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OITE paediatrics

OITE paediatrics. Amre Hamdi. 4) which of the following findings is associated with the use of a standered backboard in young children with suspected spinal injury ? 1 - decrease spinal blood flow. 2-Decrease thoracic kyphosis 3- increase cervical flexion

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OITE paediatrics

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  1. OITE paediatrics Amre Hamdi

  2. 4) which of the following findings is associated with the use of a standered backboard in young children with suspected spinal injury ? • 1- decrease spinal blood flow. • 2-Decrease thoracic kyphosis • 3- increase cervical flexion • 4- difficulty in performing a thorough physical examination . • 5- restriction of abdominal musculature needed for respiration .

  3. Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous. • Herzenberg JE, • Hensinger RN, • Dedrick DK, • Phillips WA. • Section of Orthopaedic Surgery, University of Michigan, Ann Arbor 48109. • In ten children who were less than seven years old, an unstable injury of the cervical spine was found to have anterior angulation or translation, or both, on initial lateral radiographs that were made with the child supine on a standard flat backboard. In all ten patients, extension was the proper position for reduction of the injury of the cervical spine. Young children have a large head in comparison with the rest of the body. When a young child is positioned on a standard backboard, the neck may be forced into relative kyphosis. Supine and upright lateral radiographs that were made of seventy-two children who did not have a fracture also demonstrated more relative cervical kyphosis in younger children when they were in the supine position. Calculations from anthropometric data documented disproportionate rates of growth of the head and the chest. The circumference of the head grows logarithmically, but the circumference of the chest grows linearly. This disproportionate growth causes young children to have a relatively large head. When they lie supine, the neck is flexed. To prevent undesirable cervical flexion in young children during emergency transport and radiography, a standard backboard can be modified to provide safer alignment of the cervical spine. This can be accomplished by the use of a recess for the occiput to lower the head or of a double mattress pad to raise the chest. • PMID: 2912996 [PubMed - indexed for MEDLINE]

  4. 12) A 7 year old boy who sustained a supracondyler fracture has a gunstock deformity following removal of the cast . Surgical correction of the angular deformity will primary result in improved 1- cosmoses of the arm 2- ROM of the elbow 3- pain relief in the elbow 4- fictional outcome 5-Rate of growth in the arm

  5. Uniplanar supracondylar humeral osteotomy with preset Kirschner wires for posttraumatic cubitus varus. • Voss FR, • Kasser JR, • Trepman E, • Simmons E Jr, • Hall JE. • Department of Orthopedics, Children's Hospital, Boston, Massachusetts. • Between 1974 and 1989, a lateral closing wedge osteotomy was used to correct posttraumatic cubitus varus in 36 patients. In 35 (97%) of the patients, the deformity was corrected to within 5 degrees of the contralateral elbow, and the patient was satisfied with the result. There were no nerve palsies or infections. Of the nine patients treated before age six years, seven had a minimum 2-year follow-up (average 9 years), and there was no evidence of recurrent deformity. This technique allows good correction of deformity with minimal complications.

  6. 17)Figures 2a and 2b show the radiographs of a 4year old child who has limp. Based on theses finding, management should consist of 1- I&D 2- subtalar arthrodesis 3- a short leg walking cast 4- a long leg non- wt bearing cast 5- core decompression of the tarsal bones .

  7. Kohler's disease of the tarsal navicular. • Williams GA, • Cowell HR. • Twenty patients with Kohler's disease of the tarsal navicular were treated at the Alfred I. duPont Institute between 1948 and 1974. Three patients with asymptomatic, irregular ossification of the tarsal navicular also were investigated to evaluate the various modes of therapy and the long-term effects of various treatment programs. Symptomatic or true Kohler's disease must be differentiated clinically from asymptomatic roentgenographic changes resembling Kohler's osteochondrosis. The patients showed a significant decrease in morbidity with the use of a short-leg cast for an an eight-week period. Whereas patients who were not treated in a short-leg cast had symptoms for an average duration of 15 months, treated patients had symptoms for less than three months. Notwithstanding the decrease in morbidity with the use of a short-leg walking cast, the long-term results suggest that all of our patients eventually had spontaneous reconstitution of the navicular and excellent recovery of function

  8. 26) the primary functional deficit in Sprengel’s deformity is limitation of what shoulder motion? 1- IR 2- ABDUCTION 3- ADDUCTIONJ 4- FLEXTION 5- EXTENSION

  9. Results of surgical treatment of Sprengel deformity by a modified Green's procedure. • Bellemans M, • Lamoureux J. • Department of Orthopaedics, Children University Hospital, Queen Fabiola, Brussels, Belgium. • The results of treatment of seven children with Sprengel deformity are reviewed. The patients were subjected to a modified Green procedure without dissection of the serratus anterior muscle and immediate postoperative mobilization. The results seem to indicate that the postoperative abduction gain (77 degrees) compares favorably in regard to the current literature and that this modification of the classic technique offers a substantial advantage concerning functional outcome in these patients.

