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ABSTRACT: Die Autoren stellen Kasuistiken zweier Kinder mit der Diagnose „synovialer Weichteiltumor am Sprunggelenk“ vor. Synoviale
Weichteiltumoren des Sprunggelenks sind im Kindesalter selten. Die Symptome sind unspezifisch, sodass die klinische Diagnosefindung
schwierig ist. In beiden Fällen stellten sich die Kinder primär bei schmerzhafter Schwellungen nach Trauma vor, was die Diagnosefindung
zusätzlich erschwerte. Bei protrahiertem klinischem Verlauf ist bei Kindern an die seltene Differentialdiagnose der synovialen
Weichteiltumoren zu denken.
The authors present two case histories of children with synovial soft tissue tumor of the ankle. Synovial soft tissue tumors
of the ankle in childhood are rare. The symptoms are unspecific so that the clinical diagnosis is difficult. In both cases
the children came primarily to the clinic with painful swelling at the ankle after trauma, which further complicated the diagnosis.
It should be taken into consideration that the rare differential diagnosis of pain at the ankle could be synovial soft tissue
tumor especially when the clinical course is protracted.
Der Unfallchirurg 04/2012; 111(7):559-562. · 0.61 Impact Factor
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ABSTRACT: Fast-Track-Protokolle in der Kinderchirurgie sind für einzelne Prozeduren gerechtfertigt. Bei größeren Operationen im Neonaten-
und Säuglingsalter ist eine aufwendige postoperative Betreuung notwendig, die starre Fast-Track-Protokolle nicht sinnvoll
erscheinen lassen. Bei sehr vielen Eingriffen im Kindesalter sind die Abläufe bereits so gestrafft, dass Fast-Track-Protokolle
keine weitere wesentliche Verkürzung des stationären Aufenthaltes mit sich bringen würden. Die veröffentlichten Fast-Track-Erfahrungen
für das Kindesalter zeigen, dass die Methode für einzelne Indikationen durchführbar und sicher ist. Die Komplikationsquoten
und Wiederaufnahmeraten sind gering. Die perioperativen Abläufe können anästhesiologisch durch kürzere Nüchternzeiten, die
Umgehung des Aufwachraumes und den Einsatz suffizienter, nebenwirkungsarmer Analgetika im Sinne von Fast Track angepasst werden.
Gerade für das Kindesalter muss jedoch die individuelle Anpassung an die Bedürfnisse des einzelnen Patienten gewährleistet
sein.
Fast track protocols are justified for several pediatric surgical procedures. Particular operations on neonates and babies
require specialized postoperative care. In these very young patients, no benefit can be expected from rigid fast track concepts.
Many workflows in pediatric surgery have already been optimized with a view toward very short hospital stay. The published
experiences with fast track protocols in pediatric surgery show that the method is feasible and safe. Complication and readmission
rates are very low. Perioperative adjustments, shorter fasting periods, and the use of new analgetics are desirable in pediatric
fast track protocols. Particularly for children, customizing protocols to the individual patients’ requirements must be guaranteed.
Der Chirurg 04/2012; 80(8):719-723. · 0.70 Impact Factor
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ABSTRACT: Außer den suprakondylären Humerusfrakturen gibt es eine Reihe anderer Verletzungen, die unbehandelt zu erheblicher Invalidität
führen können. Exemplarisch wird über 5 Korrektureingriffe nach primär übersehenen Ellenbogenfrakturen berichtet. Im Einzelnen
handelte es sich um eine Pseudarthrose des Condylus radialis, 3 übersehene Monteggia-Frakturen mit persistierender Radiusköpfchenluxation
im Kleinkindesalter und um eine periartikuläre Verkalkung nach übersehenem Abriss des Epicondylus radialis mit zusätzlichem
Ausriss der radialen Kapsel bei einem 13-Jährigen. Bei allen Kindern bestand eine erhebliche Behinderung der Ellenbogenfunktion.
Die übersehenen Frakturen wurden frühzeitig revidiert. Verschiedene Ostesyntheseverfahren, einschließlich Bewegungs- und Distraktionsfixateuren
kamen zu Anwendung. Insgesamt konnte bei allen Patienten eine nahezu volle Beweglichkeit bei vorhandener Stabilität erreicht
werden. Transkondyläre und Monteggia-Frakturen dürfen primär nicht übersehen werden, da die sekundäre Korrektur immer zu schlechteren
Ergebnissen führt als die primär korrekte Behandlung. Für die Behandlung der Ankylose des Ellenbogengelenkes stellt der Bewegungsfixateur
nach Distraktionsbehandlung eine sinnvolle, ergänzende Behandlung dar.
