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Yoshinori Takemura, Narihito Kodama, Hiroaki Ueba, Kosei Ando, Kensaku Kuga, Shinji Imai
Partial growth plate arrest caused by trauma may lead to severe deformity and dysfunction. The Langenskiöld method is a surgical technique that involves resection of the physeal bar causing partial growth plate arrest. However, it is a technically demanding procedure. We used the Langenskiöld method under guidance with a navigation system and endoscopy and obtained good results in 2 cases. We consider that use of these tools can be a helpful adjunct to the carrying out this procedure.
March 17, 2018: Journal of Hand Surgery
Matthew Morin, Joshua Klatt, Peter M Stevens
Proximal tibial metaphyseal fractures in children can lead to progressive and symptomatic tibial valgus. Corrective osteotomy has been abandoned, due to frequent complications, including recurrent valgus deformity. While spontaneous remodelling has been reported, this is not predictable. For children with persistent deformities, we have resorted to guided growth of the tibia. We present 19 patients who were successfully treated with guided growth, tethering the proximal medial physis. There were ten boys and nine girls, ranging in age from two to 13...
March 16, 2018: Strategies in Trauma and Limb Reconstruction
Hakan Ömeroğlu
This review aims to summarize the basic treatment principles of fractures according to their types and general management principles of special conditions including physeal fractures, multiple fractures, open fractures, and pathologic fractures in children. Definition of the fracture is needed for better understanding the injury mechanism, planning a proper treatment strategy, and estimating the prognosis. As the healing process is less complicated, remodeling capacity is higher and non-union is rare, the fractures in children are commonly treated by non-surgical methods...
April 2018: Eklem Hastalıkları Ve Cerrahisi, Joint Diseases & related Surgery
Joel B Huleatt, Carl W Nissen, Matthew D Milewski
The treatment of sports injuries in the skeletally immature has a unique set of complications. Growth deformity may occur after anterior cruciate ligament reconstruction; therefore, skeletal age is used to help guide the choice between physeal sparing and transphyseal techniques. Arthrofibrosis after tibial spine fracture fixation can be reduced by initiating immediate range of motion, and should be treated early and cautiously to avoid iatrogenic fracture. Nonunions of medial epicondyle elbow fractures are more common with nonoperative treatment, but seldom lead to clinical problems outside of certain athletes...
April 2018: Clinics in Sports Medicine
Matthew A Halanski, Blake Hildahl, Laura A Amundson, Ellen Leiferman, Annette Gendron-Fitzpatrick, Rajeev Chaudhary, Heather M Hartwig-Stokes, Ronald McCabe, Rachel Lenhart, Matthew Chin, Jennifer Birstler, Thomas D Crenshaw
BACKGROUND: The purpose of this study was to explore the role of perinatal vitamin-D intake on the development and characterization of hyperkyphosis in a porcine model. METHODS: The spines of 16 pigs were assessed at 9, 13, and 17 weeks of age with radiography and at 17 weeks with computed tomography (CT), magnetic resonance imaging (MRI), histology, and bone-density testing. An additional 169 pigs exposed to 1 of 3 maternal dietary vitamin-D levels from conception through the entire lactation period were fed 1 of 4 nursery diets supplying different levels of vitamin D, calcium, and phosphorus...
March 7, 2018: Journal of Bone and Joint Surgery. American Volume
Andrew Chia Chen Chou, Ho Yin Kevin Wong, Sumanth Kumar, Arjandas Mahadev
BACKGROUND: Distal humerus physeal separations are rare pediatric elbow fractures that are often misdiagnosed and difficult to treat. Adequate reduction is often technically challenging and up to 71% of children develop postoperative cubitus varus. We propose using the medial and lateral humeral lines as an adjunct to elbow arthrography in order to guide intraoperative fixation of distal humerus physeal separations to reduce the incidence of postoperative cubitus varus. METHODS: From 2009 to 2014, all pediatric patients under the age of 3 diagnosed with a distal humerus physeal separation and treated surgically at our institution were included for analysis...
