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Background: Clinical series of tuberculosis of elbow region in children are few. The purpose of our study was to retrospectively review the presentation, healing response and functional results of 30 children.

Methods: The pretreatment disease presentation was studied from patient’s case records. Serial radiographs of the patients were studied to see remineralization and healing of radiological lesions. For elbow’s functional evaluation, pain, range of motion and recurrence were observed at final follow up.

Results: The mean patient age was 8.2 years. The mean duration of symptoms before presentation was 47 days. A discharging sinus was present in 6 patients. Multifocal presentation was found in 7 patients. The lesion was most commonly localized in proximal ulna or lower humerus. The classical ‘ice cream scoop’ appearance of proximal ulnar metaphysis was noted in 5 elbows. Most elbows were in Martini stage 2 (70%) at the time of presentation. All patients were treated non-operatively. Average follow up after completion of antitubercular therapy was 18.97 months. The resolution of regional osteopenia, sclerosis of lytic lesions, reappearance of bony trabeculae and decrease in size of cavities was the usual sequence of radiological healing. End average elbow flexion arc deteriorated with increasing Martini stage. ‘Ice cream scoop lesions’ resulted in a worse functional outcome with formation of an irregular proximal ulnar articular surface.

Conclusions: Restriction of elbow range of motion, early discharging sinus formation and radiological ‘ice cream scoop’ appearance indicated a tubercular pathology. Late presentation with advanced disease, total joint involvement, and ‘ice cream scoop appearance’ resulted in decreased elbow flexion arc.

In spinal tuberculosis, children bone is easily destroyed, and as a result spinal deformity complicates in higher rates in comparison with the adult tuberculous spine. However, the pediatric spine with tuberculosis is more flexible than those of the adult-spine, because spontaneous intercorporal fusion of the diseased segments in children never occur. Thus, prevention and/or correction of the tuberculous kyphosis is easier than those of the adults. Also in particular by posterior tethering instrumentation surgery the formed kyphosis can be corrected gradually during growth period. The key message is that in pediatric spinal tuberculosis, spontaneous intercorporal fusion of the diseased segment hardly takes place even under the posterior instrument-aided stabilization and the coverage of antituberculous chemotherapy. Therefore, tuberculous spine in children even after cure should be observed until growth maturity.

Purpose of the Study: The aim is to report the natural history, type of treatment received and quality of life improvement of adolescent patients with isthmic low-grade lumbosacral spondylolisthesis with a slip of less than 25%.

Methods: The complete records of 299 prospective patients (127 males and 172 females) with isthmic low-grade lumbosacral spondylolisthesis referred to an orthopedic clinic were reviewed. Radiological parameters, Micheli scale, and quality of life measured by the SRS-22 questionnaire were measured at the first visit and a minimum 5-year follow-up.

Results: The average follow-up time is 5.7 ± 1.4 years. The main complaint at the initial presentation was lower back pain in 107 patients, and three patients had lower back pain and lower limbs radiculopathy. Scoliosis was found in 38 patients in the initial radiograph. One-hundred-eighty-nine patients (63%) were asymptomatic at the time of presentation. At the last follow-up; SRS-22 were 4.21 ± 0.6, 4.21 ± 0.7, 4.31 ± 0.5, 4.21 ± 0.7, 4.2 ± 0.7 for total, pain, function, mental, and self-image scores, respectively. The patients with grade one lumbosacral spondylolisthesis with normal morphology of the sacrum had responded well to the nonsurgical treatment modalities. No patient has progressed during the follow-up, and no patient underwent surgical intervention for back pain. The slip percent was relatively lower in patients with low back pain. The average slip percentage was 15.5 ± 8.4 among the asymptomatic patients and 13 ± 9 among patients who presented with low back pain ($P$-value = 0.009).

Conclusion: Adolescent patients with grade one isthmic lumbosacral spondylolisthesis have very good prognosis with nonoperative modalities and they have an almost normal quality of life at the end of follow-up. A long follow-up in an outpatient clinic with X-Rays series might not be indicated for all patients with low-grade spondylolisthesis, specifically if the slip is less than 25%.

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Background: In developing countries, lower respiratory tract infection is a major cause of death in children, with severely ill patients being admitted to the critical-care unit. While physical therapists commonly use the manual hyperinflation (MHI) technique for secretion mass clearance in critical-care patients, its efficacy has not been determined in pediatric patients.

Objective: This study investigated the effects of MHI on secretion mass clearance and cardiorespiratory responses in pediatric patients undergoing mechanical ventilation.

Methods: A total of 12 intubated and mechanically ventilated pediatric patients were included in this study. At the same time of the day, the patients received two randomly ordered physical therapy treatments (MHI with suction and suction alone) from a trained physical therapist, with a washout period of 4h provided between interventions.

Results: The MHI treatment increased the tidal volume [$V_t$; 1.2mL/kg (95% CI, 0.8–1.5)] and static lung compliance [$C_{\mathrm{\text{stat}}}$; 3.7mL/cmH₂O (95% CI, 2.6–4.8)] immediately post-intervention compared with the baseline ($p<0.05$). Moreover, the MHI with suction induced higher $V_t$ [1.4mL/kg (95% CI, 0.8–2.1)] and $C_{\mathrm{\text{stat}}}$ [3.4mL/cmH₂O (95% CI, 2.1–4.7)] compared with the suction-alone intervention. In addition, the secretion mass [0.7g (95% CI, 0.6–0.8)] was greater in MHI with suction compared with suction alone ($p<0.05$). However, there was no difference in peak inspiratory pressure, mean airway pressure, respiratory rate, heart rate, blood pressure, mean arterial blood pressure or oxygen saturation ($p>0.05$) between interventions.

Conclusions: MHI can improve $V_t$, $C_{\mathrm{\text{stat}}}$ and secretion mass without inducing adverse hemodynamic effects upon the pediatric patients requiring mechanical ventilation.

Extensor pollicis longus tendon entrapment is a rare complication of volarly displaced pediatric distal radius fractures. The few pediatric case reports have described tendon entrapment associated with conservative fracture treatment, or have been recognized at subsequent revision surgery after failure to achieve closed fracture reduction. A case of extensor pollicis longus tendon entrapment after open reduction and volar plate fixation of a pediatric distal forearm fracture is reported. This complication may also occur secondarily after open reduction and volar plating of the distal radius.