Patient-controlled versus conventional analgesia for postsurgical pain relief in adolescents.

We performed a randomized nonblinded, cross-over comparison of patient-controlled analgesia (PCA) with conventional intramuscular analgesia in 10 adolescents (13-18 years) undergoing spinal fusion for idiopathic scoliosis. PCA use afforded more effective pain control (p < 0.02) on a 10-point linear pain intensity scale than did intramuscular injections, while causing an equal amount of sedation and no side effects. PCA appears to be a promising technique for providing postoperative pain relief in this group of adolescents. Further studies are needed to define its role for other pediatric conditions.

Bone mass in healthy children: measurement with quantitative DXA.

Dual-energy x-ray bone densitometry was used to study the lumbar vertebral bone mass in 218 healthy children (134 girls and 84 boys) aged 1-19 years. Vertebral bone mass increased with weight, age, and pubertal Tanner stage. Results of multiple regression analyses showed that Tanner stage and weight were the best predictive indicators of bone mass and bone mineral density. The influences of age, sex, race, physical activity, and diet were not significant when Tanner stage and weight were controlled. Two tables of predictive intervals for lumbar vertebral bone mineral density in healthy children (one based on Tanner stage and weight; the other, on age and weight) are presented. With normative data now available for use with this precise technique, clinicians can better detect abnormal bone mineral density in children and evaluate changes in mineralization over time.

Musculoskeletal problems in association with cloacal exstrophy.

The records of all thirteen patients for whom a diagnosis of cloacal exstrophy had been recorded in our hospitals were analyzed for evidence of musculoskeletal problems. All thirteen patients had spina bifida, four had congenital scoliosis, two had congenital kyphosis, and three had non-congenital scoliosis. All had a lipomeningocele, and eleven had paralysis of the lower extremities. Hydrocephalus and its associated problems were not found, but tethered-cord syndrome was diagnosed in eleven patients. Persistent diastasis of the symphysis pubis was found in all patients. Abduction and external rotation of the hips were more than normal. Mild dysplasia was seen in six of the twenty-six hips. Deformities of the foot were common, and twelve feet had been operated on for correction. Recurrent equinovarus deformity of the foot was associated with tethered-cord syndrome in two patients.

Streptococcal toxic shocklike syndrome leading to bilateral lower extremity compartment syndrome and renal failure. Report of a case.

Compartment syndrome is considered a true emergency in orthopedic practice. To reduce morbidity and mortality from this condition, prompt diagnosis and appropriate treatment are absolutely essential. An unusual bilateral lower extremity compartment syndrome leading to renal failure and crush syndrome occurred in a 13-year-old girl with Streptococcal toxic shocklike syndrome. This situation seems not to have been previously reported. Early diagnosis and expeditious treatment produced minimal sequelae of the condition.

Comparative review of surgical treatment of the idiopathic clubfoot by three different procedures at Columbus Children's Hospital.

Ninety-nine feet in 54 children were both clinically and roentgenographically evaluated following one of three different procedures of soft tissue clubfoot release. A new rating system that weights dynamic functional results more heavily was used to compare results. Roentgenographic complications included both over- and undercorrection at the talonavicular articulation, avascular necrosis of the talus, navicular, and calcaneus, and talar dome flattening. Recommendations concerning technical aspects of operative approach to clubfeet include (a) more physiologic orientation of the bimalleolar axis, (b) anatomic alignment at the talonavicular joint, and (c) use of the hinged ankle cast brace to increase final ankle range of motion (ROM).

Pediatric orthopedic surgery during the residency--too much, too little?

Questionnaires sent to chairpersons of orthopedic surgery residency programs and to private practitioners were analyzed to determine how training in children's orthopedics is accomplished, to define which procedures should be taught to residents, and to describe what the private practitioner perceives as appropriate education in children's orthopedics. The amount of time spent on children's orthopedics is adequate by present standards. For most procedures, the residency directors and private practitioners were in agreement concerning what was appropriate to teach. Education during the residency continues to be the most important resource used by the practicing orthopedic surgeon in pediatric problems.