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Physeal Injury

Nariyoshi Ishii, Noboru Matsumura, Takuji Iwamoto, Kazuki Sato, Masaya Nakamura, Morio Matsumoto
CASE: A 15-year-old boy with a posterior physeal fracture-dislocation of the medial aspect of the clavicle and a 14-year-old boy with a posterior sternoclavicular joint dislocation were successfully treated with temporary sternoclavicular stabilization using an innovative blocking technique with Kirschner wires. CONCLUSION: When treating posterior sternoclavicular joint injuries, posterior instability should be securely stabilized. Temporary blocking stabilization of the sternoclavicular joint using Kirschner wires does not rigidly fix the sternoclavicular joint, but it prevents posterior displacement of the proximal aspect of the clavicle...
July 2018: JBJS Case Connector
Alexandr Aylyarov, Mikhail Tretiakov, Sarah E Walker, Claude B Scott, Khalid Hesham, Aditya V Maheshwari
Pediatric intrasubstance anterior cruciate ligament (ACL) tears have a significant epidemiologic impact as their numbers continue to grow globally. This review focuses on true pediatric intrasubstance ACL tears, which occur >400,000 times annually. Modifiable and non-modifiable risk factors include intercondylar notch width, ACL size, gender, landing mechanisms, and hormonal variations. The proposed mechanisms of injury include anterior tibial shear and dynamic valgus collapse. ACL tears can be associated with soft tissue and chondral defects...
September 2018: Indian Journal of Orthopaedics
Thomas Palocaren
Paediatric femoral neck fractures are uncommon injuries and are usually caused by high-energy trauma. Low-energy trauma can result in pathologic neck fractures and stress fractures of the neck, due to repetitive activity. Surgical options can vary based on age, Delbet classification and displacement of the fracture. Treatment for displaced fractures is by closed or open reduction and smooth/cancellous screw fixation. Compression screw and side plate fixation is indicated for basal fractures. Fixation should be supplemented by spica cast immobilization in younger children...
September 2018: Indian Journal of Orthopaedics
Samir Sabharwal, Sanjeev Sabharwal
Background: The presence of growth plates at the ends of long bones makes fracture management in children unique in terms of the potential risk of developing angular deformities and growth arrest. Materials and Methods: We discuss three distinct cases depicting various aspects of physeal injury of the lower extremity in children. Results: The case illustrations chosen represent distinct body regions and different physeal injuries: Salter-Harris II fracture of the distal femur, Salter-Harris VI perichondrial injury of the medial aspect of the knee region, and Salter-Harris III fracture of the distal tibia...
September 2018: Indian Journal of Orthopaedics
C Yang, S Weisbrode, J Yardley, E Schroeder, C Premanandan
Ischaemia-induced physeal injury has not been described previously in the horse. A 1-month-old Quarter horse foal was submitted for necropsy examination due to an acute onset of ataxia followed by a 4-week history of progressive decline. Focal narrowing of the spinal canal due to ventral compression by the rotation of the cranial aspect of the third cervical vertebra (C3) was observed. The metaphysis and diaphysis of C3 were markedly shortened and white-tan in colour. Microscopically, there was complete loss of the dorsal compact bone of C3 and replacement of 80% of the physis that runs parallel to the vertebral canal with fibrous tissue and thickened viable trabecular bone...
August 2018: Journal of Comparative Pathology
Gina Lesko, Kyle Altman, Grant Hogue
We present a case of a 10-year-old girl who sustained a Lisfranc fracture-dislocation after an all-terrain vehicle accident. She underwent open reduction and internal fixation with smooth Kirschner wires. At 5-year follow-up, she had developed functional pain and radiographic evidence of degenerative arthritis and partial fusion of her midfoot. There are several possible explanations for this outcome, including loss of reduction, traumatic or iatrogenic physeal injury, and severity of initial injury. Long-term outcomes in children with Lisfranc injuries are not well described...
