Journal of pediatric orthopedics. Part B
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Case Reports
Recurrent migratory sympathetically maintained pain syndrome in a child: a case report.
A 10-year-old boy presented with pain and swelling of short duration in his right hand. A traumatic cause was ruled out. He had clinical features suggestive of sympathetic overactivity in the form of hyperesthesia, edema and dry skin. ⋯ Again the clinical features were consistent with SMPS. His response to a lumbar sympathetic block was again dramatic. This case illustrates that the diagnosis of SMPS is essentially clinical and that prompt diagnosis and treatment with sympathetic blocks can be very rewarding.
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Out of 210 children suffering from severely displaced supracondylar fractures, 76 (36%) presented with immediate neurovascular complications: 47 (22%) were neurological, 16 (8%) vascular and 13 (6%) both. Injury to two nerves simultaneously was observed in six patients. The median nerve was affected in 28 cases, the ulnar nerve in 25 and the radial nerve in 13. ⋯ A conservative therapeutic approach is customary in the majority of neurovascular complications. Prognosis is generally excellent. Ischaemia of the limb and total ruptures of the nerve are very rare.