  10. 35) THE PONSETI METHOD OF CLUBFOOT TREATMENT INVOLVES WHICH OF THE FOLLOWING CONCEPTS? 1- short leg cast for 6-8 weeks, followed by percutaneous heel cord tenotomy. 2- comprehensive posterior, medial, and lateral subtalar release performed at age of 3 months . 3- supination of the foot during the initial cast correction. 4- abduction of the foot with counter pressure at the calcaneocuboid joint. 5- correction of equinus prior to correction of supination.

  11. 42) A 6year old boy sustains multiple injuries in a high speed MVC. In addition to his fractures, he has intraabdominal injuries for which a splenectomy is required. To prevent subsequent sepsis from encapsulated organisms, long term management will require 1- daily antibiotic prophylaxis 2- splenic hormone replacement 3- e-coli vaccine 4- bone marrow transplantation 5- splenic transplantation

  12. Update of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. • Davies JM, • Barnes R, • Milligan D; • British Committee for Standards in Haematology. Working Party of the Haematology/Oncology Task Force. • Western General Hospital, Edinburgh. • Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen were first published by the British Committee for Standards in Haematology in 1996. Key aspects of these guidelines related to anti-infective prophylaxis, immunisation schedules and treatment of proven or suspected infection. A recent review of the guidelines was undertaken, with a view to updating the recommendations where necessary The guideline review process did not reveal any major change in patient groups considered at risk. Occupational exposure to certain pathogens may, however, be a new risk factor for some infections. The recommendations for anti-infective prophylaxis remain unchanged. New recommendations for vaccination include the use of meningococcal group C vaccine in previously non-immunised hyposplenic patients and a need to consider the use of seven-valent pneumococcal vaccine. Recommendations for treatment of suspected or proven infection have not been significantly amended, but a local protocol should take into account relevant resistance patterns. There is an identified urgent need for further research into the effectiveness of varying vaccination strategies in the hyposplenic patient, and audit of infective episodes in this patient group should continue long term. Key guidelines are summarised below, together with grades of recommendation

  13. 54) As a patient approaches skeletal maturity, the lesion shown in fig 14a and 14b usually will undergo what changes? 1- remained unchanged 2- increase in size 3- decrease in size and may heal after growth is completed 4- become malignant after growth is completed 5- affect growth of the affected bone

  14. Unicameral bone cysts. • Wilkins RM. • University of Colorado School of Medicine, Denver, CO, USA. • Unicameral, or solitary, bone cysts are unusual tumors seen in the ends of long bones in skeletally immature persons. The etiology of these lesions is poorly understood. Various hypotheses have included dysplastic processes, synovial cysts, and abnormalities in the local circulation. Most patients present with a nondisplaced pathologic fracture, but occasionally cysts are found incidentally. Plain radiographs typically show a symmetric lesion with cortical thinning and expansion of the cortical boundaries. Once diagnosed, unicameral bone cysts continue to be a treatment dilemma. Traditional methods, such as prednisolone therapy, usually involve multiple anesthetics and injections and are associated with high recurrence rates. Major surgical procedures, such as wide exposure, curettage, and bone grafting, may be somewhat more effective, but still carry with them significant morbidity and recurrence rates. Newer techniques involving percutaneous grafting with allograft or bone substitutes or a combination of the two are promising in light of their low complication rate and lower reoperation rate

  15. 62) a 5year old boy experiences complete growth arrest of the left proximal tibia after undergoing treatment of osteomylitis 5 months ago . Which of the following procedures would best address the expected limb-length discrepancy? 1- a shoe lift on the left side 2- rt femora shortening 3- rt tibial shortening 4-Left tibial lengthening 5- epiphysiodesis of the left distal femur and the proximal tibia at age 8 years

  16. Assessment and prediction in leg-length discrepancy. • Moseley CF. • Successful treatment of patients with leg-length discrepancy requires rigorous assessment of the patient, usually over a period of time. This assessment involves not only the lengths of the legs, but all the factors that contribute to the asymmetry because they are all important in the selection of a treatment goal. Good results can be obtained with any of the three methods of prediction. Selection of a particular method must be based on convenience, accuracy, and user familiarity.