March 2018: Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews
Michelle T Sugi, Kali Tileston, Jeffery E Krygier, James Gamble
BACKGROUND: Pediatric ankle injuries are common, giving rise to ∼17% of all physeal injuries. An os subfibulare in a child with an ankle sprain may be confused with a type VII transepiphyseal fracture. Here, we evaluate the clinical and radiographic features of type VII transepiphyseal fractures to those of os subfibulare presenting with acute ankle trauma with the hypothesis that radiographs are necessary for final diagnosis and neither clinical history nor examination would be diagnostic...
November 2018: Journal of Pediatric Orthopedics
Innes Dm Smith, Ahmer Irfan, James S Huntley, Simon J Spencer
With the heightened popularity of childhood sporting activity, the number of paediatric anterior cruciate ligament (ACL) ruptures has increased. Management of these injuries presents a particular challenge due to the open femoral and tibial growth plates. Physeal damage has the potential to cause angular deformity or length discrepancy. This review was conducted to determine the best way to treat this injury. A primary search of Ovid MEDLINE (1 October 2017) used the terms: (ACL or anterior cruciate ligament) and (young or child or children or pediatric or immature or pre-pubescent)...
September 2018: Journal of Paediatrics and Child Health
Elliot M Greenberg, Christian Turner, Casey Huse, Theodore J Ganley, Philip McClure, J Todd Lawrence
OBJECTIVE: To present the case of a 15 year-old baseball player with Little League Shoulder (LLS) and describe how developmental changes in the angle of humeral retrotorsion (HRT) may contribute to the underlying pathology of this condition. DESIGN: Case report. SETTING: Two years earlier, the patient had participated in a healthy player screening program at which time measurements of height, weight, shoulder motion, and HRT were obtained...
August 14, 2018: Physical Therapy in Sport
Dong Kyu Moon, Jin Sung Park, Young Jin Park, Soon Taek Jeong
INTRODUCTION: Distal radius physeal fractures are common in pediatric patients. Although most of these fractures heal without complication, some result in significant physeal arrest. If significant physeal arrest occurs, the various treatment methods can be applied depending on the severity of deformity and remaining growth of the patient. PRESENTATION OF CASE: We present a 16-year old female with distal radial physeal arrest who presented four years after initial injury...
2018: International Journal of Surgery Case Reports
Sai-Won Kwon, Si-John Hong, Jae-Hwi Nho, Sang Il Moon, Ki Jin Jung
RATIONALE: In competitive athletes, the upper extremity is subject to tremendous torsional forces with axial loading due to repetitive weight bearing. Approximately 25% of injuries in sports are related to the hand or wrist. Skeletal deformity on the wrist physis is common in athletes due to repetitive loading and presents at early ages between 6 and 13 years. Additionally, it is more common in female than in male athletes. PATIENT CONCERNS: An 11-year-old girl who was a climber complained of pain on her left wrist without direct trauma...
August 2018: Medicine (Baltimore)
N K Sferopoulos
Superficial local cryotherapy is frequently and safely used for pain relief following musculoskeletal injury or disease. However, serious skin complications have been reported in adults following inappropriate application. Skin burns following superficial local cryotherapy have not been previously reported in children. The consequences of inappropriate use of various forms of cryotherapy in four children following sport injuries are presented. They were all primarily misdiagnosed with a soft tissue injury. The incorrect usage was due to the high severity of the local symptoms and signs...
July 2018: Journal of Bodywork and Movement Therapies
Casey Slattery, Boris Kovalenko, Kushagra Verma
Case: This rare case presents an isolated congenital shoulder dislocation in a twin delivery, without traumatic delivery. Delivered by emergent cesarean section at 33 weeks gestation, the infant presented with a lateral shoulder crease with x-rays showing anterior and inferior dislocation. Treatment included prompt reduction and stabilization, with follow-up ultrasound demonstrating a physeal injury. Conclusions: This case report presents the only published congenital shoulder dislocation in an infant after an atraumatic twin cesarean delivery...
