Treatment and Diagnosis of Panner's Disease. A Report of Three Cases.

Avascular necrosis of the humeral capitellum (Panner's disease), a relatively rare disorder in the juvenile. We diagnosed three patients using radiographs and magnetic resonance imaging, who were previously misdiagnosed with osteochondritis dissecans of the humeral capitellum. All patients were successfully treated by restriction of sports activities using the upper extremities. It is often difficult to distinguish Panner's disease from osteochondritis dissecans of the humeral capitellum. Panner's disease has been reported to occur in boys between 7 and 10 years old, which is younger than susceptible age of osteochondritis dissecans. In MRI, low intensity area in the ossification center of the humeral capitellum in T1-weighted image is useful findings for diagnosis. For the treatment, the conservative treatment has been recommended in the early stage of Panner's disease, while surgical intervention is required in some cases of osteochondritis dissecans.

Limb Deformity Caused by Distal Femoral and Proximal Tibial Growth Arrest After ACL Reconstruction in a Child: A Case Report.

CASE: We report the case of a twelve-year-old boy with limb deformity caused by physeal closure after transphyseal intra-articular reconstruction of the anterior cruciate ligament of the left knee at the age of seven years. We treated premature closure of the physis with a Langenskiöld procedure. Lengthening and correction of the deformity were accomplished with use of the Ilizarov method. Although gross instability remained, reasonable limb alignment was attained with prolonged treatment. CONCLUSION: We document growth arrest and severe limb deformity after transepiphyseal anterior cruciate ligament reconstruction with an artificial polyester ligament and successful surgical correction.

Small cell osteosarcoma successfully treated by high-dose ifosfamide and methotrexate, combined with carboplatin and pirarubicin.

Small cell osteosarcoma (SCO) is the most rare subtype of osteosarcoma and has a poor prognosis. An 11-year-old boy presented with 2-month history of painful tumefaction in the lower leg. Imaging analysis demonstrated a mixture of osteolytic and osteosclerotic lesions in the proximal tibia and extraskeletal area. Histology of the open biopsy showed small round cells producing mucous matrix. Based on these findings, SCO was suspected. The patient received three cycles of neoadjuvant chemotherapy using high-dose ifosfamide, high-dose methotrexate, pirarubicin and carboplatin. Wide-margin resection was performed followed by tibial lengthening using the Ilizarov method and two cycles of adjuvant chemotherapy with the same drugs as for neoadjuvant chemotherapy. Histology of the resected specimen showed that almost all tumor cells were necrotized. Neither recurrence nor metastasis was found after 4 years. Our experience suggests that neoadjuvant chemotherapy, such as the one used here, would be exceedingly effective for SCO without serious non-hematological toxicities.

Surgical treatment of stress fracture of the scaphoid of an adolescent gymnast.

Stress fracture of the carpal scaphoid is very rare. We present stress fracture of the scaphoid in an adolescent gymnast who was treated with internal fixation. Key pointsThere is a risk of stress fracture of the scaphoid in gymnast.Internal fixation with a screw is one of the good options for stress fracture of the scaphoid.

Scaphoid non-union after simultaneous fractures of the scaphoid and the capitate in a child: a case report.

A nine-year-old boy fell on his outstretched hand and was diagnosed with simultaneous fractures of the scaphoid and the capitate. The patient was treated conservatively with a cast for two months. Fracture of the capitate healed, however, fracture of the scaphoid resulted in non-union. We treated scaphoid non-union with an iliac bone graft and internal fixation. Three years after surgery, the patient had neither complaints nor complications and union of the scaphoid was confirmed on the radiographs.