Paediatrics

Paediatrics
   

• Mehlman CT, Hubbard GW, et al (Univ of Cincinnati, Ohio)
  Traumatic Hip Dislocation in Children: Long-term Followup of 42 Patients
  Clin Orthop 376: 68-79, 2000
    
  The authors carried out a retrospective review of the outcomes of traumatic hip dislocation in 42 skeletally immature girls, aged 2 to 15 years, treated between 1974 and 1998.
    
  It was found that most children with traumatic hip dislocation treated with reduction within 6 hours will achieve good functional outcomes and few will have avascular necrosis.
   
  The duration of hip dislocation is the key ingredient to a good outcome.
    

• Dudkiewicz I, Salai M, et al (Chaim Sheba Med Ctr, Tel Aviv, Israel)
  Total Hip Arthroplasty After Childhood Septic Hip in Patients Younger Than 25 Years of Age
  J Pediatr Orthop 20: 585-587, 2000
     
  The use of Total Hip Arthroplasty (THA) because of a septic hip in childhood, in patients younger than 25 years was reported in a study of seven patients with early coxarthrosis.
    
  All seven patients underwent THA for coxarthrosis caused by childhood septic hips. The mean age at arthroplasty was 19 years and the mean follow-up was 8 years. The mean length of hospital stay was 11 days.
    
  The authors conclude that if performed correctly, THA in young patients with early coxarthrosis from septic hips appears to yield good functional results.
     

• Skaggs DL, Samuelson MA, et al (Children’s Hosp of Los Angeles)
  Complications of Posterior Iliac Crest Bone Grafting in Spine Surgery in Children
  Spine 25: 2400-2402, 2000
    
  The morbidity associated with the harvest of autogenous posterior iliac crest graft was examined in a review of records of 214 consecutive children who underwent spinal fusion, between 1990-1996.
   
  The perioperative complication rate was low. During follow-up, pain was a significant problem which could interfere with activities of daily living.
     

• May DA, Disler DG, et al (Virginia Commonwealth Univ, Richmond)
  Using Sonography to Diagnose an Unossified Medical Epicondyle Avulsion in a Child
  AJR Am J Roentgenal 174: 1115-1117, 2000
     
  Fractures of the unossified portion of the distal humerus in young children have been a diagnostic dilemma, because clinical findings may not be specific and radiographic findings may be nondiagnostic in children with avulsion of the humeral medial epicondyle.
    
  Sonography was found to be useful in the diagnosis of a displaced avulsion fracture of an unossified medial epicondyle not detected on radiographs, in a 5-year child.
      

• Feldman DE, Rossignol M, et al (Universite de Montreal; SMBD Jewish Gen Hosp, Montreal)
  Smoking: A Risk Factor for Development of Low Back Pain in Adolescents
  Spine 24: 2492-2496, 1999
   
  A dose-dependent relationship between smoking and low back pain (LBP) has been observed in adults, but few trials have addressed this correlation in adolescents.
   
  A prospective, repeated-measures cohort design was used on 502 students in grades 7 to 9 from 3 schools.
   
  A dose-dependent relationship was observed between the number of cigarettes smoked and the development of low back pain.
    

• Mine R, Fukui M, et al (Fukuoka Tokushukai Med Ctr, Japan)
  Bicycle Spoke Injuries in the Lower Extremity
  Plast Reconstr Surg 106: 1501-1506, 2000
   
  When riding as passengers on bicycles, children sustain spoke injuries, the foot getting caught between the spoke and bicycle frame.
   
  26 patients with bicycle spoke injuries, treated in a plastic surgery department, over 5 years, accounted for 3.6% of all injuries to the lower extremities. Patient mean age was 5.6 years. 62% were female. 62% of injuries were caused by the rear wheel when the child was seated behind the rider.
    
  Most injuries involved the tendo Achilles area. The commonest injury pattern was laceration with partial avulsion. Other injuries were partial to full-thickness skin damage with elements of contusion. 9 full thickness skin lacerations required primary suture closure. Skin grafting or secondary surgery were NOT required in any patient.
    
  The authors advise a protective net around the rear wheel which would prevent most of these injuries.
    

• Kirkos JM, Beslikas T, et al (Aristotle Univ of Thessaloniki, Greece)
  Surgical Treatment of Unstable Diaphyseal Both-Bone Forearm Fractures in Children With Single Fixation of the Radius
  Injury 31: 591-596, 2000
   
  Though majority of both-bone fractures in children are treated with closed reduction and casting, for some patients with unstable fractures, it is difficult to maintain closed reduction.
   
  From 1987 to 1996 in a study group of 50 patients (45 boys, 5 girls) aged 5 to 14 years, open reduction and internal fixation (ORIF) of the radius alone was performed (with a plate and screws).
   
  The plate was removed after 6 to 25 months and forearm protective splinting done for next 3 weeks.
   
  Excellent results (after clinical and radiographic follow-up for 1 to 10 years) were achieved.
      

• Taggard DA, Menezes AH, et al (Univ of Iowa, Iowa City)
  Treatment of Down Syndrome-Associated Craniovertebral Junction Abnormalities
  J Neurosurg 93: 205-213, 2000
    
  Down syndrome can result in various abnormalities, including a propensity for occipitoatlantal dislocations.
   
  Surgical treatment of motion abnormalities at the craniovertebral junction (CVJ) is reported to be associated with a high incidence of morbidity.
   
  Medical and radiographic data of 36 patients aged 3 to 49 years, treated for CVJ instability between 1976 and 1999 were reviewed for clinical outcome. It was found that outcomes were excellent in 13 (36%), good in 11(30%) and stable in 12(33%). There were no poor outcomes.
   
  The authors conclude that surgical correction of instability of the CVJ in patients with Down syndrome can be performed with a high success rate.