Surgical and Medical Management of Deformity and Non-union with Implant Failure of Femur in OI Type III

Volume 8 | Issue 1 | January-April 2022 | Page: 35-42 | Sanjay Chhawra, Raman Jain, Unus Ahmed, Nimish Agarwal, Rajiv Chaubey, Gaganpreet Singh
DOI-10.13107/ijpo.2022.v08i01.132

Authors: Sanjay Chhawra D Ortho., DNB Ortho. FICS, Raman Jain MS Ortho., Unus Ahmed MS Ortho., Nimish Agarwal MS Ortho., Rajiv Chaubey MS Ortho., Gaganpreet Singh MS Ortho.

[1] Department of Orthopedics, Jaipur Golden Hospital, Rohini, Delhi, India.

Address of Correspondence
Dr. Sanjay Chhawra
Department of Orthopedics, Jaipur Golden Hospital, Rohini, Delhi, India.
E-mail: sanjaychhawra@yahoo.com

Abstract

Purpose: Osteogenesis imperfecta (OI) is characterized by increased bone fragility and susceptibility for fracture because of the mutation of genes. A few studies are there for treatment modalities of non-union femur fractures in children with OI. This study on adult OI patients aims to give insight into non-unions and their best treatment reporting the surgical modification by using a humeral nail for femoral fixation options to avert non-union. Best implant in the adolescent OI patients for the surgical reconstruction of the femur for correction of deformity healing non-union.
Methods: This is a retrospective, descriptive study of the OI type III fracture non-union and its treatment modality.
Conclusions: In Adolescent OI patients with the rare percentage of non-union with deformity with implant failure of the femur was fixed with Humerus nail having stable fixation deformity correction by both osteotomy rotational translational and conversion of non-union to union with a better result.
Keywords: Osteogenesis imperfecta (OI), TENS Tensile Elastic Nail System, Adolescent, Humeral nail, Femoral bowing deformity

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How to Cite this Article:  Chhawra S, Jain R, Ahmed U, Agarwal N, Chaubey R, Singh G | Surgical and Medical Management of Deformity and Non-union with Implant failure of Femur in OI Type III | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 35-42.

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A Case of Pyomyositis in a Healthy 11-Year Old Boy with Need of Surgical Drainage

Volume 8 | Issue 1 | January-April 2022 | Page: 47-50 | Alina Frolova, Joana Freitas, Rui Martins, Jorge Coutinho

DOI-10.13107/ijpo.2022.v08i01.134

Authors: Alina Frolova MD [1], Joana Freitas MD [1], Rui Martins MD [1], Jorge Coutinho MD [1]

[1] Department of Pediatric Orthopedics, The University Hospital Centre São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto Portugal.

Address of Correspondence

Dr. Alina Frolova,
Department of Pediatric Orthopedics, The University Hospital Centre São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto Portugal.
E-mail: alina.frolova.238@gmail.com

Abstract

Pyomyositis is an uncommon clinical entity affecting predominantly pediatric population. It presents with diffuse muscle involvement, mostly in the lower limb, with occasional abscess formation and need of drainage, coupled to an appropriate antibiotic therapy.
In this article we present a case of a previously healthy 11-year old boy with an acute onset of hip pain and fever, as well as elevation in blood leukocyte count and C-reactive protein. Magnetic resonance imaging showed a gadolinium-enhanced oedema of internal obturator, external obturator, adductors and quadratus femoris, with an intra-muscular abscess of external obturator. After two attempted percutaneous drainages the patient progressed to sepsis, with the need of open surgical drainage through transgluteal approach. Concomitantly, a deep venous thrombosis was also diagnosed.
After the appropriate drainage and a prolonged antibiotic regimen, patient’s condition improved, with full recovery and no sequelae.
Keywords: Pyomyositis, External obturator, Muscle abscess, Transgluteal approach

References

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12. Menge TJ, Cole HA, Mignemi ME, Corn WC, Martus JE, Lovejoy SA, Stutz CM, Mencio GA, Schoenecker JG. Medial approach for drainage of the obturator musculature in children. J Pediatr Orthop. 2014 Apr-May;34(3):307-15
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How to Cite this Article:  Frolova A, Freitas J, Martins R, Coutinho J | A Case of Pyomyositis in a Healthy 11-Year Old Boy with Need of Surgical Drainage | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 47-50.

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One-Stage Emergency Surgical Release of Amniotic Constriction Band in Streeter’s Dysplasia with Clubfoot- A Case Report

Volume 8 | Issue 1 | January-April 2022 | Page: 43-46 | Harsharan Singh Oberoi, Baldish Singh Oberoi

DOI-10.13107/ijpo.2022.v08i01.133

Authors: Harsharan Singh Oberoi MS, DNB Ortho [1], Baldish Singh Oberoi MS Ortho, MPH [1]

[1] Department of Orthopaedics, Oberoi Hospital, Jalandhar City, Punjab, India.

