The contralateral hip in slipped capital femoral epiphysis: Is there an easy-to-use algorithm to support a decision for prophylactic fixation?

Purpose: To identify a specific factor that can support the decision for prophylactic fixation in unilateral slipped capital femoral epiphysis. Methods: This retrospective cohort study included a total national population of 379 children diagnosed with slipped capital femoral epiphysis from 2007 to 2013. Regression analysis used information on slip severity, clinical classification of the index hip, age, sex, age-adjusted body mass index, the difference in epiphyseal-diaphyseal angle, and comorbidity to identify any risk factor for the subsequent development of a slip in the contralateral hip. Four observers evaluated the triradiate cartilage following the modified Oxford bone score grade. The occurrence of later development of a contralateral slip in different stage of physeal closure was used to analyze the sensitivity and specificity for this method. Results: This study's only predictor for a subsequent contralateral slip was chronological age. At age 13 years or older, 1/15 in girls and 3/65 in boys suffered from a slip in the contralateral hip. Thus, when using age <13 years as a test for deciding when to do prophylactic fixation, the sensitivity would be 88% and specificity 51% for preventing contralateral slip. However, the correlation between the four different observers was too low to be considered useful when assessing the triradiate cartilage for skeletal maturity. Conclusion: We would advocate a prophylactic fixation for children <13 years diagnosed with a unilateral slipped capital femoral epiphysis as an easy-to-use algorithm. Level of evidence: level II.

Reliability and Validity of an Ultrasound-Based Protocol for Measurement of Quadriceps Muscle Thickness in Children.

Introduction and aims: Accurate determination of skeletal muscle size is of great importance in multiple settings including resistance exercise, aging, disease, and disuse. Ultrasound (US) measurement of muscle thickness (MT) is a method of relatively high availability and low cost. The present study aims to evaluate a multisite ultrasonographic protocol for measurement of MT with respect to reproducibility and correlation to gold-standard measurements of muscle volume (MV) with magnetic resonance imaging (MRI) in children. Material and methods: 15 children completed the study (11 ± 1 year, 41 ± 8 kg, 137 ± 35 cm). Following 20 min supine rest, two investigators performed US MT measurements of all four heads of the m. quadriceps femoris, at pre-determined sites. Subsequently, MRI scanning was performed and MV was estimated by manual contouring of individual muscle heads. Results: Ultrasound measurement of MT had an intra-rater reliability of ICC = 0.985-0.998 (CI 95% = 0.972-0.998) and inter-rater reliability of ICC = 0.868-0.964 (CI 95% = 0.637-0.983). The US examinations took less than 15 min, per investigator. Muscle thickness of all individual quadriceps muscles correlated significantly with their corresponding MV as measured by MRI (overall r = 0.789, p < 0.001). Conclusion: The results of this study indicate that US measurement of MT using a multisite protocol is a competitive alternative to MRI scanning, especially with respect to availability and time consumption. Therefore, US MT could allow for wider clinical and scientific implementation.

Spine duplication or split notochord syndrome - case report and literature review.

Context: Spine duplication is a rare condition, with various extents and severe additional anomalies. The goal of this study was to describe a unique case of a boy with split notochord syndrome who was followed up from birth until maturity. Findings: Physical examination at birth showed defects of the abdominal wall and cloacal exstrophy with visible urether outlets. A transposed anus was present in the perineal region. Split bony elements of the spine with nonpalpable sacral bone were noted. A soft, skin-covered lump, with the consistency of a lipoma, was present in the sacral area. There was asymmetry of the lower limbs: the left was hypoplastic, with a deformed foot and hip. Computed tomography revealed a normal shape of the Th12 and L1 vertebrae, whereas the L2 was split. Downward from L3, there were two vertebrae at each level, with two spinal canals. The spinal cord divided into two "semicords" at the level of L1. Neurologic status and the shape of the spine remained unchanged during puberty. The last follow-up was performed at the age of 18 years. He managed to walk independently in prosthesis with visible limping. Conclusion: Spine deformities are always suspected in neonates with lipoma in the sacral region, which may sometimes be serious. Walking ability and quality of life depend on neurologic deficits; even with long duplication and double sacrum, walking can be a feasible option.

How reconstructive surgery combined with physiotherapy for a painful nontraumatic patellar dislocation enabled a woman with Rett syndrome to become pain free and remain physically active: A case report.

