Conservative treatment for juvenile osteochondritis dissecans of the talus.

PURPOSE: To assess outcome of 6 juvenile patients with osteochondritis dissecans (OCD) of the ankle treated conservatively. METHODS: Records of 4 males and one female aged 10.8 to 14.1 (mean, 12.3) years who underwent cast immobilisation and/or restriction of physical activities for OCD of the talus (4 on the left and 2 on the right) were reviewed. OCD lesions were graded using the Berndt and Harty classification. Functional outcome was assessed using the ankle-hindfoot score of the American Orthopaedic Foot and Ankle Society. Clinical and radiographic outcomes were assessed according to the Higuera classification. RESULTS: The mean follow-up period was 30.5 (range, 11-63) months. The mean ankle-hindfoot score was 90 (range, 86-100). Radiological resolution of OCD was noted in 2 ankles, although all ankles showed some degree of healing. All patients had resolution of pain after a mean of 7 (range, 3-12) months. According to the Higuera classification, clinical outcome was excellent in one and good in 5 ankles, whereas radiological outcome was excellent in 2, good in 2, and fair in 2 ankles. In one patient, the OCD of the right posteromedial talar dome resolved spontaneously. CONCLUSION: Almost all patients achieved good functional outcome after conservative management, regardless of the presence of radiological evidence of healing. Surgery should only be performed if the OCD is unstable.

Exposed versus buried wires for fixation of lateral humeral condyle fractures in children: a comparison of safety and efficacy.

INTRODUCTION: Displaced fractures of the lateral condyle of the humerus are usually treated with open reduction and fixation with smooth Kirschner wires. These may be passed through the skin and left exposed or buried subcutaneously. Exposed wires may be removed in the outpatient clinic, whereas buried wires require a formal procedure under anaesthesia. This advantage may be offset if there is a higher rate of complications with exposed wires. The aim of this study was to compare the safety and efficacy of exposed and buried wires. STUDY DESIGN: Retrospective cohort. METHODS AND MATERIALS: Children with lateral condyle fractures of the humerus who had undergone surgery were identified from our departmental database. Case records and X-rays of 75 patients were reviewed. RESULTS: Forty-two patients had buried wires and 33 had exposed wires. There were no serious complications in either group. In the exposed wires group, 1 patient had a superficial wound infection that was treated effectively with 1 week of oral antibiotics, while 2 patients had hypergranulation of pin tracts treated with topical silver nitrate. None of the patients showed loss of reduction, deep infection, or any other complications requiring additional procedures. DISCUSSION/CONCLUSIONS: There was no statistically significant difference in the rate of complications between the buried and exposed groups. We conclude that open reduction and exposed wiring is a safe and effective option for lateral condyle fractures, and recommend a period of 4 weeks of K-wire fixation followed by 2 weeks of backslab immobilisation as adequate for union with minimal risk of infection.

Acute knee injuries in skeletally immature athletes.

The knee is the body part most commonly injured as a consequence of collisions, falls, and overuse occurring from childhood sports. The number of sports-related injuries is increasing because of active participation of children in competitive sports. Children differ from adults in many areas, such as increased rate and ability of healing, higher strength of ligaments compared with growth plates, and continued growth. Growth around the knee can be affected if the growth plates are involved in injuries. This article discusses fractures, anterior and posterior cruciate ligament injuries, and meniscal and patellar conditions.