Journal of pediatric orthopedics. Part B
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Subluxation of the radial head is a common injury in young children. It occurs after longitudinal traction on the extended arm with the forearm in pronation. Diagnosis is made from history and clinical presentation. ⋯ Rarely, it requires open reduction. There are very few cases in the literature that have required open reduction and no article shows intraoperative photographs. We present two cases of delayed diagnosis owing to an atypical clinical history that required open reduction.
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Case Reports
Delayed ulnar nerve palsy after open reduction and internal fixation of medial epicondylar fractures.
We present two cases of patients with delayed ulnar nerve palsies after operative fixation of displaced medial epicondyle fractures. These fractures are common childhood injuries and the optimal management for the ulnar nerve is not universally agreed. The ulnar nerve is at risk of compression distal to the elbow and where surgical decompression is selected, care must be taken to ensure that this is complete.
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Review Case Reports
A rare case of infantile myofibromatosis and review of literature.
Infantile myofibromatosis is a rare benign tumor-disease (1/400,000). Four different types have been reported in literature. The most commonly affected body areas are the head, the neck, and the trunk. ⋯ The data of the literature review underline that a wait-and-see-policy should be considered as the first treatment of choice as in most instances the bony lesions regress spontaneously. However, a thorough examination has to be carried out to exclude lesion in other organs like gastro-intestinal or cardio-pulmonary nodular tumor masses. In conclusion, the present case report and the literature review support the notion that infantile myofibromatosis should be considered as a possible differential diagnosis for soft tissue expansions and/or osteolytic lesions in a newborn.
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Compartment syndrome of the hand is an uncommon entity in children and is usually the result of trauma or burns. Insects, such as wasps, produce a wide variety of toxins such as amines, peptides, and enzymes that can cause local and systemic inflammatory reactions after a sting. This inflammation can, in rare cases, lead to the development of a compartment syndrome. We present the case of a 5-year-old boy who developed a compartment syndrome of the hand after a single wasp sting that required emergent fasciotomy. To our knowledge, this has not been reported previously in the literature. An institutional review board approved review of the case. The clinical presentation, laboratory studies, radiographs, and possible-exacerbating factors leading to the development of a compartment syndrome, as well as the surgical procedure and postoperative course, were reviewed. Preoperative, intraoperative, and postoperative photographs are also presented. A 5-year-old boy presented to the emergency department 18 h after a single wasp sting to the dorsum of his hand. Based on his history and physical examination, hand compartment pressures were measured in his hand and found to be elevated. He underwent emergent fasciotomies with delayed wound closure. The patient healed uneventfully and at 5-month follow-up had full use of his hand, full range of motion, and normal 2-point discrimination in all the fingers. In conclusion, while wasp and other insect stings are common in children, this case is the first, to our knowledge, of a compartment syndrome of the hand after a wasp sting. Local measures used to treat insect stings such as heat and elevation may have played a role in the development of a compartment syndrome. It is important to have a high index of suspicion for this condition in a patient who presents with signs and symptoms of a compartment syndrome after an insect sting. ⋯ IV.
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The neuromuscular sequaelae of Guillain-Barré syndrome are well documented in the literature. Persistent distal muscular weakness and loss of peripheral limb reflexes are common in those affected. We report a case of a 14-year-old boy who developed the Miller-Fisher variant of Guillain-Barré syndrome at the age of 8 years. ⋯ The scoliosis was successfully treated with posterior instrumentation and fusion surgery. Neuromuscular scoliosis is rare following Guillain-Barré syndrome, with no previous reports associated with the Miller-Fisher variant that we are aware of. When evaluating patients post Guillain-Barré syndrome, structural spinal examination is essential to identify rare deformity that may need surgical correction.