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فهرست محتوای دیجیتالی
فهرست مطالب
فهرست نقدها
30 مرتبه مشاهده شده
Tachdjian's pediatric orthopaedics: from the Texas Scottish Rite Hospital for Children
- ISBN: 9780323567695 (set) , 9780323791694 (v. 1) , 9780323791700 (v. 21)
- Call Number : WS 270 T117 2022
- Title:Tachdjian's pediatric orthopaedics: from the Texas Scottish Rite Hospital for Children / [edited by] John A. Herring.
- Portion of title: Pediatric orthopaedics
- Edition:Sixth Edition.
- Publication, Distribution:Philadelphia, PA : Elsevier, 2022.
- Physical Description:2 v.: illustrations, table
- Notes:Includes bibliographical references and index
- Subject:Orthopedic Procedures.
- Subject:Child.
- Subject:Musculoskeletal Diseases - surgery.
- Added Entry:Herring, John A editor
- Added Entry:Texas Scottish Rite Hospital for Children.
- Added Entry:Pediatric orthopaedics
فهرست محتوای دیجیتالی
محتوای کتاب
فهرست مطالب
- Tachdjian’s Pediatric Orthopaedics: From the Texas Scottish Rite Hospital for Children
- Tachdjian’s Pediatric Orthopaedics: From the Texas Scottish Rite Hospital for Children
- Copyright
- Contributors
- PREFACE
- PREFACE
- 1 - Growth and Development
- 2 - The Orthopaedic History
- 3 - The Orthopaedic Examination: A Comprehensive Overview
- 4 - The Orthopaedic Examination: Clinical Application
- 5 - Gait Analysis
- 6 - The Limping Child
- 7 - Back Pain
- 8 - Disorders of the Neck
- Overview
- Developmental Anatomy
- Unique Characteristics
- Cervical Deformity: Torticollis
- Deformity Without Pain—Congenital Torticollis
- Congenital Muscular Torticollis
- Congenital Osseous Torticollis/Klippel-Feil Syndrome
- Clinical Features
- Radiographic Findings
- Treatment
- Halo Fixation. Deformity management involving head tilt or rotation frequently requires the use of a halo vest to obtain and mai...
- Indications. A strong indication for surgical treatment in KFS or other cervical anomalies is progression of head tilt or rotati...
- Techniques for Occipitocervical Fusion. Because of limited motion and craniofacial abnormalities, airway management in patients ...
- Techniques for Atlantoaxial Fusion. Atlantoaxial internal fixation, for instability/hypermobility or deformity management (see b...
- Deformity With Pain
- Inflammatory and Septic Causes
- Deformity Without Pain—Congenital Torticollis
- Cervical Deformity: Kyphosis
- Cervical Hyperlordosis
- Cervical Instability
- 9 - Scoliosis
- Definition
- Classification of Scoliotic Curves
- Idiopathic Scoliosis
- Adolescent Idiopathic Scoliosis
- Posterior Spinal Instrumentation
- Anterior Spinal Instrumentation
- Juvenile Idiopathic Scoliosis
- Congenital Spinal Deformities
- Early-Onset Scoliosis
- Other Causes of Scoliosis
- 10 - Kyphosis
- 11 - Other Anatomic Disorders of the Spine
- 12 - Disorders of the Upper Extremity
- Introduction
- Principles of Dressings and Splinting
- Dressings
- Hand Therapy
- Activities of Daily Living
- Splinting
- Materials
- Securing Splints
- Children Not Suitable for Splinting
- Static Splinting
- Dynamic Splinting
- Serial Casting or Serial Static Splinting
- Static-Progressive Splinting
- Custom Splints
- Prefabricated Splints
- Combination Custom/Prefabricated Splints
- Thumbs
- Wrist.The most common wrist splints used in pediatrics are the wrist cock-up splint, the dorsal-blocking splint, and the long ...
- Forearm.The tone and positioning (TAP) splint is a pronation/supination splint that is effective for lack of range caused by wea...
- Elbow.Splinting the elbow is a challenge in pediatrics because all elbow splints restrict motion. When moderate support is neede...
- Writing a Prescription for Hand Therapists
- Scar Management
- Principles of Acute Care
- Principles of Reconstruction
- Congenital Anomalies
- Diagnosing Associated Anomalies
- Radial Longitudinal Deficiency
- Prevalence and Epidemiology
- Etiology
- Clinical Features
- Clinical Evaluation
- Classification
- Anatomic and Surgical Pathology
- Imaging
- Pollicization
- Adolescence
- Radialization.Radialization was developed by Buck-Gramcko in the 1980s as another modification of centralization in an attempt ...
- Ilizarov Correction.Ilizarov correction can be used to lengthen the ulna through osteotomies in conjunction with realignment pro...
- Vascularized Epiphyseal Transfer.This technique, developed by Vilkki in the 1990s, aims to replace the missing radial strut with...
- Contraindications to Surgery
- Congenital High Scapula (Sprengel Deformity)(Video 12.1)
- Pseudarthrosis of the Clavicle (Video 12.2)
- Ulnar Longitudinal Deficiency
- History
- Etiology
- Clinical Features
- Classification
- Pathology
- Imaging
- Nonoperative Treatment
- Hand.Although forearm and wrist surgeries are best done during the first year of life, hand operations should be done later. Syn...
- Forearm.Creation of a one-bone forearm should be reserved for older children with type II dysplasia and is indicated only when ...
- Elbow.In selected type IV cases, osteotomy of the elbow synostosis may be useful, especially when the elbow deformity positions ...
- Nonoperative Treatment
- Phocomelia (Proximal Longitudinal Dysplasias)
- Synostosis of the Radius and Ulna
- Arthrogryposis in the Upper Limb
- Principles and Goals
- Treatment
- Shoulder
- Elbow
- Posterior Release With Tricepsplasty.Posterior elbow release with tricepsplasty is done through a posterior curvilinear incision...
- Procedures to Achieve Active Elbow Flexion.The ideal tissue to gain active elbow flexion would be an expendable muscle, synergis...
- Bipolar Pectoralis Major Transfer.The entire pectoralis major muscle can be transferred by mobilizing it on its neurovascular pe...
