rare injuries. They are almost always the result of a high-energy injury mechanism. A full trauma protocol should be instituted, having a high index of suspicion for associated life-threatening injuries. In the past, it was recommended that almost all of these injuries be treated nonoperatively. However, pelvic and acetabular fractures do not all remodel well. Prospective studies are needed to establish optimal treatment guidelines. Until then, in the presence of instability or significant displacement, operative fixation by a pelvic and acetabular fracture specialist should be considered to allow the best possible outcome...
October 2014: Orthopedic Clinics of North America
Harry Nikolić, Nado Bukvić, Zlatko Tomasić, Ana Bosak, Tedi Cicvarić
The aim of this study was to evaluate bone remodeling in treated supracondylar humeral fractures in children. The study was carried out at the Department of Pediatric Surgery of University Hospital Rijeka on 58 patients with an average of 6.2 years, followed up during 1 to 7 years. The Baumann angle of the humerus was measured by five observers on the anteroposterior radiographs of the injured elbow right after the surgery, and on routine follow-up. The results obtained were compared with the results of the Baumann angle on the healthy arm, and statistically processed...
June 2014: Collegium Antropologicum
Matthew L Vopat, Patrick M Kane, Melissa A Christino, Jeremy Truntzer, Philip McClure, Julia Katarincic, Bryan G Vopat
Both bone forearm fractures are common orthopedic injuries. Optimal treatment is dictated not only by fracture characteristics but also patient age. In the pediatric population, acceptable alignment can tolerate greater fracture displacement due to the bone's ability to remodel with remaining growth. Generally, these fractures can be successfully managed with closed reduction and casting, however operative fixation may also be required. The optimal method of fixation has not been clearly established. Currently, the most common operative interventions are open reduction with plate fixation versus closed or open reduction with intramedullary fixation...
April 22, 2014: Orthopedic Reviews
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