Background: Because of concerns about radiation exposure, some centers consider magnetic resonance imaging (MRIs) the preferred imaging modality for pediatric thoracic and/or lumbar compression fractures. The purpose of this study was to evaluate the sensitivity of computed tomography (CT) and MRI in diagnosing thoracolumbar compression fractures and the utility of MRI in their management. Methods: Retrospective review identified 52 patients aged 0 to 18 years with 191 thoracic and/or lumbar compression fractures who had both CT and MRI during the initial trauma evaluation. The decision to perform CT and/or MRI was made by the attending pediatric spine surgeon. In all cases the CT scan was performed before the MRI. All imaging studies were reviewed by a board-certified pediatric radiologist and attending pediatric spine surgeon. Results: Only 10 patients (19%) had a single-level injury. Of 42 with multiple compression fractures, 34 (81%) had fractures in contiguous levels, and 8 had noncontiguous injuries. Comparing CT and MRI, there was complete agreement in the number and distribution of fractures in 23 patients (44%). MRI identified additional levels of fracture in 15 patients (29%); 14 (27%) had fewer levels fractured on MRI than CT. Only one patient (2%) had fractures seen on MRI after a normal CT scan. Complete correlation between CT and MRI was seen in 59% (17/29) of patients aged 11 to 18 years, compared with 26% (6/23) of patients younger than 11. Conclusions: In pediatric patients with mild thoracic or lumbar compression fracture(s), CT scan demonstrates a high sensitivity in determining the presence or absence of a fracture compared with MRI. Although some variability exists between the 2 modalities in the exact number of spinal levels involved, the definitive treatment and outcome were not changed by the addition of MRI. The information that may be obtained from an MRI must be weighed against the increased time and expense of the study, as well as the risks associated with sedation when necessary. Level of Evidence: Level II—diagnostic study.
Rotator cuff tears involving the musculotendinous junction with a significant amount of tendon still attached to the footprint laterally represent a challenging scenario for shoulder arthroscopists. Because of these challenges, adjunctive techniques to bridge tissue gaps may be required, and biologic augmentation may be considered to improve the healing environment. The following technique presents a stepwise approach to accomplishing the dual goals of a stable anatomic repair and biologic augmentation of this difficult pattern of rotator cuff pathology.
Background: A 2006 study from our institution found a 10-fold increase in pediatric community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) osteoarticular infections over a 5-year period and found that these patients had a higher complication rate and required more surgical debridements than those with methicillin-sensitive Staphylococcus aureus (MSSA) infections. Clinical experience since that time has suggested that these trends may have continued. Our investigation sought to evaluate the evolving nature of these infections since the previous publication. Methods: The records of all patients treated at our institution for acute hematogenous septic arthritis and osteomyelitis between January 2005 and December 2011 were reviewed for demographic, diagnostic, clinical, and radiographic data. Results: Of the 240 patients who met the inclusion criteria, 100 were diagnosed with CA-MRSA infections, 51 had MSSA infections, and 75 had no identifiable pathogen. Group A streptococcus (GAS), group B streptococcus (GBS), Streptococcus pneumoniae, and Salmonella were together responsible for 14 infections. The overall infection incidence was 4.29 cases per 1000 hospital admissions. The mean age of CA-MRSA patients was 6.4 yr, compared to 8.9 yr for MSSA patients (P=0.002). There was no significant difference in admission laboratory values, surgical procedures, or long-term complications for CA-MRSA and MSSA infections. Subperiosteal abscess was evident in 51% and 45% of CA-MRSA and MSSA patients, respectively. Surgical intervention was required in 87% of CA-MRSA patients and 84% of MSSA patients. Deep vein thrombosis was identified in 12 CA-MRSA patients, five of whom subsequently developed septic pulmonary emboli. Eight CA-MRSA patients developed chronic osteomyelitis, as did one MSSA patient. Intramuscular abscesses were seen in nine CA-MRSA patients and four MSSA patients. Empiric antibiotic therapy consisted primarily of clindamycin or vancomycin and was tailored according to microbial sensitivities. Conclusions: Contrary to trends identified in an earlier publication, the annual frequency of CA-MRSA infections has stabilized at roughly 40% of all cases. Our data suggest that MSSA infections have become more virulent because these patients now have similar rates of complications and operative interventions to patients with CA-MRSA infections. Level of Evidence: Prognostic level II study (retrospective).
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