- Bipolar Latissimus Transfer.For this transfer the entire latissimus dorsi is mobilized on its pedicle and moved anteriorly throu...
- Transfer of the Long Head of the Triceps.This transfer is feasible because the long head of the triceps has a separate neurovasc...
- Steindler Flexorplasty.Transfer of the flexor pronator muscle origin to the anterior aspect of the humerus to flex the elbow wor...
- Free Gracilis Transfers.Theoretically, the gracilis can serve as a free muscle donor to the anterior aspect of the arm to flex t...
- Wrist
- Dorsal Closing Wedge Osteotomy of the Midcarpus and Tendon Transfers.Release of the tight volar structures is accomplished throu...
- Proximal Row Carpectomy.Proximal row carpectomy was used in the past, but because the capitate and radial articulations are gros...
- Wrist Fusion.Wrist fusion should be avoided because all motion is lost at the wrist of an arthrogrypotic child. It can be reserv...
- Hand
- Madelung Deformity
- Polydactyly
- Etiology
- Pathology
- Incidence
- Imaging
- Treatment
- Radial Polydactyly
- Wassel Type I and II Thumbs.In these patients the distal phalanx is bifid, but a common joint is shared. When one thumb is much ...
- Wassel Type III Thumbs.When one thumb is smaller, it is best deleted, but when the condition represents a truly bifid thumb, the...
- Wassel Type IV Thumbs.In this most common variety (Fig. 12.103), reconstruction of ligaments and tendons is especially critical....
- Wassel Type V and VI Duplications.These rare and complex duplications require reattachment of the abductor tendons and reconstru...
- Triphalangeal Thumbs
- Central Polydactyly
- Ulnar Polydactyly
- Mirror Hand
- Central Polydactyly
- Ulnar Polydactyly
- Radial Polydactyly
- Syndactyly
- Etiology
- Pathology
- Clinical Features
- Incidence
- Associated Syndromes
- Imaging
- Cutaneous (Simple) Syndactyly
- Preparation.All syndactyly reconstructions should be carried out under general anesthesia. A tourniquet must be used to ensure a...
- Design of the Incisions.It has been said, with some justification, that after the incisions have been drawn in a syndactyly, the...
- Separation of the Digits.We usually begin with incision and elevation of the dorsal flap distally and carry the dissection down ...
- Flap Closure.The flaps are rotated into position and meticulously closed with fine (6-0) absorbable suture (Fig. 12.123). Using...
- Skin Graft Patterns.The defects requiring grafting are now carefully measured by making a precise paper pattern of the defect. P...
- Graft Harvest and Donor Site Closure.There have been many donor sites outlined for the harvesting of full thickness skin graft—g...
- Attaching Grafts to the Digital Skin Defects.We use fine (6-0) absorbable suture and first anchor the corners and then complete...
- Tip Reconstruction.If the syndactyly is incomplete at the tip, the flaps and grafts described previously suffice to reconstruct ...
- Dressing Application.The goal of syndactyly surgery is to achieve complete and primary healing of all wounds and skin grafts. An...
- Aftercare.The wound is left undisturbed under the cast for 3 weeks unless fever, increasing pain, or an unusual odor is noticed....
- Syndactyly of the First (Thumb–Index) Web.Of all the operations performed to treat congenital hand problems, none reward the sur...
- Cutaneous (Simple) Syndactyly
- Complications and Outcomes
- Thumb Abnormalities
- Tight Thumbs (Thumb-in-Palm Deformity)
- Etiology.Trigger thumb is not a congenital deformity. An examination of 1116 newborns in Japan did not identify trigger thumb in...
- Pathology.A thickening within the tendon forms a nodule at the region of the first annular pulley of the flexor sheath mechanism...
- Imaging. Radiographs are not usually necessary but should be obtained if trauma is suspected
- Treatment.Although one report on the natural history of 71 Korean trigger thumbs found that the flexion deformity resolved in 63...
- Complications.Complications of treatment include infection, damage to digital neurovascular structures, and excessive release of...
- Etiology.Spasticity is the end pathway for the upper motoneuron dysfunction that may result from an antenatal infarct, cerebral ...
- Imaging. Imaging studies are not usually necessary unless bone procedures are being contemplated
- Treatment.Initially, manipulation and perhaps splinting may help bring the thumb out of the palm. Any splint applied must be car...
- Results.The results of both surgical and nonsurgical treatment can be encouraging if the goals are selected carefully and normal...
- Clinical Features.A clasped thumb cannot be passively extended at the CMC, MCP, or IP joint. The skin on the palmar aspect of th...
- Imaging.Imaging studies demonstrate the abnormal posture of the thumb but show no deficiencies in the bony anatomy. Later, joint...
- Treatment.Treatment consists of passive stretching and splinting until no further change in position can be achieved. Surgical t...
- Results.Nonoperative treatment of a type I clasped thumb can be successful in a patient younger than 1 year. However, nonoperati...
- Pathology
- Imaging
- Treatment
- Complications
- Etiology.Trigger thumb is not a congenital deformity. An examination of 1116 newborns in Japan did not identify trigger thumb in...
- Tight Thumbs (Thumb-in-Palm Deformity)
- Macrodactyly
- Congenital Band Syndrome
- Apert Syndrome
- Radial Longitudinal Deficiency
- Juvenile Arthritis and Other Noninfectious Inflammatory Conditions
- General Principles
- Wrist Involvement
- Wrist Joint Synovitis
- Tendon Synovitis (Tenosynovitis)
- Treatment of Synovitis and Tenosynovitis
- Splints
- Heat
- Intraarticular Corticosteroids
- Exercises
- Synovectomy.Synovectomy of the multiple tiny joints in the wrist is rarely useful in children with juvenile arthritis. In most c...
- Technique.When significant deformity is present, we tend to use small-plate fixation to ensure maintenance of alignment. Usuall...
- Technique.The surgeon should take care to resect a minimal amount of the distal end of the ulna (only just enough to allow rotat...
