Osteomyelitis of the calcaneus in children.

Eleven cases of calcaneal osteomyelitis in children are reported. Seven were hematogenous cases, and the remaining four were related to puncture wounds. The clinical presentation was less dramatic than that seen in typical long bone osteomyelitis. Laboratory findings were also less striking. A mixture of organisms was isolated from patients in the hematogenous group. In contrast, all puncture-related cases had cultures positive for Pseudomonas aeruginosa. Plain radiographic findings were noted at the time of presentation in 63%. Those findings were characteristically different in hematogenous and puncture-related cases. Oblique lateral radiographs can be important for diagnosis in puncture-related cases. Radionuclide bone scanning was an important diagnostic test in the absence of plain radiographic changes and in the very young patient. Surgery was performed in 82% of the cases. There were no recurrences or chronic infections. Two complications occurred in one patient, including residual scar sensitivity and early fusion of the calcaneal apophysis.

Lawn mower injuries of the pediatric foot and ankle: observations on prevention and management.

We reviewed 32 children with lower extremity injuries caused by power lawn mowers. Functional outcome of 21 patients was evaluated. Anatomical injury patterns provide some guidelines in management and prediction of functional outcome. Consistently, the most severe injuries result from ride-on mowers and wounds to the posterior/plantar foot and ankle. Our experience with pediatric foot and ankle lawn mower injuries permits recommendations for maximum functional outcome with minimal intervention. Public awareness and mower safety devices may be required to decrease the rate of accidents in the future.

A comparison of Wisconsin instrumentation and Cotrel-Dubousset instrumentation.

Twenty-six patients who underwent Wisconsin instrumentation and 36 patients who underwent Cotrel-Dubousset instrumentation (CDI) for idiopathic scoliosis were studied. Inclusion in the study required at least 24-month follow-up. Variables compared included operating time, blood loss, frontal plane correction, axial and sagittal plane changes, effects on compensation, and complications. In general, operating time, blood loss, and instrumentation problems were greater with CDI. Thoracic curve correction in King II curves was better with CDI. There was no advantage to either system with respect to sagittal plane alignment or rotation. When all factors were considered, a significant advantage to use of CDI could not be demonstrated.

Is pinning in situ a safe procedure for slipped capital femoral epiphysis?

This report reviews the results of 37 patients with 46 involved hips treated with pinning for slipped capital femoral epiphysis. Particular attention was given to incidence of complications, including avascular necrosis, chondrolysis, and penetration of the joint. Of 46 hips with 1-year follow-up, there were no cases of chondrolysis. Of 23 hips with 2-year follow-up, there was only 1 case of avascular necrosis. Pin penetration, recognized at the time of surgery, produced no significant sequelae. Pinning can produce satisfactory results without a significant incidence of major complication.

Percutaneous screw fixation of intercondylar fracture of the distal humerus.

A greenstick intercondylar fracture of the distal humerus occurred in a 13-year-old boy. The articular surface of the trochlea was diastased nearly 5 mm. The fracture was reduced and fixed percutaneously using a 4.5-mm cannulated screw from a lateral approach.

Roentgenographic evaluation of lumbar spine flexion-extension in asymptomatic individuals.

An experimental clinical study of angulatory and translational lumbar spine intervertebral motion was performed using flexion-extension radiographs obtained in the lateral plane. These "bending" films were obtained from 59 asymptomatic individuals undergoing routine pre-employment examination. Results indicate that there is 7 to 14 degrees of angulatory motion present in the lumbar spine but a large range of values exist so that norms of angulatory motion cannot be more precisely defined. There are 2 to 3 mm of translational motion present in the lumbar spine at each intervertebral level. Twenty percent of this study's asymptomatic subjects had 4 mm or more translational motion at the L4-5 interspace and at least 10% had 3 mm or greater motion at all levels except L5-S1. These results challenge conclusions based on earlier studies and call into question the use of lumbar flexion-extension bending films as a primary determinant of lumbar segmental stability.

Clinical and radiological evaluation of lumbosacral motion below fusion levels in idiopathic scoliosis.

The purpose of this study was to evaluate the unfused segments of the lumbar spine in patients who had Harrington instrumentation and fusion for idiopathic scoliosis. Forty-eight patients, with an average follow-up of 11 years, were evaluated. The translational motion in the unfused segments below the instrumented levels was measured, using lateral flexion and extension radiographs of the lumbar spine. This motion was compared with values obtained from an earlier study of asymptomatic nonscoliotic individuals. The amount of disc space narrowing, retrolisthesis, length and level of the fusion, and the presence of traction spurs also were recorded. The incidence of low-back pain was highest in those patients fused to L4 (62%). Individuals instrumented and fused to L3 or L4 had significantly more translational motion in the adjacent lower interspace when compared with the control group (P = 0.05 and P = 0.001, respectively). Increased translational motion correlated with the presence of low-back pain in patients fused to L4. Retrolisthesis occurred in 81% of patients instrumented to L4, in 40% of those fused to L3, and was not found in patients fused to high levels. Its presence was strongly associated with low-back pain. There was no relationship between low-back pain and traction spurs, length of the fusion mass, lumbar lordosis, or width of the disc space in the unfused lower levels. The authors conclude that retrolisthesis and increased translational motion are important factors in determining low-back pain following surgery for idiopathic scoliosis. Instrumentation to L4 should be avoided if possible.

Teratologic dislocation of the hip.

We reviewed 27 teratologic hip dislocations in 17 patients. Four hips underwent closed reduction, 10 hips had medial adductor open reduction, 9 hips had iliofemoral open reduction, and 4 hips had iliofemoral open reduction and femoral shortening. Avascular necrosis occurred in 48%, redislocation in 19%, and subluxation in 22% of the hips. Results were best in those hips treated by anterior open reduction and femoral shortening and worst in those having closed reduction. Poor results correlated with multiple other involved joints, hypotonia, developmental delay, and poor head control.