Injuries to the hand and wrist.

Because sports-related injuries to the hand and wrist are relatively frequent and lead to significant disability if misdiagnosed or improperly treated, it is important to identify the specific nature of such an injury to reach an accurate diagnosis and administer appropriate treatment. The author advocates an initial three-step process that may help the clinician to effectively diagnose and treat injuries: listen to the description of injury mechanisms; observe the site of injury; palpate the area for tenderness or instability.

Avascular necrosis of the femoral head after closed intramedullary shortening in an adolescent.

Closed intramedullary shortening has become a popular treatment method for limb-length inequality in adolescents. An important, potentially devastating complication of closed intramedullary fixation only recently described is avascular necrosis of the femoral head. We believe alternative treatment options must be considered to avoid this irreversible and catastrophic complication. A larger series may define the inherent risks of this complication and help determine the ideal treatment for femoral shortening and stabilization in the adolescent.

Healing of a large nonossifying fibroma after grafting with bone matrix and marrow. A case report.

Healing of a large tibial nonossifying fibroma in a 12-year-old girl occurred following excision, curettage, and filling of the bony defect with human demineralized bone matrix powder mixed with a small quantity of the patient's bone marrow. The use of this graft composite was successful in the treatment of the lesion and reduced the potential risk and morbidity associated with pediatric orthopedic surgical procedures with autogeneic iliac crest and other bone grafts.

Prostaglandin levels in unicameral bone cysts treated by intralesional steroid injection.

The etiology of the unicameral bone cyst remains undefined. Likewise, the treatment of the cyst has had proponents suggesting procedures ranging from decompression to diaphyseal resection. The use of intralesional steroids has gained popularity since its introduction in 1979 by Scaglietti. We present the results of aspirations of seven cysts, with serial measurements of prostaglandin levels in five cases, and suggest that the antiprostaglandin action of the steroid forms the rationale for treatment of the simple cyst.

Limb-length discrepancy measured with computerized axial tomographic equipment.

A simple, rapid, and accurate method for measuring limb-length discrepancies with computerized axial tomographic equipment is described. With this method less irradiation is delivered and some of the errors of computation are eliminated, compared with conventional methods. The costs of the technique are comparable with those of scanograms. The method is particularly applicable in the patient who has contracture of a joint.

Scapulothoracic dissociation. A case report.

A 26-year-old man sustained a scapulothoracic dissociation (STD) as a result of severe shoulder girdle trauma. In this recently described syndrome, multiple fractures of the upper extremity and closed disruption of the scapula from the thorax are combined with damage to the local neurovascular structures. The occurrence of blunt subclavian arterial injury and STD indicates the possibility of severe brachial plexus lesions.

Tomography in a juvenile Tillaux fracture.

Juvenile Tillaux fractures are Salter-Harris Type III physeal fractures involving the lateral weight-bearing surface of the distal tibia. A recent case demonstrates the usefulness of tomography as an adjunct to routine radiographs as a more accurate means of diagnosing the amount and direction of fracture displacement, a critical factor when treatment decisions are made.

Epiphyseal traction to correct acquired growth deformities. An animal and clinical investigation.

In a canine model with a transepiphyseal distal femoral fracture, varus deformity was corrected and the arrested limb was lengthened using transphyseal traction (turnbuckle). Correction was possible without removing the transphyseal bone bridge operatively. Subsequent growth was not adversely affected in most animals. Based on this study, two patients with significant growth deformities secondary to an enchondroma were treated by epiphyseal traction. Although correction was achieved initially, both lost the length previously gained because of premature removal of the external fixator and/or subsequent early growth plate closure.

The hip in arthrogryposis multiplex congenita.

The hip is involved in up to 80% of individuals with a diagnosis of arthrogryposis multiplex congenita. The hip deformity consists of contracture with or without dislocation. Isolated contracture can usually be treated conservatively by manipulation and splinting, only occasionally requiring operative intervention. Dislocation is as frequently bilateral as unilateral. Bilateral hip dislocations are best left unreduced; only accompanying contractures should be treated. The unilateral dislocation should be treated aggressively, because persistent dislocation will give rise to pelvic obliquity and scoliosis. Open reduction is always necessary.

Nonoperative treatment of retained radiolucent foreign bodies in lower limbs.

The management of radiolucent retained foreign bodies in feet is discussed. Two patients are presented in whom, despite negative initial exploration, cast treatment allowed the foreign bodies to extrude. Six further cases were discovered in a poll of other pediatric orthopedists. Cast treatment is an alternative to further surgery on the foot in search of the foreign body.