- Hand Involvement
- Treatment of Digital Involvement
- Other Noninfectious Inflammatory Conditions
- Infections
- Neonatal Brachial Plexus Palsy
- Tumors of the Upper Limb
- Nonneoplastic Masses
- Neoplasms
- Giant Cell Tumor of the Tendon Sheath
- Glomus Tumors
- Pyogenic Granuloma
- Lipomas
- Fibrous Tumors
- Aponeurotic Fibroma.Aponeurotic fibromas are unusual lesions that involve the palmar aponeurosis. They tend to occur in preteens...
- Infantile Digital Fibroma.Infantile digital fibromas occur in young children. The lesions are often multiple and appear as hard,...
- Simple Fibromas.Simple fibromas are unusual but may occur. These well-defined lesions are hard masses, typically on the dorsum ...
- Neurofibromas.Neurofibromas are seen in association with neurofibromatosis and often occur as multiple lesions. Treatment is res...
- Malignant Soft Tissue Tumors
- Benign Bone Tumors
- Giant Cell Tumor of the Tendon Sheath
- Microsurgery
- 13 - Developmental Dysplasia of the Hip
- Definition
- Incidence
- Etiology
- Associated Conditions
- Pathophysiology
- Natural History
- Clinical Features
- Radiographic Findings
- Screening Criteria
- Treatment
- Complications and Pitfalls
- Reconstructive Procedures for Dysplasia
- Teratologic Dislocation of the Hip
- 14 - Legg-Calvé-Perthes Disease
- Definition
- Incidence
- History
- Etiology
- Pathology and Pathophysiology
- Clinical Features
- Radiographic Findings
- Radiographic Classification Systems for Prognostication
- Quantitative Measures of Femoral Head Sphericity and Congruency
- Differential Diagnosis
- Treatment
- Long-Term Prognosis
- 15 - Slipped Capital Femoral Epiphysis
- Incidence and Epidemiology
- Classification
- Etiology
- Pathology
- Clinical Features
- Radiographic Findings
- Treatment
- Initial Management
- Definitive Treatment
- Postoperative Management.We allow protected partial weight bearing with crutches as soon as the patient is comfortable, usually ...
- Percutaneous In Situ Fixation Using a Radiolucent Tabletop.This technique may be used instead of the fracture table technique at...
- Bone Graft Epiphysiodesis
- Spica Cast
- Unstable Slipped Capital Femoral Epiphysis
- Closed Versus Open Reduction
- Primary Open Reduction of the Slipped Epiphysis
- Other Open Reduction Techniques
- Screw Fixation With Minimal Reduction.Screw fixation with minimal reduction remains the gold standard for internal fixation of u...
- Aftercare.Most surgeons recommend restricted weight bearing with support (crutches or walker) for 6 or more weeks postoperativel...
- Complications.Whether AVN is due to damage to the blood supply of the capital epiphysis caused by its acute displacement or by i...
- Summary.In summary, we believe that the classification of SCFE into stable and unstable is clinically meaningful and should be p...
- Postoperative Management.We allow protected partial weight bearing with crutches as soon as the patient is comfortable, usually ...
- Residual Deformity After Primary Treatment
- Prophylactic Treatment of the Contralateral Hip
- Complications
- Prognosis
- 16 - Congenital Coxa Vara
- 17 - Disorders of the Femur
- 18 - Disorders of the Leg
- Congenital Hyperextension and Dislocation of the Knee
- Disorders of the Legs Presenting After Infancy
- Genu Varum (Bowlegs)
- Physiologic Genu Varum
- Tibia Vara
- Infantile Tibia Vara (Blount Disease)
- Etiology. Several authors have reported a familial occurrence of the condition,12,65,124,196,200 and one report of infantile tib...
- Physiology. Histologic findings of the affected physis and corresponding metaphysis in infantile tibia vara have included (1) is...
- Clinical Features. The typical child with infantile tibia vara may appear similar to a child with physiologic genu varum; howeve...
- Radiographic Findings. A standing anteroposterior view of the lower extremities from hip to ankle should be obtained when initia...
- Differential Diagnosis. The most common entity in the differential diagnosis in young children is physiologic genu varum, in whi...
- Classification. In 1952, Langenskiöld classified infantile tibia vara according to the degree of metaphyseal-epiphyseal changes...
- Treatment. Untreated infantile tibia vara results in a nonresolving, progressive angular change, joint deformity, and growth ret...
- Orthoses.Literature suggests that for children younger than 3 years old with early Langenskiöld stage I to II lesions, orthotic ...
- Treatment of Langenskiöld Stage II Lesions.Surgical treatment in the early stages of the disease (stage I or II) is crucial to a...
- Treatment of Langenskiöld Stage III Lesions.Stage III lesions can respond to corrective osteotomy alone in patients older than 4...
- Treatment of Langenskiöld Stages IV/V Lesions.In stage IV and V lesions, simple mechanical realignment is rarely successful as a...
- Treatment of Langenskiöld Stage VI Lesions.Treatment of stage VI lesions with established bony bridges is based upon the age of ...
- Complications of Surgery.Complications of proximal tibial osteotomy in a growing child can be devastating. The osteotomy must be...
- Summary.Early treatment aimed at curing infantile tibia vara, when discovered in its early stages, is more likely to produce a g...
- Adolescent Tibia Vara
- Etiology. No definitive cause for adolescent tibia vara has been established. Failure of the expected resolution of a physiologi...
- Clinical Features. The typical patient with adolescent tibia vara is a male teenager, often African American, whose body weight ...
- Radiographic Findings. Radiographically, the tibial epiphysis is relatively normal, without the depression and beaking of the me...
- Treatment. Treatment is surgical. Orthotic management in heavier adolescent patients is impossible and ineffective. In the obese...
- Realignment by External Fixation.External fixation with tibial and fibular osteotomies is another option for the treatment of ad...
- Lateral Epiphysiodesis.Because of the potential complications associated with proximal tibial osteotomy and deformity correction...
- Hemiepiphyseal Stapling.Lateral hemiepiphysiodesis of the proximal end of the tibia (and distal end of the femur) can also be pr...
- Hemiepiphyseal Plating.The advent of extraperiosteal plate and screw systems introduced an alternative method to nonpermanent de...
