Reevaluation of the use of the Risser sign in idiopathic scoliosis.
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Age Determination by Skeleton↗
Biomedical subjects
J R Kasser
Publications and source records attributed to J R Kasser.
Percutaneous pinning of supracondylar fractures of the humerus.
Percutaneous pinning following closed reduction of supracondylar fractures is a preferred technique for management of type III injuries. If there is no pulse, rapid closed reduction with percutaneous fixation should be done. No arteriogram is indicated before treatment. Nerve damage is not a contraindication to this procedure but should be documented prior to surgery. The duration of immobilization is three to four weeks, with pins left protruding through the skin, to be removed in the office. Complications of vascular insufficiency and cubitus varus can be avoided with this technique.
Arm↗
Femur fractures in children.
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Adolescent↗
Slipped capital femoral epiphysis. A quantitative analysis of motion, gait, and femoral remodeling after in situ fixation.
A prospective clinical study was done for quantitative examination of motion of the hip, gait, and proximal femoral remodeling after in situ fixation of a slipped capital femoral epiphysis. In situ fixation was performed in forty-five consecutively treated patients (fifty-six hips). Thirty-nine (87 per cent) of the patients returned for examination two years after treatment. The greatest percentage of motion of the hip returned within six months after treatment. Despite loss of internal rotation of the hip, the mean foot-progression angle was 10.8 degrees. Radiography and computerized tomographic scanning revealed minimum change in the relationship of the femoral head to the femoral shaft and no change in the neck-shaft angle. Motion returned despite minimum osseous remodeling. The early return of motion (in the first three months) may have been due to relief of pain, spasm, and synovitis, while soft-tissue stretching and resorption of bone in the anterolateral part of the femoral neck may have accounted for the remainder of the increase in internal rotation.
Adolescent↗
Management of vascular injuries in displaced supracondylar humerus fractures without arteriography.
One hundred forty-three displaced (type III) supracondylar fractures of the humerus in children were treated over a 5.5-year period with 17 (11.9%) having signs of vascular impairment at the time of presentation. Rapid reduction and Kirschner wire stabilization without arteriogram was performed in each case. In three cases in which satisfactory blood supply to the hand was not present after reduction, circulation was restored after exploration of the brachial artery revealed two intimal tears and one arterial entrapment. The remaining 14 patients were normal at follow-up with no late vascular compromise. Based on these findings, we feel prereduction arteriography is not indicated in this injury.
Arm↗
Self-administered nitrous oxide for fracture reduction in children in an emergency room setting.
Analgesia using a self-administered mixture of 50% nitrous oxide and 50% oxygen (Nitronox) was evaluated prospectively in 22 children undergoing closed reduction of fractures in the emergency room. The majority of these patients underwent reduction of forearm fractures. When the children were asked about pain after the procedures, 12 (60%) recalled no pain, 7 (35%) minimal pain, and 1 (5%) moderate pain. None recalled severe pain. Eleven (52%) of the patients had minimal pain, 8 (38%) had moderate pain, and 2 (10%) had no pain, as judged by an emergency room physician. None had severe pain. There were no complications and the ease of administration was remarkable. We conclude that N2O:O2 in a 50:50 mixture provides very effective, safe analgesia for fracture reduction in the emergency room setting.
Adolescent↗
Acute septic arthritis in infancy and childhood.
Despite intensive study of acute septic arthritis in infancy and childhood, poor outcomes continue to occur. Failures are often due to delayed diagnosis and inadequate therapy, but can be due to factors beyond physicians' control such as associated osteomyelitis and occurrence during infancy. Recent advances in the understanding and management of septic arthritis include: (1) demonstration of beneficial effects of continuous passive motion in rabbits; (2) identification of inflammatory mediators of cartilage destruction and their respective sources; (3) recognition of changing patterns of pathologic organisms; (4) evolution of new antibiotics and standards for oral and home intravenous therapy; (5) development of arthroscopic debridement of septic knees; and (6) further refinement of indications for aspiration-irrigation versus open surgical drainage of septic joints. Permanent sequelae from septic arthritis can only be prevented by early diagnosis and aggressive treatment.
Acute Disease↗
Physeal bar resections after growth arrest about the knee.
Localized growth arrest about the knee can be treated with excision when less than 50% of the physis is involved and when at least 2.5 cm of growth remains. Simultaneous corrective osteotomy should be performed when the angular deformity exceeds 20 degrees. The superiority of the various interposition materials remains controversial, but the alternatives are fat, cartilage, elastomer, and methylmethacrylate.
Adolescent↗
Chronic recurrent multifocal osteomyelitis. Association with vertebra plana.
In seven children who had chronic recurrent multifocal osteomyelitis, the radiographic and histological findings were consistent with those of osteomyelitis, but the results of cultures were negative. We studied the clinical, radiographic, histological, and microbiological findings in these patients, who had a total of thirty-nine lesions. The lesions occurred most frequently in the spine, tibia, and femur; three patients had vertebra plana. The natural history of chronic recurrent multifocal osteomyelitis appears to be slow, spontaneous resolution of the osseous lesions without specific treatment. The diagnosis is one of exclusion. Biopsy is recommended, and results of cultures must be negative before therapy with antibiotics can be withheld.
