POSTER ABSTRACTS - ISAKOS

Background:
The role of arthroscopy in the treatment of
paediatric wrist problems has not been widely
reported. The incidence of hand and wrist injuries
in children has been reported to be from 3 to 65
percent We report a group of paediatric patients
who had arthroscopy of wrist for diagnosis which
led to treatment and their outcome.
Methods and patients:
This was a retrospective study done at a tertiary
children’s teaching hospital
There were 32 patients involving 33 wrists who
had undergone wrist arthroscopy. Of these 3 were
male and 29 female. Average age was 12.96 years
[range: 8 17].
23 wrists had injury of which 6 were sports
related[1 was a national shot putter] and 3
gymnastics related. The rest were injuries mainly
related to fall. Of the 10 wrists which were not
injured 2 were from patients who were regular
gymnasts. 3 had congenital problems[Type1 Ulnar
dysplasia, Arthrogryposis with post dislocation of
radial head and Blauth2 Hypoplastic thumb].The
remaining 5 had symptoms which had begun
spontaneously.All of them had pain.9 had
complained a feeling of instability. 2 had
experienced clicking.
Results:
All patients except one had a preoperative
working diagnosis.All had Xrays,24 wrists had MRI
done and 12 had videofluoroscopy done.
Arthroscopy revealed 11 scapholunate ligament
disruption.12 had TFCC tears of which 9 had
history of injury. Patient with thumb hypoplasia
was found to have a tear similar to Palmer A
although she had no history of injury. Patient with
arthrogryposis had an absent TFCC. 2 of them had
lesions similar to Palmer D although without
history of injury.8 patients had lunotriquetral
ligament tear. Other than scapholunate ligament
disruption, lunotriquetral ligament tear and TFCC
tears 8 other diagnoses were made.
In 16 out of 33 wrists arthroscopy confirmed
preoperative diagnosis .In 5 out of these 23, an
additional pathology was observed on
arthroscopy.In the rest of the patients
[17/33][51%] preoperative diagnosis did not
correlate with arthroscopic diagnosis..Arthroscopy
led to further open procedures in 14 patients.
Conclusion:
Wrist injuries are well recognised as a problem in
children especially those involved in sports.Our
study reports a considerable number of patients
in the paediatric age group undergoing
arthroscopy of the wrist for diagnosis.This has
shown that arthroscopy is a useful tool to
diagnose wrist conditions in children.
KNEE - ACL
E-poster #300
Arthroscopic Fixation of ACL Avulsion Fracture
of Tibia in Children
Kyung-taek Kim, Busan, KOREA, Presenter
Myung-Jin Lee, Busan, SOUTH KOREA
Hyung-Seo Jang, Busan, SOUTH KOREA
Sung-Hoo Kim, Busan, SOUTH KOREA
Sung-Won Lee, Busan, SOUTH KOREA
Dong-A University Medical Center, Busan, KOREA
Introduction :
ACL avulsion fracture of tibia in children is not
common. But there are many different treatment
modalities for the ACL avulsion fracture of tibia.
In general, Meyers-Mckeever type I and II can take
good result with conservative treatment, but type
III is difficult to take good result with operative
treatment. We have treated three cases of ACL
avulsion fracture in children with type II and III by
arthroscopic reduction and fixation with
cannulated screws which brought good results.
Case1 ;
A 7-year-old girl had complaints about pain and
instability of left knee for 10 months since she fell
down. She was then diagnosed of avulsion
fracture of left tibial spine. At the time of initial
physical examination, ROM was full, but anterior
drawer test was positive.(Gr III). Lysholm score
was 65. Plain radiograph showed an avulsion
fracture of tibial spine (Meyers-Mckeever typeIII).
Arthroscopic debridement of hypertophied soft
tissue have been done. Under arthroscopy,
microfracture procedure was performed on the
attached site of tibial spine. After arthroscopic
reduction, tibial spine was fixed with 5.0 mm
cannulated screw. Eight weeks after internal
fixation, bone union began to appear. Four
months later, the screw was removed. Physical
examination at post-operative 4 months revealed
negative findings of anterior drawer test and
Lachman test. At that time, Lysholm knee score
was 95. Physical examination at post-operative 18
months revealed no evidence of instability and
growth disturbance.
Case2 ;
A 11-year-old boy have sustained traumatic injury
due to traffic accident. At the time of initial
examination, intraarticular hematoma was noted