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[Incidence of painful pronation in pediatric traumatology].

After examining the traumatic mechanism responsible for the lesion and considering the possible pathogenetic interpretations, the Authors pass to a description of the clinical picture and the simple but effective reduction manoeuvre. The attached cases tend to emphasize the by no means negligible frequency of painful pronation among childhood traumatisms, a condition often misunderstood and a source of wrong diagnostic interpretations.

Arm Injuries↗

[Medial epicondylitis. Etiology, diagnosis, therapeutic modalities].

Medial epicondylitis is rather uncommon, less frequent than external epicondylitis. For this reason, the diagnosis is thought of rather late. While taking the history, one should try to find out the possible causative effects. Symptoms of irritation of the cubital nerve, which are present in one out of five cases should be looked for. Several sports such as baseball, javelin or weight throwing, volleyball, climbing, tennis, golf, which need a strong flexion of the hand and fingers can induce this condition. However, in more than half of our patients, sports or professional activities were not in cause. The majority were housewives and do-it-yourself enthusiasts. Among our 55 operated cases, out of which few had professional or sports activities, we did not encounter during the operation the macroscopic tendinous lesions that are sometimes described by some authors. The treatment should be conservative in all cases. This includes rest, anti-inflammatory drugs, physiotherapy, muscular stretching, immobilisation in a cast, steroid infiltrations. One patient out of ten will have to be operated on. The operative techniques differ on some details, but they all include the desinsertion of the flexor muscles on the medial epicondyle. When there are clinical signs of irritation of the cubital nerve, it should be transposed anteriorly. The result of these operations is good in more than 90 per cent of the cases. However, a come back to professional sport can take as long as 8 months.

Athletic Injuries↗

Intravenous regional anesthesia in the treatment of forearm and wrist fractures and dislocations in children.

OBJECTIVE: To evaluate the efficacy and safety of intravenous regional anesthesia in the treatment of unilateral closed fractures and dislocations of forearm or wrist in children. DESIGN: A prospective study over 6 years. SETTING: The study was undertaken in the well-equipped emergency department of a community general hospital for ambulatory patients. PATIENTS: One hundred and thirty-nine children between the ages of 4 and 18 years with unilateral closed fractures and dislocations of forearm or wrist. INTERVENTION: All children received premedication with a combination of meperidine and promethazine (0.5 mg/kg intramuscularly) and regional upper limb anesthesia with 0.5% lidocaine solution (3 mg/kg intravenously) after inflation of an arm tourniquet. MAIN OUTCOME MEASURES: The relief of pain, allowing closed reduction with intravenous regional anesthesia, and the incidence of complications. RESULTS: All patients had complete relief of pain allowing successful closed reduction in 133 patients (96%); tourniquet pain occurred in 10 patients (7%). There were no symptoms of lidocaine toxicity. There were no neurovascular or compartment syndrome complications. CONCLUSIONS: Intravenous regional anesthesia for the treatment of fractures and dislocations of forearm and wrist in children was found to be simple, safe and effective.

Adolescent↗

The management of common dislocations in the upper limb.

Dislocations are among the many orthopaedic injuries that the general practitioner is expected to manage. Many are fairly straightforward to treat, however, there are also many pitfalls. In this paper we provide an overview of the common dislocations in the upper limb, and some that are less common but important to recognise. We have also described the important complications to watch out for and an indication as to which dislocations should be referred for specialist management.

Acromioclavicular Joint↗

Radiology of athletic injuries: baseball.

The radiographs and medical records of 29 professional basebell players from several teams were reviewed. Each player had been selected because of radiographic abnormalities. Abduction views of the shoulder were employed in pitchers and outfielders who complained of shoulder pain. Upper extremity abnormalities predominated and accounted for 22 injuries including avulsion injuries of the origin of the long head of the triceps at the infraglenoid tubercle of the scapula and traction injuries at the origin of the pronator muscles at the medial epicondyle of the humerus. Trauma to the lower extremities was caused by collision with a fixed barrier in one man and by running and sliding in 13 others.

Ankle Injuries↗