Case Report: Halting terminal osseous overgrowth post tibia amputation in children: a report of three cases.

Terminal osseous overgrowth is a common complication after trans-diaphyseal amputation in children, leading to pain, soft tissue problems, and recurrent surgical procedures. We report three different cases with post-amputation issues of osseous overgrowth, ulceration, and deformity over the amputation site. The first case involves a 9-year-old boy with a right leg congenital amputation secondary to amniotic band syndrome. The right below-knee stump later experienced recurrent episodes of osseous overgrowth, leading to ulceration. After the prominent tibia was resected and capped with the ipsilateral proximal fibula, a positive outcome was achieved with no more recurrent overgrowth over the right leg stump. The second case involves a 9-year-old girl born with an amniotic constriction band over both legs. Her left leg remained functional after a circumferential Z-plasty, but the right leg was a congenital below-knee amputation. Multiple refashioning surgeries were performed on the right leg due to osseous overgrowth but the patient continued to experience recurrent overgrowth causing pain and difficulty fitting into a prosthesis. We performed osteocartilaginous transfer of the proximal part of the ipsilateral fibula to the right tibial end, successfully preventing the overgrowth of the tibia without any complications. The third case involves an 11-year-old boy with a history of meningococcal septicemia who underwent a right below-knee amputation and left ankle disarticulation due to complications of septic emboli. He experienced a prominent right distal tibia stump, which later developed into valgus deformity as a result of the previous insult to the proximal tibial growth plate. We performed a corrective osteotomy over the proximal right tibia and capped the entire tibia with the ipsilateral fibula as an intramedullary splint for the osteotomy site. Post-operatively, we achieved satisfactory deformity correction and successfully halted the recurrent overgrowth over the right tibia stump. The method of ipsilateral fibula capping is safe and effective in managing the osseous overgrowth complications in trans-diaphyseal amputations among children. Therefore, it is a reasonable option during primary below-knee amputations in children compared to multiple refashioning surgeries.

Office Three-Dimensional Printed Osteotomy Guide for Corrective Osteotomy in Fibrous Dysplasia.

Fibrous dysplasia is a benign condition but can lead to severe long-bone deformities. Three-dimensional (3D) printing technology is a rapidly developing field that has now been popularized to aid surgeons in preoperative planning. We report a case of hip deformity in a 21-year-old woman who suffered from fibrous dysplasia and underwent a corrective osteotomy. We utilized open-source 3D computing software for preoperative planning before producing an osteotomy guide to aid in the operation.

Outcome of Open Reduction Alone or with Concomitant Bony Procedures for Developmental Dysplasia of the Hip (DDH).

Introduction: Developmental dysplasia of the hip (DDH) is commonly managed in a tertiary centre and regularly involves surgical treatment. The aim of this study is to determine the surgical outcome of DDH patient treated with either open reduction alone or combined with bony procedures in our institution. Methods: Medical records of DDH patients treated surgically were reviewed. Patients were divided into two groups: Group A: underwent open reduction (OR) only; and Group B: underwent open reduction with additional bony procedures (ORB), such as pelvic or femoral osteotomy. Modified McKay classification was used to evaluate the clinical outcome, and Severin classification for the radiological outcome. Presence of avascular necrosis and other post-operative complications were recorded. Results: A total of 66 patients (76 hips) were reviewed with the mean age of 11.9 ± 4.8 years. Mean duration of follow up was 8.6 ± 4.7 years (ranged 2 to 23 years). From our sample, 50/66 patients (75.8%) achieved satisfactory clinical outcome, whereas 48/66 patients (72.7%) had satisfactory radiological outcome. A higher proportion of patients achieved satisfactory outcomes in the OR group compared to the ORB group (p < 0.05), but no difference was seen in terms of radiological outcome (p = 0.80). Overall, 23 hips (34.8%) developed radiographic evidence of avascular necrosis (AVN). Nineteen hips had undergone ORB, although they were mainly (63.2%) Grade I AVN. Incidence of AVN was comparable in both groups (p = 0.63), but presence of AVN led to a higher proportion of unsatisfactory clinical and radiological outcome (p < 0.05). Other complications included redislocation/subluxation (13.6%) and bleeding (0.1%). Conclusions: Good overall outcome of DDH surgery was achieved in our centre. The OR group may produce a better clinical outcome, but with similar radiological results and AVN rate with the ORB group. The presence of AVN is associated with unsatisfactory clinical and radiological outcomes.