- Tibia Vara Secondary to Focal Fibrocartilaginous Dysplasia
- Infantile Tibia Vara (Blount Disease)
- Genu Valgum (Knock-Knees)
- Tibial Torsion
- Bowing of the Tibia
- Anterolateral Bowing of the Tibia
- Anterolateral Bowing With Congenital Dysplasia
- Etiology and Pathology.The relationship of anterolateral bowing and neurofibromatosis (NF) has been known since 1937,59 and 5.7%...
- Classification.Classification systems attempt to guide prognosis for achieving union based upon radiographic findings including4...
- Clinical Features.Anterolateral bowing of the tibia is often seen at birth with an apical prominence laterally in the leg and wi...
- Treatment.Except for the type I benign lesions,233 the natural history of tibial dysplasia (anterolateral bowing) is extremely u...
- Intramedullary Fixation.Our procedure of choice to gain union and correct deformity requires resection of the pseudarthrosis (se...
- Bone Morphogenetic Protein.Beginning in the early 2000s, the introduction of recombinant human BMPs for clinical use in fracture...
- Bisphosphonates.A better understanding of the pathophysiology at the pseudarthrosis site has prompted investigations into the ef...
- Vascularized Fibular Graft.Nonvascularized bone grafts have failed to achieve definite and lasting union of CPT. The first use o...
- External Fixation and Distraction Osteogenesis.Distraction osteogenesis techniques (Ilizarov method) to improve tibial dysplasia...
- Periosteal Grafting.A number of historical and recent studies propose that the periosteum plays an intricate role in the pathoge...
- Electrical Stimulation.Bassett10,11 has demonstrated increased calcification of fibrocartilage, increased angiogenesis, and decr...
- Late Fracture in Previously Undiagnosed Congenital Dysplasia.Occasionally, a child with no history of dysplasia sustains a tibia...
- Benign Form of Anterolateral Bowing of the Tibia
- Anterolateral Bowing With Congenital Dysplasia
- Congenital Posteromedial Bowing of the Tibia
- Anterolateral Bowing of the Tibia
- Congenital Pseudarthrosis of the Fibula
- Genu Varum (Bowlegs)
- 19 - Disorders of the Foot
- Introduction
- Normal Variations
- Osteochondroses
- Congenital Deformities
- Postural Deformities
- Talipes Calcaneovalgus
- Flexible Flatfoot (Pes Planovalgus)
- Definition
- Clinical Features
- Natural History
- Treatment
- Conservative Treatment
- Arthroereisis.Arthroereisis of the subtalar joint, using a metal, silicone, or Silastic implant, has been reported as an alterna...
- Heel Cord Lengthening.An Achilles tendon contracture should always be considered and treated during any surgery for flatfoot. If...
- Subtalar Fusion.Subtalar fusion as a primary procedure for hypermobile flatfoot should probably be condemned. While there is no ...
- Lateral Column Lengthening.Lateral column lengthening by insertion of a bone graft into an osteotomy of the calcaneal neck is cu...
- Imbrication of Talonaviculocuneiform Complex.Imbrication of the talonaviculocuneiform complex medially is performed in combinati...
- Conservative Treatment
- Summary
- Skewfoot
- Congenital Talipes Equinovarus (Clubfoot)
- Etiology
- Pathologic Anatomy
- Diagnostic Features and Differential Diagnosis
- Nonoperative Treatment
- Ponseti Method
- French Physiotherapy (Functional) Method
- Origin of the Procedure.The French method for nonoperative correction of clubfeet was conceived in the early 1970s by Masse131 a...
- Current Procedure.The goal of this treatment is to reduce the talonavicular joint, stretch out the medial tissues, and then sequ...
- Results.Most of the clubfoot improvement achieved with the functional method occurs during the first 3 months. After this period...
- Surgical Treatment
- Timing of the Procedure
- Various Techniques
- Suggested Operative Technique
- Dorsal Subluxation of the Navicular.This condition, which produces a shortened cavovarus foot, has been reported frequently afte...
- Valgus Overcorrection.A so-called overcorrected foot, with excessive hindfoot valgus and usually forefoot abduction and pronati...
- Dorsal Bunion.This deformity can be considered a complication of clubfoot surgery because the underlying muscle imbalance requir...
- Revision and Secondary Procedures
- Anterior Tibial Tendon Transfer (Video 19.7).Transfer of the tibialis anterior insertion—either the entire tendon or a split tra...
- Transfer for Insufficient Triceps Surae (Calcaneus Gait).Overlengthening of the Achilles tendon or triceps insufficiency seconda...
- Lateral Column Shortening (Video 19.8).“Recurrence” of clubfoot deformity after earlier surgical release requires analysis of th...
- Calcaneal Osteotomy.In a foot with fixed heel varus, with or without other significant residual deformity, an opening or closing...
- Supramalleolar Osteotomy.Persistence of a toe-in gait is common in an otherwise plantigrade foot, regardless of the surgical te...
- Triple Arthrodesis.After the age of 10 years, management of residual deformity requires bony stabilization, not only to correct ...
- Correction Using the Ilizarov Technique.Because stretching plus elongation of contracted tissue is fundamental to the management...
- Anterior Tibial Tendon Transfer (Video 19.7).Transfer of the tibialis anterior insertion—either the entire tendon or a split tra...
- Vertical Talus
- Tarsal Coalition
- Cleft Foot
- Neurogenic Abnormalities
- Cavus Foot
- Etiology
- Clinical Features
- Radiographic Findings
- Further Diagnostic Evaluation
- Treatment
- Conservative Treatment
- Surgical Treatment
- Plantar Release.Plantar release is always performed during surgery to correct a cavus foot. With mild flexible deformities in yo...
- Peroneus Longus–to–Peroneus Brevis Transfer.One tendon transfer that has been commonly used as part of surgical reconstruction o...
- Anterior Transfer of the Posterior Tibialis Tendon.Patients with cavovarus feet as a result of peripheral neuropathy or myopathi...
- Transfer of the Toe Extensors to the Metatarsal Heads.Patients with pes cavus often have claw toes secondary to recruitment of t...
- Calcaneal Osteotomy.A calcaneal osteotomy is indicated in children with inflexible hindfoot varus on the Coleman block test. The...
