Lars G. Danielsson

Elbow fractures in children. An epidemiological analysis of 589 cases

The radiographs of 589 elbow fractures in children under the age of 16 years were reviewed. The most common fractures were: supracondylar fracture of the humerus -55 per cent, fracture of the radial neck -14 per cent, and fracture of the lateral humeral condyle -12 per cent. One fifth of all fractures of the olecranon were associated with another elbow fracture; most often a fracture of the medial epicondyle. The average annual incidence of elbow fractures in the age group studied was 12 per 10.000 (10.0-14.7) without a significant change of the incidence between 1950 and 1979. Supracondylar and lateral condylar fracture of the humerus and fracture of the olecranon occurred more often in boys. Fractures of the lateral humeral condyle were more often caused by higher energy levels than the other fracture groups.

Epicondylar elbow fracture in children: 35-year follow-up of 56 unreduced cases

Fifty-six conservatively treated children (7-17 years) with a displaced (1-15 mm) fracture of the medial humeral epicondyle were examined 35 (21-48) years after the injury. In 31 cases a pseudarthrosis had developed of which 3 had mild ulnar nerve symptoms. The function and range of motion of the elbow was good in all cases.

Incidence of congenital clubfoot in Sweden. 128 cases in 138,000 infants 1946-1990 in Malmö.

The incidence of congenital clubfoot, neurological disorders excluded, was studied over a period of 45 years (1946-1990). The number of children, born alive with clubfoot, and detailed census data for the period were available. Altogether 137,614 living infants were born and of these 128 had congenital clubfoot. 56 (44 percent) were bilateral and 101 (79 percent) were boys. The overall incidence was 0.93 per thousand children. The annual incidence rose during the 45-year-period. This was, however, fully explained by the higher incidence among children of non-Nordic extraction.

Late-diagnosed DDH: a prospective 11-year follow-up of 71 consecutive patients (75 hips).

I have prospectively studied 71 consecutive patients (75 hips) with late-diagnosed DDH (developmental dysplasia of the hip) treated uniformly with special reference to the development of the femoral head and the acetabulum. The age at the start of treatment was 10 (2-64) months. The follow-up time was 11 (6-18) years. After tenotomy and traction, closed reduction failed in 7 hips. These cases were treated by open reduction with or without Salter innominate osteotomy - in 2 hips femoral osteotomy was also done (shortening, varus and derotation). 1 hip subluxated and 1 re-dislocated after closed reduction. Avascular necrosis occurred in 4 hips and additional surgery was required in 12 hips - 11 Salter osteotomies, 1 varus femoral osteotomy. In the first year after reduction, the acetabular angle improved rapidly - faster in the younger children. When treatment started between 12 and 22 months, the improvement was slower and the final outcome more unpredictable. The femoral head continued to grow irrespective of the age at reduction and became normal in almost all cases. Salters innominate osteotomy stabilized hips after open reduction and gave excellent results in cases with an increasing acetabular angle. At the last re-examination, all but 2 patients were asymptomatic. Radiographically, 65 hips were rated Severin group I, 9 group II and 1 group III.

Children's Ankle Fractures: Classification and Epidemiology

In an investigation of childhood and adolescence fractures (age groups 0-16) occurring in Malmö during 1950, 1955, 1960, 1965, 1970 and 1975-79, a total of 8682 were found. Four per cent or 373 ankle fractures were classified according to their roentgenological appearance. Avulsion fractures of the tip of the lateral malleolus were the most frequent, followed by fractures involving the distal fibular physis. Triplane and Tillaux fractures were the third and fourth most common fracture groups. Tillaux fractures were more common in girls (0.01 greater than P greater than 0.001). There was no statistically significant difference between the sexes in the other fracture groups or in the whole series. Most injuries were caused by low energy trauma. A foot caught in a bicycle wheel resulted more often in an epiphyseal fracture of the lateral malleolus than any other type of fracture. Otherwise no other etiological factor caused a significant number of cases in any fracture group. There was a seasonal variation with twice as many fractures during April and September as compared with July and December. The incidence showed a steady increase during growth which ceased after the early teens due to a lower incidence among girls in the age groups 15-16. The incidence increased significantly during the 30 years covered by this study.

Distal tibial osteochondroma deforming the fibula.

Three children had osteochondromata in the lateral part of the distal metaphysis of the tibia causing impingement with erosion and deformity of the fibula. The osteochondromata were removed through an anterior approach without osteotomy of the fibula. At reexamination 1.5-11 years postoperatively, the patients had normal ankle function. Remodeling of the fibula had gradually occurred in all the cases, most in the youngest patient. There was no injury to the distal tibial physis.

Winged scapula due to osteochondroma: Report of 3 children

Three children with winged scapula due to subscapular osteochondromata are reported. One case with multiple osteochondromatosis had two subscapular lesions. After resection, our cases became normal immediately and had no recurrence.

Incidence and Prognosis of Coxarthrosis

To define radiographic criteria, the radiographs of all patients diagnosed with coxarthrosis during the year 1951 were reviewed. Structural or joint space changes, evident radiographically in one of every seven cases in 1951, persisted at the time of the review in 1962. In the remaining cases, the diagnosis had been based upon the presence of osteophytic changes alone. Only one of 86 such cases reviewed in 1962 had structural or joint space changes. Osteophytes had no clinical significance and did not progress to coxarthrosis. Osteophytes appear to be a part of normal age changes. The radiographic diagnosis of coxarthrosis must be based on the demonstration of structural or joint changes

Late results in 65 physeal ankle fractures

Fifty-nine Salter-Harris III and IV lesions of the medial malleolus, Tillaux fractures, and triplane fractures were examined after 9 (3-32) years to assess the frequency of late symptoms, deformity, joint incongruity, and secondary arthrosis. Six out of 18 Salter-Harris III and IV lesions of the medial malleolus were reduced open, none of which had any signs of growth disturbance, whereas 1 case, left with a 3-mm residual dislocation, had 5 degrees of anterior angulation. Of the 17 Tillaux fractures, ten were not reduced and two of these gave slight symptoms, whereas five openly reduced fractures were asymptomatic at follow-up. Out of 18 triplane fractures, not reduced, two gave slight ankle pain and another had 6 degrees of anterior angulation, whereas three of ten reduced fractures were symptomatic. The overall results were good and no case of arthrosis, defined as reduction of the joint space, was found in any of the fracture groups despite a follow-up of 12 or more years in one third of the cases.

Clubfoot with supernumerary soleus muscle Report of 2 cases

In 2 cases of clubfoot with severe and rigid varus deformity, an accessory soleus muscle with attachment on the medial side of the calcaneus was found. After cutting the distal attachment of this muscle, the deformity diminished. The accessory soleus muscle is not interpreted as the primary cause of the clubfoot, but as a highly contributing cause to the rigid varus deformity.