ABSTRACT
This study was designed to determine whether prophylactic pinning of the unaffected hip in unilateral slipped capital femoral epiphysis affects the proximal femoral morphology. Twenty-four hips prophylactically pinned were compared with 26 cases observed. The articulotrochanteric distance (ATD) and the trochanteric-trochanteric distance (TTD) were measured. Postoperative radiographs were compared with final follow-up radiographs. The final TTD : ATD ratio was higher (P=0.048) in the pinned group, suggesting relative coxa vara/breva. There was a smaller difference between the two hips in the prophylactically pinned group (0.7) as opposed to those observed (1.47). Prophylactic pinning does not cause growth to stop immediately but alters the proximal femoral morphology.
Subject(s)
Femur Head/diagnostic imaging , Femur Head/surgery , Pelvic Bones/surgery , Prophylactic Surgical Procedures/methods , Slipped Capital Femoral Epiphyses/diagnostic imaging , Slipped Capital Femoral Epiphyses/surgery , Adolescent , Bone Nails , Child , Female , Humans , Male , Prophylactic Surgical Procedures/instrumentation , Treatment OutcomeABSTRACT
Childhood discitis is rare, can be difficult to diagnose and it is unclear whether it is an infective or simply an inflammatory process. A departmental database search of 46 434 patients identified 12 cases from 1990-2008. The mean time to diagnosis from onset was 22 days. The children usually present with altered gait, a normal infection screen (temperature, white cell count, C-reactive protein, blood cultures) and radiographic loss of intervertebral disc height. Antibiotics were given in 11 cases and but no immobilization was used. Symptoms resolved by a mean of 6.5 weeks with no recurrence. This study highlights the unusual features of this rare condition which should be confirmed with MRI scanning.
Subject(s)
Databases, Factual , Discitis/diagnosis , Hospitals, Pediatric/statistics & numerical data , Adolescent , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Discitis/complications , Discitis/drug therapy , Discitis/physiopathology , Female , Gait , Humans , Infant , Intervertebral Disc/diagnostic imaging , Intervertebral Disc/pathology , Joints/pathology , Joints/physiopathology , Magnetic Resonance Imaging , Male , Radiography , Range of Motion, Articular , Remission Induction , Time Factors , Treatment OutcomeABSTRACT
The classical Monteggia injury comprises a dislocation of the radial head with an associated fracture of the ulna. In the variant type, there is no ulnar fracture merely plastic deformation. We performed a retrospective study of all Monteggia injuries from 1992 to 2001. A total of 39 were reviewed, of which 8 were missed (1 classical and 7 variant). Of those, five were male and three female with a mean age of 6.3 years. The mean follow-up was 2.5 years, with a mean interval between injury and diagnosis of 33.5 weeks. Two Monteggia injuries diagnosed within 4 weeks were successfully treated by closed manipulation. The other six required ulnar osteotomy, repair of the annular ligament and stabilisation of the radial head with a transcapitellar pin. A protocol for the diagnosis of Monteggia injuries is described. Doubtful cases require an immediate review since early treatment improves the outcome. Acceptable clinical and radiological results in late diagnosed Monteggia injuries can result from ulnar osteotomy, open reduction of the radial head with repair of the annular ligament and transcapitellar pin stabilisation of the reduced radial head.
