Fractures of the pelvis in children

Pelvic bony injuries are uncommon in children except for avulsion fractures. Medical records and radiographs of 54 children, in whom pelvic fractures were diagnosed from 1974 to 1993, were reviewed. Children 16 years of age and younger who were treated as inpatients were included in this study. Thirty-two patients were boys (59.3%) and 22 were girls (40.7%). In 47 (87.0%) patients, trauma was caused by motor vehicle accidents. The fractures were classified according to the Torode and Zieg classification and the Tile AO/Association for the Study of Internal Fixation classification. Forty-seven (87.0%) children had associated pelvic or extrapelvic injuries. The mean Injury Severity Score was 30.5 (range, 4-66). The AO classification correlated well with the severity of the injury. Eight children (14.8%) died. In most (38 patients = 70.4%) patients, the pelvic bony injury was treated by conservative means. External or internal fixation of the fracture was performed in 16 (29.6%) patients. A followup examination was conducted in 35 of 44 survivors (79.5%; 2 other patients died of unknown causes) with a mean followup of 135 months (range, 18-235 months); 1 additional patient was interviewed by telephone. In this series, long term morbidity was rare and was attributed to severe pelvic ring disruptions, acetabular fractures, or concomitant injuries. It is concluded that in unstable pelvic ring disruptions and acetabular fractures, the principles of management in children should not differ greatly from those in adults. Serious associated pelvic or extrapelvic injuries may pose more management problems than does the pelvic fracture.     

Fractures of the humerus in children

Fractures of the humerus above the distal epiphysis are not common fractures in children. Treatment should be directed toward maintenance of alignment with healing expected without fail. Contrary to experience with adults with the same fractures, children seldom have residual functional or cosmetic problems if one aligns the fractures and protects the healing process.     

Fractures about the knee in children

The seriousness of the consequences of growth and angular disturbances about the knee that occur as a result of injuries in childhood cannot be overemphasized. The resulting limb length discrepancy is well known to the office practitioner, who sees these patients presenting with back problems during adulthood. Normal knee motion and stability are prime prerequisites for normal gait, and loss of knee motion as a determinant of gait can increase the energy requirement up to 300-fold. The management of these injuries presented has produced good results for the author. The author strongly recommends careful follow-up in metaphyseal fractures to guard against the development of angular deformities, the anatomical reduction of all intra-articular fractures, and x-ray examination of the hip in patients in the four to 15 year age group who have sustained minimal or insignificant trauma and who complain of pain about the knee.     

Fractures of the patella in children and adolescents

Renal scarring is considered a criterion of reflux nephropathy and the end stage of pyelonephritis. Prednisolone, a strong anti-inflammatory drug, at doses of 1 or 2 mg/kg prevented renal scarring in rats following infection with Serratia marcescens. Four or 8 mg/kg of prednisolone, however, did not inhibit renal scar formation. In a time course experiment, renal scarring was prevented when 4-day treatment with prednisolone was initiated 2, 5, or 13 days after infection. These results show that prednisolone is effective in preventing such scarring and suggest the clinical use of this drug for preventing renal scar formation after pyelonephritis and reflux nephropathy.     

Fractures of the hip in children and adolescents

Long-term results of 52 fractures of the hip in 51 children and adolescents are discussed. A distinction was made between fractures in children (aged 1 to 11 years) and those in adolescents (aged 12 to 18 years). Irrespective of the type of fracture it was found that immediate operative treatment leads to the best results. In children as well as in adolescents the risk of avascular necrosis, premature closure of the epiphysis and non-union is less following immediate operative treatment than following delayed operative treatment or conservative treatment. The prognosis of these fractures depends on the amount of damage to the vascularization. Treatment of children consisted of open reduction and fixation with K-wires followed by postoperative immobilization in a hip-spica for 6 weeks. Adolescents were treated with three-flanged nails usually without postoperative plaster immobilization. In both children and adolescents internal fixation may also be carried out with screws, in which case these must not cross an open epiphyseal plate. In both groups a non-weight-bearing period of 6 to 12 months is advisable. The results in adolescents were definitely poorer than in children. Seemingly completely destroyed hips can reintegrate even to a nearly "restitutio ad integrum" state after a period of years.     

