Stiffness after neglected elbow trauma in children: a report of 57 cases

Neglected trauma of the elbow in the child is not rare, especially in countries where traditional treatment is still practiced. The authors report a study of 57 neglected elbow trauma in children and the complication of stiffness managed in the pediatric orthopedics department in Rabat, Morocco, between 1996 and 2002. Average patient age was 11 years, location predominated at the right elbow, and the average delay of consultation was 7 months after the trauma. Clinical examination found 36% of stiffness in bending, 29% in extension, and 35% mixed. Of these, 43% were judged very serious, 20% serious, and 37% moderate. Radiological finding showed 35 neglected elbow dislocations (61%), ten supracondylar humeral fractures (17%), and 12 posterior lesions difficult to determine. Abstention from surgery was recommended for 12 patients; 45 were operated on. The end result was 53% with minimal and moderate stiffness. The authors analyzed clinical and therapeutic aspects of all lesions, insisting on abstention from surgery according to the variable and unforeseen character of surgery results.     

Ultrasonography of acute musculoskeletal disease

With technical improvements (higher frequency and extended field-of-view sonography) the ability of ultrasound to detect pathology in the musculoskeletal system has been greatly increased. As in MRI, and unlike conventional radiography, soft tissue lesions in muscles, tendons and occasionally in joints can be shown directly. An advantage is real-time imaging of joints during stress. A disadvantage is limited demonstration of internal structures within joints. This paper provides an overview of various pathologies with emphasis on acute disorders. Received: 19 January 1999; Revised: 8 March 1999; Accepted: 27 April 1999     

Storage phosphor radiography of wrist fractures: a subjective comparison of image quality at varying exposure levels

Image quality of storage phosphor radiographs acquired at different exposure levels was compared to define the minimal radiation dose needed to achieve images which allow for reliable detection of wrist fractures. In a study on 33 fractured anatomical wrist specimens image quality of storage phosphor radiographs was assessed on a diagnostic PACS workstation by three observers. Images were acquired at exposure levels corresponding to a speed classes 100, 200, 400 and 800. Cortical bone surface, trabecular bone, soft tissues and fracture delineation were judged on a subjective basis. Image quality was rated according to a standard protocol and statistical evaluation was performed based on an analysis of variance (ANOVA). Images at a dose reduction of 37% were rated sufficient quality without loss in diagnostic accuracy. Sufficient trabecular and cortical bone presentation was still achieved at a dose reduction of 62%. The latter images, however, were considered unacceptable for fracture detection. To achieve high-quality storage phosphor radiographs, which allow for a reliable evaluation of wrist fractures, a minimum exposure dose equivalent to a speed class of 200 is needed. For general-purpose skeletal radiography, however, a dose reduction of up to 62% can be achieved. A choice of exposure settings according to the clinical situation (ALARA principle) is recommended to achieve possible dose reductions.     

Avulsion fractures and chronic avulsion injuries of the knee: role of MR imaging

Avulsion fractures and chronic avulsion injuries of the knee are common lesions in sports-related trauma, especially among adolescents. Magnetic resonance imaging may prove useful in detecting and characterizing such lesions, and has several advantages with regard to other imaging modalities. We review, illustrate, and discuss the MR imaging features of some of the more frequent avulsion fractures and chronic avulsion injuries of the knee, including avulsion fractures of the cruciate ligaments, avulsion fractures of lateral and medial stabilizers, avulsion fractures and chronic avulsion injuries of the extensor mechanism, and avulsive cortical irregularities of the distal femur. The role of MR imaging in evaluating such lesions is emphasized.     

Les fractures par insuffisance osseuse du col fémoral

Summary Fractures due to inadequate femoral neck bone stock should be suspected when a patient presents with spontaneous hip pain while retaining good movements. The combination of the clinical history (looking for predisposing factors) examination, radiographs and, above all, scintigraphy allow early diagnosis. Bed rest in appropriate cases may prevent the serious complication of femoral neck fracture.

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Les fractures par insuffisance osseuse du col fémoral

Résumé Les fractures par insuffisance osseuse du col fémoral doivent être recherchées devant toute douleur inguinale, apparue spontanément, la mobilisation de la hanche se faisant librement. La conjonction de données anamnestiques (recherche de facteurs favorisants), cliniques, radiographiques et surtout scintigraphiques permettra un diagnostic précoce, important pour prescrire une mise en décharge garante d'une évolution favorable. Méconnue, la fracture par insuffisance du col fémoral aboutira à une fracture complète nécessitant le recours à un geste chirurgical.

