The Hip - book

Femoral IM Nail Entry Point

      – Discussion:     – two sites have been proposed for nail entry:     – tip of the greater trochanter and the piriformis fossa; – Entry thru Piriformis Fossa;      – main advantage a colinear trajectory with the long axis of the femoral shaft      – accurate positioning of the entrace hole is critical.      … Read more

Femoral Anteversion in Children:

– See: adult femoral and acetabular anteversion – Discussion:     – femoral version is defined as the angular difference between axis of femoral neck and transcondylar axis of the knee;     – excessive femoral anteversion (medial femoral torsion) is most common cause of in-toeing that first presents in early childhood;     – … Read more

Femoral Anteversion

– Discussion:     – femoral version is defined as the angular difference between axis of femoral neck and the transcondylar axis of the knee;     – excessive femoral anteversion (medial femoral torsion) is most common cause of in-toeing that first presents in early childhood;     – it is twice as common in girls as … Read more

Fat Embolism Syndrome

– Discussion:     – FES results when embolic marrow fat macroglobules damage small vessel perfusion leading to endothelial damage in pulmonary            capillary beds leading to respiratory failure and ARDS like picture;            – ref: Early-Onset Fat Embolism Syndrome. A Case Report     – risk factors for FES:            – … Read more

External Fixation for Pediatric Femur Fractures

– Discussion:     – methods to enhance fixator stability;     – in the report by Minor T, et al, 37 femoral shaft fractures, in 33 pediatric patients, were treated with unilateral external fixation after reduction from 1992 through 1998 (ages from 4 to 14 years);     – average follow-up was 3 years, … Read more

Extension Gap

– Discussion:     – see flexion gap     – is space between transverse cut on distal femur & transverse proximal tibial cut while the knee is in complete extension;     – while minor loss of knee flexion or mild instability in flexion can be tolerated, priority is always be given to extension gap               adjustments; … Read more

Examination for Posterolateral Rotary Instability of the Knee

– Clinical Findings:     – history: patient may complain of a subjective knee hyperextension sensation, and twisting or pivoting are also difficult;     – lack of contained effusion is suggestive of posterolateral capsular injury;     – look for diffuse tenderness over the posterolateral joint region, fibular head, and joint line;     … Read more

Examination of Knee

– Discussion:     – serial diagnostic exam should take into consideration static deformities of the lower extremities, gait, ROM, tenderness, and knee             stability;     – in the child w/ a painful knee, it is essential to closely examine the hip as hip pathology can refer pain to the hip; – Examination:     – Gait: … Read more

Ewing’s Sarcoma

– See: Bone Tumor Menu – Discussion:     – prevalence:          – it represents approx 7% of all primary bone malignancies;           – second most common primary malignant bone tumor (behind osteosarcoma) (2.1 per 1 million children)          – Ewing’s sarcoma is more common in males and is rare in blacks;     – … Read more