Are 2 Radiographic Views As Good as 3 Views to Diagnose Ankle Fractures in Children and Adolescents?

Objectives: Ankle radiographs are among the most commonly obtained trauma images in the pediatric population, with the standard 3 views (AP/mortise [M]/lateral [L]) routinely ordered in the emergency department. The purpose of this study was to compare the diagnostic accuracy, sensitivity, and specificity of sets of 2 views (AP/L or M/L) with the standard 3 views.

Methods: One hundred twenty sets of ankle radiographs of skeletally immature patients obtained in the emergency department of a level 1 pediatric trauma center were used.

Electronic Consultation Systems: Impact on Pediatric Orthopaedic Care.

Background: The demand for pediatric orthopaedic surgery consultation has grown rapidly, leading to longer wait times for elective consultation in some regions. Some specialties are addressing this increased demand through electronic consultation services. We wanted to examine the impact of pediatric orthopaedic e-consultations in Canada's Eastern Ontario region.

Bilateral Discoid Medial Menisci: A Case Report and Review of the Literature.

Bilateral discoid medial menisci are exceptionally rare and of uncertain pathoetiology. We report on a case in an active adolescent woman who presented with bilateral medial knee joint line pain. Clinical evaluation and MRI identified atypical bilateral discoid medial menisci bilaterally.

Treatment for Clubfoot: Stockinette Versus Webril Cast Padding in the Ponseti Method.

Background: The Ponseti method of serial manipulation and casting revolutionized the treatment of one of the most common congenital orthopaedic conditions-clubfoot-resulting in less surgical morbidity and better functional results. Several studies have examined aspects of nonoperative treatment but none have explored the effect of different types of undercast padding.

Methods: The authors performed a randomized controlled trial comparing cotton Stockinette and Webril undercast padding using the Ponseti method.

The impact of electronic consultation on a Canadian tertiary care pediatric specialty referral system: A prospective single-center observational study.

Background: Champlain BASE™ (Building Access to Specialists through eConsultation) is a web-based asynchronous electronic communication service that allows primary-care- practitioners (PCPs) to submit "elective" clinical questions to a specialist. For adults, PCPs have reported improved access and timeliness to specialist advice, averted face-to-face specialist referrals in up to 40% of cases and high provider satisfaction.

Objective: To determine whether the expansion of eConsult to a pediatric setting would result in similar measures of improved healthcare system process and high provider acceptance reported in adults.

Transtibial Ertl amputation for children and adolescents: a case series and literature review.

Purpose: Despite advances in limb reconstruction, there are still a number of young patients who require trans-tibial amputation. Amputation osteoplasty is a technique first described by Ertl to enhance rehabilitation after trans-tibial amputation. The purpose of the study reported here was to evaluate the results of the original Ertl procedure in skeletally immature patients and to assess whether use of this procedure would result in a diminished incidence of bony overgrowth.

Symptomatic bunionette deformity in adolescents: surgical treatment with metatarsal sliding osteotomy.

Background: Bunionette deformity is a painful osseous prominence on the lateral aspect of the head of the fifth metatarsal. The purpose of this study is to evaluate the results of a fifth metatarsal sliding osteotomy for the treatment of this deformity in patients under 18 years of age.

Methods: We retrospectively evaluated 13 feet in 11 consecutive patients with bunionette deformity treated from January 2003 to January 2008 at 2 referral centers.

Biomechanical analysis of lateral pin placements for pediatric supracondylar humerus fractures.

Aim: Several clinical studies have shown that lateral pinning alone is of equal stability to crossed pins in the treatment of supracondylar fractures. The aim of this study was to compare the stability of parallel and varied divergent lateral pin configurations to provide an easily reproducible technique for optimal pin placement.

Methods: Twelve third-generation synthetic composite humeri were osteotomized at the level of the coronoid and olecranon fossae to simulate a humeral supracondylar fracture.

Intra-articular median nerve incarceration after spontaneous reduction of a pediatric elbow dislocation: case report and review of the literature.

Unlabelled: Intra-articular incarceration of the median nerve after closed reduction of an elbow dislocation is a rare and potentially devastating complication. We report the case of a 4-year-old boy who had an entrapment of the median nerve after spontaneous reduction of a posterior dislocation. All the cases previously reported in the literature are reviewed.

What proportion of patients need extensive surgery after failure of the Ponseti technique for clubfoot?

Unlabelled: In 1948, Professor Ignacio Ponseti began a nonoperative management form of treatment for severe talipes equinovarus. This method of manipulative treatment became attractive because long-term outcomes demonstrated the majority of feet were pain-free, plantigrade, and functioning at a high level of activity without evidence of degenerative arthrosis. We retrospectively reviewed the charts of 51 children (31 boys and 20 girls; 72 feet) with idiopathic clubfeet deformity treated with the Ponseti method from January 5, 2002, to January 5, 2007.

Management of scoliosis and syringomyelia in children.

Scoliosis is often a characteristic of an underlying syrinx. Surgical treatment, in particular instrumentation, of scoliosis in a child with an unrecognized syrinx may be associated with an increased risk of neurologic complications. The effect of syrinx treatment on scoliosis is yet to be clearly determined.