ABSTRACT
Post-traumatic premature closure of the distal fibular growth plate is a rare entity leading to shortening of the lateral malleolus. We report on a 14-year old boy who presented with a 4-year history of worsening, diffuse discomfort and swelling of his left ankle, as well as fibular shortening and talar malreduction. He had sustained a distal tibial fracture 4 years earlier and had been treated with closed reduction. He reported instability of the ankle and difficulty with running. There was 1-cm shortening of the left fibula, 1-cm shortening of the proximal fibula, and slight widening of the medial clear space. Both tibial and fibular growth plates were already closed and the left ankle joint space was slightly narrowed. He was treated with late fibular lengthening and autogenous iliac crest tricortical bone grafting and achieved anatomic restoration of the distal tibiofibular relationship. At one-year follow-up, the ankle-hindfoot score had improved from 69 to 100.
Subject(s)
Bone Lengthening , Fibula/physiopathology , Fibula/surgery , Tibial Fractures/complications , Adolescent , Ankle Joint/diagnostic imaging , Autografts , Bone Development/physiology , Bone Lengthening/methods , Bone Transplantation , Growth Plate/diagnostic imaging , Growth Plate/physiopathology , Humans , Ilium/transplantation , Joint Instability/etiology , Joint Instability/surgery , Magnetic Resonance Imaging , Male , Osteotomy , Radiography , Talus/diagnostic imaging , Tibial Fractures/diagnostic imagingABSTRACT
Pyomyositis is an infection of the skeletal muscles, resulting in a pus-filled abscess. Immunodeficiency of the patient is considered to play an important role in pathogenesis. We report a case of a 3-year-old child, who presented with multifocal pyomyositis in the gastrocnemius muscle, extending to the posterior muscles of the thigh. Even though there was no evidence of immunodeficiency, the presence of atopic eczema in the big toe of the affected limb could interfere with the immune system response, and therefore, could be associated with pyomyositis. The increasing incidence of pyomyositis in non-tropical areas and its severe complications requires an acute clinical awareness.
Subject(s)
Eczema/complications , Pyomyositis/etiology , Streptococcal Infections/etiology , Anti-Bacterial Agents/therapeutic use , Child, Preschool , Diagnosis, Differential , Eczema/diagnosis , Eczema/immunology , Follow-Up Studies , Foot , Humans , Immunocompromised Host , Magnetic Resonance Imaging , Male , Muscle, Skeletal/microbiology , Muscle, Skeletal/pathology , Pyomyositis/diagnosis , Pyomyositis/drug therapy , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus/isolation & purificationABSTRACT
HYPOTHESIS: The optimal surgical treatment for cubital tunnel syndrome remains unclear. We aim to evaluate the long-term outcome of surgical treatment by comparing the results of the different methods proposed. MATERIALS AND METHODS: We retrospectively reviewed 113 patients in whom 3 different surgical methods were used for cubital tunnel syndrome treatment. In situ decompression, partial epicondylectomy, and anterior subcutaneous transposition were performed from 1997 to 2007. RESULTS: Results were graded as excellent in 51 patients (45%), good in 34 (30%), fair in 8 (7%), and poor in 20 (18%). When we compared the results among the different surgical procedures, good and excellent results were achieved in 26 of 31 patients (84%) treated with in situ decompression, 36 of 45 (80%) treated with release and partial medial epicondylectomy, and 23 of 37 (62%) treated with release and anterior subcutaneous transposition of the nerve. CONCLUSIONS: Our results indicate that in situ decompression and partial epicondylectomy both represent efficient and safe methods for cubital tunnel syndrome management. In patients in whom anterior subcutaneous transposition was performed, although they had a significant improvement of their clinical signs and symptoms, they had an inferior outcome when compared with patients treated with the other 2 methods.
Subject(s)
Decompression, Surgical/methods , Orthopedic Procedures/methods , Ulnar Nerve Compression Syndromes/surgery , Adolescent , Adult , Aged , Elbow/physiology , Electromyography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Recovery of Function/physiology , Retrospective Studies , Treatment Outcome , Ulnar Nerve/physiology , Ulnar Nerve Compression Syndromes/diagnosis , Ulnar Nerve Compression Syndromes/physiopathology , Young AdultABSTRACT
Birth brachial plexus injury usually affects the upper roots. In most cases, spontaneous reinnervation occurs in a variable degree. This aberrant reinnervation leaves characteristic deformities of the shoulder, elbow, forearm, wrist, and hand. Common sequelae are the internal rotation and adduction deformity of the shoulder, elbow flexion contractures, forearm supination deformity, and lack of wrist extension and finger flexion. Nowadays, the strategy in the management of obstetrical brachial plexus palsy focuses in close follow-up of the baby up to 3-6 months and if there are no signs of recovery, microsurgical repair is indicated. Nonetheless, palliative surgery consisting of an ensemble of secondary procedures is used to further improve the overall function of the upper extremity in patients who present late or fail to improve after primary management. These secondary procedures include transfers of free vascularized and neurotized muscles. We present and discuss our experience in treating early and/or late obstetrical palsies utilizing the above-mentioned microsurgical strategy and review the literature on the management of brachial plexus birth palsy.