     

Accessory ossification centres at the thoracolumbar junction

Summary A survey of 810 thoracolumbar junction CT scans demonstrated several forms of accessory ossification centres and vestigial ribs associated with the posterior element processes. Four examples of short T12 ribs and 15 L1 ribs were identified, in addition to 8 accessory ossification centres at L1, and 3 at T12. Radiographic features of accessory ossification centres were compared with histologic characteristics from cadaver studies. Accessory ossification centres have occasional clinical significance when they may be confused with fractures at the thoracolumbar junction. Differential diagnosis relies on adequate visualization of their cortical margins to distinguish them from recent fractures of the processes.

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Les points d'ossification accessoires de la jonction thoracolombaire

Résumé L'étude de 810 scanners de la charnière thoraco-lombaire a mis en évidence plusieurs formes de points d'ossification accessoires et de côtes vestigiales associées aux processus de l'arc postérieur des vertèbres. Quatre exemples de 12e côte brève et 15 côtes lombaires surnuméraires en L1 ont été identifiées, ainsi que 8 points d'ossification accessoires en L1 et 3 en T12. Les images radiographiques des points d'ossification accessoires ont été comparés aux caractères histologiques étudiés sur le cadavre. Ces points peuvent prendre une importance clinique en prêtant à confusion avec une fracture de la jonction thoraco-lombaire. Le diagnostic différentiel repose sur une visualisation adéquate de leurs limites corticales denses afin de les distinguer des fractures fraîches des processus costiformes.

     

Matti-Rüsse植骨联合钢板内固定术治疗第五跖骨近端3区Ⅲ型骨折的疗效分析

目的 探讨Matti-Rüsse 植骨联合钢板内固定术治疗第五跖骨近端3区Ⅲ型骨折的临床疗效。方法 病例系列报告。纳入北部战区总医院2020年1月—2022年1月手术治疗的10例第五跖骨近端骨干陈旧性骨折患者的临床资料。患者均男性,年龄18~24岁（平均18.9岁）,均为军事训练伤所致Lawrence分区3区、Torg Ⅲ型骨折。所有患者采用Matti-Rüsse植骨联合钢板内固定术治疗。观察患者的骨折愈合情况及愈合时间、返回部队接受正常训练的时间、再骨折情况,以及术后并发症的发生情况,评估手术效果。结果 10例患者均成功完成手术并获术后随访12~25个月;术后9例患者骨折临床愈合时间6.0~7.0周（平均6.8周）,1例术后10.0周延期愈合,影像学愈合时间为6.0~10.0周（平均7.2周）;返回部队训练时间为7.0~11.0周,（平均9.8周）。10名患者中无再发骨折,取骨部位均无术后并发症,2例发生术后腓肠神经炎。结论 Matti-Rüsse植骨联合钢板内固定术治疗第五跖骨近端3区Ⅲ型骨折是有效的。     

再谈儿童骨创伤特殊性、提倡诊治专业化

前言:儿童及青少年骨折是创伤骨科不可分割的一部分,其诊治具有特殊性。目前我国专业的小儿骨科医师较少,且主要集中在我国一、二线城市,很多成人骨科医生兼任儿童骨折的处理。从儿童骨折的诊治特点出发,为骨科医生讲述儿童骨折治疗原则和注意事项,希望广大骨科医生能经历必要的小儿骨科专业培训,并提倡小儿骨科的专业化发展。     

针刺对去卵巢大鼠骨折模型脑源性神经营养因子表达的影响

目的:观察针刺疗法对去卵巢大鼠骨折的效应及作用机制.方法:SD大鼠60只,随机分为4组:A组为正常对照组,B组为模型组,C组为针刺组,D组为尼尔雌醇组,除A组为假手术外,其余各组大鼠行"去卵巢手术",以建立骨质疏松症动物模型;术后3个月,4组动物均于左侧股骨中段建立闭合骨折模型,然后,各组分别按既定方案进行治疗处置:A组及B组每周每只大鼠灌服0.9%生理盐水3 mL;C组针刺左后肢的"环跳""后三里""阳陵泉""委中",每天1次;D组每只大鼠予尼尔雌醇溶液0.6 mL/100 g体重灌胃(尼尔雌醇浓度:0.2 mg/mL),每周1次.分别于骨折造模术后第7、14、21和28 d处死取材,进行组织学、脑源性神经营养因子(BDNF)和酪氨酸蛋白激酶B(TrkB)免疫组化染色检测.结果:骨痂HE染色光镜观察结果显示,A组、C组和D组的骨折愈合进程快于B组;各组骨痂均有BDNF、TrkB表达,时间主要在骨折后7 d和14 d,表达水平由高到低依次是A、C、D、B组.结论:骨质疏松性骨折的骨痂中BDNF、TrkB的表达减少,而针刺治疗能增加其表达,加快骨折愈合进程.