March 5, 2018: Journal of Pediatric Orthopedics
Robert G Willson, Regina O Kostyun, Matthew D Milewski, Carl W Nissen
Background: Reconstruction of the anterior cruciate ligament (ACL) in the skeletally immature patient is frequently performed in hopes of preventing new or additional chondral damage and meniscal injuries. Patients within a few years of skeletal maturity are more at risk for ACL injuries than prepubescent patients, about whom several physeal-sparing techniques have been described. Reconstruction techniques in the former higher risk group need to be better understood. Purpose: To review a series of adolescent patients with ACL injuries surgically treated with the hybrid physeal-sparing technique...
February 2018: Orthopaedic Journal of Sports Medicine
Ernest Y Young, Anthony A Stans
Physeal fractures of the distal femoral are rare injuries accounting for less than 2% of all physeal injuries, and tend to have a worse prognosis than similar injuries in other locations. This article reviews the evaluation (including imaging), classification, and treatment of these injuries, and discusses their most important complications and their management, including vascular injury and growth arrest.
February 28, 2018: Journal of Knee Surgery
B Danino, R Rödl, J E Herzenberg, L Shabtai, F Grill, U Narayanan, E Segev, S Wientroub
Background: Guided growth by tension band plating is commonly used to correct coronal plane deformity. The purpose of this study was to measure the effect and further define parameters that influence results in coronal plane deformity around the knee. Methods: The retrospective multicentre study included data on 967 physes in 537 patients, with an average follow-up of 16 months after plate insertion. Alignment analysis was compared preoperatively and in at least two measurements postoperatively, as well as with parameters that influence the rate and amount of correction...
February 1, 2018: Journal of Children's Orthopaedics
Arie Franco, Apeksha Chaturvedi
Physeal injuries occurring secondary to neonatal birth-related trauma are rare entities. Most reported cases of physeal injury involve the distal humerus with only a few published case reports of proximal femoral involvement. So far, we have found only one reported case of neonatal distal femoral epiphysiolysis following Caesarean section. We hereby report a unique case of distal femoral physeal injury with at least partial epiphyseal separation following an uneventful, spontaneous vaginal delivery. Given the uneventful delivery and no known prenatal risk factors, the imaging findings were initially not recognized as being secondary to birth-related injury...
February 7, 2018: Clinical Imaging
J Örtegren, P Peterson, J Svensson, C J Tiderius
OBJECTIVE: Slipped capital femoral epiphysis (SCFE) in adolescence is associated with increased risk of future osteoarthritis (OA). The purpose of this study was to study clinical and radiographic risk factors for early cartilage degeneration after SCFE. DESIGN: 22 patients (44 hips) (mean age 24 years, range 18-27) treated with in situ fixation (The Hansson hook-pin) for stable SCFE on average 11 years previously were investigated. Cartilage status was assessed with delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC)...
February 7, 2018: Osteoarthritis and Cartilage
Chang Ho Shin, Doo Jae Lee, In Ho Choi, Tae-Joon Cho, Won Joon Yoo
BACKGROUND: The purpose of this study was to determine the efficacy and complications of arthroscopically assisted reduction and fixation with cannulated screws for tibial eminence fracture in skeletally immature patients. METHODS: This was a retrospective case series study. Forty-eight patients who were skeletally immature at the time of tibial eminence fracture were treated in a tertiary children's hospital between May 2004 and August 2015. Twenty-one patients were excluded due to non-operative treatment (n = 10), other surgical treatments (n = 9), multiple fracture (n = 1), and follow-up < 1 year (n = 1)...
February 6, 2018: BMC Musculoskeletal Disorders
Kiminori Yukata, Sho Nakai, Masaki Ikeda, Jun-Ichi Hamawaki
We describe a case of isolated physeal fracture of ulna distal end in a 13-year-old boy. This fracture type is uncommon, especially Salter-Harris type III of this injury has not been reported. Plain radiographs showed a small vertical fracture line at the ulnar distal end and an enlargement of epiphyseal plate at the base of ulnar styloid process. The present case was successfully managed with conservative treatment because of its minimal displacement.
