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PubMed1958

Treatment of athletes.

Treating participants in athletics requires the coordination of coaches, trainers, administrators and physician. Often in cases of proneness to injury, a cause can be found and correction may be obtained by further training or withdrawal of the athlete from the team. Certain types of injury should be always kept in mind in the examination of athletes, particularly football players. Ligamentous tears, myositis ossificans, navicular fracture and brain injury are injuries that may not be precisely diagnosed at the initial examination.

Athletes↗
PubMed1958

[Not Available].

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Humans↗
PubMed1958

[Not Available].

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Humans↗
PubMed1960

Elbow and wrist injuries in sports.

Any disabling injury of the elbow or wrist should be studied roentgenographically for evidence of fracture which may not be otherwise evident but which may cause permanent disability unless the joint is immobilized for healing."Tennis elbow" may be treated with physical therapy and analgesic injection but may require splinting or tendon stripping. Elbow sprain can occur in the growing epiphysis but is rare in adults. A jarring fall on the hand may cause fracture or dislocation at the elbow. Full extension of the joint should be restored gradually by active exercise rather than passive or forcible stretching. Fracture at the head of the radius may cause joint hemorrhage with severe pain which can be relieved by aspiration. A displacing fracture at the head of the radius requires removal of the head to prevent arthritic changes. Myositis ossificans contraindicates operation until after it has cleared. Healing of wrist fractures may be facilitated by exercise of the shoulder and elbow while the wrist is still in a cast. Fractures of the navicular bone are difficult to detect even roentgenographically and splinting may have to be done on clinical evidence alone.

Adult↗
PubMed2003

[Surgical treatment of elbow fracture-dislocations seen in children and adolescents].

OBJECTIVES: We evaluated surgical indications and radiologic features of elbow fracture-dislocations in children and adolescents. METHODS: Thirteen patients (12 boys, 1 girl; mean age 13 years; range 6 to 17 years) with elbow fracture-dislocations were treated surgically. Coexisting fractures included medial epicondyle fractures (n=5), medial and lateral epicondyle fractures (n=3), radial head and olecranon fractures (n=2), radial head and medial epicondyle fractures (n=1), lateral condyle fracture (n=1), and fracture of the coronoid process (n=1). Eleven dislocations were closed, two were open. Open reduction and Kirschner wire fixation were performed in all the patients. Posterior (n=6), medial (n=5), anteromedial, and lateral incisions were used. Active range of motion exercises were initiated following the removal of sutures. Above-elbow cast was applied for three weeks. The mean follow-up period was 38 months (range 7 to 58 months). The results were evaluated with the use of the Mayo elbow performance score. RESULTS: Ten patients had satisfactory (very good or good) results, while two patients with open dislocations and ipsilateral major injuries, and one patient who developed myositis ossificans postoperatively had unsatisfactory (moderate or bad) results. No postoperative nerve injuries were detected. CONCLUSION: The surgical indications for fracture-dislocations of the elbow in children and adolescents are the presence of intraarticular loose bodies or instability after reduction. The presence of open dislocation or ipsilateral major injuries are associated with unsatisfactory results.

Adolescent↗
PubMed2003

Septic arthritis of the hip in children--Aga Khan University Hospital experience in Pakistan.

OBJECTIVE: To present clinical, radiological and bacteriological features and short term outcome of septic arthritis of the hip in children. METHODS: There were 23 male and 16 female children, including 6 neonates and 10 infants with a mean age of 3.9 years. Diagnosis of septic hip was made on clinical grounds, supplemented by X-rays, leukocyte count and the erythrocyte sedimentation rate (ESR). Thirty nine patients with 40 hips were followed for a mean time period of 76 weeks. All patients had a positive joint aspirate (pus) and underwent surgical decompression along with intravenous antibiotic therapy. RESULTS: Symptoms of pain, fever and restricted range of hip motion were common to all patients. The mean leukocyte count was 14,000 and the mean ESR was 63 mm. Cultures of blood and joint aspirate were positive in 9 and 28 patients respectively. Staphylococus Aureus was the commonest organism (14 patients) identified, and only one patient had Hemophilus influenzae. Seven patients had a mixed osteoarticular infection. Positive clinical response was noted in the mean time period of 8.6 days. In follow-up, four cases developed myositis ossificans and 2 cases showed signs of partial growth plate destruction. CONCLUSION: Our findings of the absence of H. influenzae and the presence of a number of gut organisms are different from the previous studies. Duration of symptoms was an important prognostic factor and correlated well with the final outcome. Early surgical decompression was found to be the treatment of choice. A combined osteoarticular infection should be kept in mind in cases which show a poor response after the initial joint debridement.

