Fractures of the humerus in the neonatal period.

BACKGROUND: Fractures of the humerus in neonates can pose a diagnostic challenge, especially when the fracture occurs in the proximal or distal epiphysis. OBJECTIVES: To review our experience in the diagnosis and treatment of birth-related humeral fractures. METHODS: Between the years 2001 and 2009, seven newborn patients and two patients treated in the neonatal intensive care unit sustained a fracture of the humerus. Four of the fractures occurred in the humeral shaft, three in the proximal epiphysis and two in the distal epiphysis. In all the newborn patients the diagnosis was made on the first day of life using radiography and ultrasonography. The fractures of the shaft and of the distal epiphysis were treated by gentle manipulation and casting, and the fractures of the proximal epiphysis were treated by swaddling. RESULTS: All of the patients demonstrated fracture union within 2 weeks, and radiographs at the age of 6 months demonstrated complete remodeling of the fracture. CONCLUSIONS: Ultrasonography is a simple, readily available and inexpensive modality for the diagnosis of birth-related fractures of the humerus, especially in the yet unossified epiphyses.

Treatment duration of developmental dysplasia of the hip: age and sonography.

We retrospectively assessed babies treated according to Pavlik's method and followed up in our outpatient clinic between the years 2001 and 2005, investigating the influence of age at onset of treatment and severity of sonographic pathologies on the rates of avascular necrosis and treatment duration of 343 pathological hips in 311 neonates. No osteonecrosis was observed at the 1-year follow-up. Early detection of developmental dysplasia of the hip and early initiation of treatment using Pavlik's method are important in preventing osteonecrosis, and have high success rates. When using Pavlik's method for treating developmental dysplasia of the hip, starting treatment at 13 weeks and later increases the duration of treatment.

[Cerebral palsy: classification and etiology]. / Beyin felci: Siniflama ve etyoloji.

Cerebral palsy (CP), a common condition of abnormalities in the brain, arises early in life. Since the term was first introduced in 1843, many authors have tried to define and classify CP. The most recent definition was released by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) in 2005. This article summarizes the latest and familiar classifications of, and etiologies associated with CP.

Iliopsoas tenotomy at the lesser trochanter versus at the pelvic brim in ambulatory children with cerebral palsy.

BACKGROUND: Progressive hip flexion deformity is a common problem in ambulatory children with spastic cerebral palsy, causing static and dynamic deformity. The iliopsoas muscle is recognized as a major deforming force in the development of this problem. Many clinicians address this problem by lengthening the iliopsoas, either in an intramuscular location at the pelvic brim or by complete tenotomy at the lesser trochanter. The goal of this study was to compare the outcomes of patients with ambulatory cerebral palsy who had intramuscular lengthening at the pelvic brim to those who underwent complete release of the iliopsoas tendon at the level of the lesser trochanter. METHODS: Twenty patients were included in the study, 11 of whom had iliopsoas release at the lesser trochanter (group 1) and 9 of whom had intramuscular lengthening at the pelvic brim (group 2). All patients had physical examinations, plus kinematic and kinetic analyses in our gait laboratory before and 1 year after surgery. RESULTS: Hip flexion contracture was decreased significantly only in group 1, although there was a trend of decrease in group 2. There was a significant increase in maximum hip extension in terminal stance and a reciprocal decrease in maximum swing phase hip flexion in group 1, with a similar trend that did not reach significance in group 2. Stride length increased significantly in both groups. There was no significant change in power generation of hip flexion during the swing phase in either group. CONCLUSIONS: We found improved static and dynamic parameters of hip extension after iliopsoas lengthening and did not detect any adverse kinematic or kinetic change in hip function after surgery. The improvement was more robust in the group who underwent release at the lesser trochanter. Because there are no adverse effects of iliopsoas release from the lesser trochanter and the improvement in hip extension is greater, this approach should be considered in ambulatory patients with spastic diplegia when a hip flexor weakening procedure is considered. LEVEL OF EVIDENCE: Comparative cohort study, level III, case-control study.

Achilles tendon length in children evaluated sonographically.

The purpose of this study was to improve our knowledge of the behavior of the Achilles tendon as a basis for decision-making in Achilles lengthening or tenotomy, we sonographically measured the normal and club feet of 101 babies, mean age 4 months, in standard parameters: tibio-talo-calcaneal angle, length of Achilles tendon, distance from tibia to calcaneus, and distance from a line parallel to the posterior cortex of the tibia to the calcaneus. All measurements were age-matched from birth to 1 year in maximal plantar and dorsal flexion. In conclusion, we describe the normal values for the four parameters in plantar and dorsal flexion. These can serve as a basis for decision-making in clubfoot management.