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Purpose: The aim of the study is to evaluate the use of ultrasound imaging in diagnostics of Monteggia lesion in children where conventional radiographs and the use of the radiocapitellar line fail to provide an accurate diagnosis. Methods: Prospective diagnostic study of 70 patients treated between May 2018 and July 2021 in a pediatric level 1 trauma center. In 20 patients with the confirmed radiographic diagnosis of Monteggia lesion, an ultrasound of the humeroradial joint was performed to determine signs of both normal and dislocated elbow joint. In 36 patients with suspected humeroradial dislocation on plain radiographs, ultrasound imaging was performed to determine the definitive diagnosis. Overall, 14 patients with elbow joint injury other than humeroradial dislocation were excluded from the study. Results: The "double-hump sign" and the "congruency sign" were determined as normal findings on ultrasound of the humeroradial joint. These signs were applied to patients with unclear findings on radiographs. In three patients, the dislocation of the humeroradial joint was confirmed by ultrasound. In two patients, "defect in congruency sign" was seen during reduction despite normal radiographs, which required re-reduction. In 31 patients, dislocation of the humeroradial joint was refuted. In 34 out of the 36 patients, the diagnosis determined by ultrasound was confirmed in follow-up. Two patients did not attend the follow-up examination. Conclusion: Ultrasound imaging is an accessible, non-invasive, and dynamic point-of-care method that can be applied in children suffering from suspected humeroradial dislocation and/or subluxation. Level of evidence: Level III-diagnostic study.
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¼: Fractures of the growing scapula account for about 0.1% of all pediatric fractures, with the majority occurring at an age of ≥10 years. ¼: Radiographic diagnosis requires a detailed knowledge of the ossification sequence of the growing scapula. Computed tomography examination is indicated for displaced fractures of the glenoid fossa, the scapular neck, and complex fractures; magnetic resonance imaging should be performed in cases of suspected injury to the physis and with stress fractures, depending on patient age and the potential need for general anesthesia during the scanning process. ¼: Separation of the base of the coracoid process is often associated with acromioclavicular dislocation. Clavicular fractures rarely occur in combination with injuries to the growing scapula. ¼: The majority of scapular fractures can be treated nonoperatively. Indications for surgery are displaced intra-articular fractures, scapular neck fractures with a displacement of >2 cm, coracoid base separation associated with acromioclavicular dislocation, and scapulothoracic dissociation. ¼: Displaced intra-articular fractures of the glenoid fossa should be followed after healing until skeletal maturity. Complications are rare and occur most frequently with scapulothoracic dissociation.
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Cavidade Glenoide , Fraturas do Ombro , Adolescente , Criança , Clavícula/diagnóstico por imagem , Clavícula/lesões , Fixação Interna de Fraturas , Humanos , Escápula/cirurgiaRESUMO
AIM OF THE STUDY: Epidemiologic evaluation of pelvic ring injuries in children. METHODS: Retrospective analysis over a period of 13 years, excluding pathological fractures. AO/OTA type, epidemiological data, type of treatment, and complications were recorded. Data were assessed using Fisher's exact test and Wilcoxon test. RESULTS: 243 boys, 115 girls, mean age (SD) 14.1 ± 3.0 years, AO/OTA types: 281 A, 52 B, 25 C. Multiple trauma: 62, combined trauma: 59, mono-trauma: 237. 281 patients were treated non-operatively, 97 surgically. ETIOLOGY: traffic accidents 88, falls from a great height 37, crushing injuries four, and sports injuries 192, simple falls 30, others seven. High-energy mechanisms prevailed in types B and C. Low-energy mechanism in type A (p < 0.0001). Similar differences were found between type A (p = 0.0009) and in case type C requiring surgery and cases treated non-operatively (p < 0.0001). Twenty-six patients (7.3%) had complications (pelvic asymmetry 5, neurological deficits 5, non-union 1, ectopic calcification 4, others 7). Higher complication rates were associated with types B and C (p = 0.0015), with surgically treated cases (p < 0.0001) and multiple trauma (p = 0.0305). DISCUSSION: Results of this trial were comparable with other studies. CONCLUSION: Sports injuries accounted for most type A injuries, while types B and C tended to be associated with high-energy trauma. Complications were associated with the severity of pelvic trauma, more common in surgically treated group of patients; this is primarily linked to the surgical cases being more serious as well as the associated injuries.
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Fraturas Ósseas , Traumatismo Múltiplo , Ossos Pélvicos , Adolescente , Criança , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/cirurgia , Humanos , Masculino , Ossos Pélvicos/lesões , Ossos Pélvicos/cirurgia , Estudos Retrospectivos , Centros de TraumatologiaRESUMO
The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report's conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non-US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.
