Pediatric Radiology

Pediatric Radiology
   

• Miller TT, Shapiro MA, Schultz E, et al [ North Shore Univ Hosp, Manhasset, NY: North Shore Radiology, Great Neck, NY: Kernan Hosp, Baltimore, Md]
  Sonography of Patellar Abnormalities in Children
  AJR 171: 739-742, 1998
   
  Sonography, with its ability to show cartilaginous structures, is widely used to examine the unossified hip in suspected developmental dysplasia.
   
  Scans were taken in both the longitudinal and transverse planes as the scan operator flexed and extended the patient’s knee. Examination took less than 10 minutes to perform.
   
  US is recommended as the imaging procedure of choice to determine the extensor mechanism and unossifed patella in young children.
   
  The advantages of sonography over MRI include the following: no need of sedation, speed of examination and ability to compare with the contralateral knee, low cost, and the sonographer’s ability of dynamically assess the extensor mechanism.
   
  It should, by now, be well known that US scan elegantly demonstrate the unossified patella, its tendons, and the nearby surfaces of the femur. Because of the ease of dynamic sonographic imaging, exact clinical questions can be answered for such infants and toddlers.
     

• Bould M, Bannister GC (Southmead Hosp, Westbury-on-Trym, Bristol, England) 
  Refractures of the Radius and Ulna in Children
  Injury 30: 583-586, 1999
  
  Distal forearm bone fractures are common in children and refracture occurs at the rate of 5%.
  
  Conclusion- The risk of refracture decreases with the increasing cast immobilisation time up to 16 weeks.
     

• Cheng JCY, Ng BKW, Ying SY, et al (Prince of Wales Hosp, Hong Kong)
  A 10-Year Study of the Changes in the Pattern and Treatment of 6,493 Fractures
  J Pediatr Orthop 19: 344-350, 1999
  
  Accident and injury account for 35% of all pediatric emergency department visits and 20% of all pediatric hospital admission.
  
  Fractures are involved in 17-20% of all injuries.
  
  Highlights: The pattern and incidence of pediatric fractures has not changed. The use of closed reduction and percutaneous pinning increased during the study and rate of open reduction declined and so also duration of hospital stay decreased.
     

• Cheng JCY, Tang N (Prince of Wales Hosp, Hong Kong)
  Decompression and Stable Internal Fixation of Femoral Neck Fractures in Children Can Affect the Outcome
  J Pediatr Orthop 19: 338-343, 1999
  
  Fracture of the femoral neck in children is rare but carries a high complication rate, including the serious complication of AVN (17% – 47%). The incidence of AVN decreases with early decompression of the haematoma in the hip joint and also to do pinning within 24 hours.
  
  Though this series is small the subsequent results are impressive.
     

• Kocher MS, Zurakowski D, Kasser JR (Harvard Med School, Boston)
  Differentiating Between Septic Arthritis and Transient Synovitis of the Hip in Children: An Evidence-Based Clinical Prediction Algorithm
  J Bone Joint Surg Am 81-A: 1662-1670, 1999
  
  Differentiating between septic arthritis and transient synovitis of the hip in children can be difficult, because they have similar signs and symptoms. There was a difference in the investigation between the above two conditions.
  
  Four independent clinical predictors that differentiate between septic arthritis and transient synovitis.
  (1) History of fever. 
  (2) Non weight bearing status.
  (3) ESR above 40 mm/h.
  (4) Serum white cell count of more than 12000 cells/m3. 
  
  Recently it has been found that serum C reactive proteins are raised in septic arthritis than in transient synovitis and if all the above parameters are found positive it is better to aspirate the hip joint than the wait and watch policy before the infection damages the cartilage.
     

• Boardman DL, Moseley CF (Shriners Hosp for Children, Los Angeles)
  Finding Patients After 40 Years: A Very Long Term Follow-up Study of the Colonna Arthroplasty
  J Pediatr Orthop 19: 169-176, 1999
  
  In this study mainly the impact is on how follow up can be done even after many years and excellent template has been prepared so as to track down the patient. They were successful in about 90% of the patients. There was public access to private information and hence it may be that long term follow up of great number of pediatric orthopedic treatments is now more possible.