Severe Pediatric Wrist Joint Sequelae following Blunt Trauma in the Presence of Chronic Regional Pain Syndrome.

Introduction The pediatric chronic regional pain syndrome (CRPS) type I is a recognized syndrome that follows a preliminary event (e.g., trauma, fracture) with amplified spontaneous or stimuli-induced extremity pain that differs from its adult form with rather favorable outcomes. Conservative treatment is usually indicated for CRPS treatment. Case Description We present a unique case of an adolescent girl who revealed severe wrist joint sequelae following a blunt trauma, complicated by a challenging CRPS resistant to treatment. Diagnostic wrist arthroscopy eventually revealed a massive cartilage degeneration and scapholunate tear as underlying causes for the pain and CRPS. It was decided to proceed with radioscapholunate wrist fusion, which promptly led to pain relief and disappearance of the CRPS. Conclusion The relevance of this report is therefore to emphasize the possibility, against earlier thoughts, that well-indicated surgeries in pediatric CRPS patients may lead to prompt symptom improvement and may not be uniformly predicted to fail. With the clinical probability of a presence of an uncontrolled, symptomatic causative factor such as cartilage degeneration and chondrolysis, further early diagnostic and therapeutic interventions may be indicated to control the disease.

Radial Head Resection and Corium Interposition Arthroplasty in Skeletally Immature Patients With Isolated Posttraumatic Radial Head Arthrosis.

Radiocapitellar arthrosis represents a serious sequela of pediatric elbow injuries. Although persistent pain and disability are not uncommon in such cases, treatment remains controversial. The present study aimed to review the clinical outcomes after a new surgical treatment with partial radial head resection and corium interposition arthroplasty. To date, 3 adolescent cases underwent the surgical procedure and postoperative care. Thorough clinical and radiographic follow-up was performed. The mean age at the time of surgery was 14.4 years (range, 13 to 16 y) and mean duration of follow-up was 19 months (range, 12 to 29 mo). The postoperative range of motion was maintained in all cases. The outcome was rated as excellent in all 3 patients for the Disabilities of the Arm, Shoulder and Hand score (mean, 3; range, 0 to 6.7) and Mayo Elbow Performance Score (mean, 92; range, 80 to 100). The mean Timmermann score; however, was still rated as fair despite marked improvements (mean, 153; range, 145 to 165). No complications such as elbow stiffness, osteophytes formation, radial head overgrowth, or proximal radius migration occurred. In pediatric isolated posttraumatic radiocapitellar arthrosis, we believe that radial head resection and corium interposition arthroplasty is an effective salvage procedure to alleviate symptoms and maintain elbow function with good to excellent clinical outcomes and no proximal migration of the radius.