Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 9 de 9
Filter
1.
JBJS Case Connect ; 14(2)2024 Apr 01.
Article in English | MEDLINE | ID: mdl-38848402

ABSTRACT

CASE: We present a proximal femoral central physeal bar secondary to femoral neck fracture management, in a 3-year-old boy. He presented with progressive femoral neck deformity and limb length discrepancy. He was managed with a novel technique of bar resection by drilling and polymethylmethacrylate interposition. After 5 years of follow-up, the hip score by Ratliff criteria was good. CONCLUSION: Screw penetration across physis during management of femoral neck fracture can cause growth arrest in a young child. Our technique is useful when physeal bar is central and linear. It can allow sufficient growth and remodeling to restore a near-normal hip both radiologically and clinically.


Subject(s)
Femoral Neck Fractures , Humans , Male , Child, Preschool , Femoral Neck Fractures/surgery , Femoral Neck Fractures/diagnostic imaging , Leg Length Inequality/surgery , Leg Length Inequality/etiology , Fracture Fixation, Internal/methods
2.
J Pediatr Orthop B ; 2023 Nov 16.
Article in English | MEDLINE | ID: mdl-38047570

ABSTRACT

This study aimed to evaluate the clinical and radiological outcomes of surgical intervention involving acute medial hemi-plateau elevation and metaphyseal osteotomy with internal fixation and growth modulation for late-stages Blount's disease. A retrospective analysis was conducted on consecutive patients with late-stages infantile tibia vara between 2014 and 2020. Inclusion criteria consisted of children aged 8 years and older with Blount's disease with Langenskiold stage IV, V or VI, tibia vara more than 30*, medial plateau depression angle (MPDA) exceeding 25* and knee instability with a minimum follow-up period of 3 years. Patients with Limb length discrepancy greater than 5 cm were excluded. Data collection included assessments of age, weight, disease stage, clinical tibiofemoral angle (TFA), mechanical medial proximal tibial angle (mMPTA), MPDA, tibial torsion and knee instability. Functional outcomes were evaluated using modified Pediatric Outcome Data Collection Instruments (PODCI) scores. The study included 5 children with 8 affected limbs. Among them, three children with five limbs had recurrent deformities after previous surgeries. All cases showed significant improvements in TFAs, mMPTA, tibial torsion, knee instability and modified PODCI scores. Complications included 4 cases of superficial infections, 1 intra-articular fracture, 2 minor screw breakage and 2 on-table under correction. Surgical intervention involving acute Single-stage medial hemi-plateau elevation and metaphyseal osteotomy leads to satisfactory outcomes in late-stages Blount's disease among older children. It is crucial to achieve proper correction of all deformity components during surgery, with epiphysiodesis on the lateral side to prevent further recurrence. Continuous follow-up until skeletal maturity is essential for optimal results.

3.
JBJS Case Connect ; 13(2)2023 04 01.
Article in English | MEDLINE | ID: mdl-37053360

ABSTRACT

CASE: We report a six-year-old child with SCARF syndrome (skeletal anomaly, cutis laxa, ambiguous genitalia, mental retardation and distinct facial features) who presented with unilateral teratologic hip dislocation. She underwent an open reduction of her hip with femoral and pelvis osteotomies. At six years follow-up, she was asymptomatic with a mild lurch, a leg length discrepancy of 1.5cms and a good range of motion at the hip. A mild shortening of the femoral neck was noted but the joint was congruous and concentrically reduced at 6 years. CONCLUSION: The management principles must follow an aggressive approach which includes open reduction of the hip, femoral and pelvic osteotomies with a good capsular repair. We may expect good hip development after surgical intervention even in a child with increased elasticity due to this genetic condition.


Subject(s)
Cutis Laxa , Hip Dislocation , Intellectual Disability , Child , Female , Humans , Hip Dislocation/complications , Hip Dislocation/surgery , Intellectual Disability/complications , Cutis Laxa/complications , Follow-Up Studies , Femur Neck
4.
JBJS Case Connect ; 13(1)2023 01 01.
Article in English | MEDLINE | ID: mdl-36821401

ABSTRACT

CASE: A 4-year-old girl presented with a 5-week-old, neglected fourth metatarsophalangeal (MTP) joint dislocation with malunion of the fourth metatarsal. A previous attempt at closed reduction had failed. The reduction was hindered by dynamic stabilizing of soft tissues around the MTP joint. Open reduction of the fourth MTP joint dislocation and corrective osteotomy of the fourth metatarsal was performed. The patient was pain-free without any cosmetic deformity at the 1-year follow-up. CONCLUSION: Prompt recognition of a MTP dislocation is vital. The long extensor tendon to the toe can hinder the closed reduction of the MTP dislocation. Osteotomy of the metatarsal malunion is necessary for stable reduction. LEVEL OF EVIDENCE: 4.