Besides supracondylar fracture of the humerus there are several injuries of the elbow joint, which may lead to major disability.
In this study 5 cases of corrective procedures are described after elbow fractures. Initially the lesions were overlooked.
These were a fracture of the radial condyle, producing a pseudarthrosis, three cases of Monteggia fractures with persisting
dislocation of the radial head in young children and a periarticular calcification issuing from an avulsion of the radial
epicondyle and the radial capsule in a 13-year-old. All children had marked functional limitation of the elbow joint. The
primarily overlooked fractures were corrected early. Various osteosynthesis procedures including movement and distraction
extend fixator were employed. Overall, in all patients an almost complete movement of the joint at existing stability could
be achieved. Transcondylar and Monteggia fractures should not be overlooked at the initial diagnosis as secondary operations
for correction always have a less favorable outcome than the primary one. For the management of ankylosis of the elbow a movement
extend fixator after distraction is a useful additional management.
Der Unfallchirurg 04/2012; 105(5):478-482. · 0.61 Impact Factor
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ABSTRACT: Traumatic dislocation of the elbow is rare in children with an incidence of 3-6% of all elbow injuries. In the literature the outcome after elbow dislocation in childhood is rarely discussed. In the present study 33 children treated in our clinic from 2001 to 2008 with an acute traumatic dislocation of the elbow were retrospectively included. All events were unilateral whereby 1 child (3%) showed a recurrence of elbow dislocation after 9 weeks, 30% had a pure dislocation, 70% had a concomitant fracture, 55% showed a fracture of the medial epicondyle, 6% a fracture of the lateral epicondyle and 9% a further fracture. Of the fractures 83% required open reduction with osteosynthesis. After an average of 4.5 years 20 children (61%) were clinically examined. There were no instabilities of the joint and only minor clinical limitations of the range of motion. The established Mayo elbow performance score showed good to excellent results for all children. Despite severe joint trauma with frequently accompanying fractures, post-traumatic functional deficits are rarely limiting, independent of the accompanying fracture. The frequency of recurrence is low and instabilities were not seen.
Der Unfallchirurg 02/2012; 115(2):125-33. · 0.61 Impact Factor
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ABSTRACT: Neuroblastoma (NB) is one of the most common malignant tumors in infancy. The commonly used International Neuroblastoma Staging System is not suitable for determining the surgical risks. To address this, we aimed to evaluate the correlation between so-called image-defined risk factors (IDRFs) and the surgical risks in abdominal neuroblastoma.
We evaluated 60 cases who underwent surgical intervention and examined the pre-surgical radiological imaging to look for IDRFs and surgical complications in children with abdominal neuroblastoma.
The MRI- and CT-scans showed a total of 122 IDRFs in 39 cases. Complete resection was carried out in 50%, partial excision in 32%, and biopsy in 18% of cases. Total resection was possible in 100% of cases with no IDRF. Where IDRFs were present, total resection was only possible in 26% of cases (p<0.0001). We found a highly significant, negative correlation between the number of IDRFs and the possibility of performing complete resection of NB (p<0.0001). 7 (11.6%) complications were detected, all in patients who showed at least one IDRF previously.
Our findings indicate that IDRFs are useful indicators for predicting surgical risk and surgical outcome and thus should be taken into account when planning surgery.
European Journal of Pediatric Surgery 07/2011; 21(5):314-7. · 0.81 Impact Factor
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ABSTRACT: Neuroblastoma is an embryonic tumor of the sympathetic nervous system which represents one of the most common malignancies in early childhood. Its clinical and biological behavior show a remarkable heterogeneity, ranging from spontaneous regression to inexorable progression with a fatal outcome. This review summarizes the clinical risk stratification and treatment options. An extensive overview of the role of imaging during the course of the disease and typical imaging findings in all imaging modalities are demonstrated.
