Frontal cephalometric analysis in the evaluation of facial asymmetry in torticollis, and outcomes of bipolar release in patients over 6 years of age.

BACKGROUND: The aim of this study was to investigate the mid-term results of bipolar release in congenital muscular torticollis patients over 6 years of age, and the efficacy of frontal cephalometric analysis in the determination and follow-up of facial asymmetry. METHODS: Twelve patients (9 boys, 3 girls) from 7 to 12 years of age were included in the study. Bipolar release was performed, followed by 5-7 days of traction and 3 months of physiotherapy. Posteroanterior cephalometric radiography was performed at the beginning of and after therapy. The postural symmetry angle (PSA) was used to determine the presence and severity of facial asymmetry. A modified version of Lee et al.'s system was used in evaluating the results. RESULTS: The average follow-up period was 3 years and 5 months. According to the congenital muscular torticollis evaluation system, the outcome was excellent in 2 of the patients, good in 6, fair in 2 and poor in 2. Asymmetry was not severe in all patients at the beginning of therapy according to PSA values, being insignificant in 2, mild in 6, and severe in 4. The PSA results of the last examination indicated that severe facial asymmetry persisted in 3 patients. In 2 of them, PSA values remained within the limits of severe asymmetry despite a slight angular correction. DISCUSSION: Congenital muscular torticollis patients can benefit from surgical treatment over the age of 6 years. Bipolar release is an adequate and complication-free method. Moreover, PSA may be used as an objective method in the determination and follow-up of facial asymmetry in torticollis patients.

Occurrence and treatment of nonunion in long bone fractures in children.

BACKGROUND: Because of favorable local biological factors, nonunion is rarely seen in long bone fractures in children, and there are few studies on pediatric nonunion in the literature. METHODS: Twenty-six children under 15 years of age diagnosed with long bone nonunion were examined, and 19 received treatment. Patients with pseudarthrosis due to tumors or congenital causes were excluded from the study. The following factors were assessed for each patient: age and sex; cause, location, and type of fracture; form of initial treatment; incidence of infection and type of bacteria produced; time between fracture and diagnosis; and type of nonunion. RESULTS: Twenty-two of the patients had fractures in the lower extremities, and 4 in the upper extremities. The femur was the most commonly affected bone (12 patients), followed by the tibia (10 patients). The average age of the patients was 9.6 years (range 1-15 years). The frequency of occurrence increased after the age of 6, and all patients but two were above this cutoff age. In each case, there was at least one factor contributing to nonunion, such as open reduction and insufficient fixation, open fracture, and infection. Of the 19 patients treated, 3 required reoperation. CONCLUSION: In our opinion, claims that pediatric nonunion is an extremely rare condition are exaggerated, and we do not agree that it is always due to an error in treatment. Nonunion does occur in children despite appropriate treatment, especially after the age of 6, and it may be resistant to therapy.