The ambulatory status of 76 children and adolescents with spinal cord injuries was studied to delineate the natural history of ambulation and to identify factors predictive of successful ambulation. The type of orthotic used and the degree and duration of ambulation depended on age, completeness and level of the neurologic deficit, and lower extremity contractures. Younger age, L3 or better neurologic levels, incomplete lesions with motor preservation, and absence of lower extremity contractures were associated with functional walking. The psychological advantages of ambulation must be weighed against the cost of orthotics and associated training and the nonfunctional nature of ambulation in the vast majority of individuals with spinal cord injuries. In addition, the developmental aspects of pediatric spinal cord injuries require changing therapeutic goals at different developmental stages.

Adolescent↗

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Latex allergy in children and adolescents with spinal cord injuries.

The incidence of latex allergy in children and adolescents with spinal cord injuries was investigated using history and laboratory testing. Among 67 individuals with spinal cord injuries, four had histories of latex allergy, and two of these also had positive laboratory tests. There were eight individuals without a history of latex allergy who had positive laboratory tests. Defining latex allergy as a positive history or a positive laboratory test, 12 of the 67 subjects (18%) would be considered allergic to latex. The incidence of latex allergy increased with time since the spinal cord injury. Recommendations are made for the diagnosis, management, and prevention of latex allergy in individuals with spinal cord injuries.

Adolescent↗

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Operations research in outpatient services.

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Ambulatory Care↗

PubMedDate not supplied

Toxic shock syndrome in patients with external fixators.

Toxic shock syndrome (TSS), first described by Todd et al. in 1978, can be a life-threatening entity. Familiarity with the pathogenesis and clinical presentation of TSS may help achieve early diagnosis and prompt appropriate intervention. TSS is not a septicemia, but a toxemia. The most extensively described pathogenesis involves a focus of specific Staphylococcus aureus strains capable of producing an exotoxin (TSST-1). We report two patients who developed TSS while in external fixators and describe their initial symptoms, management, and subsequent problems. This report will serve to alert pediatric orthopaedic surgeons to this entity and enable them to recognize its rather precipitous presentation and initiate appropriate treatment.

Bone Nails↗

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Scoliosis in pediatric spinal cord-injured patients.

One hundred thirty children who sustained spinal cord injuries between birth and age 21 years were reviewed to determine the progression rate of paralytic scoliosis and the effects of bracing and surgery. Patients were divided into two groups: those injured before and those injured after the adolescent growth spurt. Scoliosis developed in 97 and 52%, respectively. Bracing was effective in delaying progression in the preadolescent group. The progressive paralytic spinal deformity did not appear to be related to the level of injury. The older patient is at much less risk for paralytic scoliosis, but still requires routine examination.

Adolescent↗

PubMedDate not supplied

Antibiotic-induced diarrhea.

Diarrhea is a common complication of antibiotic therapy and can range from mild soiling of a cast to severe and life-threatening pseudomembranous colitis. Although clindamycin is the most notorious, almost all antibiotics, particularly penicillins and cephalosporins, may also be responsible (Bartlett, 1992; Kelly, Pothoulakis, & LaMont, 1994). Because of the frequent use of these antibiotics in orthopaedic patients, antibiotic-associated enteric disease is a common problem in this population. About 15% to 25% of cases of antibiotic-associated diarrhea are caused by Clostridium difficile (Bartlett, 1992; George, 1984; Kelly et al., 1994). The majority of patients with antibiotic-associated diarrhea have no identifiable etiologic agent. Salmonella, enterotoxin-producing Clostridium perfringens (Borriello et al., 1984) and Candida albicans (Danna et al., 1991) have rarely been identified as causative agents. This article describes the role of C. difficile as an enteric pathogen and its spectrum of clinical disease, including diagnosis, treatment, and prevention of nosocomial transmission.

Anti-Bacterial Agents↗