OKOJ, Volume 7, No. 8

Clearing the Cervical Spine in the Child Under 8 Years

Cervical spine injuries in children are usually associated with motor vehicle accidents, sports injuries, and falls. Although cervical spine injuries in children are uncommon, these injuries deserve special attention because a missed or delayed diagnosis can result in devastating consequences, including additional injury to the cervical spinal cord and nerve roots. There are several challenging issues with regard to clearing the spine in a pediatric patient, including patient compliance, lack of agreement on the best imaging modalities for children, the complex radiographic anatomy of the pediatric cervical spine, and the lack of a well-established protocol for dealing with this problem. Therefore, expediting clearance of the cervical spine should be a multidisciplinary approach, involving the emergency room physicians, pediatric surgeons, pediatricians, and pediatric orthopaedic surgeons. Deformity, instability, and neurologic sequelae may be prevented by establishing a clear methodology for early recognition and management of those at risk.

    • Keywords:
    • cervical fractures

    • cervical injuries

    • pediatric cervical spine fractures

    • pediatric cervical spine injuries

    • pediatric upper cervical spine injuries

    • risk factors

    • diagnosis

    • emergency management

    • Subspecialty:
    • Pediatric Orthopaedics

    • Spine

Recurrent Anterior Shoulder Instability with Glenoid Bone Deficiency

Shoulder instability secondary to bony glenoid deficiency is increasingly being recognized as a common cause for recurrence and poor outcomes. Glenoid bone deficiency may result from acute trauma to the anterior glenoid rim or from repeated contact with the humeral head during subsequent dislocation episodes. If glenoid bone loss is suspected in a patient with recurrent shoulder instability, a careful preoperative evaluation including history, physical examination, imaging studies, and arthroscopic assessment is necessary to accurately diagnose and quantify the extent of the deficiency. Treatment is guided by the amount of bone loss and patient factors such as activity level, expectations, and level of sports participation. In general, nonsurgical treatment—which consists of immobilization followed by progressive range-of-motion exercises and shoulder strengthening—is best suited for low-demand patients, patients with significant comorbidities, or those with smaller defects (<15% of glenoid surface area). Arthroscopic or open capsulolabral repair is recommended for patients with less than 15% glenoid bone loss. For patients with anterior glenoid bone loss between 15% and 25%, a variety of treatments are available, including both open and arthroscopic soft-tissue reconstruction and open bone-block procedures (Latarjet or Bristow procedure). As anteroinferior glenoid deficiency approaches 25% to 30% or more, open glenoid reconstruction with bony augmentation is required to restore stability.

    • Keywords:
    • shoulder instability

    • shoulder dislocation

    • recurrent shoulder instability

    • recurrent shoulder dislocation

    • anterior glenohumeral instability

    • glenoid defect

    • glenoid bone loss

    • glenoid deficiency

    • bony Bankart lesion

    • Hill-Sachs lesion

    • engaging Hill-Sachs lesion

    • arthroscopic capsulolabral repair

    • open capsulolabral repair

    • Latarjet procedure

    • Bristow procedure

    • Eden-Hybbinette operation

    • Subspecialty:
    • Shoulder and Elbow