Fractures and dislocations of the cervical spine in children

Correct diagnosis of fractures and dislocations of the cervical spine in children requires an awareness of the pseudosubluxation and other normal variants noted in x-ray films of patients in this age group. Fractures of the odontoid process occur frequently and almost always can be treated by closed reduction and external fixation until union occurs. Fractures of the lower cervical spine are difficult to detect roentgenographically, and x-ray changes can belie the severity of soft tissue injury and cord trauma. Instability tends to persist in adolescent patients after cervical spine injury because of the combination of epiphyseal and posterior ligamentous disruption. Neoplastic, inflammatory, and congenital lesions render the cervical spine vulnerable to injury and can permit major damage to result from minor stress.     

Characteristics of protrusive and lateral excursions of the mandible in children with the primary dentition

Collection of patient-centred health status is a method for quantifying patient outcome in the context of clinical trials for the treatment of coronary artery disease (CAD). Traditional clinical trial end-points, such as morbidity and mortality, fail to adequately measure the health-related outcomes of disease states for which death is a rare occurrence. Health-related quality of life (QOL) and functional status surveys allow measurement of the general, and/or disease-specific, health-related limitations experienced by patients. Measures of patient preference, in turn, quantify the effects these health-related limitations have on the overall value patients ascribe to their current health state. Together, these outcomes measures may provide a more accurate appraisal of the benefit conferred by treatment. Currently, selection of the appropriate outcomes measures and methodological approaches for a clinical trial is complicated by the lack of consensus on a single quality of life measure for use with patients with (CAD). This article outlines the use of QOL measures in anti-anginal trials done to date and summarises the approaches currently available for assessing QOL, including the differences between psychometric and preference-based techniques, and general and disease-specific health measures. In conclusion, a framework is provided for selecting the appropriate instruments and methodology in the context of the clinical trial.     

Osteosarcoma of the mandible

We describe a case of osteosarcoma of the mandible presenting as a soft tissue mass associated with an enlargement of the mandibular canal at imaging work-up. Radiographic, isotopic, CT and MR features are reported.     

Fractures of the facial skeleton in children: a survey of patients under the age of 11 years

Six flit-gun sprayers were tested for possible use in mosquito adulticide programs where inexpensive nonmotorized application technology may be required. An analysis of variance for differences in droplets < or = 24 microns (mu), droplets > or = 48 mu, droplets/cm2, volume median diameters, and mosquito mortality is provided. As shown by these data, good results can be achieved with this equipment.     

Biomechanics of torsion in the human mandible

Staff competence in the application of behavioral techniques is critical to improve quality of life for persons with a developmental disability. Development of efficient staff training programs is therefore of great importance. This paper describes some of the procedures most frequently used in staff training research. Research in this area is reviewed in relation to client outcomes as a function of staff training, maintenance of staff skills, and transfer of staff skills across settings, clients, and programs. Current concerns and further improvements in behavioural techniques, acquisitional strategies, and assessment are discussed.     

Brown tumor of the mandible

OBJECTIVE: To investigate the inhibitory effect of IL-10 on inflammatory reaction in rat mesangial cells (rMC). METHODS: Cell proliferation was tested by 3H-thymidine uptake and absolute cell counts. The production of IL-1 and TNF alpha by rMC was assessed by bioactivity assay and their gene expression by Northern blot hybridization. The expression of intercellular adhesion molecule-1 (ICAM-1) on rMC was determined by ELISA. RESULTS: IL-10 (25 ng/ml) inhibited 5% FCS and IL-1 induced cell proliferation by 39% and 52% respectively. It also suppressed the production of IL-1 and TNF alpha bioactivity by rMC by 48% and 68%, which was consistent with the decline of IL-1 and TNF alpha gene expression. The IL-1-induced expression of ICAM-1 on surface of rMC was attenuated by IL-10 treatment. CONCLUSION: Our data suggest that IL-10 may be an inhibitory cytokine in regulation of inflammatory reaction in glomerular mesangial cells.     