Address of Correspondence

Dr. Baldish Singh Oberoi
Orthopaedic Surgeon, Oberoi Hospital, Jalandhar City, Punjab, India.
Email: baldishoberoi@gmail.com

Abstract

Streeter’s dysplasia is a rare condition that occurs in 1 in 1200 to 1 in 15000 live births. Timely intervention is the key in saving the limb in vascular compromised cases. A 7 days old neonate presented with Streeter’s Dysplasia with a grossly swollen, deformed and cyanosed foot. The deformity was a clubfoot deformity. There was a circumferential amniotic constriction band in the lower third left leg, causing a vascular compromise leading to bluish discoloration and gross swelling of the foot and toes. There was another semicircular band in the mid-foot region. One stage urgent circumferential band excision and multiple Z plasties for skin cover were done. The foot and the toes turned pink immediately. The swollen foot was treated by debulking of the foot and the clubfoot deformity by the Ponseti method.
Keywords: Streeter’s dysplasia, Vascular compromise, Constriction ring, One stage release, Clubfoot, Debulking

References

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How to Cite this Article:  Oberoi HS, Oberoi BS| One-Stage Emergency Surgical Release of Amniotic Constriction Band in Streeter’s Dysplasia with Clubfoot- A Case Report | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 43-46.

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Fixation of Displaced Paediatric Humeral Lateral Condyle Fractures with 3 K-Wires

Volume 8 | Issue 1 | January-April 2022 | Page: 31-34 | Deepak Jain, Tushar Agrawal, Saijyot Raut, Parimal Malviya

DOI-10.13107/ijpo.2022.v08i01.131

Authors: Deepak Jain MS Ortho [1], Tushar Agrawal MS Ortho [2, 3], Saijyot Raut MS Ortho [2],
Parimal Malviya MS Ortho. [2]

[1] Department of Orthopaedics & Spine Surgery Ganga Hospital, Coimbatore, Tamil Nadu, India.
[2] Department of Orthopaedics, MGM Hospital, Navi Mumbai, Maharashtra, India.
[3] Aastha Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Deepak Jain,
Paediatric Orthopaedic Fellow, Department of Orthopaedics & Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
E-mail: deepaksjain1993@gmail.com

Abstract

Background- Management of paediatric humeral lateral condyle fractures by 2 Kirschner wire or screw fixation in parallel or divergent manner remains the treatment of choice and has long remained unchallenged. In this study, we are recommending using a third K wire for fracture fixation technique for the age group less than 10 years which provides a more stable fixation enhances stability and ensures better outcomes without any significant disadvantages.
Materials & Methods- We Present a Cohort of 20 pediatric lateral condyle fractures of Song et al stage 3 and above. Of the 20 patients treated, 12 were male and 8 females. All fractures were fixed using 3 lateral Kirschner wires of size 1.2 or 1.5mm. Out of the 20 fractures, 12 were opened and 8 were fixed percutaneously.
Results- All Patients showed union at 6 weeks. K-wires were removed at 6 weeks. Good radiological and clinical outcomes were noted on the periodical check-up. Hardacre score was used to calculate clinical outcome. None of the patients had any loss of reduction, non-union, or implant-related failure except for pin tract infections in a few patients.
Conclusion- We recommend adding a third wire to the construct for three k wires fixation for lateral condyle humerus fractures in all patients less than 10 years which is useful tool, cost-effective, enhances stability and ensures good outcomes without any significant disadvantages. We found all benefits of the cannulated screws by inserting the third wire and the fracture was found to be biomechanically more stable, none showed loss of reduction, had early union, early mobilization, minimal chances of nonunion, full ROM, no infection with the added advantage of no re-surgery for implant removal
Keywords- Pediatric fractures, Elbow fractures, Lateral condyle fractures, K-wires

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24. Danielle S. Wendling¬Keim1 Sandra Teschemacher1 Hans¬ Georg Dietz1 Markus Lehner Lateral Condyle Fracture of the Humerus in Children: Kirschner Wire or Screw Fixation? European Journal of Pediatric Surgery 2020.

25. Ya¬ Fei Qin, MD, Zhi¬ Jun Li, MD, Cheng¬ Kai Li, MD, Shu ¬Cai Bai, MD, Hui Li, MD Unburied versus buried wires for fixation of pediatric lateral condyle distal humeral fractures A meta-analysis Qin et al. Medicine (2017) 96:34.

26. Avijeet Prasad, Puneet Mishra, Aditya N Aggarwal, Manish Chadha, Rohit Pandey, Rahul Anshuman Exposed versus Buried Kirschner Wires Used in Displaced Pediatric Fractures of Lateral Condyle of Humerus. Indian Journal of Orthopaedics | Volume 52| Issue 5 | September¬-October 2018

How to Cite this Article:  Jain D, Agrawal T, Raut SJ, Malviya P | Fixation of Displaced Paediatric Humeral Lateral Condyle Fractures with 3 K-Wires | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 31-34.