  17. 67) a 16 year old girl underwent treatment for sever SCFE 3 years ago. She has no pain ; however, she walks with asymmetric foot progression and finds it difficult to enter or sit in a car. Current radiographs are shown in figurers 18a and 18b. Treatment should consist of 1- hip arthrodesis 2- THA 3- proximal femoral resection arthroplasy 4- extension, ER and varus producing osteotomy of the proximal femur. 5- flexion , IR and valgus producing osteotomy of the proximal femur

  18. The geometry of slipped capital femoral epiphysis: implications for movement, impingement, and corrective osteotomy. • Rab GT. • University of California Davis Medical Center, Sacramento, USA. gtrab@ucdavis.edu • Metaphyseal impingement limits motion in high-grade slipped capital femoral epiphysis (SCFE). A three-dimensional volume/surface computer model was used to study the geometry of impingement, which may take the form of impaction, which causes levering or requires compensatory alteration in motion, or inclusion that occurs after remodeling and may lead to acetabular cartilage damage. The majority of deformities seen clinically can be reproduced with posterior epiphyseal displacement in the plane of the physis. By using the 3-D movements of normal walking, this model predicts little anterior metaphyseal impingement in the normal hip. As posterior slip angle increases to 25 degrees , minor impingement can be eliminated with as little as 20 degrees of external rotation. High-grade posterior slips (75 degrees ) require external rotation of 50-60 degrees during walking to minimize impaction. Sitting increases impingement for all slip geometries, requiring proportionately greater external rotation. As remodeling restores a more normal arc of motion, an increasing proportion of the femoral head is composed of the remodeled, included metaphyseal prominence. This study explores the potential role of contact between the acetabulum and the metaphysis in the production of abnormal range of motion after SCFE, and simulation estimates the correction needed by osteotomy to allow normal walking and sitting. The inclusion of significant metaphyseal surfaces in the remodeled hip may be one factor in subsequent degenerative changes associated with SCFE.

  19. 74)what is the most common genetic disorder caused by a new mutation of a single gene? 1- Homocystinurea 2- Neurofibromatosis type1 3- Gaucher’s disease 4- Marfan’s syndrome 5- Larsen’s syndrome

  20. Neurofibromatosis in children: the role of the orthopaedist. • Crawford AH, • Schorry EK. • Division of Human Genetics, Children's Hospital Medical Center, Cincinnati 45229-3039, USA. • Type 1 neurofibromatosis (NF-1), also known as von Recklinghausen disease, is one of the most common human single-gene disorders, affecting at least 1 million persons throughout the world. It encompasses a spectrum of multifaceted disorders and may present with a wide range of clinical manifestations, including abnormalities of the skin, nervous tissue, bones, and soft tissues. The condition can be conclusively diagnosed when two of seven criteria established by the National Institutes of Health Consensus Development Conference are met. Most children with NF-1 have no major orthopaedic problems. For those with musculoskeletal involvement, the most important issue is early recognition. Spinal deformity, congenital tibial dysplasia (congenital bowing and pseudarthrosis), and disorders of excessive bone and soft-tissue growth are the three types of musculoskeletal manifestations that require evaluation. Statistics gathered from the Cincinnati Children's Hospital Neurofibromatosis Center database show the incidence of spinal deformity in children with NF-1 to be 23.6%; pectus deformity, 4.3%; limb-length inequality, 7.1%; congenital tibial dysplasia, 5.7%; hemihypertrophy, 1.4%; and plexiform neurofibromas, 25%. The orthopaedic complications can be managed, but only rarely are they cured.

  21. 81) which of the following conditions leads to recurrent ankle injuries in children and adolescents? 1- Tarsal coalition 2- Accessory navicular 3- Os trigonum 4- Osteochondral fracture 5- Physeal fracture

  22. Ankle Pain in Children: Diagnostic Evaluation and Clinical Decision Making. • Churchill JA, • Mazur JM. • Nemours Children's Clinic, Jack-sonville, Florida. • Ankle pain in children can be caused by traumatic injuries to bone, ligament, or tendon or by nontraumatic conditions, such as congenital and developmental anomalies, infections and other inflammatory disorders, neural compression, metabolic derangements, and neoplasia. Evaluation of children with this complaint should include a focused history and an anatomically oriented physical examination. Depending on the findings, further diagnostic workup and laboratory evaluation should be done. Appropriate treatment-whether casting, surgery, antibiotic therapy, or a combination thereof-can then be selected on a rational basis.