- Satisfactory results have been reported in more than half of patients after a Dwyer osteotomy. Although incomplete correction or...
- Midfoot Osteotomies.Several different osteotomies of the midfoot have been proposed for surgical reconstruction of a cavus foot....
- Triple Arthrodesis.When the amount of deformity present in a foot with pes cavus cannot be corrected fully by soft tissue releas...
- Cavus Foot
- Toe Deformities
- Hallux Valgus
- Hallux Valgus Interphalangeus
- Hallux Varus
- Hallux Rigidus
- Polydactyly
- Syndactyly
- Macrodactyly
- Varus Fifth Toe
- Curly Toe
- Hammer Toe
- Mallet Toe
- Longitudinal Epiphyseal Bracket
- Hair Tourniquet Syndrome
- Subungual Exostosis
- Glomus Tumor
- 20 - Limb Length Discrepancy
- Leg Length Inequality
- Etiology and Associated Conditions
- Impact of Inequality
- Assessment of Inequality
- Prediction of Leg Length Inequality in the Skeletally Immature Child
- Treatment
- Psychological and Social Factors
- Indications
- Orthotic Management
- Shortening of the Long Leg
- Results.In Green and Anderson’s series (163) of 77 epiphysiodeses, there were 5 cases of angular deformity (4 requiring correcti...
- Eight Plate and Tension Band Plating
- Acute Shortening
- Lengthening of the Short Leg
- Stimulation of Growth in the Short Leg
- Surgical Lengthening of the Short Leg
- History.Codivilla89 is credited with the earliest description of limb lengthening.236,351 He stated that the “best results are o...
- Indications.In 1958, after evaluating 40 patients who had undergone leg lengthening 20 or more years previously, Sofield and col...
- Effects of Gradual Lengthening.Ilizarov deserves much credit for his studies on the effects of gradual distraction on bone and s...
- Bone.After extensive studies in dogs, as well as an assessment of his clinical experience, Ilizarov concluded that the quality a...
- Muscle.The effect of lengthening on the function of muscle and, correspondingly, the resistance to lengthening by muscle tissue ...
- Peripheral Nerves.Ilizarov described histologic evidence of the development and growth of nerves, including axon elongation and ...
- Joints and Articular Cartilage.The one tissue that appears to incur only deleterious effects from lengthening is articular carti...
- Complications of Gradual Lengthening.The reported incidence of complications associated with gradual leg lengthening ranges from...
- Nerve or Vessel Injury During Device Application.Acute nerve or vascular injury during application of an external fixator is an ...
- Incomplete Osteotomy.When a low-energy corticotomy is performed through a small incision in an effort to minimize soft tissue i...
- Premature Consolidation.This complication is unique to the gradual distraction techniques of callotasis. On occasion, the rate o...
- Poor Regenerate Bone Formation.The opposite of premature consolidation is poor regenerate bone formation. This may be a global p...
- Joint Subluxation.One of the most serious complications of leg lengthening is joint subluxation or frank dislocation. Typically,...
- Neurapraxia.In addition to acute nerve injury at the time of external fixation, neurapraxia can occur with lengthening.ff This m...
- Pin Site Infection.Pin site infection is nearly universal in external fixation for leg lengthening because of a combination of t...
- Sequestrum.Much less frequent than pin site infection is the development of a true ring sequestrum. The presumed mechanism is bo...
- Regenerate Bone Fracture.A significant complication of lengthening is fracture or bending of regenerate bone after apparatus rem...
- Subsequent Growth Disturbance of the Lengthened Limb.Many reports exist of significant deceleration of expected growth after leg...
- Psychological Stress.The prolonged treatment protocol, the intensity of treatment of the extremity, and chronic pain, even if on...
- Other Complications.In addition to the aforementioned well-recognized complications, loss of joint motion, joint contracture, a...
- Dynamic Axial Fixator.Aldegheri and co-1396983920workers11139705914013 and De Bastiani and colleagues1061397059140108 popularize...
- Ilizarov Apparatus.Ilizarov began his work with external fixation for the management of fractures, deformity correction, and len...
- Combined Internal and External Fixation (Lengthening Over Intramedullary Rods).A significant disadvantage associated with gradua...
- Totally Implantable Lengthening Devices.An intriguing concept is that of totally implantable lengthening devices. Such a device ...
- Summary of Lower Extremity Lengthening
- Angular Deformity
- Leg Length Inequality
- 21 - Limb Deficiencies
- Proximal-Distal Axis
- Anterior-Posterior Axis
- Dorso-Ventral Axis
- Classifying Limb Deficiencies
- General Treatment Concepts
- Congenital Absence of Limbs
- Congenital Lower Limb Deficiencies
- Proximal Focal Femoral Deficiency
- Hamanishi Classification
- Clinical Features
- Treatment
- Rotationplasty.Rotationplasty was first described in 1930 by Borggreve, who used the procedure to treat a knee severely damaged ...
- Femoral Pseudarthrosis Stabilization.The need to stabilize the upper femoral defect is controversial. Paley and others recommend...
- Hip Stabilization.Children with major femoral deficiencies who are managed with either amputation or rotationplasty usually func...
- Limb Lengthening.In some patients with PFFD, and in most patients with congenital shortening of the femur, the projected final d...
- Rotationplasty.Rotationplasty was first described in 1930 by Borggreve, who used the procedure to treat a knee severely damaged ...
- Fibular Deficiency
- Tibial Deficiency
- Foot Deficiency
- Proximal Focal Femoral Deficiency
- Congenital Upper Limb Deficiencies
- Acquired Limb Absences
- Multilimb Deficiencies
- Prosthetic Management
- 22 - Arthritis
- Joints
- Juvenile Idiopathic Arthritis (Formerly Juvenile Rheumatoid Arthritis)
- Enthesitis-Related Arthritis and Spondyloarthropathies
- Acute Transient Synovitis of the Hip
- Neuropathic Arthropathies
- Tuberculous Arthritis
- Tuberculosis of the Spine
- Gonococcal Arthritis
- 23 - Infections of the Musculoskeletal System
- Overview
- Radiology
- Laboratory Studies
- Local Tissue and Blood Cultures (Microbiology)
- Staphylococcus aureus
- Streptococcus pyogenes
- Kingella kingae
- Streptococcus pneumoniae
- Neisseria meningitidis
- Neisseria gonorrhoeae
- Borrelia burgdorferi
- Mycobacterium tuberculosis
- Nontuberculous Mycobacteria
- Treponema pallidum
- Brucella melitensis
- Bartonella henselae
- Mycotic Organisms
- Coccidioides immitis
- Blastomyces dermatitidis
- Actinomyces israelii
- Sporothrix schenckii
- Disease Manifestations
- Osteomyelitis
- Acute Hematogenous Osteomyelitis
- Pathophysiology
- Classification
- Neonatal.Neonatal osteomyelitis occurs in two distinct varieties. The first is encountered in infants 2 to 8 weeks of age who ar...
