We have reviewed 74 tuberculous hips in 73 children treated from i950 to i99i. From 1979 to 1991 we treated 28 patients with rifampicin, isoniazid and pyrazinamide given for nine mo nths (series A), using
We reviewed 33 children with tuberculosis of the knee treated during the period from 1979 to 1991. All were treated with triple chemotherapy, using rifampicin, isoniazid and pyrazinamide for nine months. No patient had a synovectomy; surgery was united to open biopsy or salvage procedures such as posterior release and arthrodesis for late stages of the disease. The radiological appearance of the knee at presentation predicted the outcome. The 30 patients with stage-i (normal) or stage-2 (osteomyelitic) disease had excellent or good results; the three with narrowed joint spaces in stage 3 or stage 4 (arthritic) had fair or poor results. Early active mobilisation, as against long-term immobilisation, seemed to have no effect on the outcome of stage-i or stage-2 disease.
The authors reviewed nine children with 10 displaced supracondylar femoral fractures that were treated by closed reduction and percutaneous pinning. The average age of the patients was 8.3 years (range 5-13). After removal of the pins and plaster at 5 weeks, full range of movement was regained within 3 weeks. At late follow-up (average 7.4 years [range 4-10]), seven of the eight patients reviewed (nine fractures) had a satisfactory result. One patient had a valgus deformity of 6 degrees. There was no growth plate arrest and no leg length discrepancy. Intra-articular pin placement was avoided, considering the different synovial attachments on the medial and lateral sides. One patient developed a common peroneal nerve palsy, and therefore a cadaver study was performed to determine whether movement of the knee after pin placement affected the nerve. Although the lateral pin did tether the iliotibial band, the common peroneal nerve was not affected.
Study design: Retrospective diagnostic feasibility study and clinical review.Objectives: To evaluate the feasibility of making an initial atlanto-occipital dissociation (AOD) diagnosis from four radiological measurements of the craniocervical relationship on lateral cervical spine x-rays and to assess the AOD patients' clinical outcomes relative to their magnetic resonance imaging (MRI) findings.Methods: The Powers ratio, Wackenheim line, basion-dens distance (BDD), and the C1/2:C2/3 interspinous ratio were measured in 58 pediatric controls and ten MRI-confirmed patients with AOD. The ability to identify the required anatomical landmarks and make the measurements was noted and sensitivity and specificity calculated. The correspondence between the clinical presentation and outcomes for patients with AOD and their MRI features was investigated.Results: Clear landmarks for measuring interspinous ratio and Wackenheim line were confirmed by all x-rays. The BDD was measureable in 90% and the Powers ratio could be calculated in only possible in 59%. The interspinous ratio and BDD offered high sensitivities and specificity. Although the Wackenheim line was consistantly measured, it conferred a low sensitivity but reasonable specificity. The Powers ratio offered high specificity with low sensitivity. On MRI, all patients with AOD had apical ligament disruption, with a high rate of interspinous ligamentous injury (8/9); prevertebral swelling (7/9); retroclival hematoma (6/9); and tectorial membrane injury (4/9). The only MRI feature associated with poor outcome was that of altered cord signal. Both patients who died had cord signal changes on T1- and T2-weighted images. The third patient with cord signal change was limited to T2 changes with a normal T1. He had a C5-L3 sensory deficit that resolved. The degree of tectorial membrane injury did not appear to influence outcome.Conclusions: The BDD and interspinous ratio offer the best measures for initial x-ray diagnosis of AOD. This will alert the surgeon to the need for MRI. These patients often have a reduced level of consciousness, thus making clinical evaluation difficult. The MRI findings, although apparently indicative of severe abnormality, did not actually correspond to outcomes except for the presence of T1 cord signal changes that matched with severe neurological impairment and subsequent death.
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