OKOJ

OKOJ, Volume 13, No. 3


Anterior Cruciate Ligament Injuries in Skeletally Immature Patients: An Updated Review of Research and Treatment Options

Reconstruction of the ACL in skeletally immature patients is a topic of constant debate and research because of the risk of significant physeal injury about the knee resulting from femoral and tibial tunnel drilling and placement of therapeutic hardware. Surgical techniques for reconstructing the ACL may violate the proximal tibial, distal femoral, and tibial tubercle physes and can potentially cause premature growth arrest with resultant limb-length discrepancy or angular deformity of the lower extremity. This article is a review of the literature on reconstruction of the ACL in children and adolescents, including recently reported studies of surgical reconstruction in adolescent patients and animals, with a specific focus on physeal injury and surgical technique. These studies indicate that reconstruction of the ACL in patients with open physes is a viable option, although the small possibility of its inducing physeal injury remains a significant concern. Special consideration should be given to technique, anatomy, and hardware placement in such repair for each individual patient, and may reduce the risk of disturbances in physeal growth from reconstruction of the ACL.

    • Keywords:
    • anterior cruciate ligament reconstruction

    • children

    • adolescents

    • physeal arrest

    • Subspecialty:
    • Sports Medicine

    • Pediatric Orthopaedics

Elbow Fractures in Children

Elbow fractures are common injuries in children, and often require surgical treatment. Evaluation and diagnosis of these injuries can be difficult in this population of patients because of the presence of secondary ossification centers of the elbow that develop over time, sometimes mimicking fractures. The additional challenge of recognizing occult fractures makes this one of the most demanding sets of injuries to manage in children. Successful treatment of an elbow fracture in a pediatric patient requires an understanding of the normal order of fusion of the secondary growth centers, the mechanism of injury, the natural histories of the different treatments for elbow fractures, and the potential complications of treatment. This article reviews the diagnostic and management strategies for the most common elbow fractures seen in pediatric patients.

    • Keywords:
    • supracondylar fracture

    • medial epicondyle fracture

    • lateral condyle fracture

    • radial head/neck fracture

    • olecranon fracture

    • occult fracture

    • Subspecialty:
    • Trauma

    • Pediatric Orthopaedics

Salvage Treatment of Hip Fractures After Failure of Surgical Fixation: A Systematic Review

Surgical fixation is generally the treatment used for the repair of uncomplicated fractures of the hip. However, complications following the fixation of such fractures, such as nonunion, hardware failure, osteonecrosis, posttraumatic osteoarthritis, and infection may require salvage treatment with total hip arthroplasty. This systematic review article addresses the challenges of conversion to total hip arthroplasty after prior fixation of a hip fracture, and provides recommendations for minimizing complications related to such conversion.

    • Keywords:
    • femoral neck fracture

    • intertrochanteric fracture

    • fixation failure

    • conversion total hip arthroplasty

    • Subspecialty:
    • Adult Reconstruction

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