RöFo - Fortschritte auf dem Gebiet der R 03/2011; 183(3):217-25. · 2.76 Impact Factor
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C J Schupp,
A Nitsche,
O Bock-Hensley,
S Böhm,
C Flechtenmacher,
A Kurth,
K Saenger,
M Hoferer,
U Küsters, P Günther,
G Engelmann,
P Schnitzler
Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 01/2011; 50(1):1-3. · 3.12 Impact Factor
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ABSTRACT: Hemangiomas are the most common tumors of infancy. Multiple cutaneous hemangiomas may be associated with the presence of hemangiomas in inner organs. However, there is little data on the risk factors for organ involvement and the outcome of a large sample of patients.
patients with 3 or more cutaneous hemangiomas were evaluated with regard to patient characteristics, distribution of hemangiomas, results of radiological abdominal/cerebral imaging, clinical course, and therapeutic approach. We analyzed the risk factors for organ involvement and complications/outcome.
The average gestational week at birth was 32.8; radiological imaging showed liver hemangiomas in 13.5% and mesenteric lesions in 1 (1.9%) but no cerebral lesions. Preterm infants (p=0.02) and patients with high numbers of cutaneous hemangiomas (p=0.02) were at higher risk of organ involvement. A life-threatening event occurred in 1 patient (1.9%). None of the patients died.
Organ manifestation is relatively common in patients with multiple hemangiomas, complications are rare, but potentially life-threatening. We recommend abdominal imaging for patients with 3 or more hemangiomas, especially in preterm infants.
European Journal of Pediatric Surgery 11/2010; 20(6):379-81. · 0.81 Impact Factor
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ABSTRACT: Surgical complications after tumor operations are frequent in children, with rates of up to 30% cited in the literature. Various approaches to reduce these complication rates have been attempted, with preoperative chemotherapy holding pride of place. One approach to minimize surgical complications is better preoperative preparation. In a retrospective analysis, we evaluated the complications associated with tumor surgery.
We retrospectively analyzed patient data from 1991 to 2007. The distribution of the various tumors, the type of surgery, and complications were evaluated. For neuroblastomas a differentiated analysis of complications was performed, which included staging and radiologically defined surgical risk factors (SRFs). Patients were divided into two groups: A and B. Intensified surgical planning with 3D visualization was used in patients of group B.
A total of 145 operations for abdominal tumors were performed in 123 patients. The three most common diseases were neuroblastoma (36%), nephroblastoma (26%), and ovarian tumor (19%). In 68% of patients complete resection and in 19% of cases partial resection of the tumor was carried out; open biopsy was performed in 13%. A total of 15 (10.3%) complications developed: the incidence of complications for group A was 11.8% and 7.7% for group B (p=0.5). For nephroblastoma these figures were 27.9% and 21.2% (p=1.0). In the group of patients with neuroblastoma, six complications developed in patients from group A (21.4%) and one in a group B patient (4.2%) (p=0.107). 54% of neuroblastomas were completely and 33% partially resected; these figures and the distribution of SRFs were similar in the two groups. A significant increase in the risk of complications could be seen with an increase in SRFs (p=0.0267) and with disease stages 2 and 3 (p=0.016). Tumor reduction surgery was also associated with an increase in complications (p=0.086).
In summary, tumor surgery is associated with considerable risks in children. Therefore it is very important to look for new approaches that could potentially minimize these risks. As the causes of surgical complications are multifactorial, we are of the opinion that intensified surgical planning can contribute to reducing risks. Particularly neuroblastoma surgery could profit from an increased use of 3D visualization and improved preoperative planning.
European Journal of Pediatric Surgery 06/2009; 19(5):297-303. · 0.81 Impact Factor
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ABSTRACT: Fast track protocols are justified for several pediatric surgical procedures. Particular operations on neonates and babies require specialized postoperative care. In these very young patients, no benefit can be expected from rigid fast track concepts. Many workflows in pediatric surgery have already been optimized with a view toward very short hospital stay. The published experiences with fast track protocols in pediatric surgery show that the method is feasible and safe. Complication and readmission rates are very low. Perioperative adjustments, shorter fasting periods, and the use of new analgetics are desirable in pediatric fast track protocols. Particularly for children, customizing protocols to the individual patients' requirements must be guaranteed.
Der Chirurg 04/2009; 80(8):719-23. · 0.70 Impact Factor
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[hide abstract]
ABSTRACT: The authors present two case histories of children with synovial soft tissue tumor of the ankle. Synovial soft tissue tumors of the ankle in childhood are rare. The symptoms are unspecific so that the clinical diagnosis is difficult. In both cases the children came primarily to the clinic with painful swelling at the ankle after trauma, which further complicated the diagnosis. It should be taken into consideration that the rare differential diagnosis of pain at the ankle could be synovial soft tissue tumor especially when the clinical course is protracted.
