Two clinical cases of peroneal nerve lesion (patients 13 and 16 years) resulted from intraneural ganglion are presented. It is shown that only radical surgical intervention including resection of tibiofibular junction, removal of communicating canal and nerve decompression using cyst dissection (Spinner technique) could prevent ganglion relapse. In first patient completely lost peroneal nerve function was restored by musculotendinous transposition.
Background. Patellar instability is a common problem in pediatric patients. Up to 2%–3% of all knee injuries are associated with acute patellar dislocation. According to the data in the literature, patients aged 10–17 years are at the highest risk of patellar dislocation and subsequent instability. These patients must be evaluated according to the proposed algorithm to select the optimal treatment method.
Aim. To diagnose patellar instability in children and subsequently select the optimal treatment method based on acquired data.
Materials and methods. The study is based on data acquired through the examination and treatment of 147 patients at the 9th Department of Pediatric Traumatology and Orthopedics. Great emphasis was put on computed tomography (CT) data, its essential parameters, which require the most thorough analysis, and assessment methods. These parameters include patellar tilt, dysplasia of the distal metaepiphysis of the femur, the tibial tubercle–trochlear groove index, and the rotational relation of the femur and tibia.
Results. A novel algorithm for patient examination using CT is proposed. Data obtained by multislice CT (MSCT) had a significant influence on the selection of the surgical method for treating patients with patellar instability.
Conclusion. The examination of patients with patellar instability using MSCT in adherence to the proposed diagnostic algorithm allows the selection of the optimal treatment method, which will increase the likelihood of rapid recovery of patients and their return to the level of activity similar to that before injury.
Treatment results of 1353 children and adolescents with acute elbow injuries were performed. The main difficulties for diagnosis and treatment of those injuries were shown. Using stored experience the methods of diagnosis and treatment for all types of injuries were optimized. Potential complications and mistakes were described; the ways of their prevention were presented. Tactics of postoperative management of patients was elaborated. Differentiated approach to the treatment of every type of injuries enabled to obtain good and excellent results in 93.2% of patients.
Experience in knee arthroscopy in children with acute knee trauma and sequelae of knee injuries is presented. There were 417 patients, aged 4-18, who were under treatment at the clinic in the period from 1994 to 2002. One hundred forty four patients (34.5%) had injury of articular cartilage. In 12 cases diagnostic and in 132 cases diagnostic and curative arthroscopy was performed. Evident advantages of arthroscopy in diagnosis of intraarticular knee structures injuries, especially cartilagenous tissue were emphasized. Protocol of diagnostic examination including clinical, roentgenologic, ultrasonographic methods as well as CT and MRT (as indicated) is suggested. Indications to knee arthroscopy in children and adolescents are determined. Clinical-arthroscopic classification of knee articular cartilage injuries is given. Due to exact diagnosis and adequate curative tactics total restoration of knee function was achieved in 75% of patients with articular cartilage injuries.
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