Faculty Bibliography

Salter-Harris type III fractures of the proximal humerus are rare injuries. We report a Salter-Harris type III anterior fracture-dislocation of the proximal humerus in a 10-year-old boy that was open reduced and internally stabilized. A bone scan performed during the initial hospitalization and at 2-year follow-up revealed devascularization and subsequent revascularization of the humeral head. At 2-year follow-up, the patient had full motion of the shoulder, no pain, and arm strength equal to that of the contralateral side. Four cases of Salter-Harris type III fractures of the proximal humerus have been previously reported; good early clinical outcomes were obtained in all. Despite devascularization of the epiphyseal fragment, excellent clinical outcomes may result

An unusual case of newborn unilateral dislocated hip is presented. The condition was refractory to conservative treatment. The cause was found during surgery at the age of 1 month: the adductors were replaced by myofibromatosis. The tumor was excised and at follow-up a normal hip was noted.

A rare case of a complete fracture-separation of the proximal radial epiphysis is described in a pediatric patient. A further complicating factor is the delay in diagnosis that may worsen prognosis. An emphasis on early detection by physical examination and imaging studies, as well as consideration of treatment options, are presented

The records concerning 64 hips in 36 cerebral palsy patients treated with varus derotational osteotomy (VDO) alone (2 hips), VDO with muscle releases (adductors, iliopsoas, hamstrings; 46 hips), and VDO, soft-tissue release, and innominate bone osteotomy (16 hips) were reviewed. There were 23 quadriplegic and 13 diplegic patients. Average age at surgery was 7 years. Average follow-up period was 3.8 years. All hips that had VDO, soft-tissue release, and innominate osteotomy were stable at follow-up. Nine hips of the 44 treated with VDO and muscle release alone dislocated, and required second osteotomies.

Seventeen cases of dislocated/subluxated hips in 14 cerebral palsy patients that were relocated by the combined hip procedure were reviewed. The combined hip procedure includes varus derotation osteotomy, open reduction, innominate bone osteotomy, adductor releases, and iliopsoas recession, all done at one stage. Eleven patients were spastic quadriplegic, 1 was spastic diplegic; and 2 were spastic hemiplegic. Average age at operation was 10 years. Average follow-up was 3 years. A total of 16 hips (94%) remained stable at follow-up with almost no change in center edge angle and the migration percentage, although the neck shaft angle remodeled over time. We conclude that the combined hip procedure is effective in maintaining hip reduction in cerebral palsy patients.

An unusual case is presented in which minor soft tissue injury may have caused premature asymmetrical closure of the proximal tibial physis resulting in a 30 degrees genu recurvatum that necessitated corrective osteotomy. Awareness of the possibility of a hidden physeal injury in the presence of soft tissue injury and a normal radiograph may lead to its early recognition and treatment.

A longitudinal study was performed in a series of 124 New Zealand White rabbits to determine the radiographic versus the histologic age of closure of the growth plates of the distal femur, proximal tibia, and proximal fibula. Periodic assessment was made by standard radiographs and histological studies. Histologically, growth plates in the distal femur closed at 19-24 weeks; growth plates in the proximal tibia, at 25-32 weeks; and growth plates in the proximal fibula, at 26-32 weeks. Radiographically, evidence of closure of growth plates in the distal femur occurred at 20-23 weeks; in the proximal tibia, at 22-27 weeks; and in the proximal fibula, at 23-31 weeks. A discrepancy in age between radiographic and histologic closure of the growth plate occurred in 3.6% of the femora, 10.9% of the tibias, and 16% of the fibulas

This article discusses the unique contribution of MR imaging to the evaluation of selected pediatric disorders of the ankle and foot. MR imaging is helping to unravel the complex congenital malformation of talipes equinovarus. It is the study of choice for the examination of intraarticular abnormalities such as Trevor's disease. The MR imaging staging of osteochondritis dissecans and delineation of a tarsal coalition have shown great promise in guiding surgical management of these abnormalities

The use of a dome osteotomy in the treatment of infantile tibia vara is reportedly associated with insufficient intraoperative assessment of the correction achieved. This article discusses a method to overcome this problem and the long-term advantages of using a dome osteotomy in the treatment of this disease.

In vivo and in vitro studies were performed over the past 6 years to evaluate the short- and long-term biocompatibility, absorbability, strength, and efficacy of polylactic acid (PLA) as a suitable material for an internal fixation system of bone, consisting of a plate and screws. The study was conducted on 30 dogs that underwent osteotomy of the radius and three dogs that underwent osteotomy of the femur. Bone fragments were fixed by the PLA plate and screws. In all specimens, the osteotomy healed in the usual length of time. The dogs were killed after 12 weeks to 4 years. At the time of death, specimens were obtained for mechanical testing and histological analysis. It appears that PLA is biocompatible, is of adequate strength, and has a suitable absorption pattern in the canine model in which it was tested. PLA did not interfere with the process of bone healing and was completely absorbed 4 years after implantation.