Der Unfallchirurg 08/2008; 111(7):559-62. · 0.61 Impact Factor
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ABSTRACT: 3D imaging and surgical planning for the treatment of embryonal tumors using different techniques (CT versus MRI) are presently under discussion. Up to now, the main focus has been on visualizing the anatomy. Contrast medium dynamics have not been taken into consideration. The aim of the present study was to establish the technical means of integrating the 3D images from functional MRI data into the anatomical images and to determine clinical applications for this approach.
In 11 patients (mean age: 2.4 years) with solid tumors, 26 diagnostic MRI examinations were performed for primary diagnosis, treatment monitoring, or as part of the surgical planning. Seven children presented with neuroblastomas, three with Wilms' tumor, and one with advanced bilateral nephroblastomatosis. The MRI data were acquired using a 1.5-T system. For post-processing, we used volume rendering software, including an evaluation of perfusion. By using color-coded parametric images and integrating functional information, perfusion could be visualized and used for interactive surgical planning. Macroscopic and microscopic sections served as the gold standard for assessing tissue viability.
We were able to integrate the dynamic data into the anatomical images for all patients. A good agreement was found between the results of surgical planning, including perfusion mapping, with the surgical site, subsequently produced macroscopic sections and the results of random microscopic examinations.
Perfusion mapping using color-coded parametric images of pediatric abdominal tumors extends the diagnostic techniques currently available. We provide first proof of the possibility of integrating functional information into 3D MR images in children. Monitoring the treatment of nephroblastoma and surgical planning for pediatric embryonal tumors represent potential applications of this technique.
European Journal of Pediatric Surgery 03/2008; 18(1):7-12. · 0.81 Impact Factor
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ABSTRACT: Exact surgical planning is necessary for complex operations of pathological changes in anatomical structures of the pediatric abdomen. 3D visualization and computer-assisted operational planning based on CT data are being increasingly used for difficult operations in adults. To minimize radiation exposure and for better soft tissue contrast, sonography and MRI are the preferred diagnostic methods in pediatric patients. Because of manifold difficulties 3D visualization of these MRI data has not been realized so far, even though the field of embryonal malformations and tumors could benefit from this.A newly developed and modified raycasting-based powerful 3D volume rendering software (VG Studio Max 1.2) for the planning of pediatric abdominal surgery is presented. With the help of specifically developed algorithms, a useful surgical planning system is demonstrated. Thanks to the easy handling and high-quality visualization with enormous gain of information, the presented system is now an established part of routine surgical planning.
Der Radiologe 09/2006; 46(8):689-97. · 0.61 Impact Factor
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ABSTRACT: Acute scrotum represents an emergency situation although testicular torsion is present in less than 20% of the cases. Sonography has meanwhile become the definitive modality for diagnosis. Its increasing use before surgical intervention has led to technical improvements in ultrasound diagnostics and critical assessment of ultrasound criteria to exclude testicular torsion as well as standardization of examination procedures. Central arterial and venous perfusion shown to be bilaterally equal on Doppler sonography is the most important criterion for excluding torsion. This article discusses other criteria such as the "resistance index," comparison of parenchymal structure of both testes, evidence for spermatic cord torsion, or differences between the sides in perfusion of the testicular parenchyma and highlights the difficulties involved in partial and intermittent testicular torsion. Alternative investigative methods and the significance of sonography in the differential diagnosis of other underlying causes are addressed. In summary, the combination of interpreting B-mode imaging, color Doppler, and power Doppler sonography and analyzing Doppler flow curves after clinical examination results in successful and conclusive evaluation of the testes in cases of acute scrotum in boys.