The effects of orthopedic measures, with the exception of scoliosis surgery, are rarely described in individuals with Rett syndrome. In this case, treating a painful dislocation of the patella with combined orthopedic and physiotherapeutic measures enabled a woman with Rett syndrome to become pain free and remain physically active.

Injuries in children and adolescents--analysis of 41,330 injury related visits to an emergency department in northern Sweden.

OBJECTIVES: We present an overview of the injuries seen at the emergency department of a regional hospital in northern Sweden and the variations in the injury pattern with age, sex and time. METHODS: Data consisting of all injuries sustained by those 0-19 years of age seen at the emergency department of Umeå University Hospital between 1998 and 2008 (41,330 injury events) were analysed with respect to injury type, mechanism, activity, age and sex. Rates were calculated using population data from Statistics Sweden. RESULTS: The rate of injury related visits to the emergency department was 110/1000 person years. The most common causes of visits to the emergency department were minor injuries such as contusions, abrasions and open wounds. 12% of the injuries resulted in admission to a ward. Variations in type of injury, mechanism and activity at injury were noted, in particular with age, but also with sex. We noted a 31% rate increase of visits to the hospital's emergency department between 1998 and 2008, rate ratio 1.31 (1.27-1.38). There was no significant increase in the rate of injuries resulting in hospitalisation. CONCLUSIONS: Our results give an estimate of the rate of all injuries and subsets of injuries resulting in visits to the only hospital emergency department within a well defined catchment area. It was not possible to determine whether the increased rate of visits to the ED was due to an increase in the actual rate of injuries within the catchment area. The variations seen in different age groups reflect the hazards associated with different periods in growth and the ability to cope with these. The results point to areas where improved preventive measures may be implemented or where further research may be of value.

Epidemiology of fractures in children and adolescents.

BACKGROUND AND PURPOSE: Fractures are most common in youth and in the elderly, with differences in incidence over time and between regions. We present the fracture pattern in a population of youths

[Fractures of the proximal tibial epiphyseal cartilage]. / Zluszczenie nasady blizszej kosci piszczelowej w materiale wlasnym.

The authors present 9 children who sustained 10 fractures of proximal tibial epiphyseal cartilage (7--left tibia, 3--right tibial), and were treated in Children's University Hospital in Kraków between years 1994-2001. Mean age in the time of trauma was 12.7 years (6-17 years), the mean follow-up time was 17.4 months (8-48 months). According to Salter-Harris classification there was 5 fractures of type I, 4 of type II, 1 of type III. One child was treated by closed reduction and percutaneous Kirschner wires fixation. One child was treated by traction. The rest of the children were treated by casting, in knee flexion about 30 degrees. In one child there was premature closing of epiphyseal cartilage, shortening 1.5 cm and posterior curvature of tibia. In this child we performed flexion tibial osteotomy. In one child few months later we recognized meniscal tears (the patient was operated on). The results in the rest of children were good and there were not complications. The authors discuss the literature connecting to proximal tibial epiphyseal fractures.

[Fractures of the tibia's intercondylar eminentia in children]. / Zlamania wynioslosci miedzyklykciowej piszczeli u dzieci.

We have described management in tibia's intercondylar eminentia fractures in children, based on own data and review of the contemporary bibliography. The data contain 16 children from 6 to 14 years of age with all Meyers' and McKeever' fractures types. Type I and II fractures can be treated conservatively. Such factors like fracture's type and child's age must be taken under consideration for an operative treatment most often, but in children below 10 years of age, the conservative one should be considered as well.

[Subacute osteomyelitis in children]. / Podostre zapalenie kosci u dzieci.

The paper presents diagnostic and therapeutic procedures in subacute osteomyelitis in children, basing on Robert's classification. The analyzed material consists of 11 children (aged 2 to 14 years) treated between 1990 and 2000. Particular attention was given to signs and symptoms before full diagnosis, the clinical picture and to laboratory findings. Diagnostic difficulties were related to radiological similarities in subacute osteomyelitis and certain neoplastic processes. The authors stress the fact that non-invasive diagnostics are not sensitive enough for a definite diagnosis. Surgical treatment allows a histological confirmation and proper treatment.

[Seatbelt syndrome]. / Zespól pasów bezpieczenstwa.

The authors review reference publications and discuss diagnostic intricacies in a case of a 7 year old boy with seatbelt syndrome. The syndrome concerns most commonly children aged 4 to 9 years. It results from injuries in communication accidents--and actuation of two-point seatbelts. Injuries concern both the abdominal cavity organs (i.e. intestines, mesentery) and lumbar segments of the spine--including Chances's fractures.