Subject(s)
Fractures, Bone , Fractures, Malunited , Joint Dislocations , Metatarsal Bones , Metatarsophalangeal Joint , Female , Humans , Child, Preschool , Metatarsal Bones/surgery , Joint Dislocations/surgery , Toes
5.
J Clin Orthop Trauma ; 47: 102316, 2023 Dec.
Article in English | MEDLINE | ID: mdl-38196497

ABSTRACT

Background: During the COVID lockdown in India, which lasted for more than a year, all schools were closed and children were homebound. When the lockdown was lifted, we observed an increased prevalence of Vitamin D deficiency(VDD) in adolescents. We want to highlight the effect of home lockdown on adolescents, which can predispose such children to VDD. Aim: To document the increased prevalence of symptomatic VDD in adolescents after COVID lockdown and to study the symptoms, biochemical abnormalities, and response to therapy in this subset. Methods: This prospective observational study was done from November 2021 to May 2022 with a minimum follow-up of six months. Inclusions: Consecutive children presenting with gait abnormalities, proximal myopathy, and pains, with documented VDD. Exclusion: Genetic, neuromuscular disorders, juvenile rheumatoid arthritis, chronic renal failure, thyroid disorders and those on anti-epileptic medications and vitamin D supplementation in the past 6 months were excluded from the study. We recorded the symptomatology, biochemical abnormalities, and muscle weakness and followed their improvement after Vitamin D and Calcium supplementation. Results: A statistically significant increase in symptomatic VDD in adolescents, in six months post-lockdown was noted. Thirty-one adolescents between 9 to 14 years were studied. All cases were relieved of pain and muscle power normalized in 12 weeks. Conclusion: Prolonged house arrest may cause VDD in adolescents. Physicians should consider VDD in adolescents with myopathy and pain after pandemic lockdowns. Supplementation of Vitamin D and calcium resolves most symptoms except deformities. Follow-up is needed until growth spurt completion for recurrence of symptoms.

6.
J Orthop ; 27: 92-102, 2021.
Article in English | MEDLINE | ID: mdl-34588744

ABSTRACT

PURPOSE: To review controversies systematically in the management of pediatric neck femur fracture from the literature and to develop consensus for the optimum management. METHODS: Authors searched literature by using keywords of pediatric neck femur fracture, proximal femur fracture, complications, management by following PRISMA guidelines. A common dilemma was listed. RESULTS: Age, mechanism of injury, fracture type, presentation, treatment method, implant, and nature of complications were compared. Inference from recent literature was extracted for optimum management. CONCLUSION: Immediate anatomical reduction with stable fixation must be accomplished. Complications continue to happen despite the best efforts and a longer follow-up is important.

7.
J Orthop Case Rep ; 11(2): 24-28, 2021 Feb.
Article in English | MEDLINE | ID: mdl-34141664

ABSTRACT

INTRODUCTION: Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare bone pathology affecting small bones of hand and feet. This benign lesion needs to be distinguished from many malignant bone tumors as it poses a diagnostic dilemma due to its clinical, radiological, and histological picture. We report three cases of BPOP affecting the hand and foot. CASE 1: A 21-year-old gentleman presented with painful swelling in the long finger of the right hand. A plain radiograph showed a radio dense mass which was later excised and diagnosis confirmed in histopathology. There was no recurrence in 2 years of follow-up. CASE 2: A 5-year-old boy presented with painful swelling over the right ankle with no history of antecedent trauma. Following radiological evaluation, the patient was successfully treated with excision. CASE 3: A 35-year-old lady presented with a painful swelling on the dorsal aspect of her hand which was gradually increasing in size. After radiological evaluation, the patient was successfully treated with excision and lesion confirmed to be BPOP on histological examination. She was symptom free without recurrence in up to 2 years of follow-up. CONCLUSION: Nora's lesion is a rare pathology requiring high index of suspicion. Excision is the recommended mode of treatment. All our cases responded well with excision with immediate pain relief following surgery and no recurrence in up to 2 years of follow-up.

8.
J Orthop ; 22: 207-212, 2020.
Article in English | MEDLINE | ID: mdl-32425419

ABSTRACT

OBJECTIVES: Pediatric femoral neck fractures were reviewed to compare complications with the time of presentation. METHODS: 34 pediatric femoral neck fractures were studied to detect union time, avascular necrosis, premature physis fusion, and the neck-shaft angle. All complications were comparable between both groups. RESULTS: The mean union time was more in late presented group. Four children developed AVN. The neck shaft angle and pre mature fusion of growth plate were same in both groups. CONCLUSIONS: The frequency of the complications except union time in pediatric neck femur fracture is comparable in early and late presented groups.

9.
J Pediatr Orthop B ; 28(5): 491-494, 2019 Sep.
Article in English | MEDLINE | ID: mdl-30308552

ABSTRACT

We present a rare case of a previously healthy 16-year-old boy who sustained simultaneous bilateral femoral neck fractures after a single first-time seizure episode. He was diagnosed to have severe vitamin D deficiency and secondary hyperparathyroidism. Symptomatic hypocalcemia was the cause of seizures. Both fractures were treated surgically and united at 3 months. Bilateral femoral neck fractures after seizures are very rare, especially in children. Severe vitamin D deficiency may cause seizures and also weakening of bone, predisposing to fractures without significant trauma. We recommend that paediatric cases of femoral neck fractures after seizures should be investigated for underlying metabolic disease.


Subject(s)
Femoral Neck Fractures/etiology , Femoral Neck Fractures/surgery , Hypocalcemia/complications , Seizures/complications , Adolescent , Closed Fracture Reduction , Fracture Fixation, Internal , Humans , Hyperparathyroidism, Secondary/complications , Hyperparathyroidism, Secondary/drug therapy , Hypocalcemia/drug therapy , Male , Seizures/drug therapy , Vitamin D Deficiency/complications , Vitamin D Deficiency/drug therapy
SELECTION OF CITATIONS
SEARCH DETAIL
...