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Role of Non Vascularized Fibula Graft in the Management of Post Osteomyelitic Bone Defects in Children

Volume 8 | Issue 1 | January-April 2022 | Page: 24-30 | Anil Agarwal, Ankur, Ankit Jain

DOI-10.13107/ijpo.2022.v08i01.130

Authors: Anil Agarwal MS Ortho. [1], Ankur MS Ortho. [1], Ankit Jain D Ortho. [1]

[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.

Address of Correspondence
Dr. Anil Agarwal,
Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
E-mail: anilrachna@gmail.com

Abstract

Osteomyelitis continues to be widely prevalent in low socioeconomic countries. The challenges associated with the disease include weakened pathological bone, cavities, pathological fractures, non-union and gaps. This article discusses the uses of non-vascularized fibular graft for the management of the sequelae of osteomyelitis. A review of literature reveals this technique to be quite successful with fewer complications. Being technically less demanding and easy, this procedure remains an important tool in the management of bone defects due to osteomyelitis in children.
Keywords: Osteoarticular infection, Reconstruction, Bone graft

References

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How to Cite this Article:  Agarwal A, Ankur, Jain A | Role of Non Vascularized Fibula Graft in the Management of Post Osteomyelitic Bone Defects in Children | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 24-30.

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Diagnosis of Pediatric Musculoskeletal Infections: Current Concepts Review

Volume 8 | Issue 1 | January-April 2022 | Page: 14-23 | Neeraj Vij, Jessica Burns, Melissa Esparza, Alexandra Dominianni, Yerin Cho, Mohan V Belthur

DOI-10.13107/ijpo.2022.v08i01.129

Authors: Neeraj Vij BS [1], Jessica Burns MD [2], Melissa Esparza MD [2], Alexandra Dominianni BA [1], Yerin Cho BS [1], Mohan V Belthur MD [1, 2]

[1] Department of Child Health & Orthopaedics, University of Arizona, College of Medicine, Phoenix, Arizona, USA.
[2] Department of Orthopedics, Phoenix Children’s Hospital, Phoenix, Arizona, USA.

Address of Correspondence
Dr. Mohan V. Belthur,
Department of Child Health & Orthopaedics, University of Arizona, College of Medicine, Phoenix, Arizona, USA. Department of Orthopedics, Phoenix Children’s Hospital, Phoenix, Arizona, USA.
E-mail: mbelthur@phoenixchildrens.com

Abstract

Introduction: Pediatric musculoskeletal infections are common and constitute one of the top five conditions contributing to the burden of musculoskeletal disease in childhood. With early accurate diagnosis and appropriate treatment, the clinical course, and outcomes of musculoskeletal infections can be favorable. However, poor outcomes (morbidity/mortality), a wide spectrum of post-infective sequela and significant functional impairment can occur, especially in the setting of delayed diagnosis and inadequate treatment. The purpose of this narrative review is to provide an overview of the standard diagnostic modalities with an emphasis on the recent literature and to summarize the current state of knowledge on the newer diagnostic modalities of the 21rst century.
Materials and Methods: A literature search was performed using the following keywords: “diagnosis”, OR “diagnostic modalities”, OR “diagnostic capability” AND “children” OR “pediatric” AND “musculoskeletal” OR “bony” OR “orthopedic” OR “muscular” AND “infection” OR “bacterial” OR “viral” OR “fungal”. Databases searched included PubMed, EMBASE, Cochrane Library, and SCOPUS. This returned a total of 315 articles. English language articles published between January 1990 and March 2022 regarding traditional or newer diagnostic modalities and pediatric musculoskeletal infection were included in this review.
Results: A total of 62 articles met the inclusion criteria. Our knowledge base regarding the traditional diagnostic modalities has evolved to include several scoring systems with good sensitivities and specificities. Cellular acute phase reactants show promise in the recent literature. There is good literature regarding the evolution of imaging techniques to improve diagnosis. Novel diagnostic modalities in the recent literature include plasma-based acute phase reactants, polymerase chain reaction, and next-generation sequencing.
Conclusion: Continuing to improve our diagnostic accuracy of Pediatric MSKIs can help decrease the worldwide burden of these conditions. As the use of adjunctive biomarkers becomes more common, diagnoses and pathogen identification could be made timelier and antibiotic choices could be individualized leading to improved outcomes. Limited sequence imaging techniques can reduce the associated costs. Polymerase chain reaction and next generation sequencing are important novel technologies that can revolutionize the diagnosis of pediatric musculoskeletal infection.
Keywords:  Paediatric, Musculoskeletal infection, Diagnosis.

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How to Cite this Article:  Vij N, Burns J, Esparza M, Dominianni A, Cho Y, Belthur MV | Septic Arthritis Management: Current Guidelines | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 14-23.

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