BackgroundDespite the wide use of knee radiography in children and adolescent patients visiting the outpatient clinic, there has been no analysis about the prevalence and type of incidental findings yet. This study was performed to investigate the incidental findings on knee radiographs in children and adolescents according to age.MethodsA total of 1,562 consecutive patients younger than 18 years of age were included. They who visited Seoul National University Bundang Hospital's outpatient clinic with a chief complaint of knee pain or malalignment between 2010 and 2011. We reviewed the knee radiographs and analyzed the prevalence and type of incidental findings, such as metaphyseal lucent area, epiphyseal cortical irregularity, osteochondroma and Harris growth arrest line.ResultsThe mean age of the patients was 10.2 years (range, 1 month to 18 years). We identified 355 incidental findings in 335 patients (21.4%) and 98 abnormal findings (6.3%). The most common incidental finding was metaphyseal lucent area (131, 8.4%), followed by epiphyseal cortical irregularity (105, 6.7%), Harris growth arrest line (75, 4.8%), and osteochondroma (44, 2.8%). An epiphyseal cortical irregularity tended to have a higher prevalence at younger age (p < 0.001) and the prevalences of metaphyseal lucent area and Harris growth arrest line were also higher at a younger age (p = 0.001 and p < 0.001, respectively). However, the osteochondroma tended to have a higher prevalence at an older age (p = 0.004).ConclusionsThis study describes the incidental findings on knee radiographs in children and adolescents and provides effective information from a viewpoint of an orthopedic doctor. The authors recommend considering those incidental findings if unfamiliar findings appear on a knee radiograph in the pediatric outpatient clinic.
Soft tissue and bone defects of the lower leg, ankle, and heel region often require coverage by local or distant flaps. The authors successfully used the distally based adipomuscular abductor hallucis flap for the treatment of 7 patients with soft tissue defect on the plantar forefoot after diabetic ulcer (n = 2), excision of melanoma at the medial forefoot (n = 3), and posttraumatic defects of the plantar forefoot (n = 2). The size of the defects ranged from 6 to 36 cm. All defects were covered successfully without major complications. The distally based adipomuscular flap from the abductor hallucis muscle provides a reliable coverage for small and moderate defects of the plantar and medial forefoot. This flap is often preferable to the use of free flaps because the surgery is rapidly performed and does not require microsurgical expertise.
The reconstruction of femur and tibia defects following tumor resection remains a surgical challenge. The clinical outcome of free vascularized fibula graft (VFG) reconstruction with locking plate for massive femur and tibia defects of more than 10 cm that were secondary to skeletal tumor resection is reported. Materials and Methods: Thirteen patients with a mean follow-up of 3.3 years were reviewed. Seven patients received vascularized fibula grafts in the femur and six in the tibia. The mean bony defect of the femur and tibia was more than 10 cm and the length of the grafted fibula was more than 15 cm. All defects were stabilized with long locking plates. Results: All patients were free of disease at final follow-up; All VFGs were transferred successfully. All patients had a successful outcome with bony union. Stress fractures of the grafted fibula had occurred but the locking plate stabilized the fracture and healed until the last follow-up. All patients were able to walk without a brace after a mean of 9 months postoperatively. Conclusion: VFG with locking plate is a reliable reconstructive procedure for massive femur and tibia defects.
Purpose: Though clavicle fractures are the second most common fractures to occur in active adults, there have been a few epidemiological studies conducted on the Korean population in recent years. To better understand clavicle fractures, an epidemiological study reflecting the changes in current life style and injury mechanism may be important. Hence, the purpose of this study was to conduct an epidemiological study on the Korean population. Materials and Methods: This was a retrospective study of 973 patients (977 cases) who presented with clavicle fractures from January 2000 to August 2015. Radiological results were classified by the Allman system-3 groups and 7 subgroups. The study collected information regarding gender, age at the event of injury, injury mechanism, other associated injuries, occurrence rate of each year, and seasonal variation. Results: The study consisted of 627 male patients (64.4%, 1 bilateral case) and 346 female patients (35.6%, 3 bilateral cases). The mean age at the time of injury was 31.8±24.9 years (male, 31.2±22.6 years; female, 32.7±28.7 years). Midshaft clavicle fractures (Allman group I) were the most common with 758 cases (77.6%). There were 397 cases with displacement (40.6%). The occurrence of clavicle fractures decreased with increasing age in male patients and showed a bimodal distribution in female patients. Injury due to a fall from standing height was the most common mechanism of injury. There were 61 cases (6.2%) who had other associated injuries and the most common associated injury was a rib fracture. The occurrence of clavicle fractures increased with time, and falling was associated with the highest occurrence rate of clavicle fractures. Conclusion:The mean age of clavicle fracture was 31.8 years in a recent 15-year period. The occurrence of fracture in male patients was 1.8 times than female patients, primarily occurring as midshaft fractures. There were more cases of displacement than minimally displaced cases. The most common injury mechanism was a fall from standing height, and the occurrence of clavicle fractures has shown an increasing trend recently.
Purpose: While all midshaft clavicle fractures have traditionally been treated with conservative measures, recent operative treatment of displaced, communited midshaft clavicle fractures has become more common. Though a recent increase in operative treatment for midshaft clavicle fractures, we have done the operative methods in limited cases. The aim of this study is to present indications, operative techniques and outcomes of the experienced cases that have applied to this limited group over the previous 10 years.Methods: This study consists of a retrospective review of radiological and clinical data from January of 2005 to July of 2015. Operative criteria for midshaft clavicle fractures having considerable risk of bone healing process were 4 groupsa floating shoulder, an open fracture, an associated neurovascular injury, and a nonunion case after previous treatment.Results: The study consisted of 18 patients who had operative treatment for midshaft clavicle fractures in adults. The most common surgical indication was a floating shoulder (10 cases, 55.6%), followed by nonunion (5 cases, 27.8%), an associated neurovascular injury (4 cases, 22.2%), and open fracture (3 cases, 16.7%). All cases were treated by open reduction and internal fixation in anterosuperior position with reconstruction plate or locking compression plate. Bone union was achieved in all cases except 1 case which was done bone resection due to infected nonunion. Mean bone union period was 19.5 weeks. There were no postoperative complications, but still sequelae in 4 cases of brachial plexus injury. Conclusion:We have conducted an open reduction and internal fixation by anterosuperior position for midshaft clavicle fractures in very limited surgical indications for last 10 years. Our treatment strategy for midshaft clavicle fractures showed favorable radiological results and low postoperative complications. [ J Trauma Inj 2016; 29: 105-115 ]
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