Follow-up study of arthroscopic reduction and fixation of type III tibial-eminence fractures.

UNLABELLED: Nine children (average age, 13.1 years) with 10 displaced type III tibial-eminence fractures were reviewed with an average follow-up of 3.5 years. The fractures were treated with arthroscope-assisted reduction and suture fixation. Nine of the 10 knees demonstrated meniscal interposition at the fracture site that contributed to unsuccessful closed reduction. At follow-up, subjective knee function was excellent in all cases, and no clinical or objective evidence of knee laxity or instability was detected in any patient. All patients demonstrated full range of motion of the affected knee compared with the contralateral side. CLINICAL SIGNIFICANCE: Arthroscopic reduction and fixation allow early mobilization; assists in defining and treating associated knee pathology; assists in fracture reduction; and reduces the morbidity associated with arthrotomy.

An arthroscopic technique for the reduction and fixation of tibial-eminence fractures.

A technique of arthroscopic reduction and fixation of type III tibial-eminence fractures is described. After reduction of the fracture, polyglactin (Vicryl) suture was passed into the knee with the use of the arthroscope to fix the fracture. Early mobilization of the patients was begun after 2 weeks. Two patients (aged 10 and 13 years old), with 2 years follow-up after treatment of their fracture with this technique, had full range of motion of the knee with no sign of instability. Arthroscopic reduction and fixation of type III tibial-eminence fractures is a technique that can reduce hospital stay, rehabilitation, and the morbidity associated with the use of an arthrotomy for treatment.

Magnetic resonance imaging in acute physeal injuries.

Magnetic resonance imaging (MRI) permits noninvasive evaluation of the cartilage of the growth plate and epiphysis. This paper reports three cases where MRI was used to supplement conventional radiography in the assessment of acute physeal injuries. In the first patient, MRI was used for postoperative assessment of a radial neck fracture, avoiding further surgical exploration. In the second case, MRI was compared with ultrasonography in the diagnosis of proximal humeral epiphyseal separation in a neonate. In the third case MRI and computed tomography were compared in evaluation of a Salter-Harris type 4 distal femur fracture. In all cases MRI was diagnostic. MRI is the investigation of choice in acute complex physeal injuries, and is particularly appropriate for use prior to the appearance of the secondary ossification center.

Biodegradation of polydioxanone in bone tissue: effect on the epiphyseal plate in immature rabbits.

Implants of polydioxanone (PDS), 1.3 mm in diameter, were operatively fixed in the juxta-epiphyseal area of the right proximal tibial metaphysis in six rabbits and were driven into a drill hole of equal bore through the right proximal tibial epiphyseal plate in ten rabbits. The PDS implants had biodegraded almost completely in cortical bone at 16 weeks without any significant sign of inflammation or foreign body reaction. The PDS implants did not cause any growth disturbance. Histologic studies, however, showed that seven of 10 rabbits demonstrated significant osseous bridge formation across the epiphyseal plate.

Scapular winging in young athletes.

Traumatic winging of the scapula is not common in children. We report three cases of athletic injuries resulting in scapular winging. With conservative management, each patient resolved in a 6-month period. Scapular winging should be considered in all injuries about the shoulder in young athletes.

Arthrodesis of the shoulder in children.

Ten children had an arthrodesis of the shoulder for a paralytic condition involving the muscles; nine of them were available for long-term follow-up. In the children who were eight to fifteen years old at the time of operation, the angle of arthrodesis was 45 degrees of abduction, 25 degrees of flexion, and 25 degrees of internal rotation. This angle allowed symptomless and useful function of the extremity. No patient had a stress fracture or discomfort when the arm was at rest at follow-up. An asymptomatic click in the acromioclavicular joint in one patient indicated that this may be a future site of abnormality. The children apparently accommodated easily to the arthrodesis of the shoulder. Neither self-image nor overall function seemed to be impaired by the operation. The over-all function postoperatively was related to the neurological integrity of the distal muscles.

Posterior fusion for Scheuermann's kyphosis.

Ten patients with Scheuermann's kyphosis were surgically treated with posterior spine fusion and Harrington heavy compression-rod instrumentation. This procedure relieved pain and deformity in all ten patients. The average follow-up period was 26.6 months. The average curve before surgery was 71.4 degrees and at follow-up examination was 39.3 degrees. The postoperative correction of kyphosis averaged 32 degrees (45%), with an average loss of correction of 7.8 degrees. Posterior fusion with Harrington heavy compression-rod instrumentation may prove to be the procedure of choice in Scheuermann's kyphosis that is severe but flexible on hyperextension with a curve greater than 65 degrees.

Threaded K-wire spinous process fixation of the axis for modified Gallie fusion in children and adolescents.

A retrospective analysis of a technique for achieving atlantoaxial arthrodesis was performed. Fourteen patients underwent a modified Gallie technique, and all patients achieved successful arthrodesis with minimal restriction in rotation of the neck postoperatively. No patients showed neurologic deterioration. Fixation of a threaded K-wire to the spinous process of the axis improved the stability of the wiring technique, and we have been very successful in achieving atlantoaxial arthrodesis in the pediatric population.

Monostotic fibrous dysplasia of the hand.

A case of monostotic fibrous dysplasia of a long bone of the hand is reported. There has been only one similar case recorded, though it is not uncommon in other long bones. The diagnosis was proved by histology, and the tumour treated by subperiosteal excision. There has been no recurrence after 31 months, though in similar cases excision including the periosteum has been advised to reduce the likelihood of recurrence.