Knee Pain and Activity Outcomes After Femoral Derotation Osteotomy for Excessive Femoral Anteversion.

Background: Excessive femoral anteversion is a developmental condition that can become symptomatic into adolescence and manifest as anterior knee pain, tripping, and or problems with sports. Femoral derotational osteotomy about an antegrade intramedullary nail (IMN) is an accepted option to treat this condition. This is the first report of the clinical and functional outcomes of treatment of excessive anteversion with femoral derotational osteotomy stabilized with an IMN.

Urgent reduction, fixation, and arthrotomy for unstable slipped capital femoral epiphysis.

Background: The management of unstable slipped capital femoral epiphysis (SCFE) is controversial. A high incidence of avascular necrosis (AVN) has been reported after unstable SCFE.

Methods: Twenty-eight consecutive patients with thirty unstable SCFE underwent urgent reduction and fixation with two 6.

Use of an intramedullary rod for the treatment of congenital pseudarthrosis of the tibia. Surgical technique.

Background: The treatment of congenital pseudarthrosis of the tibia remains difficult and controversial. The purpose of this study was to evaluate the long-term results of a technique consisting of excision of the pseudarthrosis, autologous bone-grafting, and insertion of a Williams intramedullary rod into the tibia.

Methods: Twenty-one consecutive patients with congenital pseudarthrosis of the tibia were managed with this technique between 1978 and 1999, and the results were retrospectively reviewed.

Smoking and socio-economic status in the etiology and severity of Legg-Calvé-Perthes' disease.

Background: The etiology of Legg-Calvé-Perthes disease is poorly understood. An association has been found in the past between Legg-Calvé-Perthes disease and smoking as well as low socio-economic status.

Methods: A prospective study was carried out in which families with a child diagnosed with Legg-Calvé-Perthes' disease were interviewed about the presence and duration of household second-hand smoke exposure to children.

Use of an intramedullary rod for treatment of congenital pseudarthrosis of the tibia. A long-term follow-up study.

Background: The treatment of congenital pseudarthrosis of the tibia remains difficult and controversial. The purpose of this study was to evaluate the long-term results of a technique consisting of excision of the pseudarthrosis, autologous bone-grafting, and insertion of a Williams intramedullary rod into the tibia.

Methods: Twenty-one consecutive patients with congenital pseudarthrosis of the tibia were managed with this technique between 1978 and 1999, and the results were retrospectively reviewed.

A comparison of monolateral and circular external fixation of unstable diaphyseal tibial fractures in children.

Forty-six tibial fractures in 44 children, which were treated by external fixation at our institution between 1 January 1991 and 31 December 1999, were retrospectively identified. Twenty-nine fractures were treated with monolateral fixation and 16 were treated with circular fixation. The average age of the patients was 11 years 8 months (range 3 years 11 months-17 years 7 months).

Proximal femoral radiographic changes after lateral transtrochanteric intramedullary nail placement in children.

Background: Recent reports have described osteonecrosis of the femoral head after intramedullary nailing of the femur through the piriformis fossa in children. Other reports have raised concerns about the development of femoral neck narrowing and valgus deformity of the proximal part of the femur after intramedullary nailing through the tip of the greater trochanter. We evaluated the radiographic changes in the proximal part of the femur following intramedullary nailing through the lateral trochanteric area at a minimum of two years postoperatively in twenty-five affected extremities.

Septic arthritis of the hip in infancy: long-term follow-up.

At a mean 15-year follow-up, the authors evaluated five hips in five patients who had complete destruction of the femoral head and neck from septic arthritis when they were 3 months old. All patients were treated with a trochanteric arthroplasty in combination with a proximal femoral varus osteotomy at a mean age of 30 months in an attempt to salvage a femoral-pelvic articulation. Results suggest this treatment can provide a stable, painless, and functional hip, with an improved gait and less leg-length discrepancy than predicted if no reconstructive effort were attempted.

Combined midfoot osteotomy for severe forefoot adductus.

A one-stage procedure combining a closing wedge osteotomy of the cuboid with an opening wedge of the medial cuneiform was used for the treatment of severe forefoot adductus. Results were reviewed in 33 patients (50 feet) followed-up for at least 2 years postoperatively. Clinical and radiographic improvement in forefoot position was achieved in 90% of cases.

Prevalence of neural axis abnormalities in patients with infantile idiopathic scoliosis.

Background: Although reports in the literature have demonstrated an approximately 20% prevalence of neural axis abnormalities in patients with juvenile idiopathic scoliosis who have a curve of >20 degrees, the prevalence of neural axis abnormalities in patients with infantile idiopathic scoliosis is not well documented. In two previous studies involving a total of only ten patients with infantile idiopathic scoliosis, five patients were noted to have a neural axis abnormality on magnetic resonance images.

Methods: The records of forty-six consecutive patients who were seen between 1992 and 2000 at three spinal deformity clinics were retrospectively reviewed.

Treatment of rigid hypertrophic posttraumatic pseudarthrosis of the tibia in children using distraction osteogenesis.

Posttraumatic tibial pseudarthrosis is a relatively uncommon complication of tibia fractures in children. Although reported as a successful method of treating tibial nonunions in adults, distraction osteogenesis through a nonunion site via ring external fixation has not been described in children. The authors report three consecutive cases of distraction through an angulated, shortened, hypertrophic, posttraumatic nonunion to achieve successful union and concurrent correction of deformity.

Causes of false-negative ultrasound scans in the diagnosis of septic arthritis of the hip in children.

Ultrasound scans of the hip were carried out in 132 children with hip pain during an 18-month period to evaluate the hip for the presence of an effusion. Seventy-three of these patients were followed up long enough to ascertain the presence or absence of septic arthritis. The remaining 59 patients were discharged with diagnoses other than septic arthritis but could not be located to confirm the ultimate accuracy of the diagnosis.

Surgical correction of the snapping iliopsoas tendon in adolescents.

Background: There have been very few reports regarding symptomatic snapping of the iliopsoas tendon, and none of those reports have dealt exclusively with an adolescent population. We report our experience with the surgical treatment of this entity in a group of patients who had an average age of fifteen years.

Methods: Nine adolescent patients (eleven hips) underwent fractional lengthening of the iliopsoas tendon at the musculotendinous junction because of persistent painful snapping of the hip.