March 2018: Journal of Hand Surgery Asian-Pacific Volume
James M Brian, David H Choi, Michael M Moore
The primary physis is responsible for long bone growth in children and adolescents. Injury and physiologic or metabolic stress to the primary physis present unique radiologic findings that are important for radiologists to recognize and diagnose. Appreciation of the anatomy and histology of the primary physis forms the basis for understanding the imaging findings associated with pathologic conditions affecting the primary physis. Salter-Harris injuries, physeal bars, growth arrest lines, rickets, and focal periphyseal edema zones are common conditions with recognizable radiologic presentations...
February 2018: Seminars in Musculoskeletal Radiology
Takuya Otani, Yasuhiko Kawaguchi, Keishi Marumo
Slipped capital femoral epiphysis (SCFE) is not frequently encountered during routine practice and diagnosis and treatment are often delayed. It is important to understand symptoms and imaging features to avoid delayed diagnosis. After the diagnosis is made correct classification of the disease is required. The classification should be based on the physeal stability in order to choose safe and effective treatment. However, surgeons should bear in mind that the assessment is challenging and actual physeal stability is not always consistent with the stability predicted by a clinical classification method...
January 17, 2018: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Kranti V Peddada, Brian T Sullivan, Adam Margalit, Paul D Sponseller
BACKGROUND: It is important to estimate the likelihood that a pediatric fracture is caused by osteogenesis imperfecta (OI), especially the least severe type of OI (type 1). METHODS: We reviewed records of 29,101 pediatric patients with fractures from 2003 through 2015. We included patients with closed fractures not resulting from motor vehicle accidents, gunshot wounds, nonaccidental trauma, or bone lesions. Patients with OI of any type were identified through International Classification of Diseases-9 code...
January 19, 2018: Journal of Pediatric Orthopedics
R S Khakha, S K Yasen, A J Wilson
BACKGROUND: Paediatric PCL injuries are rare but constitute a significant management challenge. We describe a novel approach to the surgical management of an 11-year-old boy who presented with persisting symptomatic instability following 18months of failed conservative therapy. METHODS: PCL reconstruction was performed using a physeal sparing, all-inside technique under fluoroscopic control. This avoids the potential for iatrogenic growth injury. A parentally donated hamstrings allograft was used to ensure adequate graft size, and reinforced using a non-elastic two millimetre braided suture...
January 14, 2018: Knee
Julio de Pablos, Lucas Arbeloa-Gutierrez, Antonio Arenas-Miquelez
PURPOSE OF REVIEW: Treatments available to correct adolescent Blount disease deformities differ in terms of features, advantages, and disadvantages. Each is indicated, therefore, for different scenarios of severity, physeal condition, and maturity. The purpose of this review is to update basic concepts, surgical treatments, and controversies concerning this disorder. RECENT FINDINGS: The cause of Blount disease is unknown although etiologic factors as morbid obesity and hypovitaminosis D are thought to be associated with it...
February 2018: Current Opinion in Pediatrics
Mark C Zipser, Jonathan C Sum, Alison G Wilcox
A 15-year-old baseball pitcher presented to physical therapy with a 1-week history of acute right shoulder pain experienced during the acceleration phase of throwing. The week after physical therapy evaluation, the patient returned with radiographs and magnetic resonance imaging results that revealed lateral physeal widening with adjacent edema. Additionally, a nondisplaced labral tear was noted. In this case, imaging was necessary for an accurate diagnosis of lateral physeal widening, commonly referred to as "Little League shoulder...
January 2018: Journal of Orthopaedic and Sports Physical Therapy
Yasushi Oshima, Norishige Iizawa, Shinro Takai
BACKGROUND: Treatment of multiligament knee injuries, especially in adolescent patients, is challenging for orthopedic surgeons. Repair of collateral ligaments and reconstruction of cruciate ligaments are usually performed, however, ligament reconstruction with transphyseal or physeal-sparing techniques may lead to physeal damage and growth disturbances in skeletally immature patients. We present a case report on performing bicruciate ligament sutures arthroscopically in an adolescent patient...
2017: Journal of Nippon Medical School, Nippon Ika Daigaku Zasshi
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