  23. 87) what is the most important variable in determining the outcome of compartment syndrome in children ? 1- peak tissue pressure 2- severity of fracture 3- duration of compartment syndrome prior to treatment 4- presence of associated nerve injury 5- number of compartments affected.

  24. Compartmental syndromes in children. • Matsen FA 3rd, • Veith RG. • Compartmental syndromes are reported in 24 children after injuries and surgery. In these cases, increased tissue pressure compromised local perfusion and neuromuscular function. Compartmental syndromes occurred in the interosseous compartments of the hand, the volar and dorsal compartments of the forearm, and the four compartments of the leg. The most common etiologies were fracture, vascular injury, and tibial osteotomy. In many instances, clinical data were sufficient to establish the diagnosis. However, in young patients or in patients with neurologic or vascular injuries, tissue pressure measurement helped to resolve otherwise ambiguous findings. The most significant determinant of the quality of the end result was the duration of the compartmental syndrome prior to surgical decompression. We conclude that prompt diagnosis and decompression of compartmental syndromes can minimize the sequela from these conditions.

  25. 98) what is the site of primary abnormality in hereditary motor sensory neuropathy? 1- Muscle 2- peripheral nervous system 3- anterior horn cells 4- spinocerebellar system 5- motor end plate-synapse

  26. 104) A child has a short limbed dwarfism, a cauliflower deformity of the pinna, and an abduction deformity of the thumb(hitchhicker’s thumb). A radiograph is shown in figure 27. the patient has what form of dysplasia? 1- Metatrophic 2- Geleophasic 3- Chondroectodermal 4- Diastrophic 5- Multiple epiphyseal

  27. The phenotypic variability of diastrophic dysplasia. • Horton WA, • Rimoin DL, • Lachman RS, • Skovby F, • Hollister DW, • Spranger J, • Scott CI, • Hall JG. • To determine the relationship between so-called "diastrophic variant" and diastrophic dysplasia, four patients considered to have the variant condition were studied in detail and compared to 67 patients (including 17 sets of affected sibs) considered to have classical diastrophic dysplasia. Analysis of the combined clinical, radiographic, histologic, and genetic data indicates that there is wide variability in the phenotypic expression of diastrophic dysplasia, even within sibships, and that those individuals previously labeled as having "diastrophic variant" appear to have mild diastrophic dysplasia.

  28. 110) an 8 year old girl sustains an injury to her knee playing softball. Examination reveals tenderness over the medial aspect of the knee and valgus instability to stress testing . The NV examination is normal, AP and lateral radiographs reveals no abnormalities. A stress radiograph is shown in figure 30. management should consist of 1- a hinged knee brace for 3 weeks 2- a hinged knee brace for 4 weeks and weight bearing as tolerated . 3- closed reduction and percutanious pin fixation 4- open repair of the medial collateral ligament 5- ORIF of lateral femoral condyle

  29. Distal femoral physeal problem fractures. • Graham JM, • Gross RH. • Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston 29425. • Treatment options in the past for distal femoral physeal fractures have varied from closed reduction to open reduction with internal fixation to balanced skeletal traction. In this study, ten patients with distal femoral physeal fractures treated with closed reduction and casting or skeletal traction are reviewed. Seven fractures lost position in comparison with original reduction films. Nine patients developed subsequent deformity. No consensus exists regarding the use of open versus closed treatment with internal fixation. This review of closed treatment yielded a high rate of unacceptable results. Initial anatomic reduction with rigid fixation of physeal injuries about the ankle has been demonstrated to decrease the incidence of growth deformity. The authors' experience and a review of the literature suggest that a similar approach is applicable to distal femoral physeal fractures

  30. 131) in children with osteomylitis , CRP level s are influenced by 1- needle aspiration 2- splint immobilization 3- levels of protein S and C 4- resolution of infection 5- the location of the infection

  31. The limping child: evaluation and diagnosis. • Flynn JM, • Widmann RF. • University of Pennsylvania School of Medicine, Philadelphia, PA, USA. • A limp is a common reason for a child to present to the orthopaedist. Because of the long list of potential diagnoses, some of which demand urgent treatment, an organized approach to evaluation is required. With an understanding of normal and abnormal gait, a directed history and physical examination, and the development of a differential diagnosis based on the type of limp, the patient's age, and the anatomic site that is most likely affected, the orthopaedist can take a selective approach to diagnostic testing. Laboratory tests are indicated when infection, inflammatory arthritis, or a malignant condition is in the differential diagnosis. The C-reactive protein assay is the most sensitive early test for musculoskeletal infections; an abnormal value rapidly returns to normal with effective treatment. Imaging should begin with plain radiography. Ultrasonography is particularly valuable in assessing the irritable hip and guiding aspiration, if necessary.

