ABSTRACT
A series of 29 subtrochanteric femoral fractures in children and adolescents treated during the last twenty years is presented. Primary osteosynthesis was done in five, secondary osteosynthesis in eleven patients. Ten patients were treated by an unilateral external fixator, two by a DC-plate, two by intramedullary nails, one by a Rushpin and one by cerclage wires. There were no deep infections. 13 patients were treated conservatively. Axial deviations resulted from conservative therapy in 9 of 11 patients, from osteosynthesis in one of 15 patients. One third of both series showed rotatory malalignment. Spontaneous corrections of axial deviations during growth can only be expected in small children to a small amount. In the average, operatively treated children had a positive leg length difference of one to two centimeters, whereas conservative treatment mostly resulted in equal leg lengths, but few patients showed differences from -4cm to +1 cm. Rotation and leg length seem to be more important for the clinical outcome than axial deviations of less than 20 degrees. Except in cases of severe concomitant injuries subtrochanteric fractures of the femur do not present an indication for primary osteosynthesis. If fracture reduction is not achieved by conservative means during the first four days osteosynthesis by DC-plates is recommended.
Subject(s)
Bone Plates , Growth , Hip Fractures/therapy , Adolescent , Casts, Surgical , Child , Child, Preschool , Female , Follow-Up Studies , Hip Fractures/diagnostic imaging , Hip Fractures/physiopathology , Humans , Leg Length Inequality/etiology , Male , Radiography , Retrospective Studies , Wound HealingSubject(s)
Femoral Neck Fractures/surgery , Fracture Fixation, Internal/methods , Adolescent , Child , Child, Preschool , Humans , Infant , Prognosis , Wound HealingSubject(s)
Acromioclavicular Joint/surgery , Joint Dislocations/surgery , Acromioclavicular Joint/injuries , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Methods , Middle Aged , Orthopedic Fixation DevicesABSTRACT
This study was undertaken in order to assess the clinical and immunological consequences of splenectomy for traumatic reasons in childhood. Immunological testing of 22 persons 1 to 20 years subsequent to removal of the spleen for traumatic rupture between the ages of 3 and 6 revealed diminished or absent agglutinins in 10 cases and diminished or absent opsonins to E. coli in 16 cases. All patients were in good health and no clinical evidence of increased susceptibility to severe infections was found postoperatively. It is, therefore, assumed that the diagnosed defects had been compensated for by other immunological mechanisms. In contrast to the opinions of other authors, it is concluded that splenectomy in childhood between the ages of 3 and 6 does not appear to carry greater risks than in later years.
