Magnetic resonance-guided growth plate bone bridge resection at 0.23 Tesla: report of a novel technique.

BACKGROUND: Growth plate or physeal cartilage trauma may result in delayed or immediate failure of growth due to bone bridge formation at the insult site. With computed tomography (CT) and magnetic resonance imaging (MRI), the role of imaging has expanded from diagnosis to treatment planning and therapy guidance. PURPOSE: To describe a technique for MR-guided growth plate bone bridge resection and to evaluate feasibility of the procedure. MATERIAL AND METHODS: Three consecutive patients with growth plate bone bridges were treated surgically under MR guidance. All bridges were detected with prior MRI and radiographs. All patients were referred to procedure due to growth plate bridge associated growth anomaly and pertaining clinical symptoms. The effect of the treatment was evaluated after 48 months with a clinical follow-up. RESULTS: All bridges were successfully detected, marked, and removed under MRI guidance. All patients had relief from their symptoms. Two patients had lasting results from the operation with no further operative treatment needed or scheduled at 48 months from primary treatment. There was one clinical failure, with the patient requiring repeated osteotomies. CONCLUSION: We have successfully implemented a novel therapy for growth plate bridge resection.

Lateral release and proximal realignment for patellofemoral malalignment. A prospective study of 40 knees in 36 adolescents followed for 1-8 years.

We performed lateral release and proximal realignment for painful patellofemoral malalignment in 36 adolescents (40 knees), with a mean age of 14 (9-16) years. The mean follow-up was 4 (1-8) years. The subjective outcome was excellent in 20 knees, good in 13, fair in 5, and poor in 2. The mean radiographic correction of the lateral patellar shift was 75%, and of the tilting angle of the patellar 27%. There was a positive association between the realignment effect and the subjective outcome.

Axial radiography or CT in the measurement of patellofemoral malalignment indices in children and adolescents?

The present study compares the repeatability of patellofemoral malalignment (PFM) indices obtained by 20 degree flexion axial radiography (AR) and computerized tomography (CT) with 0 degree and 20 degree flexion of the knees in children and adolescents. Thirty-one patients with a mean age of 14.2 years (range 8 to 19.2 years) suffering from PFM were examined using these two radiographic techniques. The lateral patellofemoral angle (LPA), the lateral patellar tilt (LPT), and the lateral patellar displacement (LPD) were measured by by two different investigators on different occasions, and the agreement of these indices between CT and AR was evaluated according to Bland and Altman's statistical method. LPT and LPD obtained by AR were more reliable and repeatable than those obtained by CT. The quadriceps muscle contraction exacerbates PFM indices significantly with the knees in full extension (P = 0.0001). LPT and LPD measured at 20 degrees AR show reliably the two pathological components (the patellar tilt and the lateral patellar displacement) of PFM which are necessary for diagnosis and treatment planning. CT with quadriceps contractions is better in qualitative screening of more subtle cases of PFM.

Arthroscopy in the diagnostics and treatment of non-acute knee disorders in children.

199 arthroscopies were performed on children with non-acute knee problems during 1985-1992 at the University Hospital of Oulu (76 boys and 123 girls). The mean age was 13 (2-15) years. The ratio between boys and girls was 1:1.6 showing the incidence among girls to be greater. The mean duration of symptoms was 16 (0.3-96) months before the arthroscopy. Major diagnostic groups were plica syndrome (43 cases), malalignment of the patella (29 cases), osteochondritis dissecans (28 cases) and arthritis of the knee (28 cases). The accuracy of clinical diagnosis was 47% in preadolescents and 51% in adolescents. Operations were performed arthroscopically in 71 cases, by open arthrotomy in 15 and by other extra-articular operations in 39. These children were followed until no further treatment was needed. The mean follow-up time was 4 years and 6 months (20-97 months). A total of 172 (87%) patients needed no further treatment, while 27 (13%) children were rearthroscopied and a reoperation was performed on 15 of these.

Prevalence of chronic knee pain in children and adolescents in northern Finland.

A questionnaire was sent to 967 schoolchildren, in two age groups, in northern Finland in order to investigate the prevalence of chronic knee pain. A response rate of 88.5% was achieved. Adolescents (aged 14-15 years) had significantly more knee pain (p < 0.0001) than children (aged 9-10 years). The total prevalence of chronic knee pain at the time of the evaluation was 18.5% among adolescents and 3.9% among children. There was no significant difference in the prevalence of chronic knee pain between boys and girls in these age groups. Overweight was not a predisposing factor in chronic knee pain.

Operative realignment of patellar malalignment in children.

Realignment operations were performed on 57 knees to correct patellar malalignment in children between 1985 and 1991. Three different operative techniques were used: the lateral release, the lateral release and medial reefment, and the Roux-Goldthwait patellar tendon transposition. Roentgenographic values were measured before and after the operation by Laurin's method. The mean follow-up time was 4 years 2 months, after which 20 knees were excellent, 20 good, 11 fair, and six poor, according to Insall's criteria. The effect of the operation on pathological roentgenographic values was obvious, and the malalignment of the patella was in most cases corrected. There are differences in the improvement effected by these three techniques. The lateral release and medial reefment correct the patellar tilt most effectively, and the Roux-Goldthwait operation, the lateral patellar deviation. The lateral release seems to be the appropriate technique for mild malalignment.

Technical report: radiological evaluation of patellar malalignment using a new frame for axial imaging of the patellae.

Axial radiographs were performed on 59 children and adolescent patients with patellar malalignment using the method described by Laurin. A special frame was used to keep the knees in 20 degrees flexion and to maintain standard conditions. Radiological indices were measured before realignment surgery. A statistically significant difference (P < 0.0001) in the lateral patellofemoral angle was observed comparing malaligned and control patellae. Laurin's technique using a special frame provides a method of obtaining standard radiological measurements of patellar malalignment for use in surgical planning.

Arthroscopy of the acute traumatic knee in children. Prospective study of 138 cases.

We performed diagnostic arthroscopy for acute knee trauma in 138 children and adolescents aged 13 (1-15) years. The compatibility between the clinical examination and the arthroscopic findings was 59 percent. Ligament injuries were found in 32 cases, 14 of which had rupture of the anterior cruciate ligament. The compatibility in the case of ligament injuries was 31 percent. 48 patients had dislocation of the patella, and a displaced osteochondral fragment was seen in 19, 14 of which were radiographically silent. In 37 cases of distortion of the knee a correct diagnosis would have been missed unless arthroscopy had been performed. Arthroscopy is therefore indicated in children with severe distortion of the knee, hemarthrosis and with dislocation of the patella.

Treatment of penile incarceration by the string method: 2 case reports.

We report 2 cases of penile incarceration in a 10-year-old boy and a 40-year-old man. In both cases the penis was encircled by a metallic object. The string method described was successful, rapid, atraumatic and simple to use.

Effect of cholestyramine on acute diarrhoea in children receiving rapid oral rehydration and full feedings.

Cholestyramine 2 g twice daily for 3 days was compared to an equivalent placebo in a randomized double-blind study of infants hospitalized for acute diarrhoea. All the patients received oral rehydration with the WHO solution, and full feedings were reintroduced after 6-10 hours' rehydration. Cholestyramine therapy, initiated at the time of feedings, significantly shortened the duration of watery diarrhoea (0.8 +/- 0.6 vs. 2.3 +/- 1.6 days, p less than 0.005), although it did not significantly reduce the total stool volume. No adverse effects were associated with cholestyramine treatment. It is concluded that diarrhoea patients treated according to the present WHO guidelines may benefit from short adjunct therapy with cholestyramine.