  32. 140) the most common nerve injury associated with the fracture shown in figure 43 results in which of the following physical findings ? 1- normal sensation, inability to flex the DIPJ of the index finger abd the IPJ of the thumb 2- normal sensation, inability to extend the IPJ of the thumb 3- normal sensation, inability to fully spread the fingers apart 4- decrease sensation over the ulnar aspect of the 5th digit, inability to cross the fingers 5- decrease sensation over the theaner eminence, inability to flex the IPJ of the thumb.

  33. Incidence of anterior interosseous nerve palsy in supracondylar humerus fractures in children. • Cramer KE, • Green NE, • Devito DP. • Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee. • A retrospective review of 101 supracondylar humerus fractures in children between the ages of 0 and 11 years identified 15 patients with neural lesions. All were associated with displaced fractures, and 10 (66%) required open reduction for definitive fracture management. Six of these lesions were isolated anterior interosseous nerve palsies and four other patients had an anterior interosseous nerve injury in combination with another nerve injury, producing a sensory deficit. Two patients had a complete median nerve palsy. Only three patients had nerve lesions that did not involve the anterior interosseous nerve. The incidence (15%) of neural lesions in this study is similar to that reported elsewhere, but the incidence of anterior interosseous nerve lesions, particularly those occurring as an isolated injury, is much higher than has been reported previously. Because an anterior interosseous nerve palsy results in motor loss only, this injury may be easily overlooked.

  34. 147) a 14y old girl who was stuck by an automobile sustained bilateral midshaft femoral fracture. There was no LOC. After a lucid interval of 6 hours, she becomes confused, tachypnic, and tacycardic. Her abdomen is soft and nontender. A CT scan of the brain is unremarkable. What is the most likely diagnosis? 1- TSS 2- Fat embolism 3- Acute post traumatic psychosis 4- Neurogenic shock 5- Hysterical hyperventilation

  35. 152) a child with Poland’s syndrome has chest wall anomalies. The hands should be examined for 1- camptodactyly 2- clinodactyly 3- syndactyly 4- kriner’s deformity 5- symphalangism

  36. Poland'ssyndrome • DC Ireland, N Takayama and AE Flatt • Forty-three consecutive cases ofPoland'ssyndrome were analyzed and therelevant literature was reviewed. The syndrome is not hereditary and is ofunknown origin. It affects males more frequently than females. The clinicalfeatures are variable but always include congenital aplasia and syndactyly. The middle phalanges are hypoplastic or absent so that effectively there isonly one interphalangeal joint. The syndactyly is usually incomplete andsimple. It may involve all fingers and frequently includes the thumb, whichthen lies in the same plane as the fingers. Poland'ssyndrome may alsoinclude hypoplasia of the nipple and breast, hypoplasia of the upper ribs, herniation of the lung, contracture of the anterior axillary web, andelevated scapula. The arm and more frequently the forearm are hypoplastic. The right side is more often affected than the left. Surgical treatment byseparating the syndactyly is recommended. In some cases a digit is removedto produce a three-fingered hand. Surgery is initiated by the age of oneyear and is completed by the time the child enters school, althoughperiodic revisions may be necessary. Although the hand remains hypoplasticand functional capacity is limited by the inherent skeletal anomalies, surgical treatment improves functional capacity and cosmetic appearance inthe majority of patients

  37. 159) in addition to an elevated ESR and elevated WBC . Which of the following findings are considered the best predictors of septic arthritis in children ? 1- Fever, inability or refusal to bear weight 2- Fever, limited hip extension 3- Fever , rash 4- hip irritability, inability or refusal to bear weight. 5- hip irritability , rash

