By U. Akascha. Southwestern College, Kansas.

Another common back problem that can develop during adolescence is scoliosis order doxycycline 100mg on-line virus barrier for mac. According to the latest findings doxycycline 200mg without prescription treatment for uti cranberry juice, idiopathic scoliosis does not develop as a re- sult of an asymmetrical muscle contraction, but rather a discrepancy between the growth of the vertebral bodies and that of the posterior elements – possibly as a result of an inadequate response of the posterior ligaments to the tensile loading associated with growth ( Chapter 3. The available statistics show that idiopathic scoliosis is no more common in athletes undergoing asymmetrical loading, e. By contrast, there is clear evidence to show that scoliosis is more common in those sports involving an extremely straight posture ⊡ Fig. Typical injury in adolescents: Apophyseal avulsion (here (rhythmic and standard gymnastics, figure skating and in the anterior inferior iliac spine, attachment of the rectus femoris also ballet dancing). Murray PM, Weinstein SL, Spratt KF (1993) The natural history and The musculoskeletal system consists of tissues with wide- long-term follow-up of Scheuermann kyphosis. Murray RO, Duncan C (1971) Athletic activity in adolescence as an occur at the weakest point. The mechanical properties of etiological factor in degenerative hip disease J Bone Joint Surg 2 the various structures change during growth. The critical structure in small children under 10 dylolysis in the female athlete. Clin Orthop 372: years of age is bone tissue, while this role is as- 74–84 sumed by growth cartilage in adolescents. Pouliquen JC, Kassis B, Glorion C, Langlais J (1997) Vertebral adults, the ligaments can ultimately be described growth after thoracic or lumbar fracture of the spine in children. J as the weakest point in the tissue system of the Pediatr Orthop 17: 115–20 14. Segesser B, Morscher E (1978) Die Coxarthrose bei ehemaligen musculoskeletal apparatus. Segesser B, Morscher E, Goesele A (1995) Störungen der Wachs- the lowest loading tolerance. Stokes I, Mente P, Iatridis J, Farnum C, Aronsson D (2002) Enlarge- So what advice should we give to young athletes? When ment of growth plate chondrocytes modulated by sustained should they start performance training? J Bone Joint Surg Am 84-A: 1842–8 cents wait until growth is completed and run the risk of 17. Tanchev P, Dzherov A, Parushev A, Dikov D, Todorov M (2000) no longer being competitive? Spine 25: 1367–72 questions we need to know more about the long-term ef- 18. Williamson A, Chen A, Masuda K, Thonar E, Sah R (2003) Tensile mechanical properties of bovine articular cartilage: variations fects of the aforementioned illnesses. Legitimate doubts exist as to whether a thoracic Orthop Res 21: 872–80 19. Clin Scheuermann disease or spondylolysis actually rep- Sports Med 21: 77–92 resents a major problem in later life. Wren T, Beaupré G, Carter D (1998) A model for loading-depen- apply, however, to a tilt deformity, which leads to dent growth, development, and adaptation of tendons and liga- impingement in the hip and constitutes a distinct ments. J Biomech 31: 107–14 form of pre-arthrosis – and coxarthrosis does actu- ally appear to be more common in former athletes than in the general population. Consequently, ex- cessive loading should be avoided particularly dur- ing early puberty.

This algorithm The choice of surgical intervention is complex and is currently evolving and will undoubtedly change as involves the consideration of many factors cheap doxycycline 100 mg with visa virus united states department of justice, including we acquire new information from animal studies and defect size order doxycycline 100 mg overnight delivery infection behind eye, depth, location, chronicity, response to clinical trials. Multiple options often exist for similar lesions and there is not necessarily a consensus regarding the opti- REFERENCES mal treatment. Ann rently amenable to a menu-driven decision making Pharmacother 32:574–579, 1998. Clin Orthop 253:197–202, These include: location and size of the injury or extent 1990. A survivor- ular defects in osteochondritis dissecans of the lateral femoral ship analysis. Blevins FT, Steadman JR, Rodrigo JJ, et al: Treatment of articu- Ghazavi MT, Pritzker KP, Davis AM, et al: Fresh osteochondral lar cartilage defects in athletes: An analysis of functional out- allografts for post-traumatic osteochondral defects of the knee. Gill TJ, Steadman JR, Rodrigo JJ, et al: Indications and long- Osteologie 9:17–25, 2000. Gillogly SD, Voight M, Blackburn T: Treatment of articular car- Brittberg M, Lindahl A, Nilsson A, et al: Treatment of deep car- tilage defects of the knee with autologous chondrocyte implan- tilage defects in the knee with autologous chondrocyte trans- tation. New York, NY, Marcel Dekker 1992, Buckwalter, JA: Articular cartilage injuries. Grande D, Pitman M, Peterson L, et al: The repair of experimen- Buckwalter JA, Mankin HJ: Articular cartilage I: Tissue design tally produced defects in rabbit articular cartilage by autologous and chondrocyte-matrix interactions. Gross AE: Fresh osteochondral allgorafts for post-traumatic knee Buckwalter JA, Mankin HJ: Articular cartilage II: Degeneration defects: Surgical technique. Gross AE, Aubin P, Cheah HK, et al: A fresh osteochondral allo- J Bone Joint Surg 79A:612–632, 1997b. Buckwalter JA, Mow VC: Cartilage repair in osteoarthritis, in Hangody L, Feczki P, Bartha L, et al: Mosaicplasty for the treat- Moskowitz RW, Howell DS, Goldberg VM, Mankin HJ (eds. Hangody L, Kish G, Karpati Z, et al: Mosaicplasty for the treat- Buckwalter JA, Rosenberg LA, Hunziker EB: Articular cartilage: ment of articular cartilage defects: application in clinical prac- Injury and repair, in Woo SL, Buckwalter JA (eds. Park Ridge, IL, Hjelle K, Solheim E, Strand T, et al: Articular cartilage defects in American Academy of Orthopaedic Surgeons 1988, pp 465–482. Buckwalter JA, Rosenberg LA, Hunziker EB: Articular cartilage: Hubbard MJ: Articular debridement versus washout for degener- Composition, structure, response to injury, and methods of ation of the medial femoral condyle. Buckwalter JA, Hunziker EB, Rosenberg LC, et al: Articular car- Khanna BAJ, Cosgarea AJ, Mont MA, et al: Magnetic resonance tilage: Composition and structure, in Woo SL, Buckwalter JA imaging of the knee. Park Ridge, IL, American Academy of Orthopaedic Surgeons Kish G, Modis L, Hangody L: Osteochondral mosaicplasty for 1988, pp 405–425. Chu CR, Convery FR, Akeson WH, et al: Articular cartilage Mandelbaum BR, Romanelli DA, Knapp TP: Articular cartilage transplantation. Cole BJ, Frederick R, Levy A, et al: Management of a 37 year old Martin JA, Buckwalter JA: The role of chondrocyte-matrix inter- man with recurrent knee pain. J Clin Outcomes Manag actions in maintaining and repairing articular cartilage. Curl W, Krome J, Gordon E, et al: Cartilage injuries: A review of Meyers MH, Akeson W, Convery F. J Bone Joint Surg 71A:704–713, DaCamara CC, Dowless GV: Glucosamine sulfate for oste- 1989. Micheli LJ, Browne JE, Erggelet C, et al: Autologous chondro- Finerman GAM, Noyes FR (eds. Clin J Sports Med 11:223–228, American Academy of Orthopaedic Surgeons 597, 1992.