Arthritis, Infectious↗
PubMed2004

[Muscle and tendon injuries in children and adolescents].

The pediatric athlete with open physeal plates is more susceptible to growth plate injuries and avulsion fractures than to ligament and muscle-tendon injuries that most often occur in adults. Muscle contusions and strains are common injuries in young athletes. Although they are rare in the early and middle stages of childhood, they become quite common during the growth spurt period. Healing of muscle tissues is much more rapid in children than that in adults, but it must be ensured that full motion and full strength are regained before returning to sports activities, because recurrences of injuries may result in more serious complications such as myositis ossificans. On the other hand, acute tendinous injuries are quite rare in children; however, repetitive submaximal stress may lead to overuse syndromes. This article reviews the basic anatomy and function of skeletal muscle and discusses the physiopathology of muscle-tendon injuries, and the methods of treatment and prevention, with particular focus on the growing child.

Adolescent↗
PubMedDate not supplied

Aspiration cytology of heterotopic ossification. A case report.

Heterotopic ossification (myositis ossificans) is usually a posttraumatic reactive process involving new bone formation. This nonneoplastic process can be clinically and radiologically confused with osteosarcoma. A case of heterotopic ossification is reported in which cytologic material was obtained from a partially calcified thigh mass from a 17-year-old, athletic male. Aspiration cytology revealed numerous osteoclastic giant cells containing multiple plump nuclei. These cells were admixed in a benign-appearing stromal background composed of mature fibroblasts and were typified by elongated spindle cells. A small incisional biopsy showed new bone formation, osteoclasts, osteoblasts and fibroblasts consistent with maturing heterotopic ossification. Heterotopic ossification may be distinguished cytologically from osteosarcoma by the presence of numerous uniform benign stromal cells composed of mature fibroblasts and osteoclastic giant cells. The differential diagnosis may be more difficult in the early stages of this reactive and proliferative process. Adequate sampling of suspected heterotopic ossification by aspiration cytology may avoid surgery in a selected group of patients.

Adolescent↗
PubMed2005

[Closed reduction and percutaneous pinning with three Kirschner wires in children with type III displaced supracondylar fractures of the humerus].

OBJECTIVES: We evaluated the results of closed reduction and percutaneous pinning in the treatment of displaced supracondylar fractures of the humerus in children. METHODS: Sixty-one children (41 boys, 20 girls; mean age 7.6 years; range 2 to 13 years) were treated for type III displaced supracondylar fractures of the humerus within the first six hours after trauma. Initial neurologic examinations were normal. Treatment included closed reduction followed by percutaneous pinning with two lateral and one medial K-wires, the last being placed during decreased (80 to 90 degrees) elbow flexion. The ulnar nerve was examined intraoperatively, at the time of discharge, at the end of two weeks, and in the third and six months. On final examinations, the range of motion and carrying angles of both elbows were measured with a goniometer and anteroposterior and lateral radiograms of the affected elbows were examined. The results were evaluated using the clinical scoring system developed by Flynn et al. The mean hospital stay was 3.4 days (range 1 to 10 days) and the mean follow-up was 28.9 months (range 17 to 53 months). RESULTS: Iatrogenic ulnar nerve injury occurred in two patients (3.3%), which showed complete clinical improvement in three months. Union was achieved in all the patients. Superficial pin tract infections were seen in four patients (6.6%); and cubitus varus (1.6%) and myositis ossificans in two patients, respectively. Deep infection or compartment syndrome were not encountered. The results were excellent in 49 (80.3%), good in seven (11.5%), fair in two (3.3%), and poor in three patients (5%). CONCLUSION: Closed reduction and percutaneous pinning with three K-wires is an efficacious and safe procedure with a low complication rate in the treatment of type III displaced supracondylar fractures of the humerus.

