Delayed union of the distal ulna in a child after both bone forearm fracture.

Fractures of the distal third of the forearm are common in children. These fractures are known to heal readily and rapidly. We describe a 10-year-old boy who had a closed, low-energy fracture of the distal radius and ulna. The radius healed promptly, but the ipsilateral ulna had radiographic evidence of delayed union. We have not found a report of a nonunion of this kind in the literature. With the increasing use of internal fixation and the lack of guidance in the literature, we questioned the standard use of closed treatment. We treated this patient nonoperatively, despite the delay in union, and the fracture healed in 4 months.

Compression (Salter-Harris Type V) physeal fracture: an experimental model in the rat.

Histologic evidence of damage to the proximal tibial physis of immature rats was documented in greater than 30% of hind limbs subjected to a valgus and compressive force. The lesion was consistent with that theorized for the Salter-Harris Type V fracture. Two additional groups of immature rats were subjected to the same insult and followed to maturity. One of the groups sustained an intentional concomitant ipsilateral femoral shaft fracture. No tibia demonstrated a growth disturbance in the absence of the femoral fracture, while similar angular deformities were noted in four tibiae (13%) in the presence of a fractured femur. Previously theorized traumatic physeal injuries, implicated in subsequent growth disturbances and seen clinically in association with ipsilateral long bone fractures, were identified in this animal study.

Treatment of the unstable intertrochanteric fracture. Effect of the placement of the screw, its angle of insertion, and osteotomy.

We created unstable intertrochanteric fractures with a large posteromedial defect in eighteen pairs of fresh-frozen femora from cadavera, and used the femora to evaluate the stability of six combinations of treatment with sliding compression screws and sideplates. The variables that were tested were high (150-degree) angle plates compared with low (130-degree) angle plates, the position of the lag-screw in the femoral head and neck (in the center of the head as seen on both anteroposterior and lateral roentgenograms compared with posteroinferiorly), and whether or not medial cortical contact had been re-established with a limited osteotomy of the greater trochanter. The femora were loaded to the point of failure. The mode of failure, maximum load to failure, and bending rigidity of each method of fixation were measured. Of the six types of treatment, the use of a 150-degree-angle plate, position of the lag-screw in the center of the head as seen on both anteroposterior and lateral roentgenograms, and osteotomy of the greater trochanter resulted in the highest mean load to failure and the greatest rigidity. Over-all, re-establishment of medial cortical contact by means of an osteotomy of the greater trochanter significantly improved the mean load to failure and the rigidity of the fixation. The higher-angle plate, although more difficult to insert, increased the mean load to failure but had no effect on rigidity. The position of the lag-screw (in the center of the head as seen on both anteroposterior and lateral roentgenograms or posteroinferiorly) had no bearing on the mean load to failure, but it significantly affected the mode of failure.

Hip pain in three children accompanied by transient abnormal findings on MR images.

In a study of three children experiencing hip pain, low-signal-intensity patterns in the femoral head on T1-weighted magnetic resonance (MR) images eventually resolved, reverting to the normal signal patterns. These findings occurred in conjunction with documented clinical improvement of the patients' condition. T2-weighted images revealed isointense signals initially at the abnormal sites. Isointense signals prevailed on follow-up T2-weighted images. These MR imaging findings are likely due to transient bone marrow edema. These findings support the apparent sensitivity of MR imaging in the evaluation of marrow-based pathologic processes. Some pediatric patients with hip pain may have signs of transient bone marrow edema, rather than avascular necrosis, on MR images. Conservative management should be considered in such cases.

Septic arthritis: process, etiology, treatment outcome. A literature review.

Septic arthritis is a serious infection that can lead to truly devastating complications. The key to minimizing irreversible damage is rapid initiation of treatment. The best results are obtained when treatment is instituted within 1 week of the onset of symptoms. Effective treatment involves antibiotics, joint drainage and decompression, and immobilization followed by rehabilitation of the affected joint. The best choice of empiric antibiotics can be made by considering the patient's age, the synovial fluid gram stain results, and any preexisting conditions (eg, alcoholism, hypogammaglobulinemia). An episode of septic arthritis requires long-term follow up to check for relapses and to assess the outcome of any residual joint damage.

Osteoid osteoma of the femoral neck stimulating an inflammatory synovitis.

The case report presents a nine-year-old child with an osteoid osteoma of the femoral neck, simulating an inflammatory synovitis. Osteoid osteoma is a common benign bone tumor. However, when intracapsular lesions occur they may pose a diagnostic challenge. Nonspecific clinical signs and symptoms, such as inflammatory synovitis, joint effusion, and soft tissue swelling, may pose a problem in diagnosis and treatment. The delay in diagnosis can range from six months to two years. When the hip is involved, the patient may have nonspecific pain, limp, restricted motion, and thigh atrophy. An accurate diagnosis may be difficult to elicit, requiring detailed history and physical examination and culminating in the use of computed tomography.

Disappearing bone disease: a case report and review of the literature.

Disappearing bone disease is a rare condition manifested by massive osteolysis. Its etiology is unknown. Histologically, involved bones show a nonmalignant proliferation of thin-walled vessels. The mechanism of bone absorption remains unclear. No treatment has proven effective in arresting the disease. Cases in which there is extraosseous involvement have a much poorer prognosis.