October 2018: Radiology Case Reports
Mohamed Sarraj, Darren de Sa, Ajaykumar Shanmugaraj, Volker Musahl, Bryson P Lesniak
PURPOSE: To assess clinical outcomes of over-the-top (OTT) ACL reconstruction (ACLR) in skeletally mature patients, where physeal sparing is not a consideration. The hypothesis is that OTT will produce successful yet inferior outcomes compared to anatomic ACL approaches in both primary and revision settings. METHODS: Two reviewers searched two online databases (EMBASE and MEDLINE) from inception to October 2017 for literature on OTT ACLR in skeletally mature patients...
August 4, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
John Michael Wattenbarger, Amanda Marshall, Michael D Cox, Helen Gruber
BACKGROUND: Physeal fractures and resultant physeal bars can pose significant problems in skeletal development for the injured growing child. Although now well-recognized, only a small body of experimental literature covering this problem is available. The goal of this study was to help further develop an understanding of the different regions of the physis and the way in which each region responds to injury/fracture. METHODS: This Institutional Animal Care and Use Committee (IACUC)-approved study assessed bar formation using radiologic and histologic methods and measured leg lengths of skeletally immature rats...
November 2018: Journal of Pediatric Orthopedics
Andrew T Pennock, Henry G Chambers, Robby D Turk, Kristina M Parvanta, M Morgan Dennis, Eric W Edmonds
Background: Multiple surgical approaches have been described for the management of anterior cruciate ligament (ACL) tears in skeletally immature patients. Purpose: To provide a detailed description of a modified all-epiphyseal ACL reconstruction and report early outcomes and complications with this new technique. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of all skeletally immature patients undergoing ACL reconstruction via a modified all-epiphyseal technique prior to July 2015 was performed...
July 2018: Orthopaedic Journal of Sports Medicine
Z Deniz Olgun, Stephanie Maestre
PURPOSE OF REVIEW: Summarize classic and recent information regarding the unique subset of ankle fractures in children with open growth plates and share the authors' decision-making and surgical techniques. RECENT FINDINGS: Recent research on pediatric ankle fractures has centered on the accurate prediction and prevention of growth arrest following fractures of the distal tibia. Another source of discussion is the necessity and benefit of CT scanning in classification and treatment approach...
July 9, 2018: Current Reviews in Musculoskeletal Medicine
Jeffrey E Otte, James E Popp, Julie Balch Samora
PURPOSE: To evaluate the surgical outcomes in a series of Madelung wrists treated with a Vicker ligament release at a young age. We hypothesize that early treatment of Madelung deformity with Vicker ligament release is safe and may minimize progression of deformity. METHODS: A retrospective review was performed at a single large pediatric institution from 2013 to 2016 of patients with a diagnosis of Madelung deformity treated with Vicker ligament release and radial physiolysis...
June 19, 2018: Journal of Hand Surgery
Tristan Maerz, Michael Newton, Abigail A Marek, Michael Planalp, Kevin Baker
BACKGROUND/CONTEXT: Degenerative disc disease (DDD) is associated with longitudinal remodeling of paravertebral tissues. While chronic vertebral changes in advanced stages of DDD are well-studied, very little data exists on acute vertebral bone remodeling at the onset and progression of DDD. PURPOSE: To longitudinally characterize bony remodeling in a rodent model of disc injury-induced DDD. STUDY DESIGN/SETTING: In vivo animal study involving a rat annulus fibrosus injury model of DDD...
June 7, 2018: Spine Journal: Official Journal of the North American Spine Society
Zachary K Pharr, Joan D Roaten, Alice Moisan, Derek M Kelly, Jeffrey R Sawyer
A central distal femoral physeal bone bridge in a boy aged 5 years and 7 months was resected with a fluoroscopically guided core reamer placed through a lateral parapatellar approach. At 3-year follow-up, the boy's leg-length discrepancy was 3.0 cm (3.9 cm preoperatively), and the physeal bone bridge did not recur. The patient had full function and no pain or other patellofemoral complaints. This technique provided direct access to the physeal bone bridge, and complete resection was performed without injury to the adjacent physeal cartilage in the medial and lateral columns of the distal femur, which is expected to grow normally in the absence of the bridge...
May 2018: American Journal of Orthopedics
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