Der Radiologe 08/2006; 46(7):590-5. · 0.61 Impact Factor
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ABSTRACT: Das akute Skrotum ist eine Notfallsituation, wobei in weniger als 20% der Flle eine Hodentorsion vorliegt. Inzwischen hat sich die Sonographie zur entscheidenden diagnostischen Untersuchungsmodalitt entwickelt deren zunehmende Anwendung zu technischen Fortschritten der Ultraschalldiagnostik, zu einer kritischen Bewertung von Ultraschallkriterien zum Ausschluss einer Hodentorsion und zu einer Standardisierung der Untersuchungsablufe gefhrt hat. Die in der Dopplersonographie dargestellte seitengleiche zentrale arterielle und vense Perfusion ist hierbei das wichtigste Kriterium zum Ausschluss einer Torsion.Weitere Kriterien wie resistant index, Parenchymstruktur des Hodens im Seitvergleich, Nachweis eines torquierten Samenstrangs oder seitendifferente Perfusion des Hodenparenchyms werden errtert und auf die Schwierigkeiten bei der partiellen und intermittierenden Hodentorsion hingewiesen. Alternative Untersuchungsmethoden und die Bedeutung der Sonographie zur Klrung weiterer Ursachen in der Differenzialdiagnose des akuten Skrotums werden aufgezeigt. Zusammenfassend gelingt durch die gemeinsame Betrachtung von B-Mode-Bildgebung, Farbdoppler- und Powerdopplersonographie sowie der Analyse der Doppler-Fluss-Kurven nach klinischer Untersuchung die geforderte umfassende Beurteilung des Hodens beim akuten Skrotum des Jungen.Acute scrotum represents an emergency situation although testicular torsion is present in less than 20% of the cases. Sonography has meanwhile become the definitive modality for diagnosis. Its increasing use before surgical intervention has led to technical improvements in ultrasound diagnostics and critical assessment of ultrasound criteria to exclude testicular torsion as well as standardization of examination procedures. Central arterial and venous perfusion shown to be bilaterally equal on Doppler sonography is the most important criterion for excluding torsion.This article discusses other criteria such as the resistance index, comparison of parenchymal structure of both testes, evidence for spermatic cord torsion, or differences between the sides in perfusion of the testicular parenchyma and highlights the difficulties involved in partial and intermittent testicular torsion. Alternative investigative methods and the significance of sonography in the differential diagnosis of other underlying causes are addressed. In summary, the combination of interpreting B-mode imaging, color Doppler, and power Doppler sonography and analyzing Doppler flow curves after clinical examination results in successful and conclusive evaluation of the testes in cases of acute scrotum in boys.
Der Radiologe 01/2006; 46(7):590-595. · 0.61 Impact Factor
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ABSTRACT: Kidney tumors represent 6.2% of malignant tumors in children. History, clinical course and radiological findings are necessary elements in the differential diagnosis of the different renal tumors. In the case of nephroblastoma, chemotherapy is based solely on the radiological diagnosis without prior histology. In therapy-optimizing studies of the Society of Pediatric Oncology and Hematology, preoperative chemotherapy is performed. Therapy monitoring is performed in the course of and after preoperative chemotherapy to verify tumor response. Radiological staging plays a significant role in deciding on further treatment and in operative planning. Three-dimensional visualization of the abdominal situs can assist preoperative planning. In summary, diagnostic imaging in renal tumors in children plays a role in differential diagnosis, staging, monitoring of therapy, and surgical planning.
Der Radiologe 01/2006; 45(12):1112-23. · 0.61 Impact Factor
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ABSTRACT: 6,2% der kindlichen Tumorerkrankungen betreffen die Nieren. Anamnese, Klinik und radiologischer Befund fhren zur Differenzialdiagnose der verschiedenen Nierentumoren. Im Falle eines Nephroblastoms erfolgt die therapierelevante Diagnose allein radiologisch ohne histologische Sicherung. Im Rahmen der Therapieoptimierungsstudien der Gesellschaft fr Pdiatrische Onkologie und Hmatologie wird eine properative Chemotherapie durchgefhrt. Whrend und nach der properativen Chemotherapie erfolgt bildgebend ein Therapiemonitoring, um ein Ansprechen des Tumors auf die Therapie zu belegen. Das radiologische Staging hat groe Bedeutung fr die weitere Therapie und beeinflusst die Operationsplanung. Die properative Planung wird durch 3D-Visualisierung erleichtert. Die Relevanz der radiologischen Diagnostik von Nierentumoren im Kindesalter ergibt sich zusammenfassend aus Differenzialdiagnostik, Staging, Therapiemonitoring und Operationsplanung.Kidney tumors represent 6.2% of malignant tumors in children. History, clinical course and radiological findings are necessary elements in the differential diagnosis of the different renal tumors. In the case of nephroblastoma, chemotherapy is based solely on the radiological diagnosis without prior histology. In therapy-optimizing studies of the Society of Pediatric Oncology and Hematology, preoperative chemotherapy is performed. Therapy monitoring is performed in the course of and after preoperative chemotherapy to verify tumor response. Radiological staging plays a significant role in deciding on further treatment and in operative planning. Three-dimensional visualization of the abdominal situs can assist preoperative planning. In summary, diagnostic imaging in renal tumors in children plays a role in differential diagnosis, staging, monitoring of therapy, and surgical planning.
