Knee ligament injuries in children.

Nine children who were less than fourteen years old and had open physes and ligament injuries of the knee were studied. Despite an initial thorough physical and roentgenographic evaluation, the full extent of the lesion was determined only at operation in seven of the nine patients. The intercondylar eminence of the tibia was avulsed in five patients, four of whom had associated collateral ligament injuries and a positive anterior drawer sign. Despite surgical repair, all nine patients demonstrated some degree of postoperative ligament instability. This was increased in those patients in whom menisectomy had been performed concomitantly with ligament repair. Although none of the children were symptomatic at the time of writing, development of degenerative arthritis in the future must be considered. Ligament injury must be considered in the differential diagnosis of the child suffering from knee trauma. The association of avulsion of the tibial spine and collateral ligament injury is emphasized.

Anomalies of the lumbosacral nerve roots. Review of 16 cases and classification.

Sixteen cases of lumbar nerve root anomalies found at surgery are reviewed and a classification system presented. All but two patients had an associated disc herniation which initiated the symptomalogy and was the indication for surgery. Fifty percent were found at repeat exploration. Eleven patients had conjoined nerve roots, five had two roots in one foramen, and three had connecting roots. Nerve root anomalies should be suspected in cases of failed disc surgery. Adequate decompression by foraminotomy or excision of pedicles is required as well as discectomy to alleviate the symptomatology.

Low back pain. Evaluation and treatment in the emergency department setting.

The author outlines the most common clinical syndromes causing back pain, including degenerative disc disease, disc herniation syndrome, and cauda equina syndrome. Also discussed are specific guidelines regarding the need for immediate orthopedic and neurosurgical consultation or admission to the hospital.

Fractures of the tibial plateau: a review of ninety-five patients and comparison of treatment methods.

Ninety-five patients with fractures of the tibial plateau have been reviewed. The fractures were grouped, according to the X-ray pattern, into five fracture types. Treatment was grouped into plaster immobilization or traction in the conservative group, and open reduction with internal fixation, open reduction with bone grafting, or open reduction with internal fixation and bone grafting in the operated group. It was concluded from this review that tibial plateau depression or tibial plateau widening of less than 10 mm was usually tolerated well and did not preclude a successful result. Adequacy of reduction was a least as important as early motion in obtaining a satisfactory result regardless of the type of fracture treated. If open reduction is undertaken both internal fixation and bone grafting are required in the most common types of these fractures. The exceptions are Type I or split fractures which do not require a bone graft and Type III or central depression fractures which do not require internal fixation.