Surgical treatment Deformities: Doubling of the epicondylar contours ▬ Isolated epicondylar avulsions with more than 5 mm and hypo- or hyperplasia of the epicondyle can occur 3 of displacement heal in the form of a pseudarthrosis regardless of treatment cheap doxycycline 100mg with amex infection, but can usually just be classed in 50 percent of cases doxycycline 200 mg online infection of the pancreas, which in itself is no indication as radiological phenomena. However, since stable screw fixation permits earlier and more active rehabilita- tion, this option should be discussed for youngsters 3. Around 5% of all pediatric fractures are intra-articular ▬ The pseudarthrosis rate (approx. Children between the ages of 4 both the fragment and the avulsion site on the hu- and 8 are especially affected. At this age the trochlear ossi- merus of apophyseal cartilage with a sharp curette. It can therefore be correspond- cancellous lag screw on a toothed washer is preferable ingly difficult to establish the course of the epiphyseal to Kirschner wires or absorbable pins. In fact, distal, intra-articular humeral fractures ▬ Fractures accompanying elbow dislocations: Epicon- are the ideal example illustrating the whole problem of the dyles incarcerated in the joint represent an obstacle diagnosis of fractures that primarily involve the cartilagi- to reduction and therefore make open reduction a nous parts of the skeleton. The challenge of condylar fractures lies in the cor- wedged, the guidelines for isolated avulsion fractures rect identification of the fracture type. Follow-up controls are continued until satisfactory mo- bility and confirmed joint stability are restored in the asymptomatic patient. Diagnosis Clinical features Complications Swelling and hematoma over the lateral aspect of the el- ▬ Pseudarthroses result in over 50 percent of cases after bow. Imaging investigations In addition to AP and lateral x-rays of the elbow, a view! Since patients with or without an epicondylar with internal rotation should be recorded if the findings pseudarthrosis are usually symptom-free, the pri- are unclear. Fracture types Cases of symptomatic pseudarthrosis can be managed The radial condyle is by far the most commonly affected. Completely intra-articular fractures ▬ Medial instability with pseudarthrotic healing is rare with rupture of the epiphyseal cartilage are unstable and and often leads to symptoms at a late stage. Incomplete articular fracture of the radial condyle of the complete articular fracture can even be displaced secondarily during humerus ( a): This so-called »hanging« fracture can be treated conserva- cast immobilization and lead to pseudarthroses. Complete articular placement – as a sign of a complete articular fracture – must be identi- fracture of the radial condyle of the humerus (b): The non-displaced, fied as such and the fracture can then be managed surgically! The poste- cartilage-bone junction is less than 2 mm, it may be rior soft tissues over the condyle must be preserved so assumed that the cartilage is also intact. Exposure of the posterior, metaphyseal fracture sections is essential Employing this simple, radiological criterion, we have not for both the reduction and accurate implant place- missed any cases of primary or secondary displacement ment. The diagnosis based on the trauma x-ray screw produces secure fixation, consolidation within 4 is clear only if the fracture is completely displaced. If it weeks and thus the prevention of partially stimulatory initially appears non-displaced or minimally displaced, growth disturbances. A cast-free check x-ray after 5–7 days is essential in order to check for secondary dislocation. Follow-up controls Ulnar condylar fractures and Y- or T fractures are much Consolidation x-ray after 4–5 weeks. The diagnostic considerations for radial condylar removal after 3–4 months.

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