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Measurements of radiographs of the foot in normal infants and children
INTERNATIONAL ABSTRACTS
unrecognized postoperative obstruction. The authors conclude that VUR in myelodysplasia neurogenic bladder may be of high grade with serious risk of renal damage. Together with diligent pre- and postoperative CIC, antireflux surgery using the transverse advancement technique with dissection or pull-through mobilization of the ureter gives satisfactory results.--Patricia M. Davidson Hematuria and Clinical Findings as Indications for Intravenous Pyelography in Pediatric Blunt Renal Trauma. T.A. Lieu, G.R.
Fleisher, S. Mahboubi, et al. Pediatrics 82:216-222, (August), 1988. A retrospective study of 78 patients who underwent intravenous pyelography (IVP) for suspected renal trauma is reported. Correlation between the radiographic findings and the mechanism of injury was neither sensitive nor specific for detecting renal injury. Extremity fractures were present in a significant number of patients with renal injury, while flank hematoma and pelvic fracture did not correlate closely with renal injury. All 13 patients with a renal injury had urine dipstick 3+ or 4 + for blood and >20 RBCs per high power field. Five of six patients with bladder rupture had a microscopic urinalysis in which RBCs were too numerous to count. Congenital abnormalities were noted in 17%; two patients with ureteropelvic junction obstruction had significant urinalysis findings. More severe injuries (renal fracture, renal pedicle injury) were less frequently identified since more severely injured patients underwent an immediate abdominal computed tomography (CT) scan or laparotomy. The authors suggest that IVP may be of limited value in patients with minimal hematuria. They conclude that IVP is indicated in patients whose urinalyses show RBCs too numerous to count, and suggest that IVP be performed in injured patients with >20 RBCs per high-power field if it is deemed important to identify patients with renal contusions. IVP or CT scan should be considered in patients with lesser hematuria but with clinical findings suggestive of significant trauma.--Jeffrey L. Zitsman MUSCULOSKELETAL SYSTEM Measurements of Radiographs of the Foot in Normal Infants and
Children. R. Vanderwilde, T. Staheil, D.E. Chew, et al. J Bone Joint
Surg 70A:407-415, (March), 1988. Radiographs of seventy-four normal infants and children (age range, from 6 to 127 months) were studied. Measurements of the talocalcaneal, talus-first metatarsal, and calcaneus-fifth metatarsal angles were recorded on anterior-posterior projection. On lateral projection, the talocalcaneal, tibial calcaneal, tibial talor, talus-first metatarsal, and talo-horizontal angles were documented. This article contains a series of graphs documenting the mean values, and serves as a reference article for the evaluation of all x-rays of children's feet. It is an effort to document whether or not a significant deformity is present.--Anthony H. Alter The Results of Tenolysis of the Tendo-Achilles to the Fibula for
Paralytic Pes Calcaneus. G.W. Westin, R.D. Dingeman, and S.H.
Gausewitz. J Bone Joint Surg 70A:320-328, (March), 1988. Sixty-six procedures were done in children who, with the exception of one, had polio-acquired pes calcaneus. Follow-up averaged 5.7 years (range, 2 to 10.8 years). The procedure consisted of cutting the achilles tendon and suturing it into a periosteal window in the fibular metaphysis. The procedure was successful in eliminating the calcaneus hitch in all patients, with a radiographic improvement of the deformity. Sixteen patients required revision of the tenodysis because of an acquired equinus deformity. This complication was primarily seen in patients who were operated on at a younger age.
