Arthroscopic synovectomy in children and adolescents with hemophilia.

PURPOSE: To retrospectively review the authors' institutional experience with arthroscopic synovectomy in young patients with hemophilia. PATIENTS AND METHODS: Patients with moderate or severe hemophilia seen in the authors' center were eligible to undergo synovectomy if they developed subacute or chronic synovitis that did not improve with prophylactic factor replacement. A single orthopedic surgeon performed all procedures. Each patient received aggressive physical rehabilitation and regular factor replacement for 6 weeks following surgery. Outcome data regarding the frequency of bleeding and range of motion were evaluated. RESULTS: Twenty-eight arthroscopic synovectomies (11 knees, 12 ankles, 5 elbows) were performed on 26 joints in 20 hemophilia patients between November 1992 and May 2002. There were no intraoperative complications. One patient developed hemarthrosis 1 week postoperatively and another had a soft tissue hematoma at the incision site. Two patients required a second procedure on the same joint because of trauma that occurred 2 months following surgery. Follow-up data were available on 26 joints during the first year after the procedure. The frequency of hemarthrosis diminished significantly in that first year and was maintained for up to 5 years in all but three joints. Seventy-six percent of evaluable patients (19/25) had stable or improved joint function at their most recent comprehensive clinic visit. Patients whose range of motion worsened were older and required more than one procedure. CONCLUSIONS: Arthroscopic synovectomy significantly reduces hemorrhage into the index joint and allows for stabilization of joint range of motion. This procedure should be considered in young hemophilia patients with chronic synovitis.

The hidden dangers of winter sliding.

One of the irresistible allures of freshly fallen snow is the urge to flop onto the ground and slide downhill. Generations of families have been coming together to go sledding for centuries. Unfortunately, this perceived innocuous activity has predictable injury patterns, many of which are preventable with minimal effort or expense. Catastrophic injuries, not infrequently involving younger children, also seem to be preventable with education of the parents and the general public. The current authors reviewed the available literature on sledding injuries and summarized the findings on injury patterns and the recommendations on injury prevention. Proposals for injury prevention and public education, several of which have been designed by national interest groups, are included.

Teenage driver safety: should graduated drivers licensing be universal?

The number of motor vehicle deaths has decreased significantly in the last quarter century. However, there remain a disproportionate number of automobile crashes involving teenage drivers. Studies have shown these accidents are related to several, possibly behavioral, factors, including driver error, speeding, and increasing numbers of passengers. The injuries and fatalities also involve a disproportionate number of teenage passengers. A three-stage Graduated Drivers Licensure process has been adopted by 34 states to try to address this potentially preventable problem. The Graduated Drivers Licensure involves a very well-supervised permit period, a lengthened provisional period that includes advanced drivers' education and supervised practice, and finally a full license. Studies from Maryland, California, Oregon, Florida, Michigan, North Carolina, and Kentucky have shown significant decreases in the crash rates among teenage drivers. The Graduated Drivers Licensure, if adopted as a national standard, may be effective in decreasing the toll of teenage driving accidents.