The management of the neglected congenital foot deformity in the older child with the Taylor spatial frame.

Background: Neglected or inadequately treated rigid congenitally deformed feet in older children are a nightmarish challenge for the child, the parents, and the orthopaedic surgeon. Because of the multiplicity of spatial deformities exhibited by these feet and legs, it was hypothesized that correction using the Taylor spatial frame (TSF) would decrease morbidity, facilitate correction, and minimize treatment time in children from remote regions with extremely rigid deformed feet.

Methods: Recent experience with the management of 11 such feet (Dimeglio type IV) in 9 children with an average age of 9.

Pinning technique for shoulder fractures in adolescents: computer modelling of percutaneous pinning of proximal humeral fractures.

Background: In the technique of percutaneous pinning of proximal humerus fractures, the appropriate entry site and trajectory of pins is unknown, especially in the adolescent population. We sought to determine the ideal entry site and trajectory of pins.

Methods: We used magnetic resonance images of nonfractured shoulders in conjunction with radiographs of shoulder fractures that were treated with closed reduction and pinning to construct 3-dimensional computer-generated models.

Management of subtrochanteric fractures in skeletally immature adolescents.

Background: There have been no studies that have specifically looked at the management of subtrochanteric femoral fractures in skeletally immature adolescents. It was the purpose of this study to investigate the treatment of this injury in this unique patient population.

Methods: A retrospective review of all subtrochanteric femoral fractures treated at a major pediatric trauma center since 1990 was performed.

Traumatic growth arrest of the distal tibia: a clinical and radiographic review.

Background: Injury to the physis of the distal tibia in children can lead to subsequent growth arrest. This can result in physeal bars, leg-length discrepancies and angular deformities.

Method: The cases of 12 children with distal tibial growth arrest due to ankle trauma were reviewed.

Multiple epiphyseal dysplasia in children: beware of overtreatment!

Purpose: To determine the various musculoskeletal manifestations of multiple epiphyseal dysplasia in children, and the course of this disease in childhood.

Methods: Ten children were diagnosed and treated at the Children's Hospital of Eastern Ontario (CHEO) for multiple epiphyseal dysplasia, 1976-2001. We reviewed the clinical, pathological and radiographic records for these cases to determine cause of presentation and progress of the musculoskeletal pathology during the course of this disease in this age group.

Slipped capital femoral epiphysis: an analysis of treatment outcome according to physeal stability.

Introduction: Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents. Treatment can be associated with serious complications, mainly avascular necrosis (AVN). The objective of this study was to evaluate treatment outcomes and complications based on physeal stability at presentation.

Hemangioma of the radius associated with Kasabach-Merritt syndrome: case report and literature review.

The Kasabach-Merritt syndrome of consumptive coagulopathy associated with massive hemangiomas is a potentially life-threatening problem in patients with a pathologic fracture of the osseous lesion. This can result in massive bleeding even after minor trauma. In such patients, operative management of long bone hemangiomatous lesions, including percutaneous needle aspirations, may be contraindicated, and nonoperative management may be preferable.

Osteofibrous dysplasia: a review of the literature and presentation of an additional 3 cases.

Osteofibrous dysplasia is a rare fibro-osseous lesion of uncertain etiology that occurs exclusively in the pediatric population. Diagnosis and treatment are complicated by the fact that osteofibrous dysplasia can resemble monostotic fibrous dysplasia and adamantinoma of long bones grossly and microscopically and that it tends to recur if surgical intervention is performed before skeletal maturity is reached. We present 3 cases of this lesion seen at our institution and provide a review of all previous cases reported in the literature.

Discoid meniscus in children: treatment and outcome.

Introduction: Discoid meniscus is an atavistic anomaly in which the meniscus of the knee, predominantly the lateral meniscus, is discoid rather than semilunar in shape. The abnormality is diagnosed relatively infrequently and may even go unrecognized or be untreated. Treatment has consisted of either partial or complete meniscectomy performed either arthroscopically or by open arthrotomy.

Efficacy of aprotinin in reducing blood loss in spinal fusion for idiopathic scoliosis.

Aprotinin is a proteinase inhibitor with antifibrinolytic properties that has found widespread application during cardiac surgical procedures due to its ability to decrease blood loss and transfusion requirements. Recently it has been used by orthopedic surgeons in hip replacement and other major surgeries except for scoliosis surgery, which is known to be associated with major blood loss. To evaluate the effect of aprotinin in reducing blood loss during spinal fusion surgery for idiopathic scoliosis, a double-blind randomized prospective clinical study was performed.

Osteochondritis dissecans of the talus in children.

Osteochondritis dissecans (OCD) of the talus is rare in children. The lesion is encountered on either the medial or lateral surface of the talar dome. The etiology is unknown, although trauma has been implicated, particularly in lateral lesions.

Pelvic osteomyelitis in children: a comparison of decades from 1980-1989 with 1990-2001.

Since 1980, 64 children with pelvic osteomyelitis (40 boys) were treated at a major pediatric referral center. The average age was 11 years and 6 months. The presenting complaints included pain in 61 children, fever in 30, and altered weight-bearing in 31.

Operative management of pediatric scaphoid fracture nonunion.

Fractures of the scaphoid are uncommon childhood injuries that can usually be successfully managed by standard immobilization techniques. However, scaphoid waist fractures are less frequent in children and may proceed to nonunion. The authors retrospectively reviewed the charts and radiographs of 19 adolescents with 20 scaphoid waist fractures that had required operative intervention for nonunion from January 1975 to December 2000.

Surgical management of chronic lateral ankle instability in adolescents.

Chronic lateral ankle instability in adolescents is an infrequent result of either an acute or recurrent ankle inversion injury. The majority of these patients improve with nonoperative management. Numerous surgical interventions have been proposed when nonoperative management is ineffective.

Multiple-level thoracolumbar burst fractures in teenaged patients.

The purpose of this study was to examine the characteristics of multiple-level burst fractures in teenaged patients. Five teenaged patients were identified with this injury pattern. The mean age at injury was 17.

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.

Simultaneous fracture of every cervical vertebra: a case study.

Study Design: The case of a 14-year-old boy who sustained simultaneous fractures of every cervical vertebra in a high-energy snowmobile accident is reported.

Objective: To describe a case of multiple cervical spine fractures and their management.

Summary Of Background Data: Injuries from all-terrain vehicles and off-road vehicles, including snowmobiles, are increasing in severity and frequency.

Cervical spine instability in children with Goldenhar's syndrome.

Objective: To study the vertebral involvement of the cervical spine, in particular the stability of C1-C2, in children with proven Goldenhar's syndrome.

Design: A case review.

Setting: The Children's Hospital of Eastern Ontario, Ottawa.

Complications of rigid intramedullary rodding of femoral shaft fractures in children.

Background: Intramedullary rodding of femoral shaft fractures has been frequently performed in adults, but until recently rarely in children. It was the purpose of this study to investigate the experience with this treatment method at a pediatric trauma center.

Methods: From 1987 to 1998, 54 children were treated for traumatic femoral fractures with intramedullary rods at a major pediatric trauma center.

Partial sleeve fractures of the tibia in children: an unusual fracture pattern.

Sleeve avulsion fractures of the patella are a well-recognized fracture pattern in children. Less appreciated is a similar fracture pattern involving the anterior metaphyseal area of the tibia. These metaphyseal sleeve fractures represent a fracture pattern characterized by the avulsion of a large area of periosteal attachment of the patellar tendon associated with small subchondral fragments of bone, encountered in skeletally immature children secondary to contraction of the quadriceps associated with forced knee flexion.