Ameloblastic carcinoma of the mandible

BACKGROUND: Ameloblastic carcinoma is a rare, aggressive odontogenic neoplasm of the jaws in which the epithelial cells exhibit cytologic features of recognizable ameloblastoma and malignancy. Cases with metastasis have been infrequently reported. METHODS: A case of a 64-year-old white woman with mandibular ameloblastic carcinoma with documented distant metastasis is presented. The patient's presenting symptoms included facial asymmetry of the right jaw over 2 months and the development of moderate trismus. Clinical manifestations, pathology, treatment, and biologic behavior are discussed. The nomenclature and classification of odontogenic carcinomas are reviewed, including entities that should be considered in the differential diagnosis. RESULTS: The patient underwent surgical resection consisting of mandibulectomy, parotidectomy, and modified radical neck dissection followed by radiation to both necks and tumor bed. Postsurgically, the patient developed pulmonary metastasis at 11 months and expired with widespread metastatic disease at 28 months. CONCLUSIONS: This case demonstrated an unusual behavior pattern in that local recurrence and regional metastasis did not occur. Distant metastasis occurred despite apparent adequate control of the primary mandibular tumor. The ameloblastic carcinoma is a highly malignant neoplasm which requires aggressive therapy. Prognosis is poor. Further reporting of ameloblastic carcinoma is encouraged.     

Cross-sectional area of the mandible

PURPOSE: The anatomy of the mandible was examined by measuring the cross-sectional area (CSA) of multiple regions of 10 fully dentulous hemimandibles to provide a better understanding of regional structural differences that may have implications regarding biomechanical strength, surgical reconstruction, and fracture site frequency. MATERIALS AND METHODS: Fifteen cuts from the condyle to the symphysis were made of each hemimandible (n = 150 cuts). A Zeiss Videoplan digitizer was used to determine the CSA. RESULTS: The total CSA through the condyle was greater than the CSA through the condylar neck. The CSA through the ramus exceeded that of the condylar neck. The total CSA of the midramus was significantly greater than that of the upper ramus. The total CSA at the body, parasymphysis, and symphysis was significantly greater than at the mid-angle. The total CSA of the cortex increased anteriorly; these differences become significant between the condylar neck and the body, parasymphysis, and symphysis. The total CSA, and the CSA of the cortex and spongiosa, remained relatively constant from the inferior angle anteriorly. CONCLUSIONS: Significant differences exist in the CSA at different points, with an increase in the total, cortical, and spongiosal CSA anteriorly from the condylar neck to the angle. The total CSA and the CSA of the cortex and spongiosa remain relatively constant anterior to the inferior angle. These data suggest that bony CSA alone is not the sole factor in determining fracture site frequency.     

Fractures of the scaphoid

Scapho?d fractures are the most common carpal injury. The diagnosis is often difficult and the treatment often controversial. Late complications are frequent and include nonunion, avascular necrosis and arthrosis. Carpal pathomechanics, the scaphoid's blood supply and fracture healing are basic concepts leading to a better understanding of the injury. This paper discusses the scapho?d in relation to the pathomechanics of the wrist, the relationship of the blood supply of the scapho?d to the injury and the diagnosis, classification and treatment of these fractures.     

Fractures of the elbow

Elbow fractures encompass a spectrum of severity from low energy nondisplaced fractures to high energy fractures with associated severe soft-tissue injury. Treatment is based on fracture pattern, patient age, bone quality, associated soft-tissue injuries, and associated fractures. The basis for treatment relies on the knowledge of the complex osseous and soft-tissue anatomy of the elbow. The goals of operative and nonoperative treatment are to achieve a stable, anatomic reduction that allows early motion to maximize function.     

Lateral displacement of the mandible in Rhesus monkeys

Lateral displacement of the mandible was induced experimentally in five adult male Rhesus monkeys. Following from 2 1/2 weeks to 19 months, the animals were sacrificed and examined histologically. Two of the monkeys received H3 proline 4 months prior to sacrifice and radioautographs were prepared. The lateral displacement apparently caused great discomfort because the monkeys refused to eat and lost weight rapidly for a few months. After about 12 months, the monkeys could again eat their normal diet to the extent they started to gain weight slowly. The histological and radio-autographic findings indicated almost no changes of the articular surfaces of the temporomandibular joints. However, extensive reorganization of the neck of the condyles was observed. Severe periodontal trauma and extensive movements of the teeth occurred in spite of the fact that the teeth in each jaw were splinted firmly together.