Refractures after Operative Fixation in Severe Spastic Cerebral Palsy: A case report

Patients with severe cerebral palsy (CP) are susceptible to bone fractures due to low bone mineral density, deformity from contracture and developmental disability. We experienced a 12-year-old spastic CP female who sustained recurrent fracture of the right femur. The first episode occurred when she had been moved passively by another child in residential care. She underwent operative treatment with plate fixation, but seventeen days after operation, spasticity of legs aggravated and refracture happened at the fixation site. She underwent re-operative fixation, but at three days after the second operation, she sustained another fracture at the top of the plate, for which she underwent the third operation. She was then referred to our department for scissoring patterns of the lower extremities. We performed bilateral obturator nerve block which relieved patient's spasticity. We think that her recurrent fracture may be related with ignored risk factor of refracture such as uncontrolled spasticity.

Superficial Radial Nerve and Cephalic Vein: An Anatomic Study by Cadaver Dissection

OBJECTIVE: To acquire normal anatomy of superficial radial nerve and cephalic vein and identify the optimal site for venipuncture of cephalic vein at wrist to decrease the damage of superficial radial nerve. METHOD: We examined anatomic relationships of the superficial radial nerve, cephalic vein, and styloid process of radius in 14 hands from 10 cadavers. The distances were measured from the styloid process of radius to the point at which the superficial radial nerve pierced fascia, and to the crossing point of superficial radial nerve with cephalic vein. RESULTS: The mean distance from the styloid process of radius to the point at which the superficial radial nerve pierced fascia was 79.9+/-9.84 (60~93) mm and from the styloid process of radius to the crossing point of superficial radial nerve with cephalic vein was 29.5+/-15.24 (13~55) mm. CONCLUSION: The most optimal injection site for venipuncture of cephalic vein at wrist was located 55 mm more proximal area from styloid process.