Hip range of motion in Perthes' disease: comparison of pre-operative and intra-operative values.

Background: Children with early Perthes' disease and clinical loss of motion are commonly noted to have normal or almost normal hip range of motion (ROM) when examined under anesthesia (EUA). Despite anecdotal comments about this observation, no series has documented these findings. The lack of such data led to this study.

Open reduction through a medial approach in developmental dislocation of the hip: a follow-up study to skeletal maturity.

Forty-four developmentally dislocated hips occurring in 30 patients with an average age at initial surgery of 10.7 (range 2-19) months underwent medial open reduction by Ferguson's approach. All patients were skeletally mature at most recent evaluation.

Acute tibial tubercle avulsion fractures.

A retrospective analysis of 18 patients with 19 acute tibial tubercle avulsion fractures was performed. Mean age at injury was 13 years 8 months. Mean follow-up time was 2 years 8 months.

Physeal-sparing intraarticular anterior cruciate ligament reconstruction in preadolescents.

Background: In the very young patient in need of anterior cruciate ligament reconstruction, the option of reconstruction with physeal-sparing techniques is valid because it is not known what percentage of physeal transgression causes adverse growth consequences.

Purpose: To report our experience with an intraarticular technique for anterior cruciate ligament reconstruction that spares the open femoral and tibial physes yet allows soft tissue graft fixation in the femoral and tibial tunnels.

Methods: Eight preadolescents underwent physeal-sparing intraarticular reconstruction for anterior cruciate ligament insufficiency with the use of semitendinosus and gracilis tendon grafts.

Preoperative evaluation and anterior cruciate ligament reconstruction technique for skeletally immature patients in Tanner stages 2 and 3.

Background: Transphyseal anterior cruciate ligament reconstruction in skeletally immature patients carries the risk of adverse sequelae.

Purpose: 1) To provide clinical and radiographic methods to identify skeletally immature patients with significant remaining lower limb growth. 2) To provide a method for calculating the percent area lesion created by a 6-mm distal femoral physeal tunnel.

Osteochondritis dissecans: Wilson's sign revisited.

Background: In 1967, Wilson described a clinical sign that he thought was diagnostic of medial femoral osteochondritis dissecans. He postulated that impingement of the tibial eminence on the osteochondritic lesion caused pain and a resultant compensatory lateral rotation during gait. He described reproducing the pain by internally rotating the patient's tibia during knee extension between 90 degrees and 30 degrees of flexion and then relieving that pain by externally rotating the tibia.

Acute tibial tubercle avulsion fractures.

Acute tibial tubercle avulsion fractures are uncommon, and these injuries typically occur in mature-appearing adolescent boys involved in jumping sports, particularly basketball. The developmental anatomy of the tibial tuberosity and the changes surrounding normal physiologic epiphysiodesis render this structure susceptible to acute avulsion fractures. Possible associated injuries include patellar and quadriceps avulsions, collateral and cruciate ligament tears, and meniscal damage.

Anterior cruciate ligament injury in the skeletally immature.

Although ACL injuries in truly skeletally immature patients are relatively uncommon events, they are experienced more frequently than initially reported--especially in the adolescent population. Natural history data is limited but appears to mirror the natural history in adults with this injury if return to high-risk activity is allowed. Treatment of this injury presents unique challenges because of the substantial growth that occurs through the distal femoral and proximal tibial physes.

Slipped capital femoral epiphysis: physeal histologic features before and after fixation.

Physeal histopathologic changes following slipped capital femoral epiphysis (SCFE) are usually considered permanent. This assumption may not be correct, since radiographic signs of proximal femoral neck growth and remodeling are commonly seen after fixation. This work analyzed the physeal histologic features of chondroepiphyseal biopsies before and after SCFE surgical fixation but before complete physiologic epiphysiodesis.

Fibular hemimelia: a new classification system.

A new classification system for fibular hemimelia is proposed based on the authors' experience with 32 patients with 33 involved limbs representing a spectrum of involvement. The data demonstrate the broad and unpredictable relationships among the fibula, ankle, and foot in this disorder. The classification system, based on fibular and ankle morphology, hindfoot coalition, and foot ray deficits, is designed to improve communication about the condition.