Journal of pediatric orthopedics. Part B
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Displaced Salter-Harris type-IV fractures are rare in young children and can result in articular incongruity or premature physeal arrest. We describe a 5-year-old boy who sustained a displaced left distal radial Salter-Harris type-IV fracture. ⋯ Our patient is by far the youngest reported child with a displaced Salter-Harris type-IV fracture of the distal radius. Prompt anatomic reduction and fixation of a displaced distal radial Salter-Harris type-IV fracture can result in excellent short-term wrist motion with maintenance of physeal function.
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Case Reports
Avulsion fracture of the lesser trochanter in a skeletally immature freestyle footballer.
We report the case of a skeletally immature freestyle footballer who presented with avulsion fracture of the lesser trochanter. The patient had precursor symptom before onset during a ball juggling. ⋯ This repetitive movement might cause continuous stretching stress of the iliopsoas muscle at the apophysis of the lesser trochanter, causing disruption at this site. This new sporting activity in this age cohort may have higher prevalence of this type of injury due to its unique repetitive hip flexion movement.
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A total of 230 children undergoing closed reduction and percutaneous pinning of supracondylar humerus fractures were analyzed retrospectively. Severe pain (score ≥ 7/10) was reported in 10% of general anesthesia-only patients in the postanesthesia care unit and in 28% of the 130 admitted patients. The 36 patients who received ultrasound-guided regional analgesia+general anesthesia had decreased intraoperative opioid consumption and postanesthesia care unit pain scores. ⋯ No patient developed compartment syndrome. Severe pain is frequent after closed reduction and percutaneous pinning of supracondylar humerus fractures. Further study of ultrasound-guided regional analgesia is needed.
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Case Reports
Posterior shoulder dislocation with ipsilateral proximal humerus type 2 physeal fracture: case report.
In pediatric patients, proximal humeral physeal fractures are uncommon injuries compared with distal physeal fractures. Usually, the growth plate is the most vulnerable site of fracture in the proximal humerus. ⋯ Here, we describe a case of posterior shoulder dislocation with ipsilateral proximal humerus type 2 physeal fracture in a 9-year-old boy. We treated the patient by closed reduction and percutaneous pinning under general anesthesia.
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Since the beginning of Operation Enduring Freedom, management of Afghan military or civilian casualties including children is a priority of the battlefield medical support. The aim of this study is to describe the features of paediatric wartime extremities injuries and to analyse their management in the Kabul International Airport Combat Support Hospital. A retrospective review was carried out using the French surgical database OPEX (Service de Santé des Armées) from June 2009 to January 2013. ⋯ There were four deaths, yielding a global mortality rate of 2.6%. This study is the first to analyse specifically paediatric extremities trauma and their management at level 3 of battlefield medical facilities in recent conflicts. Except for severe burns and polytrauma, treatment of paediatric extremities injuries can be readily performed in Combat Support Hospitals by orthopaedic surgeons trained in paediatric trauma.