507
Associated cavovarus deformities were treated by a concomitant plantar release.--Anthony 1-1.Alter Management of the Displaced Extension-Type Supracondylar Fractures of the Humerus in Children. A.M. Pirone, H.K. Graham,
and J.L Krajbich. J Bone Joint Surg 70A:641-649, (June), 1988. Two hundred thirty patients with displaced extension type supradylar fractures of the humerus were available for complete review. Median follow-up was 4.6 years (range, 1 to 9 years). The epidemiology of the fractures corresponded to that of the literature. Associated injuries were documented. Treatment choices included (1) closed reduction and application of a cast (130 cases initially and 101 cases definitively); (2) closed reduction and percutaneous Kirschner-Wire fixation (78 cases initially and 96 cases definitively); (3) skeletal traction, with ultimate casting (15 cases initially and 24 cases definitively); and (4) open reduction and internal fixation (seven cases initially and nine cases definitively). Results were graded according to motion, carrying angle, and function. Some patients were begun with one therapeutic approach and, due to lack of success, completed with a second approach. Treatment results were compared with the uninjured opposite elbow, looking for range of motion and carrying angle. Function was graded, as was the cosmetic appearance of the elbow. The poorest function and cosmetic results occurred in patients treated with a closed reduction and casting. Fifteen developed cubitus varus, and eight required a corrective osteotomy at the time of writing. The results with skeletal traction were comparable to those with percutaneous KirschnerWire fixation, but the traction required a longer hospital stay. There was also an increased recurvatum of the elbow associated with persistent posterior tilt of the distal fragments. The results of open reduction were excellent in patients who were operated on through an anterior surgical approach. The two patients with poor results, treated by a medial approach, had stiffness secondary to infection and residual cubitus yarns. Fractures treated with percutaneous Kirschner-Wire fixation had a 78% excellent result, which is comparable to other series. The authors found that placing the two wires parallel from the lateral approach provided adequate fixation, as opposed to a more traditional crossed Kirschner-Wire approach. There was one case of myositis ossificans in a patient who had had two attempts at closed reduction in another facility before a closed reduction was achieved at the final treating hospital. In summary, the authors feel that crossed medial and lateral percutaneous Kirschner-Wire fixation is the treatment of choice for the majority of displaced elbow fractures.--Anthony H. Alter Current Techniques of Limb Lengthening. D. Paley. J Pediatr
Orthop 8:73-92, (January/February), 1988. This is a review article on the status of limb lengthening in the world. The author discusses the traditional Wagner technique, the Ilizarov coricotomy technique, callus lengthening, and the epiphyseal distraction technique. The review includes consideration of the fixation devices as well as the soft tissue responses. This is a thorough review to serve as a reference for all physicians participating in the leg lengthening process.--Anthony H. Alter Non-Union of Fractures in Children Who Have Osteogenesis Imperfecta, J.G. Gamble, L.A. Rinsky, J. Strudwick, et al. J Bone
Joint Surg 70A:439-443, (March), 1988. Fractures in children with osteogenesis imperfecta generally have a reputation of union without event. Twelve non-union fractures are reported in ten of 52 patients with osteogenesis imperfecta. Most non-unions followed multiple fractures that occurred at the same site with progressive skeletal angulation.--Anthony 1-1.Alter
unrecognized postoperative obstruction. The authors conclude that VUR in myelodysplasia neurogenic bladder may be of high grade with serious risk of renal damage. Together with diligent pre- and postoperative CIC, antireflux surgery using the transverse advancement technique with dissection or pull-through mobilization of the ureter gives satisfactory results.--Patricia M. Davidson Hematuria and Clinical Findings as Indications for Intravenous Pyelography in Pediatric Blunt Renal Trauma. T.A. Lieu, G.R.
Fleisher, S. Mahboubi, et al. Pediatrics 82:216-222, (August), 1988. A retrospective study of 78 patients who underwent intravenous pyelography (IVP) for suspected renal trauma is reported. Correlation between the radiographic findings and the mechanism of injury was neither sensitive nor specific for detecting renal injury. Extremity fractures were present in a significant number of patients with renal injury, while flank hematoma and pelvic fracture did not correlate closely with renal injury. All 13 patients with a renal injury had urine dipstick 3+ or 4 + for blood and >20 RBCs per high power field. Five of six patients with bladder rupture had a microscopic urinalysis in which RBCs were too numerous to count. Congenital abnormalities were noted in 17%; two patients with ureteropelvic junction obstruction had significant urinalysis findings. More severe injuries (renal fracture, renal pedicle injury) were less frequently identified since more severely injured patients underwent an immediate abdominal computed tomography (CT) scan or laparotomy. The authors suggest that IVP may be of limited value in patients with minimal hematuria. They conclude that IVP is indicated in patients whose urinalyses show RBCs too numerous to count, and suggest that IVP be performed in injured patients with >20 RBCs per high-power field if it is deemed important to identify patients with renal contusions. IVP or CT scan should be considered in patients with lesser hematuria but with clinical findings suggestive of significant trauma.--Jeffrey L. Zitsman MUSCULOSKELETAL SYSTEM Measurements of Radiographs of the Foot in Normal Infants and
Children. R. Vanderwilde, T. Staheil, D.E. Chew, et al. J Bone Joint
Surg 70A:407-415, (March), 1988. Radiographs of seventy-four normal infants and children (age range, from 6 to 127 months) were studied. Measurements of the talocalcaneal, talus-first metatarsal, and calcaneus-fifth metatarsal angles were recorded on anterior-posterior projection. On lateral projection, the talocalcaneal, tibial calcaneal, tibial talor, talus-first metatarsal, and talo-horizontal angles were documented. This article contains a series of graphs documenting the mean values, and serves as a reference article for the evaluation of all x-rays of children's feet. It is an effort to document whether or not a significant deformity is present.--Anthony H. Alter The Results of Tenolysis of the Tendo-Achilles to the Fibula for
Paralytic Pes Calcaneus. G.W. Westin, R.D. Dingeman, and S.H.
