RESUMEN
OBJECTIVE: To examine the incidence and risk factors of any-cause reoperation after primary ACLR in children and adolescents. DESIGN: Retrospective Cohort. SETTING: Electronic medical records from a large tertiary care, single institution integrated healthcare delivery system. PATIENTS: Patients were under the age of 18 years and had anterior cruciate ligament reconstruction. They were excluded if they had a multi-ligamentous knee injury or <1 year follow-up. INTERVENTIONS: Patients were further identified to have undergone a subsequent knee operation ipsilaterally or contralateral ACLR. MAIN OUTCOME MEASURES: The rate of any-cause reoperation was our primary outcome measure. RESULTS: The median age was 16. There were 208 females (53.9%) and 178 males (46.1%) included. The median follow-up was 25 months with a minimum of 12 months (interquartile range: 16.0, 46.0). The rate of any-cause reoperation was 34.7%. There was no statistically significant difference between those who underwent reoperation versus those who did not undergo reoperation relative to age, sex, BMI, graft type, or the presence of concomitant meniscal injury. The rates of ipsilateral ACLR and contralateral ACLR at any time during the study period was 8.0% and 10.9% respectively. There was no statistically significant difference for rate of reoperation between graft types, between various concomitant injuries, between those who underwent meniscus repair or no repair. CONCLUSIONS: This study reflects a 34.7% rate of a subsequent knee operation after ACLR in patients younger than 18 years. These findings can be used to inform pediatric patients undergoing primary ACLR on their risk of returning to the operating room.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Traumatismos de la Rodilla , Adolescente , Niño , Femenino , Humanos , Masculino , Reoperación , Estudios RetrospectivosRESUMEN
Successful results of osteoarticular allografts in reconstruction of periarticular bone defect after tumor resection encouraged its utilization in post-traumatic defects. Here we describe a case of post-traumatic skeletal defect in a 4 year-old girl treated with osteoarticular allograft reconstruction. Due to severity of the associated soft tissue injury and contamination at presentation staged treatment with antibiotic spacer followed by the reconstruction was carried out. At the end of one year the patient achieved 'Musculoskeletal tumor society' functional score of 27 points and radiographic score of 93%. Reconstruction immediately after healing of soft tissues prevented development of any varus or valgus deformity of the knee. Our case demonstrates utility of osteoarticular allograft in a pediatric post-traumatic skeletal defect.
Asunto(s)
Trasplante Óseo/métodos , Cartílago/trasplante , Lesiones por Desenguantamiento/terapia , Fijación Interna de Fracturas , Fracturas Conminutas/terapia , Fracturas Abiertas/terapia , Deformidades Adquiridas de la Articulación/prevención & control , Traumatismos de la Pierna/terapia , Recuperación del Miembro , Aloinjertos , Antibacterianos/administración & dosificación , Preescolar , Desbridamiento/métodos , Lesiones por Desenguantamiento/diagnóstico por imagen , Lesiones por Desenguantamiento/fisiopatología , Femenino , Fracturas Conminutas/diagnóstico por imagen , Fracturas Conminutas/fisiopatología , Fracturas Abiertas/diagnóstico por imagen , Fracturas Abiertas/fisiopatología , Gentamicinas/administración & dosificación , Humanos , Articulación de la Rodilla , Traumatismos de la Pierna/diagnóstico por imagen , Traumatismos de la Pierna/fisiopatología , Recuperación del Miembro/métodos , Férulas (Fijadores) , Irrigación Terapéutica/métodos , Factores de Tiempo , Resultado del Tratamiento , Vancomicina/administración & dosificaciónRESUMEN
BACKGROUND: Bier block regional anesthesia was first described in 1908; however, it is uncommonly used for fears of cardiac and neurological complications. Although recent studies have documented safe usage in an adult population, no study to date has investigated its use in a pediatric setting. In addition, most emergency departments feel that splint placement is safer than casting after acute forearm fracture reduction in the pediatric population. However, to our knowledge there is no such study that documents the complication rates associated with immediate casting. The goal of this study was to assess the safety and efficacy of Bier block regional anesthesia and immediate cast application after closed reduction of pediatric forearm fractures. METHODS: A retrospective review was conducted of patients treated for forearm fractures in a 2-year period at a major metropolitan pediatric hospital. Rates of complications and length and costs of the 2 procedures were analyzed. RESULTS: A total of 600 patients were treated with Bier block regional anesthesia and 645 were treated with conscious sedation for displaced fractures of the forearm in the 2-year study period. No complications requiring admission were seen in either group. No patient experienced compartment syndrome or a need for readmission secondary to cast application. 2.2% and 4.3% (P=0.0382) of patients in the Bier block and sedation groups, respectively, needed their cast bivalved secondary to swelling. The average time from initiation of procedural sedation to discharge was 1 hour and 42 minutes, whereas the time to discharge from initiation of Bier block regional anesthesia was 47 minutes (P<0.0001). The average cost for a patient treated with procedural sedation was $6313, whereas the average cost for the Bier block regional anesthesia group was $4956. CONCLUSIONS: Bier block regional anesthesia is a safe, efficient, and cost-effective method of reducing pediatric forearm fractures. Immediate cast application can be used without fear of major complications. LEVELS OF EVIDENCE: Level III--retrospective review.