James Gamble, MD

BACKGROUND: Pediatric athletes who undergo anterior cruciate ligament reconstruction are at risk for a growth deformity if the surgery violates the physes.CASE: A 12-year-old African American boy underwent anterior cruciate ligament reconstruction using a hamstring autograft. The procedure violated the distal femoral growth plate and the perichondrial ring of LaCroix, resulting in a distal femoral lateral physeal growth arrest. Three years later, he had developed a 15° valgus deformity, an increased quadriceps angle and patellofemoral instability. He was able to return to sports after undergoing a distal femoral osteotomy to correct the valgus and medial patellofemoral ligament reconstruction to stabilize the patella.CONCLUSION: Anterior cruciate ligament reconstruction in athletes with open physes has the potential to cause distal femoral valgus deformity, an increased quadriceps angle, and subsequent patellofemoral instability.

View details for DOI 10.1186/s13256-023-03920-2

View details for PubMedID 37211594

Fyodor Mikhailovich Dostoevsky was a brilliant nineteenth-century Russian novelist who had a seizure disorder that influenced his life and his creativity. His novels explore issues of love, faith, doubt, morality and reflect his personal experience with epilepsy. He was a keen observer of familial psychodynamics. The Brothers Karamazov (1880)was Dostoyevsky's longest and last novel, completed just a few months before his death from a pulmonary hemorrhage, most likely related to his life-long habit of cigarette smoking. In this novel, he explores the subtility of interpersonal relationships and the psychopathology within the Karamazov family and how one of the three brothers, Smerdyakov, uses psychogenic non-epileptic seizures as an alibi to get away with the perfect crime of patricide.

View details for DOI 10.7759/cureus.38602

View details for PubMedID 37168406

View details for PubMedCentralID PMC10166408

CASE: A 12-year-5-month-old boy presented with a 3-month history of a 2 * 3-cm enlarging painful mass on the medial plantar aspect of his left foot. The radiograph was normal, but the magnetic resonance (MR) images clearly disclosed a foreign body in the shape of a toothpick that had been quiescent for 31 months. Thirty-three months after surgical removal, the patient was asymptomatic and had returned to full activity.CONCLUSION: A retained wood foreign body can present as an expanding mass, and MR is the modality of choice to image wood foreign bodies.

View details for DOI e22.00772

View details for PubMedID 37279299

A wide range of implants are used in the treatment of pediatric fractures, including wires, plates, screws, flexible rods, rigid rods, and external fixation devices. Pediatric bones differ from adult bones both mechanically and biologically, including the potential for remodeling. Implants used in pediatric trauma patients present a unique set of circumstances regarding indications, risks, timing of implant removal, weight-bearing restrictions, and long-term sequelae. Indications for implant removal include wire/pin fixation, when substantial growth remains, and infection. When considering implant removal, the risks and benefits must be assessed. The primary risk of implant removal is refracture. The timing of implant removal varies widely from several weeks to a year or more with the option of retention depending on the fracture, type of implant, and skeletal maturity of the patient.

View details for DOI e22.00050

View details for PubMedID 35427259

View details for DOI 10.5435/JAAOSGlobal-D-22-00050

View details for Web of Science ID 000783752200002

View details for DOI 10.1097/BPO.0000000000001912

View details for PubMedID 34397787

A discoid lateral meniscus (DLM) is a congenital anomaly of the knee in which the lateral meniscus has an "O" shape and contains irregular, abnormal collagenous tissue. A DLM can cause mechanical symptoms and pain. Treatment of a symptomatic DLM is arthroscopic saucerization to reshape the meniscus to a more normal contour. Enough tissue must be removed to eliminate mechanical symptoms but not too much to create instability. The residual width of the meniscus is crucial at the popliteus hiatus because here the peripheral rim is unattached at the capsule. Reports in the literature recommend a residual width of 6 to 8 mm.The purpose of this research was to determine the width of the lateral meniscus at the popliteal hiatus in normal specimens. Our null hypothesis was that a residual width of 6 to 8 mm will be sufficient to approximate normal anatomy.Cross-sectional study; Level of evidence, 3.We made direct measurements of the radial width of the lateral meniscus from the outer rim at the popliteal hiatus to the inner edge in 19 specimens (age, 2-120 months.) We measured one 4-year-old specimen with a bilateral complete DLM. We also measured 39 digital images of specimens (age, 1-132 months) using ImageJ. Finally, we made direct arthroscopic measurements of 8 skeletally mature specimens.The average width of specimens <3 years old was 5.5 mm. The average width of the 10-year-old specimens was 12 mm. The average width of the skeletally mature specimens was 16 mm. A 4-year-old DLM specimen measured 19 mm.We rejected our null hypothesis. Direct measurements suggest that a residual width of 6 to 8 mm is insufficient for children ≥8 years old. A width of at least a full centimeter approximates the normal for 8-year-olds and at least 15 mm for adolescents.

View details for DOI 10.1177/03635465211056661

View details for PubMedID 34780308

CASE: Approximately three-quarters of neonates with unstable hips will spontaneously stabilize without treatment in the first few weeks of life. This report presents the long-term follow-up of an infant with developmental dysplasia of the hips that stabilized at an older age and without any orthopaedic treatment.CONCLUSIONS: Factors contributing to the spontaneous stabilization in this case included the patient's self-selected lower extremity position of comfort with hips flexed, abducted, and externally rotated; her delayed walking; and her light body weight.

View details for DOI 10.2106/JBJS.CC.20.00294

View details for PubMedID 33512920

CASE: An 8-year-old girl presented with a displaced right medial patella sleeve fracture. She underwent open reduction and suture fixation. Three years later, she presented with a left medial patella sleeve fracture that was less displaced than on the right. This was treated with immobilization and structured rehabilitation. She was able to return to full activity with normal radiographs at the final follow-up.CONCLUSION: Patella sleeve fractures are rare. We report a unique case of bilateral medial patella sleeve fractures in an otherwise healthy child in which one side was treated operatively and the other was treated nonoperatively.

View details for DOI 10.2106/JBJS.CC.19.00533

View details for PubMedID 32649152

A subfibular ossicle (SO), also known as an os subfibulare, is present in ∼1% of the general population. Two theories have been proposed to explain the origin of SOs: (1) as a failure of fusion of a secondary center of ossification; (2) as a posttraumatic sequela. This report offers prospective, longitudinal radiographic evidence for the formation of SOs as a posttraumatic sequela of type VII transepiphyseal fractures of the lateral malleolus in children.This Institutional Review Board-approved study was performed at a tertiary care pediatric hospital from March 2012 to April 2019. The study group included 37 children with a type VII fracture of the lateral malleolus and a minimum follow-up of 6 months.Twenty-one children (57%) healed their fracture. Sixteen children (43%) went on to form SOs. The most common location for the fractures was the distal third of the epiphysis, and the most common fracture type forming SOs was a sleeve avulsion fracture. Four of the children forming SOs have had surgery to address pain and recurrent sprains.Overall, 43% of children who sustained a type VII fracture of the lateral malleolus went on to form SOs, giving support to the posttraumatic theory of origin. Sleeve avulsion fractures have the greatest chance of forming SOs. So far, 4 of the 16 children forming SOs have undergone surgery for ankle pain and recurrent sprains.Level II.

View details for DOI 10.1097/BPO.0000000000001638

View details for PubMedID 32675577