Common pediatric elbow fractures.

Fractures of the elbow are a very common injury in children. The most common mechanism of injury is a fall on an outstretched upper extremity during play. Ranging in complexity from low-energy nondisplaced occult fractures to high-energy fractures with associated severe soft-tissue and neurovascular injuries, elbow fractures are a challenging problem for all pediatric healthcare providers. Because of the wide spectrum of fracture severity and associated bony and ligamentous injury, a very diverse spectrum of treatment modalities is necessary for optimal results. Management is based on fracture pattern, patient age and bone quality, extent of soft tissue damage, functional needs of the patient, and the presence of associated injuries. This article will give a brief overview of 4 common pediatric fractures, current treatment algorithms, and frequent complications associated with these injuries.

Scheuermann's thoracic kyphosis in the adolescent patient.

Scheuermann's thoracic kyphosis is a condition characterized by increased posterior rounding of the thoracic spine in association with structural deformity of the vertebral elements. It is a structural deformity of the spine that is classically characterized by anterior wedging of 5° or more of 3 adjacent thoracic vertebral bodies with kyphosis measuring greater than 45° between T5 and T12. The cause of the deformity remains unknown but it is believed to be multifactorial, and it likely has a genetic component as well. Most adolescent patients seek orthopaedic evaluation for increased rounding and deformity of the thoracic spine that is occasionally associated with back pain. Parental concerns are also often related to the cosmetic deformity and the progressive nature of the condition. Bracing has been demonstrated to be an effective nonsurgical treatment modality for the skeletally immature child and/or adolescent with a progressive deformity. Operative management has been advocated for adolescents with progressive kyphosis measuring over 70°, for those who have had progression despite bracing, for patients with intractable back pain, and also for patients with unacceptable cosmetic deformity. Surgical options include posterior spinal arthrodesis with or without anterior spinal release via thoractomy or video-assisted thoracoscopic surgery (VATS). This article will review the diagnosis, pathophysiology, physical examination findings, and the nonoperative and surgical treatment options for adolescent patients with Scheuermann's kyphosis of the thoracic spine.

Intraoperative neuromonitoring in pediatric spinal deformity surgery.

Pediatric spinal deformity includes a broad range of disorders with differing causes, natural histories, and treatments. Spinal deformity surgery is performed to arrest the progression of and correct coronal and sagittal plane deformities including scoliosis and kyphosis. It is also undertaken to improve cosmesis and decrease the pain that can be associated with certain types of spinal deformity. Iatrogenic spinal cord injury remains the most feared complication of corrective spine surgery. Intraoperative neuromonitoring may be the single innovation that has had the greatest impact in lowering neurological complication rates over the last 2 decades. It is currently recommended in pediatric spinal deformity surgery whenever cord-level spinal instrumentation is planned and reliable signals can be anticipated. This article will briefly discuss common types of pediatric spinal deformity and corrective spine surgery. The use of intraoperative neuromonitoring in pediatric spine surgery will also be reviewed. As our abilities to correct more complex spinal deformities continue to improve, the importance of more advanced methods to decrease the risk of intraoperative neurological complications will also continue to increase.

Clavicle fractures in children: the essentials.

A fracture of the clavicle is a relatively common injury that occurs in patients of all ages. The clavicle is the most commonly fractured long bone in children. The infant, child, or adolescent with a clavicle fracture usually has a history of trauma. Typically, there is localized pain over the fracture, with associated edema and crepitus. Consideration of anatomy within the area of the fracture is essential so that associated injuries can be diagnosed and appropriately treated. Most clavicle fractures heal uneventfully and can be treated nonoperatively. Surgical treatment with open reduction and internal fixation is occurring more often, however, because of potential long-term concerns with functional outcome and decreased range of motion. This article briefly reviews the anatomy and function of the clavicle, common mechanisms of injury, physical examination findings, and conservative as well as surgical management of pediatric clavicle fractures.