Herndon Wa

Management of femoral shaft fractures in the adolescent.

Forty-four patients (45 fractures) with open physes (age range 11–16 years) underwent treatment for femoral shaft fractures. Seven malunions occurred in the 24 fractures in the nonoperative group; none occurred in the 21 fractures treated by intramedullary nailing. Hospital stay was significantly shorter in the operatively treated patients. There was no premature growth arrest in the surgical group.

Management of septic arthritis in children.

Summary: Forty-five children underwent initial nonoperative treatment of hematogenous septic arthritis in joints other than the hip. Only joints with symptoms for <6 days and without associated osteomyelitis were included. Thirty-four of the 49 joints were successfully managed by aspiration and antibiotics, whereas the remaining joints were successfully managed by surgical drainage following a lack of response to nonoperative treatment. All children had a satisfactory result after an average followup of >3 years. Early diagnosis and treatment are more important than the method of drainage. If a lack of response is seen to initial nonoperative treatment, surgical drainage will still lead to a satisfactory outcome.

Spinal cord injury without osseous spine fracture.

Sixteen patients with spinal cord injury without osseous spine fracture and 55 patients with spinal cord injury with osseous spine fracture aged from birth through 18 years were studied. Those without osseous fracture were younger (mean age 6 years) than were those with osseous fracture (mean age 16 years). Extravasation of myelographic dye from the spinal canal was a poor prognostic sign. All three in the group with this finding without osseous fracture had complete spinal cord lesions. Those without osseous fracture should be followed for the development of late spinal deformity that may require orthotic support or surgical stabilization.

Child abuse in a military population

A retrospective review of all Child Advocacy Committee records at Naval Regional Medical Center, Portsmouth, Virginia, was carried out in an attempt to characterize abuse in a military population. We found little difference between our 273 cases of documented abuse and previous reports from civilian institutions as far as patient age, death rate, types of injuries, and social factors involved. We attributed our low incidence of fractures (11%) to our active Child Advocacy Committee. Spiral fractures in children less than 3 years old were the most common orthopedic injury and we concluded that a high index of suspicion should be maintained in young children with spiral fractures.

Lawn Mower Injuries of the Pediatric Foot and Ankle: Observations on Prevention and Management

We reviewed 32 children with lower extremity injuries caused by power lawn mowers. Functional outcome of 21 patients was evaluated. Anatomical injury patterns provide some guidelines in management and prediction of functional outcome. Consistently, the most severe injuries result from ride-on mowers and wounds to the posterior/plantar foot and ankle. Our experience with pediatric foot and ankle lawn mower injuries permits recommendations for maximum functional outcome with minimal intervention. Public awareness and mower safety devices may be required to decrease the rate of accidents in the future.

Osteomyelitis of the calcaneus in children.

Eleven cases of calcaneal osteomyelitis in children are reported. Seven were hematogenous cases, and the remaining four were related to puncture wounds. The clinical presentation was less dramatic than that seen in typical long bone osteomyelitis. Laboratory findings were also less striking. A mixture of organisms was isolated from patients in the hematogenous group. In contrast, all puncture-related cases had cultures positive for Pseudomonas aeruginosa. Plain radiographic findings were noted at the time of presentation in 63%. Those findings were characteristically different in hematogenous and puncture-related cases. Oblique lateral radiographs can be important for diagnosis in puncture-related cases. Radionuclide bone scanning was an important diagnostic test in the absence of plain radiographic changes and in the very young patient. Surgery was performed in 82% of the cases. There were no recurrences or chronic infections. Two complications occurred in one patient, including residual scar sensitivity and early fusion of the calcaneal apophysis.

Effects of neurodevelopmental treatment on movement patterns of children with cerebral palsy.

Twelve children with mild, moderate, or severe cerebral palsy were examined and videotaped before and alter an intensive course of physical therapy in a neurodevelopmental treatment course. These tapes, demonstrating various predetermined movement patterns, were then randomized and viewed by six evaluators.None of the evaluators could tell the difference between before and after films. This demonstrated that significant changes were not seen in children with cerebral palsy after 6 weeks of therapy.

A comparison of Wisconsin instrumentation and Cotrel-Dubousset instrumentation

Twenty-six patients who underwent Wisconsin instrumentation and 36 patients who underwent Cotrel-Dubousset instrumentation (CDI) for idiopathic scoliosis were studied. Inclusion in the study required at least 24-month follow-up. Variables compared included operating time, blood loss, frontal plane correction, axial and sagittal plane changes, effects on compensation, and complications. In general, operating time, blood loss, and instrumentation problems were greater with CDI. Thoracic curve correction in King II curves was better with CDI. There was no advantage to either system with respect to sagittal plane alignment or rotation. When all factors were considered, a significant advantage to use of CDI could not be demonstrated.

Scoliosis and maple syrup urine disease

The intermediate variant of maple syrup urine disease produced frequent infections and significant mental retardation in a young female patient recently treated for scoliosis. There were no problems with infection, wound healing, or fusion with a regimen consisting of a low protein diet, perioperative antibiotics, good hydration, and early postoperative ambulation.

Iatrogenic false aneurysm in slipped capital femoral epiphysis.

A 15-year-old male underwent pinning of bilateral grade III slipped capital femoral epiphyses. The pins were left long, and on one side a false aneurysm subsequently formed. If pins are placed anteriorly, protrusion should be kept to a minimum.