- Infantile and Early Childhood.Several organisms appear to have the ability to cause deep infection in children between 3 and 36 ...
- Childhood.Among children between 3 and 12 years of age, the most common causative organism of AHO is S. aureus (80%–90%); S. pyo...
- Adolescent.Invasive musculoskeletal infection in adolescents is most commonly caused by S. aureus, followed by GABHS. Additional...
- Treatment
- Surgery.Considerable difference of opinion exists regarding the timing, extent, and necessity of surgery to treat AHO.j The prim...
- Outcomes of Osteomyelitis
- Subacute Osteomyelitis
- Pathophysiology
- Classification
- Evaluation and Treatment
- Outcomes
- Chronic Osteomyelitis
- Pathophysiology
- Classification
- Evaluation
- Treatment
- Antibiotic Therapy.In most cases, decisions regarding antibiotic selection, route of administration, and duration of treatment a...
- Surgery.Débridement surgery is the foundation of osteomyelitis treatment. The major goal of surgery in chronic osteomyelitis is ...
- Complications.Recurrence of disease within 2 years has been reported in 20% to 30% of children with chronic osteomyelitis, despi...
- Chronic Recurrent Multifocal Osteomyelitis
- Pathophysiology
- Evaluation
- Treatment
- Complications
- Septic Arthritis
- Tuberculous Arthritis
- Tuberculosis of the Spine
- Gonococcal Arthritis
- Pyomyositis
- Other Soft Tissue Infections of Orthopaedic Significance
- Osteomyelitis
- Infection in Challenging Locations
- Systemic Diseases Associated With Infection
- 24 - General Principles of Tumor Management
- 25 - Benign Musculoskeletal Tumors
- Simple Bone Cysts (Solitary Bone Cyst, Unicameral Bone Cyst)
- Aneurysmal Bone Cyst
- Fibrous Dysplasia
- Osteofibrous Dysplasia of the Tibia and Fibula (Campanacci Disease)
- Solitary Osteochondroma
- Hereditary Multiple Exostoses
- Solitary Enchondroma
- Multiple Enchondromatosis (Ollier Disease) and Maffucci Syndrome
- Chondroblastoma
- Chondromyxoid Fibroma
- Osteoid Osteoma
- Osteoblastoma
- Langerhans Cell Histiocytosis (Histiocytosis X)
- Eosinophilic Granuloma: Solitary and Multiple Without Extraskeletal Involvement
- Pathology
- Hand-Schüller-Christian Disease: Multifocal Eosinophilic Granuloma With Extraskeletal Involvement (Chronic Disseminated Type)
- Letterer-Siwe Disease: Multifocal Eosinophilic Granuloma (Acute Disseminated or Infantile Form)
- Nonossifying Fibroma and Fibrous Cortical Defect
- Primary Synovial Chondromatosis
- Pigmented Villonodular Synovitis and Giant Cell Tumor of the Tendon Sheath
- Dysplasia Epiphysealis Hemimelica (Trevor Disease)
- 26 - Malignant Bone Tumors
- Osteosarcoma
- Classic Osteosarcoma
- Pathology
- Clinical Features
- Position Emission Tomography-Computed Tomography
- Laboratory Findings
- Differential Diagnosis
- Staging
- Biopsy
- Treatment
- Chemotherapy
- Surgical Treatment
- Amputation.Irrespective of the method chosen to treat osteosarcoma, the local tumor must be completely excised with negative mar...
- Rotationplasty.An alternative to amputation for distal femoral osteosarcomas is the rotationplasty (Fig. 26.11). Young children ...
- Limb salvage.After a complete staging workup, biopsy, and (usually) preoperative chemotherapy, the primary tumor is assessed for...
- Metastatic Osteosarcoma
- Classic Osteosarcoma
- Ewing Sarcoma and Peripheral Primitive Neuroectodermal Tumor
- Chondrosarcoma
- Soft Tissue Sarcomas
- Osteosarcoma
- 27 - General Principles of Managing Orthopaedic Injuries
- 28 - Spinal Injuries
- 29 - Upper Extremity Injuries
- Injuries to the Clavicle
- Fractures of the Scapula
- Fractures Involving the Proximal Humeral Physis
- Traumatic Dislocation of the Glenohumeral Joint
- Fractures of the Proximal Metaphysis and Shaft of the Humerus
- Fractures About the Elbow
- Supracondylar Fractures of the Humerus
- Anatomy
- Mechanism of Injury
- Classification
- Diagnosis
- Radiographic Findings
- Treatment
- Emergency Treatment
- Treatment of Nondisplaced Fractures
- Treatment of Displaced Fractures
- Closed Reduction of Flexion-Type Fractures
- Open Reduction of Supracondylar Humerus Fractures
- Percutaneous Pinning
- Cast Immobilization
- Traction
- Timing of Reduction for Type III Fractures
- Pinning Technique and Iatrogenic Ulnar Nerve Injury
- Management of a Viable, Pulseless Hand
- Management of Late-Presenting or Malreduced Fractures
- Complications
- Transphyseal Fractures
- Lateral Condyle Fractures
- Anatomy
- Mechanism of Injury
- Classification
- Diagnosis
- Radiographic Findings
- Treatment
- Complications
- Cubitus Varus and Lateral Spur Formation
- Delayed Union and Nonunion
- Fractures With Delayed Union.We use the term delayed union to refer to a minimally displaced fracture that does not heal with 6 ...