Adolescent↗
PubMed1992

[Intramedullary nailing of unstable proximal humeral fractures].

Unstable subcapital fractures and dislocation fractures of the humerus can usually be set by closed reduction. Stabilization of these fractures by intramedullary pins is a method which avoids damage to the soft tissues around the shoulder. Since 1985, elastic steel pins with special features have been in use. The last 20 mm of the tip of the pins is angulated at 15 degrees, and the distal end is curved in a special way for the last 20 mm. According to our experience, the results after using this method in the treatment of unstable fractures of the surgical neck (ASIF type A II/2) and dislocation fractures (ASIF type A III/2) are fair to very good. For unstable fractures (ASIF type C I/2) and other dislocation fractures (ASIF type C III/2), the method is only suitable if good reduction is possible. Between the end of February 1985 and the end of December 1990, 101 fractures of the proximal end of the humerus were treated by closed reduction and fixation with intramedullary pins. Following fractures in the anatomical neck, aseptic necrosis of the fragment of the head leads to unfavorable results. In two patients, pseudarthrosis with poor function developed. Disturbance of wound healing, postoperative hematoma, infection, myositis ossificans, or Sudeck's desease have not been observed.

Adolescent↗
PubMed2005

[Closed reduction and percutaneous lateral pin fixation in the treatment of displaced supracondylar fractures of the humerus in children].

OBJECTIVES: We evaluated the results of closed reduction and percutaneous lateral-pin fixation in the treatment of displaced supracondylar fractures of the humerus in children. METHODS: Thirty-four children (25 boys, 9 girls; mean age 7.2 years; range 3 to 13 years) were treated for displaced supracondylar fractures of the humerus. Five patients had Gartland type 2, and 29 patients had type 3 fractures. After closed reduction, lateral-pin fixation was performed with two parallel (n=11) or crossed (n=23) K-wires. Three K-wires were used in five patients. The mean duration of fixation was 3.8 weeks (range 3 to 6 weeks). For comparison with the normal side, the Baumann and carrying angles were measured on anteroposterior, and the humerocapitellar angle on lateral radiographs. The range of motion of the elbow was assessed clinically. The results were evaluated according to the criteria of Flynn et al. after a mean follow-up of 22.6 months (range 10 to 48 months). RESULTS: Union was achieved in all the patients. Complications such as pin-tract infections, myositis ossificans, compartment syndrome, or nerve injuries did not occur. According to the criteria of Flynn et al., functional and radiographic results were satisfactory in all the patients (100%) and in 33 patients (97.1%), respectively. One patient developed cubitus varus of 14 degrees. No significant differences were found between the mean Baumann, humerocapitellar, and carrying angles of the normal and affected sides (p>0.05). CONCLUSION: Closed reduction and percutaneous lateral pinning proved an efficient, reliable, and safe method in the treatment of displaced supracondylar fractures of the humerus in children.

Adolescent↗
PubMed2006

[Malignant tumors of long bones in children: differential diagnosis and the role of imaging methods].

