Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Pediatrics 104 articles


Is the Clavicula Pro Humero Technique of Value for Reconstruction After Resection of the Proximal Humerus in Children?

Dominique Barbier MD, Benoît Billy MD, Philippe Gicquel MD, Sophie Bourelle MD, Pierre Journeau MD

There are several options for reconstruction of proximal humerus resections after wide resection for malignant tumors in children. The clavicula pro humero technique is a biologic option that has been used in the past, but there are only scant case reports and small series that comment on the results of the procedure. Because the longevity of children mandates a reconstruction with potential longevity not likely to be achieved by other techniques, the clavicula pro humero technique may be a potential option in selected patients.

Is There Asymmetry Between the Concave and Convex Pedicles in Adolescent Idiopathic Scoliosis? A CT Investigation

Colin M. Davis BSc, MBBS, Caroline A. Grant PhD, Mark J. Pearcy DEng, Geoffrey N. Askin FRACS, Robert D. Labrom MSc, FRACS, Maree T. Izatt BPhty, Clayton J. Adam PhD, J. Paige Little PhD

Adolescent idiopathic scoliosis is a complex three-dimensional deformity of the spine characterized by deformities in the sagittal, coronal, and axial planes. Spinal fusion using pedicle screw instrumentation is a widely used method for surgical correction in severe (coronal deformity, Cobb angle > 45°) adolescent idiopathic scoliosis curves. Understanding the anatomic difference in the pedicles of patients with adolescent idiopathic scoliosis is essential to reduce the risk of neurovascular or visceral injury through pedicle screw misplacement.

Lawnmowers Versus Children: The Devastation Continues

Mariano Garay BS, William L. Hennrikus MD, Joseph Hess RN, Erik B. Lehman MS, Douglas G. Armstrong MD

Accidents with lawnmowers can cause mutilating injuries to children. Safety guidelines regarding the use of lawnmowers were promoted by professional organizations beginning in 2001. The Pennsylvania Trauma Systems Foundation maintains a database including all admissions to accredited Levels 1 to 4 trauma centers in the state. The annual rates of admission for children in our state and the severity of injuries subsequent to introduction of safety guidelines have not been reported, to our knowledge. Ride-on lawnmowers have been associated with more severe injuries in children.

Anterolateral Ligament of the Knee Shows Variable Anatomy in Pediatric Specimens

Kevin G. Shea MD, Matthew D. Milewski MD, Peter C. Cannamela BS, Theodore J. Ganley MD, Peter D. Fabricant MD, Elizabeth B. Terhune BS, Alexandra C. Styhl BA, Allen F. Anderson MD, John D. Polousky MD

Anterior cruciate ligament (ACL) reconstruction failure rates are highest in youth athletes. The role of the anterolateral ligament in rotational knee stability is of increasing interest, and several centers are exploring combined ACL and anterolateral ligament reconstruction for these young patients. Literature on the anterolateral ligament of the knee is sparse in regard to the pediatric population. A single study on specimens younger than age 5 years demonstrated the presence of the anterolateral ligament in only one of eight specimens; therefore, much about the prevalence and anatomy of the anterolateral ligament in pediatric specimens remains unknown.

Classifications In Brief: Salter-Harris Classification of Pediatric Physeal Fractures

Daniel J. Cepela MD, Jason P. Tartaglione MD, Timothy P. Dooley MD, Prerana N. Patel MD

Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

Hoon Park MD, Keun Jung Ryu MD, Hyun Woo Kim MD, PhD, Jin Ho Hwang MD, PhD, Joon Woo Han MD, Dong Hoon Lee MD, PhD

During tibial lengthening, the soft tissues of the posterolateral compartment produce distraction-resisting forces causing valgus angulation. Although this occurs with the classic Ilizarov method, whether a valgus deformity develops with the lengthening over nail (LON) technique is questioned, because the intramedullary nail is thought to resist deforming forces and adequately maintain alignment of the distracted bone.

Periosteal Fiber Transection During Periosteal Procedures Is Crucial to Accelerate Growth in the Rabbit Model

Matthew A. Halanski MD, Tugrul Yildirim MD, Rajeev Chaudhary MS, Matthew S. Chin MD, Ellen Leiferman DVM

Disruption of the periosteum has been used to explain overgrowth after long bone fractures. Clinically, various periosteal procedures have been reported to accelerate growth with varied results. Differences between procedures and study populations, in these prior studies, make drawing conclusions regarding their effectiveness difficult.

A Radiation Safety Training Program Results in Reduced Radiation Exposure for Orthopaedic Residents Using the Mini C-arm

David Gendelberg MD, William Hennrikus MD, Jennifer Slough MD, Douglas Armstrong MD, Steven King PhD

Fluoroscopy during fracture reduction allows a physician to assess fractures and immediately treat a pediatric patient. However, concern regarding the effects of radiation exposure has led us to find ways to keep radiation exposures as low as reasonably achievable. One potentially simple way, which to our knowledge has not been explored, to decrease radiation exposure is through formal education before mini C-arm use.

Reamed Intramedullary Nailing has an Adverse Effect on Bone Regeneration During the Distraction Phase in Tibial Lengthening

Keun Jung Ryu MD, Bang Hyun Kim MD, Jin Ho Hwang MD, PhD, Hyun Woo Kim MD, PhD, Dong Hoon Lee MD, PhD

The lengthening over nail (LON) technique has gained popularity because it enables shorter periods of external fixation, prevents deformities during lengthening, and reduces the risk of refracture after removal of the frame compared with the classic Ilizarov method. However, it is not clear if the violation of endosteal blood supply by reamed intramedullary nailing in the LON technique has a negative effect on bone regeneration or a positive effect by compensatory enhancement of periosteal circulation.

Determinants of Hip Displacement in Children With Cerebral Palsy

Chia Hsieh Chang MD, Ying Chih Wang MD, Pei Chi Ho MS, Ai Wen Hwang MD, Hsuan Kai Kao MD, Wei Chun Lee MD, Wen E. Yang MD, Ken N. Kuo MD

Coxa valga and femoral anteversion often are seen in patients with spastic hip displacement and osteotomy is recommended. However, the relationship between femoral deformities and hip displacement has not been clearly defined and other factors, such as joint motion and posture, should be considered before recommending treatment.