- Late-1396983920Presenting Fractures.Historically, some have reported better results in patients treated with observation rather ...
- Nonunited Fractures.We use the term nonunion to refer to a fracture that has not healed within 3 months. Clinically, nonunion ca...
- Growth Arrest
- Fishtail Deformity and Avascular Necrosis
- Medial Epicondyle Fractures
- Elbow Dislocations
- Radial Head and Neck Fractures
- Anatomy
- Mechanism of Injury
- Classification
- Diagnosis
- Radiographic Findings
- Treatment
- Immobilization
- Reduction
- Closed Reduction.There are several techniques of closed reduction. Patterson is credited with describing a technique advocated b...
- Percutaneous and Intramedullary Reduction.In type II (30 to 60 degrees of angulation) and type III (>60 degrees of angulation) r...
- Open Reduction.Salter-Harris types III and IV injuries, as well as fractures that remain significantly angled after attempts at...
- Treatment of Late-Presenting Displaced Fractures
- Radial Head Excision
- Complications
- Olecranon Fractures
- Uncommon Elbow Fractures
- Associated Conditions
- Supracondylar Fractures of the Humerus
- Fractures of the Forearm
- Monteggia Fractures
- Fractures of the Shaft of the Radius and Ulna
- Anatomy
- Mechanism of Injury
- Classification
- Diagnosis
- Radiographic Findings
- Treatment
- Follow-Up.After reduction and splinting or casting, the patient is discharged with instructions to elevate the arm “with the fi...
- Operative Treatment
- Open Reduction and Internal Fixation.Open reduction plus internal fixation with compression plate and screws, the standard of ca...
- Flexible Intramedullary Fixation.The advent of image intensification has made closed reduction and percutaneous intramedullary f...
- Single-Bone Fixation.There have been reports of successful management of both-bone forearm fractures with stabilization of onl...
- External Fixation.External fixation of children’s forearm fractures can refer to treatment with traditional external fixation de...
- Malunion
- Delayed Union or Nonunion
- Synostosis
- Compartment Syndrome
- Peripheral Nerve Injury
- Other Complications
- Fractures of the Distal Forearm
- Anatomy
- Mechanism of Injury
- Classification
- Diagnosis
- Radiographic Findings
- Greenstick Fractures
- Metaphyseal Fractures
- Nondisplaced Metaphyseal Fractures.Nondisplaced metaphyseal fractures only need to be immobilized in a short- or long-arm cast...
- Displaced Distal Metaphyseal Fractures.There has been considerable controversy over the treatment of displaced distal fractures ...
- Treatment by Closed Reduction and Casting.Despite one report supporting closed treatment without manipulation,66 we still treat ...
- Operative Treatment.Indications for operative treatment include open fractures, irreducible fractures, fractures associated with...
- Parameters of an Acceptable Reduction.The factors that affect remodeling are discussed in detail in Chapter 31; these include th...
- Distal Radial Physeal Fractures
- Distal Ulnar Physeal Injuries
- Galeazzi Fractures
- Complications
- Fractures and Dislocations of the Wrist and Hand
- 30 - Lower Extremity Injuries
- Pelvis and Acetabulum
- Pelvis
- Anatomy
- Mechanism of Injury
- Classification
- Associated Injuries
- Clinical Features
- Radiographic Findings
- Treatment
- Types of Injuries (Torode and Zieg Classification)
- Type III: Simple Pelvic Ring Fractures. This injury includes fractures of the pubic rami, disruptions of the pubic symphysis, ...
- Type IV: Pelvic Ring Disruption Fractures. Pelvic ring disruption fractures include the following: bilateral pubic rami fracture...
- Straddle Fracture. Straddle fractures consist of bilateral fractures of both the superior and inferior rami or separation of the...
- Double-Ring Fracture. The second group of type IV fractures includes vertically or rotationally unstable pelvic fractures (or b...
- Lateral Compression. A lateral compression–type injury (Fig. 30.11) that produces an anterior pelvic ring fracture and partial s...
- Anterior Compression. Anterior compression–type injuries (Fig. 30.12) in children younger than 10 years usually heal without dif...
- Vertical Shear. A Malgaigne-type injury (Fig. 30.13) is characterized by complete disruption of the entire hemipelvis with a ve...
- Treatment Techniques
- Complications
- Acetabulum
- Anatomy
- Mechanism of Injury
- Classification
- Associated Injuries
- Clinical Features
- Radiographic Findings
- Treatment
- Types of Injuries
- Type II Fractures. Type II fractures are often associated with other pelvic ring fractures, which must be assessed and treated a...
- Type III Fractures. Type III fractures are treated similarly to those in adults with assessment of the fracture pattern. Applica...
- Type IV Fractures. Type IV fractures with a central fracture-dislocation should be treated initially by skeletal traction in an...
- Triradiate Cartilage Injuries. Although isolated triradiate cartilage injuries account for a small percentage of acetabular frac...
- Treatment Techniques
- Types of Injuries
- Complications
- Pelvis
- Hip
- Hip Dislocations
- Hip Fractures
- Anatomy
- Mechanism of Injury
- Classification
- Clinical Features
- Radiographic Findings
- Treatment
- Complications
- Avascular Necrosis
- Predisposing Factors.Several studies found the following risk factors for AVN: fracture displacement, which is the most importan...
- Clinical Features and Radiographic Findings.Symptoms of AVN may occur early, with complaints of groin pain. Radiographic evidenc...
- Patterns.Three patterns of AVN have been described by Ratliff (Fig. 30.50). 49
- Treatment and Prognosis. In general, AVN after hip fractures in children results in poor outcomes in up to 60% of cases
- Coxa Vara
- Nonunion
- Premature Physeal Arrest
- Infection
- Avascular Necrosis
- Femur
- Femoral Shaft Fractures
- Anatomy and Development
- Mechanism of Injury
- Classification
- Clinical Features
- Radiographic Findings
- Treatment
- 7 Months to 5 Years.When shortening of the fracture is limited to less than 2 to 3 cm and the fracture has a stable, simple patt...
- 6 to 10 Years.Femoral shaft fractures in children between 6 and 10 years of age are routinely treated by closed or open reductio...