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Analgesia/métodos , Circuncisão Masculina , Infecções Sexualmente Transmissíveis/prevenção & controle , Humanos , MasculinoRESUMO
PURPOSE: Our aim was to assess operative treatment for post-traumatic avascular necrosis of the femoral head (ANFH) in adolescents. METHODS: Eleven patients with an average age of 17 (range 14-26) years were operated up on for ANFH after proximal femoral fractures. The average interval between injury and reconstructive surgery was four (range two to eight) years. The average follow-up of the entire cohort was 89 (range 48-132) months. Five patients with total ANFH were treated by total hip replacement (THR). Six patients with partial ANFH were treated with valgus intertrochanteric osteotomy (VITO). RESULTS: In all patients, operation improved hip function. The average preoperative Harris Hip Score (HHS) was 70 points and average postoperative HHS was 97 points. Comparison of magnetic resonance imaging (MRI) scans before and after VITO demonstrated resorption of the necrotic segment of the femoral head and its remodelling in all six patients with partial ANFH. A complication was encountered in one patient. CONCLUSION: Patients treated for ANFH had good medium-term outcomes after THR for total necrosis and also after VITO for partial necrosis.
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Fraturas do Colo Femoral/cirurgia , Necrose da Cabeça do Fêmur/cirurgia , Cabeça do Fêmur/cirurgia , Adolescente , Adulto , Remodelação Óssea , Estudos de Coortes , Coxa Vara/etiologia , Coxa Vara/cirurgia , Avaliação da Deficiência , Feminino , Fraturas do Colo Femoral/complicações , Fraturas do Colo Femoral/patologia , Cabeça do Fêmur/patologia , Necrose da Cabeça do Fêmur/etiologia , Necrose da Cabeça do Fêmur/patologia , Fixação Interna de Fraturas/efeitos adversos , Nível de Saúde , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Osteotomia , Complicações Pós-Operatórias , Procedimentos de Cirurgia Plástica , Recuperação de Função Fisiológica , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: Acute tibial tubercle avulsion fractures typically occur in adolescent boys involved in certain sports. All of the excerpted authors recommend open reduction and internal fixation (ORIF) as the only method to manage the displaced form of the injury. We attempted to select the optimal medical treatment of various types of this injury. The closed reduction and internal fixation (CRIF) method was selectively used. METHODS: During a period of 10 years (1997-2006), we treated 12 children with an acute injury to the tibial tubercle. Ogden's classification was used to describe the type of injury. Nine patients with a displaced fracture were treated surgically, using either the CRIF or ORIF methods. In cases of intraarticular fracture, the use of the CRIF method was tested. The suitability of the CRIF method was decided during manipulation of the fragments under an X-ray amplifier. RESULTS: According to Ogden's classification, three children were classified with type 1A, one with 1B, three with 2A, four with 3A, and one with 3B. In patients with the displaced extraarticular injury (types 1B and 2A), the ORIF method of treatment was necessary. In all but one case of intraarticular fracture (type 3A and 3B), the CRIF method was sufficient. CONCLUSIONS: The authors recommend that, for displaced intraarticular Ogden's type 3A or 3B fracture, the CRIF method should be considered as a first choice.
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Fractures of the sacrum in children are rare. In the 17 cases described in the past 25 years, surgery was indicated only for treatment of the consequences of the primary injury. We present the case of a 10-year-old girl who sustained the following injuries as a result of a fall from a swing: posterior angulation of S2/3 with suspected injury of anterior ligamentous structures, fracture of the proximal part of the S4 body with a displacement by the bone width anteriorly and contraction of 5 mm, posterior angulation of S5/Co1 also with a suspected injury of anterior ligamentous structures. After an unsuccessful attempt at closed reduction, open reduction and fixation by two K-wires was indicated. The fracture healed in 8 weeks. Two years after the treatment, the patient is without complaints and limitations. The question is whether surgery was necessary for treatment of this fracture or whether spontaneous healing and subsequent remodelling of the sacral bone in such a young patient may be expected which would be also fully satisfactory. In our view, the described surgical treatment was appropriate and is definitely indicated for patients with a similar injury associated with a neural lesion.
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Acidentes por Quedas , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Sacro/lesões , Fios Ortopédicos , Criança , Feminino , Humanos , Ligamentos/lesõesRESUMO
A 12-year-old boy sustained a gunshot injury to the proximal femur. The bullet hole passed through the femoral neck very close to the proximal femoral physis (Ogden type 8 physeal injury) without neurovascular injury. The boy was treated conservatively with antibiotics and bedrest. Nine months later, avascular necrosis of the femoral head (Ratliff type 2) and limb shortening of 2 cm had developed. For this reason, a valgus intertrochanteric osteotomy was performed 1 year after the injury. However, only partial revascularization of a necrotic femoral head segment occurred. For the residual necrotic segment in the weight-bearing area and progressive shortening of the femur 3.5 years after injury, a valgus-extension intertrochanteric osteotomy was performed and remodelling of the necrotic fragment done. The boy is now over 19 years old. He has only minimal pain after sports activity and a slightly limited range of movement. The limb shortening is 1.5 cm.