Median nerve entrapment and ulnar nerve palsy following elbow dislocation in a child.

This report presents a rare case of a child who presented with neglected intra-articular entrapment of the median nerve, ulnar nerve palsy, and intra-articular incarceration of the medial epicondyle following closed reduction of an elbow dislocation. In the present case, as in most other cases, the diagnosis and treatment were delayed. Careful initial and postreduction neurological examination, as well as careful interpretation of the plain radiographs, is necessary for early detection of any nerve complications and associated fractures of an elbow dislocation. The authors' opinion is that a child with an elbow dislocation, which is initially neurologically intact but advances to a median or ulnar nerve deficit after the reduction, must undergo early surgical exploration, especially when the dislocation is associated with a medial epicondyle fracture.

Flexible intramedullary nailing in paediatric femoral shaft fractures.

This retrospective study aims to evaluate the efficacy of flexible intramedullary (IM) nails as a fixation device of paediatric femoral shaft fractures. A total of 36 children with 37 closed fractures were treated by this method. The patients ranged in age from 7.2 to 13.5 years and the mean follow-up was 25.5 months. All patients had open femoral growth plates at the time of surgery. All fractures united and none of the patients needed re-operation. Complications included pain/irritation at the insertion site, superficial wound breakdown and one case of delayed union. No major complications were recorded. After nail removal, all children had full range of hip and knee motion. At final follow-up, although radiographs revealed that 44% of the children had malalignment at the fracture site in one or both planes, none of the children presented with clinical malalignment of the fractured limb. Maximum angulation that was calculated on the coronal plane was 5 degrees into varus and on the sagittal plane 7 degrees of anterior angulation (apex posteriorly). Leg-length discrepancy was assessed clinically and radiographically when needed. A total of 50% of the children had a leg-length inequality but none of them complained of a functional problem. Flexible nailing of diaphyseal fractures of the femur is a reliable method with a small learning curve and allows early mobilisation. Most of our minor complications were technique related and could be avoided.

Popliteal artery pseudoaneurysm secondary to osteochondroma in children and adolescents: a case report and literature review.

Osteochondroma is the most frequent bone tumor and can rarely cause vascular complications. False aneurysms of the popliteal artery due to an osteochondroma are not common in the pediatric population. The case of an 11-year-old boy who presented with a painful mass on the posterior aspect of his distal thigh is described. Radiologic studies revealed an osteochondroma of the distal femur and a pseudoaneurysm of the popliteal fossa. A combined orthopaedic and vascular surgery was undertaken. The exostosis was excised and the popliteal artery was repaired by performing a venous patch angioplasty technique. A review of the literature regarding this vascular complication in young patients is also reported.

Intraosseous pseudotumour of the talus in a child with severe haemophilia.

We report a case of a large pseudotumour in the right talus of an 11-year-old boy with severe haemophilia A. The described intraosseous lesion was treated with surgical curettage and autologous bone grafting. Twenty months postoperatively computed tomography scan showed no signs of recurrence. Forty months postoperatively radiological studies confirmed satisfactory incorporation of the graft, no evidence of bone growth disturbance and improvement of Pettersson score of the ankle joint. At the same time, regarding his clinical situation, he was able to fully participate in his daily activities, presenting painless and almost full range of motion of his right ankle joint. Surgical intervention seems to be the best option in treating a big pseudotumour of the talus during childhood. As conservative management in the treatment of large lesions may fail, disastrous complications like a pathological fracture may happen. Anatomical reconstruction of a talus when pseudotumour and pathological fracture coexist is a major challenge for an orthopaedic surgeon.

An attempt to improve the clinical scale for assessment of haemophilic arthropathy in children.

Of the methods used to evaluate haemophilic arthropathy, clinical joint score can only detect advanced and not minor changes, which usually occur in younger patients. In addition, the currently used clinical scores are poorly correlated with the MRI and X-rays scales. In an attempt to address these shortcomings, a modification of Stockholm clinical scale was designed in which elements of clinical information were included. This new scale was applied in 165 joints of 40 patients with haemophilia A and B and the results were statistically analyzed for its capacity to detect early joints alterations. Furthermore, the adjusted score was compared with Pettersson's radiological score and Denver's MRI score, which can detect early signs of arthropathy. The adjusted scale (a) revealed the earliest abnormalities of haemophilic arthropathy and its correlation with the Pettersson and Denver scores is better than those of Stockholm's scale, (b) provided prediction of the Denver score and (c) was simple and safe to be performed and it could easily be repeated.

Correction of adolescent hallux valgus by proximal crescentic osteotomy of the first metatarsal.

Thirty nine surgical hallux valgus corrections in 32 adolescents (7 bilateral) performed between 1994 and 2001 were retrospectively studied. The mean age at the time of surgery was 14.2 years. The operation consisted of a proximal dome osteotomy of the first metatarsal, excision of the medial protuberance, lateral capsular and adductor release, and distal medial soft tissue plication. The patients were followed for an average of 42 months (range 32 to 62). Post-operative evaluation was based on the duPont bunion rating score. The result was excellent in 11 feet, good in 22 cases, fair in 5 and poor in 1 case. Using subjective criteria of the duPont score, such as cosmesis and discomfort, a satisfactory result was achieved in 35 feet (90%). Our opinion is that correction of the angle between the 1st and 2nd metatarsal as well as preservation of the length of the first metatarsal are of crucial importance in the surgical treatment of adolescent hallux valgus.