Zebra lines of pamidronate therapy in children.

BACKGROUND: Pamidronate therapy is increasingly used in children for the treatment of low bone mineral density and increased bone fragility resulting from a spectrum of conditions. The aim of the present study was to determine and describe the radiographic features associated with cyclical bisphosphonate therapy in the growing skeleton. METHODS: A retrospective review of the radiographs of thirty-five children who had been managed with cyclical pamidronate was carried out. The physeal growth rates were estimated by measuring the band intervals on radiographs and the corresponding time intervals between the administered doses of pamidronate. RESULTS: Metaphyseal bands, which we call zebra lines, were observed with band intervals that were dependent on the age of the patient, the rate of growth, and the dosing regimen. Epiphyseal and apophyseal bands were also observed in some patients. A distinction was made between Harris growth arrest lines and zebra lines. There was no evidence to suggest a deceleration in bone growth in children managed with pamidronate. CONCLUSIONS: The term zebra lines is proposed as a descriptive term for the characteristic pattern of metaphyseal banding seen on the radiographs of children receiving cyclical bisphosphonate therapy.

Volar lunate dislocation associated with a Salter-Harris Type III fracture of the distal radial epiphysis in an 8 year-old child.

Carpal fracture-dislocations in children are extremely rare injuries and are easily missed or misdiagnosed. An 8 year-old boy who presented with a volar lunate dislocation associated with a Salter Harris Type III injury of the distal radial epiphysis is reported. Open reduction without internal fixation followed by plaster immobilisation achieved good short-term results.

The risk of anterior cruciate ligament rupture with generalised joint laxity.

We assessed hyperextension of the knee and joint laxity in 169 consecutive patients who underwent an anterior cruciate ligament reconstruction between 2000 and 2002 and correlated this with a selected number of age- and gender-matched controls. In addition, the mechanism of injury in the majority of patients was documented. Joint laxity was present in 42.6% (72 of 169) of the patients and hyperextension of the knee in 78.7% (133 of 169). All patients with joint laxity had hyperextension of their knee. In the control group only 21.5% (14 of 65) had joint laxity and 37% (24 of 65) had hyperextension of the knee. Statistical analysis showed a significant correlation for these associations. We conclude that anterior cruciate ligament injury is more common in those with joint laxity and particularly so for those with hyperextension of the knee.

Unstable extra-articular fractures of the distal radius: a prospective, randomised study of immobilisation in a cast versus supplementary percutaneous pinning.

We performed a prospective, randomised study on 57 patients older than 60 years of age with unstable, extra-articular fractures of the distal radius to compare the outcome of immobilisation in a cast alone with that using supplementary, percutaneous pinning. Patients treated by percutaneous wires had a statistically significant improvement in dorsal angulation (mean 7 degrees), radial length (mean 3 mm) and radial inclination (mean 3 mm) at one year. However, there was no significant difference in functional outcome in terms of pain, range of movement, grip strength, activities of daily living and the SF-36 score except for an improved range of movement in ulnar deviation in the percutaneous wire group. One patient developed a pin-track infection which required removal of the wires at two weeks. We conclude that percutaneous pinning of unstable, extra-articular fractures of the distal radius provides only a marginal improvement in the radiological parameters compared with immobilisation in a cast alone. This does not correlate with an improved functional outcome in a low-demand, elderly population.