[To the problem of Monteggia's injury].
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The gymnast often places unphysiologic extreme stresses upon her body during the maneuvers characteristic of that sport. These may result in stress fractures to the skeleton, the lumbar spine being at greatest risk. Minor malalignments of the extremities can encourage injury. The extremes of joint position can produce significant symptoms with chrondromalacia.
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The authors reviewed 17 fractures of the olecranon apophysis in 10 children with mild osteogenesis imperfecta (OI). Seven of the 10 patients sustained the same injury to the opposite extremity 1 to 70 months (mean 15.1) after their initial fracture. Four fractures were initially treated by cast immobilization alone. Two of these eventually required operative treatment because of refracture or late displacement. In all, 15 fractures were treated operatively. All had healed at the time the cast was removed; however, two refractured. At latest follow-up (mean 53 months), no patient reported pain or limited function. Children with OI may be prone to this injury. Cast immobilization with careful follow-up may be used for minimally displaced fractures, but operative treatment is recommended for displaced fractures. The high rate of bilateral injury (70%) suggests that children with OI who sustain this fracture should be counseled regarding the risk of injury to the opposite extremity.
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To analyze a prototype mobile C-arm image amplifier (Iso-C3D) in the evaluation of different joint fractures of the upper and lower limbs using multiplanar reconstruction (MPR). Different cadaver joint specimens (n = 14) were examined with a prototype (Iso-C3D, Siemens AG, Erlangen, Germany), plain radiographs (CR), and spiral computed tomography (CT). The motorized C-arm provides fluoroscopic images during a 190 degrees orbital rotation computing a 119-mm data cube. These three-dimensional data sets yielded MPR images, which were evaluated by two readers for the detection and extent of fracture lines. Initial data show that fractures were easily depicted and correctly classified on MPR images with the Iso-C3D and that there was no difference between the Iso-C and CT in the detection of fractures. The preliminary results suggest a remarkably good detection of joint fractures with the Iso-C3D. Studies in an adequate number of patients are required to elucidate whether these promising results can also be obtained in a clinical setting.
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Injury of the ulnar nerve may occur when using percutaneous Kirschner wires (K-wires) in the treatment of supracondylar humeral fractures of the elbow especially in children whose bony landmarks are masked by swelling. We describe a technique in which this complication can be avoided during the procedure. The nerve is located first using a needle attached to a nerve stimulator. The K-wire is then inserted 0.5 to 0.75 mm anterior and parallel to the needle. Ten supracondylar fractures of the humerus were stabilized using this procedure and there were no ulnar nerve complications.
The pediatric musculoskeletal system differs greatly from that of an adult. Although these differences diminish with age, they present unique injury patterns and challenges in the diagnosis and treatment of pediatric orthopedic problems.
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