Adolescent↗
Juvenile hyaline fibromatosis. A case report and review of musculoskeletal manifestations.
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Contracture↗
Physeal arrest about the knee associated with non-physeal fractures in the lower extremity.
The cases of seven patients who had a physeal arrest about the knee in association with nonphyseal fractures in the lower extremity were reviewed. The patients were between ten and twelve and one-half years old at the time of injury, and the physeal arrest involved either the posterolateral part of the distal femoral physis or the anterior part of the proximal tibial physis. There was no evidence of iatrogenic trauma to the physis. Recognition of the physeal injury was delayed for an average of one year and ten months until a gross angular deformity appeared. Adolescents who have fractures of the lower extremities that do not appear to involve a physeal plate should nevertheless be evaluated and followed for possible physeal injury about the knee that can be detected only after additional growth has taken place.
Child↗
The association of femoral retroversion with slipped capital femoral epiphysis.
We examined twenty-five patients who had a unilateral or bilateral slip of the capital femoral epiphysis and determined the degree of anteversion of the thirty-nine involved hips with computerized axial tomography. Thirteen patients (eighteen hips) were seen at the time of the original diagnosis (Group I), and twelve patients (twenty-one hips) were seen one to seven years after operative treatment (Group II). The mean amount of anteversion for all of the involved hips was +1.0 +/- 8.2 degrees. The mean amount of anteversion for the Group-I hips was -0.7 +/- 7.4 degrees and the mean amount for the Group-II hips was 2.5 +/- 8.7 degrees. The mean amount of anteversion for the hips in both Groups I and II was less than the predicted mean amount for individuals of the same age. The mean amount of anteversion of the unaffected hips of our patients who had a unilateral slip was +6.3 +/- 8.2 degrees. The amount of internal rotation of the hip in extension exceeded the amount when it was in flexion in all of the patients. A decreased angle of femoral anteversion appears to be specifically associated with the development of slipped capital femoral epiphysis. The mechanical forces that act across the proximal femoral physis may be altered by this rotational abnormality, and this may lead to an increased shear stress that ultimately causes failure of the growth plate.
Adolescent↗
Varus derotation osteotomy in the treatment of persistent dysplasia in congenital dislocation of the hip.
We have attempted to define the indications for and limitations of varus derotation osteotomy in the treatment of persistent dysplasia in congenital dislocation of the hip. We studied the cases of thirty-four patients (forty-four hips) who were divided into three groups according to age at operation, and evaluated the influence of femoral remodeling, age, acetabular response, instability, and pre-existing avascular necrosis with respect to the final results. The length of follow-up ranged from five to twenty-two years. Rapid return to a valgus femoral neck-shaft angle by remodeling was not a cause of failure in any age group. There were consistently good results in the patients who were less than four years old at the time of operation. Acetabular correction by remodeling occurred through the age of eight years, but four of thirteen hips in patients who were between the ages of four and eight showed persistent dysplasia despite the operative procedure. The results were less predictable as the patients approached the age of eight years. There was no benefit from isolated femoral osteotomy in ten of eleven hips in patients who were older than eight. Pre-existing avascular necrosis appeared to compromise the results of the procedure in all age groups.
Age Factors↗
Hematogenous osteomyelitis. Untangling the diagnostic confusion.
Hematogenous osteomyelitis is a disease of children which if diagnosed accurately and treated promptly will result in neither loss of life nor loss of function. Aggressive aspiration and biopsy yields a high rate of positive cultures. Oral antibiotics have a role in the treatment of osteomyelitis if monitoring can assure bactericidal levels and if 100% compliance is insured. Aggressive aspiration and biopsy to increase diagnostic accuracy is an important aspect of therapy.
Anti-Bacterial Agents↗
Osteomyelitis caused by Capnocytophaga ochracea.
A 13-year-old boy is reported with osteomyelitis of the greater trochanter caused by a facultative anaerobic organism (Capnocytophaga ochracea) not known to cause infections in normal immunocompetent individuals, nor implicated in bone or joint infections even in compromised hosts. There remains a need to consider unusual organisms and to obtain accurate bacteriologic data in all cases of osteomyelitis.
Adolescent↗
Tendon injuries about the ankle.
The proper treatment of tendinous ankle injuries will yield a strong, stable joint. Generally, athletes can expect to return to their preinjury athletic level. Tendon strain or inflammation, either from a single incident or simple overuse, requires prolonged conservative therapy. Tendon rupture should be approached aggressively to insure a powerful, stable ankle.
Achilles Tendon↗
Tendon injuries about the ankle.
The proper treatment of tendinous ankle injuries will yield a strong, stable joint. Generally, athletes can expect to return to their preinjury athletic level. Tendon strain or inflammation, either from a single incident or simple overuse, requires prolonged conservative therapy. Tendon rupture should be approached aggressively to insure a powerful, stable ankle.
Achilles Tendon↗