Publications (2)2.95 Total impact
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ABSTRACT: Pain in noncommunicative children can be difficult to localize and diagnose. The purpose of this study is to report our experience using a 3-phase whole-body technetium bone scan as a screening tool in identifying the source of persistent pain in children with profound disabilities who cannot communicate. We reviewed the medical and imaging records of 45 patients who met the inclusion criteria of the study, which included a diagnosis of spastic quadriplegic cerebral palsy with severe motor and cognitive impairment, persistent pain of more than 1 week in duration with no recognizable source, and a 3-phase whole-body bone scan as part of the pain workup. The study group included 26 females and 19 males with an average age at presentation of 13.5 years (range, 3-20 years). A positive bone scan was seen in 24 patients (53%). The diagnosis and the source of pain were identified in all 24 patients with a positive bone scan, with the bone scan being instrumental in establishing a diagnosis or localization in 22 patients. An orthopaedic diagnosis was not established in the 21 other patients with a negative bone scan. Based on the bone scan results, additional imaging was obtained at the anatomical location indicated. The bone scan was used to establish a diagnosis of fracture in 10 of 24 patients. Other diagnoses included 3 patients with painful internal hardware, 2 with sinusitis, 2 with infections, and 1 with an obstructed kidney. Whole-body bone scan is a viable imaging option to identify the source of persistent pain in children who are noncommunicative. The bone scan can assist in localizing the source of pain and direct the location for further imaging as needed.
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ABSTRACT: The primary goal in treatment of slipped capital femoral epiphysis (SCFE) is to prevent further slip by stabilizing the physis. Debate exists concerning prophylactic fixation of the uninvolved hip at presentation. Our goal was to determine predictive factors for a contralateral slip after presentation with a unilateral SCFE. Ninety patients with SCFE and complete radiographs were followed up until the bilateral closure of the proximal femoral physis. Chronological age at presentation, sex, and race were recorded. Open or closed triradiate cartilage was recorded, and a modified Oxford bone age assessment was performed. Twenty patients (22%) had bilateral SCFE at presentation, and 70 patients (78%) were unilateral. Of these 70 patients, 16 (23%) later developed a contralateral SCFE. Analysis revealed that chronological age was the only significant (P = 0.010) predictor for developing a contralateral slip. All girls younger than 10 years and all boys younger than 12 years who presented with unilateral SCFE developed a contralateral slip. Twenty-five percent of girls younger than 12 years and 37% of boys younger than 14 years developed a contralateral slip. No girl older than 13 years and no boy older than 14 years developed a contralateral slip in our series. Surgical complications were infrequent and isolated to the side of the initial SCFE. Chronological age is a predictor for a contralateral slip in patients presenting with a unilateral SCFE. The authors recommend that all girls younger than 10 years and all boys younger than 12 years presenting with unilateral SCFE should undergo strong consideration for prophylactic screw fixation on the contralateral side. In older age groups, prophylactic treatment may be considered on a case-by-case basis.