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Analgesia using a self-administered mixture of 50 nitrous oxide and 50 oxygen (Nitronox) was evaluated prospectively in 22 children undergoing closed reduction of fractures in the emergency room. The majority of these patients underwent reduction of forearm fractures. When the children were asked about pain after the procedures, 12 (60) recalled no pain, 7 (35) minimal pain, and 1 (5) moderate pain. None recalled severe pain. Eleven (52) of the patients had minimal pain, 8 (38) had moderate pain, and 2 (10) had no pain, as judged by an emergency room physician. None had severe pain. There were no complications and the ease of administration was remarkable. We conclude that N2O:O2in a 50:50 mixture provides very effective, safe analgesia for fracture reduction in the emergency room setting.

Treatment for children with congenital deformities of the lower extremities may vary, depending on the state of the unossified skeletal structures and surrounding soft tissues. The purpose of our study was to demonstrate the spectrum of the osteochondral and extrasosseous abnormalities as depicted with MR imaging. We retrospectively reviewed MR examinations of 13 limbs of ten children (aged 1 month-9 years, mean 2.1 years) with longitudinal and transverse deformities of the lower extremities. The lesions imaged were fibular hemimelia (n = 5), tibial hemimelia (n = 5), and congenital constriction bands (n = 3). Each examination was assessed for abnormalities in the osteocartilaginous and extraosseous (articular or periarticular components such as ligaments, tendons, and menisci; the muscles and the arteries) structures. Abnormalities were seen in all patients. Osteocartilaginous abnormalities in the patients with longitudinal deformities included abnormal distal femoral epiphyses, abnormal proximal tibial physes, hypertrophied and dislocated proximal fibular epiphyses, unsuspected fibular and tibial remnants, and absence or coalition of the tarsal bones. No osteocartilaginous abnormalities were seen in the patients with congenital constriction bands. Articular abnormalities about the knee in patients with either form of hemimelia included absent cruciate ligaments and menisci, dislocated or absent cartilaginous patellae, absent patellar tendons, and abnormal collateral ligaments. All but one limb imaged had absent or attenuated muscle groups. Of the nine MR arteriograms performed at the level of the knee, eight were abnormal. The normal popliteal trifurcation was absent or in an abnormal location. We conclude that MR imaging of children with congenital lower extremity deformities shows many osteochondral and extraosseous abnormalities that are not depicted by conventional radiography. This information can help to plan early surgical intervention and prosthetic rehabilitation.

We carried out a cross-sectional study to define the prevalence of ulnar nerve instability and its relationship to ligamentous laxity in the pediatric population. Children were divided into three age groups: group I (0-5 years), group II (6-10 years), and group III (11-18 years). Of children in group I 17.7%, of children in group II 7.7%, and 5.7% of children in group III had dislocating ulnar nerves. With the exception of one patient, nerve instability was bilateral. Of those children possessing all five Wynne-Davies signs of ligamentous laxity, 25.4% had dislocating nerves, 71.9% had subluxing nerves, and 2.6% had stable nerves. Age, ulnar nerve instability, and ligamentous laxity were statistically associated (p< 0.0001).