Gausewitz. J Bone Joint Surg 70A:320-328, (March), 1988. Sixty-six procedures were done in children who, with the exception of one, had polio-acquired pes calcaneus. Follow-up averaged 5.7 years (range, 2 to 10.8 years). The procedure consisted of cutting the achilles tendon and suturing it into a periosteal window in the fibular metaphysis. The procedure was successful in eliminating the calcaneus hitch in all patients, with a radiographic improvement of the deformity. Sixteen patients required revision of the tenodysis because of an acquired equinus deformity. This complication was primarily seen in patients who were operated on at a younger age.
507
Associated cavovarus deformities were treated by a concomitant plantar release.--Anthony 1-1.Alter Management of the Displaced Extension-Type Supracondylar Fractures of the Humerus in Children. A.M. Pirone, H.K. Graham,
and J.L Krajbich. J Bone Joint Surg 70A:641-649, (June), 1988. Two hundred thirty patients with displaced extension type supradylar fractures of the humerus were available for complete review. Median follow-up was 4.6 years (range, 1 to 9 years). The epidemiology of the fractures corresponded to that of the literature. Associated injuries were documented. Treatment choices included (1) closed reduction and application of a cast (130 cases initially and 101 cases definitively); (2) closed reduction and percutaneous Kirschner-Wire fixation (78 cases initially and 96 cases definitively); (3) skeletal traction, with ultimate casting (15 cases initially and 24 cases definitively); and (4) open reduction and internal fixation (seven cases initially and nine cases definitively). Results were graded according to motion, carrying angle, and function. Some patients were begun with one therapeutic approach and, due to lack of success, completed with a second approach. Treatment results were compared with the uninjured opposite elbow, looking for range of motion and carrying angle. Function was graded, as was the cosmetic appearance of the elbow. The poorest function and cosmetic results occurred in patients treated with a closed reduction and casting. Fifteen developed cubitus varus, and eight required a corrective osteotomy at the time of writing. The results with skeletal traction were comparable to those with percutaneous KirschnerWire fixation, but the traction required a longer hospital stay. There was also an increased recurvatum of the elbow associated with persistent posterior tilt of the distal fragments. The results of open reduction were excellent in patients who were operated on through an anterior surgical approach. The two patients with poor results, treated by a medial approach, had stiffness secondary to infection and residual cubitus yarns. Fractures treated with percutaneous Kirschner-Wire fixation had a 78% excellent result, which is comparable to other series. The authors found that placing the two wires parallel from the lateral approach provided adequate fixation, as opposed to a more traditional crossed Kirschner-Wire approach. There was one case of myositis ossificans in a patient who had had two attempts at closed reduction in another facility before a closed reduction was achieved at the final treating hospital. In summary, the authors feel that crossed medial and lateral percutaneous Kirschner-Wire fixation is the treatment of choice for the majority of displaced elbow fractures.--Anthony H. Alter Current Techniques of Limb Lengthening. D. Paley. J Pediatr
Orthop 8:73-92, (January/February), 1988. This is a review article on the status of limb lengthening in the world. The author discusses the traditional Wagner technique, the Ilizarov coricotomy technique, callus lengthening, and the epiphyseal distraction technique. The review includes consideration of the fixation devices as well as the soft tissue responses. This is a thorough review to serve as a reference for all physicians participating in the leg lengthening process.--Anthony H. Alter Non-Union of Fractures in Children Who Have Osteogenesis Imperfecta, J.G. Gamble, L.A. Rinsky, J. Strudwick, et al. J Bone
Joint Surg 70A:439-443, (March), 1988. Fractures in children with osteogenesis imperfecta generally have a reputation of union without event. Twelve non-union fractures are reported in ten of 52 patients with osteogenesis imperfecta. Most non-unions followed multiple fractures that occurred at the same site with progressive skeletal angulation.--Anthony 1-1.Alter