  38. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. • Kocher MS, • Zurakowski D, • Kasser JR. • Department of Biostastics, Orthopaedic Surgery, Children's Hospital, Harvard medical School, Boston, Massachusetts 02115, USA. kocher_m@al.tch.harvard.edu • BACKGROUND: A child who has an acutely irritable hip can pose a diagnostic challenge. The purposes of this study were to determine the diagnostic value of presenting variables for differentiating between septic arthritis and transient synovitis of the hip in children and to develop an evidence-based clinical prediction algorithm for this differentiation. METHODS: We retrospectively reviewed the cases of children who were evaluated at a major tertiary-care children's hospital between 1979 and 1996 because of an acutely irritable hip. Diagnoses of true septic arthritis, presumed septic arthritis, and transient synovitis were explicitly defined on the basis of the white blood-cell count in the joint fluid, the results of cultures of joint fluid and blood, and the clinical course. Univariate analysis and multiple logistic regression analysis were used to compare groups. A probability algorithm for differentiation between septic arthritis and transient synovitis on the basis of independent multivariate predictors was constructed and tested. RESULTS: Patients who had septic arthritis differed significantly (p < 0.05) from those who had transient synovitis with regard to the erythrocyte sedimentation rate, serum white blood-cell count and differential, weight-bearing status, history of fever, temperature, evidence of effusion on radiographs, history of chills, history of recent antibiotic use, hematocrit, and gender. Patients who had true septic arthritis differed significantly (p < 0.05) from those who had presumed septic arthritis with regard to history of recent antibiotic use, history of chills, temperature, erythrocyte sedimentation rate, history of fever, gender, and serum white blood-cell differential. Four independent multivariate clinical predictors were identified to differentiate between septic arthritis and transient synovitis: history of fever, non-weight-bearing, erythrocyte sedimentation rate of at least forty millimeters per hour, and serum white blood-cell count of more than 12,000 cells per cubic millimeter (12.0 x 10(9) cells per liter). The predicted probability of septic arthritis was determined for all sixteen combinations of these four predictors and is summarized as less than 0.2 percent for zero predictors, 3.0 percent for one predictor, 40.0 percent for two predictors, 93.1 percent for three predictors, and 99.6 percent for four predictors. The chi-square test for trend and the area under the receiver operating characteristic curve indicated excellent diagnostic performance of this group of multivariate predictors in identifying septic arthritis. CONCLUSIONS: Although several variables differed significantly between the group that had septic arthritis and the group that had transient synovitis, substantial overlap in the intermediate ranges made differentiation difficult on the basis of individual variables alone. However, by combining variables, we were able to construct a set of independent multivariate predictors that, together, had excellent diagnostic performance in differentiating between septic arthritis and transient synovitis of the hip in children.

  39. 171) Figure 55 shows the radiograph of a 5 year old girl who sustained closed injury to her left arm after jumping of a swing. The initial NV exam is normal. Six hours later she has increasing pain that is not well controlled by oral medication . What is the next most appropriate step ion management? 1- pain service consultation 2- strict elevation and bed rest 3- measurement of forearm compartment pressures 4- x-rays of the entire forearm 5- Arterigraphy of the forearm

  40. Compartment syndrome in the forearm following fractures of the radial head or neck in children. • Peters CL, • Scott SM. • Division of Orthopedic Surgery, University of Utah School of Medicine, Salt Lake City 84132, USA. • A volar compartment syndrome of the forearm was identified following a minimally displaced or angulated fracture of the radial head or neck in three children. The fractures were due to a fall from a bed or from a standing height on an outstretched hand. All three patients had symptoms and signs that were consistent with elevated intracompartmental pressure in the forearm when they were first examined, twelve to twenty-four hours after the injury, and all were managed with an emergency fasciotomy of the forearm. The radial fracture was treated without reduction in the first patient, with manipulative closed reduction in the second patient, and with open reduction and stabilization with Kirschner wires in the third patient. All three patients had a full functional recovery.

  41. 175) in most patients with spastic hip dysplasia, the acetabular deficiency is located 1- postrosuperior 2- postroinferior 3- postromedial 4- antrolateral 5- anterior

  42. Morphology of the acetabulum in hip dislocations caused by cerebral palsy. • Brunner R, • Picard C, • Robb J. • Department of Orthopaedic Surgery, University of Basle, Switzerland. • Twenty-four hip joints in 20 children with spastic cerebral palsy were assessed by standardised three-dimensional reconstructions from computed tomographic scans. All the hip joints showed a channel-like ebony deformity of the acetabulum along which the femoral bead had slid out, indicating a unidirectional instability. The channel was oriented along the longitudinal axis of the body within a sector of 25 degrees anteroposteriorly. In relation to the pelvis, the dislocation was directed more dorsally by 20 degrees as a result of a flexion contracture of the hip. The size of the femoral head corresponded with the size of the acetabulum in every case, even in long-standing dislocations.

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