ABSTRACT
BACKGROUND: Complex regional pain syndrome (CRPS) type 1 is a disorder of the extremities characterized by pain, edema, limited range of motion, integument changes, and vasomotor instability often after an inciting event. In the pediatric population, CRPS may be misdiagnosed, or missed entirely, as CRPS literature for this patient population is lacking. METHODS: Twenty-seven pediatric patient medical records with the diagnosis of CRPS type 1 from the institutional and private practices of the principal investigator (E.J.H.) were reviewed for demographics, inciting event, lower-extremity clinical examination, ancillary testing, previous treatments, time to diagnosis, treatment after diagnosis, and time to resolution of symptoms. RESULTS: Females composed 85.2% of the patient population (n = 23) (mean age of females, 11.11 years). An inciting event preceded pain in 74.1% of patients (n = 20). On physical examination, more than 50% of patients were identified as having changes in skin color and temperature, edema to the affected lower extremity, painful or decreased range of motion in affected joints, and intact lower-extremity motor function. The average time to resolution of symptoms was 6.8 weeks for the entire population. CONCLUSIONS: Diagnosis of CRPS type 1 should be considered in a preadolescent female complaining of pain out of proportion after an inciting event with a physical examination demonstrating change in skin color, decrease in skin temperature, edema, and painful or diminished range of motion in affected joints. Prompt diagnosis can decrease the time to resolution of symptoms.
Subject(s)
Complex Regional Pain Syndromes/physiopathology , Lower Extremity/physiopathology , Child , Complex Regional Pain Syndromes/diagnosis , Complex Regional Pain Syndromes/therapy , Female , Humans , Male , Physical Examination , Retrospective StudiesABSTRACT
Puncture wounds in children are very common and often result in foreign body retention. Organic materials in the form of plant thorns present problems in identification and localization because they are not visualized with plain radiographs. A case of a 10-year-old girl with a small piece of retained hawthorn is presented. Correct diagnosis and treatment were delayed because of misinterpretation of magnetic resonance image studies. Ultrasound ultimately located the foreign body, and assisted in its excision. Plant thorns may be toxic and produce an intense local inflammatory response. In the case described in this article, deep infection caused by Enterobacter cloacae and Pantoea agglomerans was associated with the retained thorn. The small size of the foreign body, misinterpretation of diagnostic images, and the deep infection highlight the challenges that can be encountered by physicians managing puncture wounds in children.
Subject(s)
Foot Injuries/diagnosis , Foreign Bodies/diagnosis , Wound Infection/etiology , Wounds, Penetrating/diagnosis , Child , Crataegus , Enterobacter cloacae , Enterobacteriaceae Infections/diagnosis , Enterobacteriaceae Infections/drug therapy , Enterobacteriaceae Infections/microbiology , Female , Foot Injuries/surgery , Foreign Bodies/complications , Foreign Bodies/surgery , Humans , Magnetic Resonance Imaging , Pantoea , Wound Infection/microbiologyABSTRACT
The frequent occurrence of flexible flatfoot raises the question of its pathologic status. There may be cultural overtones resulting in the consideration that flat feet are always pathologic. Parents may believe that their own flat feet were successfully treated when they were children and wish the same for their offspring. Few studies attempt to answer the question of the natural history of this condition. This article reviews the available literature dealing with the natural history, comorbidities, recommendations for treatment, expansion of biomechanical theory, and classification of flatfoot. Issues associated with imaging of flatfoot and the design of studies to validate the effects of treatment are also reviewed.
Subject(s)
Flatfoot/diagnosis , Child , Flatfoot/pathology , Flatfoot/physiopathology , Flatfoot/therapy , Foot/pathology , Foot/physiopathology , HumansABSTRACT
Pediatric clinical management is highly specialized. Problems are complex and often complicated by other medical issues that dictate limitations on therapeutic options. Appropriate diagnosis and successful clinical management depend on the experience and skill of the surgeon. This roundtable discussion focuses on seven difficult cases and presents the views of three experienced and skilled experts in the field.
Subject(s)
Decision Making , Podiatry/methods , Cerebral Palsy/complications , Charcot-Marie-Tooth Disease/diagnosis , Child , Child, Preschool , Chromosome Deletion , Female , Flatfoot/physiopathology , Flatfoot/therapy , Foot Deformities/genetics , Foot Deformities/therapy , Hallux Valgus/therapy , Humans , Male , Postoperative Care , Pronation/physiology , Tarsal Bones/abnormalitiesSubject(s)
Flatfoot/diagnosis , Flatfoot/therapy , Child , Critical Pathways , Flatfoot/diagnostic imaging , Foot/diagnostic imaging , Humans , RadiographyABSTRACT
Infants are susceptible to digital ischemia if a toe is encircled by a strand of hair on some other similar material. Infants under 6 months are particularly at risk. There is often a delay of 3-4 days before the condition is recognized. Prompt removal is necessary in order to prevent loss of the part. This syndrome is referred to as the hair-thread tourniquet syndrome. Two cases illustrating the presenting clinical findings and the operative treatment are presented.