- 11 Years to Skeletal Maturity.Flexible intramedullary rodding is an acceptable choice with a stable fracture pattern. Submuscula...
- Skin Traction.Skin traction is a noninvasive technique that is used in two settings. First, in a small child whose fracture is t...
- Skeletal Traction.Skeletal traction is a more powerful technique to apply traction to the femur, although its use is limited to ...
- Results and Cautions.Traction should reduce the fracture to within 2 cm in a younger child, and end-to-end apposition should b...
- Spica Casting.Immediate spica casting has been advocated in a child with an isolated stable femoral shaft fracture and less than...
- External Fixation.The main indications today for external fixation are as follows: (1) an open fracture with severe disruption o...
- Open Reduction and Internal Fixation.Proponents of internal fixation with plates and screws recommend this form of treatment for...
- Submuscular Bridge Plating.Submuscular plating through a limited approach with indirect fracture reduction has been shown to be ...
- Intramedullary Fixation: Overview.Intramedullary fixation has assumed a more prominent role in the treatment of femoral shaft fr...
- Procedure.The fracture pattern most amenable to this treatment is a transverse stable fracture with minimal comminution. Long sp...
- Complications.The incidence of complications with flexible nails in appropriate fracture patterns is low. Complications are more...
- Results.Comparison studies of other techniques generally indicate that flexible nails yield superior results in treating femoral...
- Complications.Although relatively rare, the most severe complication from intramedullary nailing of a femoral shaft 1396983920fr...
- Unacceptable Angulation
- Rotational Deformities
- Nonunion and Delayed Union
- Compartment Syndrome
- Traction Injuries
- Vascular Injury
- 7 Months to 5 Years.When shortening of the fracture is limited to less than 2 to 3 cm and the fracture has a stable, simple patt...
- Femoral Shaft Fractures
- Knee
- Distal Femoral Injuries and Fractures
- Anatomy
- Mechanism of Injury
- Classification
- Clinical Features
- Radiographic Findings
- Treatment
- Distal Femoral Metaphyseal Fractures
- External Fixation.We limit the indications for external fixation to the following: significant soft tissue injury associated wit...
- Closed Reduction and Internal Fixation.The method of closed reduction of the distal metaphyseal fracture depends on the deformit...
- Open Reduction and Internal Fixation.Indications for this technique include fractures that are irreducible by closed means and a...
- Nondisplaced Physeal Fractures.Nondisplaced physeal injuries can be treated with a long-leg cast for 4 to 6 weeks, depending on...
- Salter-Harris Type I Fractures.A Salter-Harris type I injury in a newborn can be treated by immobilization without attempts at...
- Salter-Harris Type II Fractures.Of all type II fractures, 60% to 75% are displaced at the time of initial evaluation.16,41,67 I...
- Salter-Harris Type III Fractures.Type III injuries of the distal femur are relatively less common, are usually displaced, and g...
- Salter-Harris Type IV Fractures.Management of type IV fractures is similar to that for type III fractures: anatomic reduction t...
- Distal Femoral Metaphyseal Fractures
- Complications
- Peroneal Nerve Injury.Peroneal nerve injury may result from direct trauma on the posterolateral aspect of the leg or from a seve...
- Ligamentous Injuries.Associated ligamentous injuries occur relatively commonly in injuries to the distal femoral physis. A compi...
- Loss of Reduction.Loss of reduction occurs because of suboptimal stabilization of the unstable fracture, usually a result of ina...
- Angular Deformity.Angular deformity is less frequently seen than limb length discrepancy, with a reported incidence of 29% (49 o...
- Loss of Knee Motion.Loss of knee motion occurs in approximately 27% of distal femoral physeal injuries (45 of 167 patients in fi...
- Peroneal Nerve Injury.Peroneal nerve injury may result from direct trauma on the posterolateral aspect of the leg or from a seve...
- Patellar Fractures
- Tibial Tuberosity Fractures
- Proximal Tibial Physeal Fractures
- Proximal Tibiofibular Joint Dislocations
- Distal Femoral Injuries and Fractures
- Tibia and Fibula
- Anatomy
- Tibial and Fibular Fractures
- Proximal Tibial Metaphyseal Fractures
- Tibial and Fibular Diaphyseal Fractures
- Open Tibial Diaphyseal Fractures
- Distal Tibial Metaphyseal Fractures
- Stress Fractures of the Tibia
- Ankle
- Anatomy
- Ankle Fractures
- Classification
- Clinical Features
- Radiographic Findings
- Treatment
- Complications
- Foot
- Pelvis and Acetabulum
- 31 - Disorders of the Brain
- Levels of Involvement
- Cerebral Palsy
- Definition
- Epidemiology
- Etiology
- Classification
- Evaluation
- Muscle Strength
- Prognosis for Ambulation
- Treatment
- Management of Foot Involvement in Cerebral Palsy
- Management of Knee Involvement in Cerebral Palsy
- Management of Hip Involvement in Cerebral Palsy
- Management of Spinal Deformity in Cerebral Palsy
- Scoliosis
- Nonoperative Treatment
- Surgical Treatment
- Segmental Instrumentation of Scoliosis.Segmental instrumentation is recommended in patients with scoliosis secondary to CP. Subl...
- Galveston Technique.Fusion of the spine to the pelvis was classically accomplished with the Galveston technique, as described by...
- Dunn-McCarthy Technique.Another form of fixation that was used for patients with CP was the Dunn-McCarthy technique, in which ...
- Iliac and Sacroiliac Screw Fixation Technique.Recent advances in modular spinal instrumentation have improved the ease and secur...
- Growing Rod Instrumentation.Growing rod instrumentation has been used in small numbers of very young children with CP and scolio...
- Segmental Instrumentation of Scoliosis.Segmental instrumentation is recommended in patients with scoliosis secondary to CP. Subl...
- Spondylolysis and Spondylolisthesis
- Rhizotomy
- Scoliosis
- Management of Fractures in Cerebral Palsy
- Outcome Assessment
- Rett Syndrome
- Hereditary Spastic Paraparesis
- Ataxia Syndromes
- 32 - Disorders of the Spinal Cord