Der Radiologe 11/2005; 45(12):1112-1123. · 0.61 Impact Factor
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ABSTRACT: To improve surgical planning of kidney tumors in childhood (Wilms tumor, mesoblastic nephroma) after radiologic verification of the presumptive diagnosis with interactive colored 3D-animation in MRI.
In 7 children (1 boy, 6 girls) with a mean age of 3 years (1 month to 11 years), the MRI database (DICOM) was processed with a raycasting-based 3D-volume-rendering software (VG Studio Max 1.1/Volume Graphics). The abdominal MRI-sequences (coronal STIR, coronal T1 TSE, transverse T1/T2 TSE, sagittal T2 TSE, transverse and coronal T1 TSE post contrast) were obtained with a 0.5T unit in 4 - 6 mm slices. Additionally, a phase-contrast-MR-angiography was applied to delineate the large abdominal and retroperitoneal vessels. A notebook was used to demonstrate the 3D-visualization for surgical planning before surgery and during the surgical procedure.
In all 7 cases, the surgical approach was influenced by interactive 3D-animation and the information found useful for surgical planning. Above all, the 3D-visualization demonstrates the mass effect of the Wilms tumor and its anatomical relationship to the renal hilum and to the rest of the kidney as well as the topographic relationship of the tumor to the critical vessels. One rupture of the tumor capsule occurred as a surgical complication. For the surgeon, the transformation of the anatomical situation from MRI to the surgical situs has become much easier.
For surgical planning of Wilms tumors, the 3D-visualization with 3D-animation of the situs helps to transfer important information from the pediatric radiologist to the pediatric surgeon and optimizes the surgical preparation. A reduction of complications is to be expected.
RöFo - Fortschritte auf dem Gebiet der R 11/2004; 176(10):1447-52. · 2.76 Impact Factor
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ABSTRACT: Solid abdominal tumours are of special importance in the field of paediatric surgery. Because of the dangers of cumulative irradiation and improved delineation of soft parts MRI is usually employed in children for diagnostic assessment. Compiling the radiologic information for surgical planning is often difficult by conventional methods. Newly improved and efficient 3-D volume rendering software is now available for visual reconstruction of tumour anatomy utilising segmentation and other special techniques. Because the intraoperative complication rate is close to 20 % as described in the literature, optimal preoperative visualisation and planning would seem imperative.
All children with solid abdominal tumours at Heidelberg University in the year 2002 were included in this study. MR examinations were performed with a 0.5 Tesla magnet using a standard protocol. All MR data were processed with VG Studio Max 1.1, converting the two-dimensional data into three-dimensional data.
This report presents 15 cases using this special technique: 7 with abdominal neuroblastoma, 6 with nephroblastoma, 1 ganglioneuroma, and 1 ovarian teratoma.
Our experience shows that a better understanding of the surgical anatomy, particularly regarding the surrounding organs and vasculature, can be helpful in decreasing the incidence of inadvertent intraoperative injuries to these structures.
European Journal of Pediatric Surgery 11/2004; 14(5):316-21. · 0.81 Impact Factor
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[hide abstract]
ABSTRACT: Besides supracondylar fracture of the humerus there are several injuries of the elbow joint, which may lead to major disability. In this study 5 cases of corrective procedures are described after elbow fractures. Initially the lesions were overlooked. These were a fracture of the radial condyle, producing a pseudarthrosis, three cases of Monteggia fractures with persisting dislocation of the radial head in young children and a periarticular calcification issuing from an avulsion of the radial epicondyle and the radial capsule in a 13-year-old. All children had marked functional limitation of the elbow joint. The primarily overlooked fractures were corrected early. Various osteosynthesis procedures including movement and distraction extend fixator were employed. Overall, in all patients an almost complete movement of the joint at existing stability could be achieved. Transcondylar and Monteggia fractures should not be overlooked at the initial diagnosis as secondary operations for correction always have a less favorable outcome than the primary one. For the management of ankylosis of the elbow a movement extend fixator after distraction is a useful additional management.
Der Unfallchirurg 06/2002; 105(5):478-82. · 0.61 Impact Factor