PURPOSE OF THE STUDY: The aim of the study was to analyze primary malignant tumors and tumor-like lesions of long bones, in relation to their localization, characteristics and distribution in age groups, in children and young adults, and to assess the role of radiography and magnetic resonance imaging (MRI) in their diagnosis. MATERIAL: Sixty-four patients, aged between 3 and 20 years, who were referred to us with the diagnosis of a suspected malignant long-bone tumor of osseous or cartilage origin in the period from 2000 to 2004 were included in the study. METHODS: Plain radiography and MRI were carried out on the same day. For MRI, the Magnetom Open Viva system (magnetic field strength of 0.2 T) was used and examination comprised a conventional STIR (corresponding to fat saturation) and a T-weighed sequence. Most patients also underwent post-contrast examination with paramagnetic contrast medium infusion. RESULTS: In 26 children (40.6 %) a primary malignant tumor of osseous or cartilage origin was diagnosed; one child (1.5 %) had a giant-cell tumor. The definitive diagnoses in 37 children (57.9 %) included osteomyelitis in 12, fatigue fracture in 11, posttraumatic myositis ossificans in three children, and miscellaneous diagnoses in the remaining 11 children (one, cartilaginous exostosis; three, unicameral bone cyst; two, non-ossifying fibroma; one, fibrous dysplasia; one, subperiosteal abscess; one, histiocytosis; one, foreign body; one, negative MRI findings). CONCLUSIONS: To confirm the diagnosis of a malignant long-bone tumor, high quality X-ray and MRI are essential; CT examination is recommended in specific indications. The results of imaging methods cannot be assessed without reference to each other. Primary malignant tumors of long bones usually involve a large soft-tissue mass, and an exclusively intraosseous localization is rare. Osteosarcoma often invades the epiphysis. In making the differential diagnosis of primary malignant bone tumors, special attention must be paid to differentiation from osteomyelitis or fatigue fractures. The majority of juvenile bone lesions of any origin are usually detected between 10 and 13 years of age. These pathologic lesions are most frequently localized in the distal or proximal transition zones between the diaphysis and metaphysis.

Adolescent↗
PubMed1991

Treatment of soft tissue calcifications with magnesium.

80 patients with soft tissue calcifications were treated. 24 patients suffered from myositis ossificans traumatica, 23 from calcific bursitis (Duplay's disease), 6 from osteoarthropathy of elbow joint after severe craniocerebral trauma, 9 from calcifications round elbow joint after local trauma, 13 from calcifications round hip joint, 5 from calcifications in ligaments and tendons. About 75 per cent patients were cured. Calcifications disappeared or substantially diminished. Very good functional improvement followed in affected joints. Patients were treated with new method: local application of MgSO4 into calcification area was used for 2-20 weeks, peroral administration of Mg lactate was given for 4-6 months. There were neither complications nor side effects of this treatment.

Adolescent↗
PubMed1991

Induced bone development in transplants of fresh human pseudomalignant heterotopic ossification tissue in athymic nude mice.

Biopsy specimens of mature trabecular bone from tumors of two typical cases of pseudomalignant heterotopic ossification (PHO; myositis ossificans circumscripta) were transplanted into athymic nude mice. Specimens of normal metaphyseal bone in adjacent areas were also transplanted in the contralateral hindquarter muscles for controls. By seven days, control bone transplants were necrotic and enveloped in granulation tissues whereas PHO transplants were surrounded by proliferating connective tissue derived from the host-bed muscle tissues. In the intervals from 14 and 21 days, the PHO transplants showed vascular and hypertrophied connective-tissue proliferation with appositional deposits of new bone. The microscopic features of the new bone suggested that it was of mouse host-bed origin because the new bone from Case 1, a female, showed nuclei without sex chromatin. The quantities of new bone were measured by correlated histomorphometric and computer image analysis of microradiographs. Little or no cartilage development was noted at any stage. The normal control trabecular bone tissue was slowly resorbed by macrophages and mononuclear phagocytes; multinucleated giant cells were few and relatively small. Except in one questionably small area of one transplant, nontumorous undemineralized normal human bone failed to induce bone formation within the 28-day period of observation. The quantity of new bone formed in athymic mice in response to implants of PHO, estimated from equivalent quantities of bone developed from implants of lyophilized matrix-free bone morphogenetic protein (BMP) was about 1 microgram/g of wet PHO tumor weight. Although circumstantial evidence implicates BMP in the pathogenesis of heterotopic ossification, more research should be directed toward regional and systemic factors inhibiting bone development in normal and abnormal conditions, including malignant bone tumors.

Adult↗