Congenital Constriction Band With Lymphedema in a Neonate: A 17-Year Follow-Up After Single Stage Excision and Z-Plasty.

Congenital constriction band syndrome is a rare condition that presents with constriction bands affecting different types of extremities. Timely surgical intervention for moderate and severe stages of this condition can be performed either in a single stage or multiple stages. We report the case of a neonate who presented with a congenital constriction band and had excision of the constriction band and z-plasty reconstruction. The surgery was done in a single stage. This case highlights the outcome and safety of this single-stage surgery with Z-plasty reconstruction. At 17 years of age, he has a functional lower limb and excels in archery.

Clostridium perfringens surgical site infection after osteotomy for knee deformity correction in a non-immunocompromised child.

BACKGROUND: Clostridium perfringens myonecrosis following an elective surgical procedure in a previously healthy child is a rare incident. METHODS: Case report and literature review. RESULTS: A two-year old boy admitted for elective bilateral osteotomies of tibiae was detected to be febrile at day one post-operatively with crepitus felt at his left ankle. An emergency wound debridement was performed followed by a course of antibiotics. Clostridium perfringens was isolated from tissue culture. His wound was later covered with a split-thickness skin graft. CONCLUSION: Clostridium perfringens infection following a surgical procedure in a healthy child is rare. A high index of suspicion is important to recognize this debilitating infection.

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. There were 182 boys (67%) and 90 girls (33%). The mean age was 6.0 years, ranging from 1 to 12 years. Of 272 supracondylar fractures, 79 were type II and 193 were type III. Fifty-one (19%) patients had closed reduction, 160 (59%) had closed reduction and percutaneous crossed Kirschner (K) wires, and 61 (22%) had open reduction and crossed K-wires. Associated nerve injuries involving the median, radial, and ulnar nerves were observed in 48 (18%) patients. Nerve injuries were observed in nine (3%) patients upon admission. Thirty-nine (14%) patients developed nerve injuries following treatment. Of these 39 patients, 34 had ulnar, three had radial, and two had median nerve injuries. Nerve exploration was performed in five patients (in four patients following debridement of open fracture and in one because of unacceptable postoperative radiographs, and they subsequently underwent open reduction and exploration). Except for these five patients, the K-wires were not removed earlier nor were the nerves surgically explored in others. 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.

Hypertrophic nonunion of the ulna in a child: treatment with an elastic stable intramedullary nail without bone graft.

Nonunion following diaphyseal forearm fracture is an uncommon complication in children. Compression plate fixation with bone grafting has been the standard method to treat this complication. We report a case of hypertrophic nonunion of the ulna in a child who was treated surgically using an elastic stable intramedullary nail (ESIN) without bone grafting. The nonunion healed 4 months after surgery.

Sporotrichosis atypical presentation as a soft tissue tumour.

Sporotrichosis is a mycosis caused by a saprophytic dimorphic fungus named Sporothrix schenckii. Infections occur following traumatic inoculation of fungus from plants and infected cat bites and scratches. We report a case of a farmer who presented with a solitary subcutaneous nodule initially diagnosed as a soft tissue tumour. A history of agricultural activity and feline contact should draw the clinician's attention to sporotrichosis, as the diagnosis can be easily missed in atypical cases. The diagnosis, microbiology and management of the case are discussed.

Sporotrichosis atypical presentation as a soft tissue tumour

Sporotrichosis is a mycosis caused by a saprophytic dimorphic fungus named Sporothrix schenckii. Infections occur following traumatic inoculation of fungus from plants and infected cat bites and scratches. We report a case of a farmer who presented with a solitary subcutaneous nodule initially diagnosed as a soft tissue tumour. A history of agricultural activity and feline contact should draw the clinician's attention to sporotrichosis, as the diagnosis can be easily missed in atypical cases. The diagnosis, microbiology and management of the case are discussed.