Journal of pediatric orthopedics. Part B
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Review Case Reports
High-grade spondyloretrolisthesis in a 12-year-old girl with neurofibromatosis type 1: a case report and literature review.
Neurofibromatosis (NF) type 1 is characterized by several skin, endocrine, central nervous system and musculoskeletal manifestations, spine deformities being the most common, affecting up to 64% of patients. Thoracic kyphoscoliosis is the most common deformity observed; however, high-grade spondylolisthesis and dural defects such as dural ectasia can also be found. The aim of this study is to describe a case of high-grade spondyloretrolisthesis in an NF-1 patient, associated with dural ectasia and extensive lumbar laminectomies, and to discuss our management and review the current literature on this controversial topic. ⋯ Dural ectasia is not a common finding in children with NF-1; however, it should be identified as its presence may predispose to spine instability and as a consequence the development of a high-grade spondyloretrolisthesis. Even though a few cases have been reported, we believe that it is important to consider the option of a double approach to achieve a better correction in both planes and a good outcome. If an extensive laminectomy is involved, it is mandatory to perform a posterior fusion and instrumentation.
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Review Case Reports
Simultaneous juxta-epiphyseal proximal phalanx fracture with flexor tendon entrapment in a child: a case report and review of literature.
Juxta-epiphyseal/Salter-Harris fractures are the most common hand fractures in children and the proximal phalanx is involved in most cases. In the absence of soft-tissue interposition, these growth plate injuries are simple to reduce and are stable. However, in some cases, flexor tendon entrapment could be present. ⋯ Excellent functional as well as radiological outcomes were achieved. These types of injuries are very uncommon and a high index of suspicion on the basis of clinical as well as radiological findings is needed to make an early diagnosis and for adequate treatment. Multiple proximal phalangeal fractures could be associated with the simultaneous entrapment of flexor tendons in different fingers as in our case; this is important to keep in mind as it is useful when planning the definitive surgical treatment and doing so will have a positive impact on the final functional as well as radiological outcomes.
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Comparative Study
Nerve injuries in supracondylar fractures of the humerus in children: is nerve exploration indicated?
A retrospective study of nerve injuries with displaced supracondylar fractures of the humerus in children younger than 12 years of age, treated in Hospital Universiti Kebangsaan Malaysia. Our objectives were to determine the incidence of primary and iatrogenic nerve injuries in supracondylar humerus fractures Gartland types II and III and to determine the outcome of nerve recovery. A total of 272 patients with displaced supracondylar humerus fractures who required admission to Hospital Universiti Kebangsaan Malaysia from January 2000 to December 2007 were reviewed. ⋯ The nerve injuries resolved clinically on an average time of 3.5 months (range from 3 weeks to 8 months). Our study found complete resolution of all patients with nerve injuries confirmed by clinical assessment. On the basis of our study, we believe that there is no indication to remove the K-wires immediately or to explore the nerve surgically following a mini-open technique, which reduces the risk of penetrating a nerve during pinning.
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Comparative Study
Community-associated, methicillin-susceptible, and methicillin-resistant Staphylococcus aureus bone and joint infections in children: experience from India.
Previously, the treatment of Staphylococcus aureus infections was less complex, as most of those isolated were susceptible to β-lactam antibiotics. In recent years, there has been a marked increase in the incidence of invasive community-acquired (CA) methicillin-resistant S. aureus (MRSA) among children worldwide. However, data on the clinical characteristics and outcomes related to pediatric bone and joint infections caused by CA-S. aureus are very limited in India. ⋯ The morbidity associated with MRSA bone and joint infection in children is significantly higher than that caused by MSSA. Early diagnosis at the primary healthcare level and treatment with appropriate antistaphylococcal therapy are crucial to achieve optimal clinical outcomes. High levels of antimicrobial resistance of both MSSA and MRSA isolates to several classes of antibiotics are a major concern warranting the need for antimicrobial stewardship and ongoing surveillance.
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Comparative Study
Is there a role for Ender's nailing of paediatric femoral fractures in a resource-restricted hospital set-up?
Paediatric femur fractures are managed with the titanium elastic nail system (TENS) in the 5-16-year age group. TENS is costly and not easily available in public hospitals. This study compares TENS nailing with stainless-steel Ender's nail fixation of paediatric femur fractures. ⋯ The union time and time to weight bearing were significantly shorter for Ender's nailing than TENS nailing. The outcome according to Flynn's criteria was significantly better in the Ender's nailing group. The results of Ender's nailing in paediatric femur fractures were comparable with TENS, with a rapid healing time and reduced angular malunion.