Journal of pediatric orthopedics. Part B
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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 aim of this study is to assess the long-term results of Ethibloc injection in aneurysmal bone cysts (ABC). Thirty-three patients with ABC were treated with computed tomography-guided percutaneous injection of Ethibloc into the cyst cavity. Twenty-two patients had Ethibloc injection as primary treatment and 11 patients had presented to us with recurrence after previous procedures including steroid injection, bone marrow injection, curettage bone grafting and various other surgical procedures. ⋯ They are under follow-up but asymptomatic and another two patients encountered more significant complications after the procedure. Ethibloc injection is a relatively simple, minimally invasive alternative procedure for the treatment of ABC, and makes open operation unnecessary by stopping the expansion of the cyst and inducing endosteal new bone formation. This technique may be used as the primary management of ABC's excluding spinal lesions as shown by our largest and longest follow-up study.
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There has been no earlier report in the literature on sustentaculum tali fractures in children (pediatric age). Here a pediatric case of a sustentaculum tali fracture that has not been previously reported in the literature is reported. ⋯ Radiography, computed tomography and MRI findings are discussed. This is a case report that describes the presentation and management of a comparatively rare and often miss-diagnosed fracture of sustentaculum tali in pediatric age.
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The elastic stable intramedullary nailing (ESIN) is the current treatment of choice for unstable forearm shaft fractures in children. There is no large study on paediatric nonunion of forearm shaft fractures in children after intramedullary nailing. There are only sporadic reports on nonunions after ESIN in children. ⋯ It may also be higher in such cases, which represent a refracture. Despite the small risk of developing a pseudarthrosis after forearm fracture, the indication for ESIN is clear. The surgical trauma needs to be as minimal as possible in cases with open reduction with as little as possible compromise of the blood circulation of the affected bone.
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Case Reports
Early-onset facioscapulohumeral muscular dystrophy - significance of pelvic extensors in sagittal spinal imbalance.
Although facioscapulohumeral muscular dystrophy (FSHD) is the third most common inherited myopathy, cases of infantile or early-childhood onset have rarely been reported. The purpose of this study was to describe a case of early-onset FSHD with lumbar hyperlordosis, which shows the significance of the dynamic component of sagittal spinal imbalance. An 11-year-old girl presented with progressive gait disturbance and lumbar hyperlordosis. ⋯ The patient stands with her spine hyperextended to maintain upright posture by a compensatory mechanism of relatively strong back extensor muscles. Corrective surgery for lumbar hyperlordosis was not considered because it could have eliminated the compensatory lumbar hyperextension, thus making the spine of the patient stoop forward through her hip joint during walking by the weakness of her pelvic extensor muscles. This FSHD case is an impressive example of a patient showing the concept that weak pelvic extensor muscles cannot keep the spine upright and balanced.