Neuro-vascular Injuries Associated with Supracondylar Fractures of the Humerus in Children / 대한정형외과학회잡지

PURPOSE: Supracondylar fractures in children have the potential for associated neuro-vascular injuries. It is important to diagnose and manage these fractures because they are often underestimated when assessing a painful elbow in agitated children. This study focused on evaluating the frequency of neuro-vascular injuries associated with fracture displacement, and to define a therapeutic strategy. MATERIALS AND METHODS: From January 1997 to December 2006, 128 children who were available to follow up were examined restrospectively. The incidence of neuro-vascular injuries was investigated, and the types and displacement of fractures were classified. The therapeutic strategy and complications were also defined. RESULTS: Neuro-vascular complications occurred in 24 patients. Seventeen, 12, 4, 4 and 1 patient had only neural injuries, radial, ulnar, median, and anterior interosseous nerve. There were 4 patients with both neural and vascular injuries, and 3 patients had only vascular injuries. Most neural injured patients had recovered completely, but 1 patient had not recovered after 6 months. Therefore, exploration and sural nerve graft was performed. CONCLUSION: The frequency of neuro-vascular injury is a result of severely displaced supracondylar fracture. A therapeutic strategy for supracondylar fractures in children is proposed to minimize complications.

Giant Neonatal Hemangioendothelioma of the Liver Diagnosed by 99mTc-RBC Scintigraphy

Infantile hemangioendothelioma (IHE) is a benign tumor of the liver composed of anastomosing vascular channels lined by plump endothelial cells. The major clinical findings of IHE are abdominal mass, hepatomegaly, cutaneous hemangioma, congestive heart failure, anemia and disseminated intravascular coagulopathy. Precise diagnosis of IHE is crucial because medical therapies using steroid and/or interferon can be tried unless there are grave compressive symptoms. Along with CT scan and MRI studies, scintigraphic evaluation with 99mTc-RBC offers an accurate method of identification of these lesions, and allows differentiation from other common primary or secondary hepatic masses. We report two cases of giant IHE of the liver those were diagnosed with 99mTc- RBC scan and confirmed with pathologic evaluation after surgical removal.