Osseous Manifestation of Systemic Mastocytosis in a Paediatric Bone Scan: A Case Report

Volume 7 | Issue 3 | September-December 2021 | Page: 46-49 | Nurnadiah A Denil, Siti Zarina A Hassan

DOI-10.13107/ijpo.2021.v07i03.124

Authors: Nurnadiah A Denil MMed Nucl. Med. [1], Siti Zarina A Hassan MMed Nucl. Med. [1]

[1] Department of Nuclear Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.

Address of Correspondence
Dr Nurnadiah A Denil
Department of Nuclear Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
E-mail: nadiahdenil@yahoo.com

Abstract

Systemic mastocytosis is a rare disorder of the mast cells with a wide spectrum of clinical manifestations depending on the organs involved.
We report a case illustrating the role of Tc-99m hydroxyl diphosphonate (HDP) to assist in diagnosing systemic mastocytosis in a 4-year-old girl who presented right thigh pain and intermittent fever. She initially presented with right thigh pain. The findings of the radiograph of the lower limbs were unremarkable. MRI of the right femur showed heterogenous intramedullary signal within the right femur, involving the diaphysis and metaphyseal region. Based on the radiographs and MRI changes, the differential diagnosis of disseminated acute osteomyelitis was made. Bone scan with Tc-99 hydroxy diphosphonate (HDP) performed showed diffuse skeletal uptake involving the appendicular and axial skeleton. Bone biopsy of the femur showed the presence of mast cell infiltration.
Diagnosing systemic mastocytosis remains challenging due to the contradictory results of available imaging modalities. When interpreting a focal or diffuse uptake on bone scintigraphy, systemic mastocytosis should be considered, particularly in the paediatric age group.
Keyword: Systemic mastocytosis, Tc-99m bone scintigraphy

References

1. Arrington ER, Eisenberg B, Harthshorne MF. Nuclear Medicine Imaging of Systemic Mastocytosis. J Nuclear Med (1989) 30: 2046-2048. (1989).
2. Fritz J, Fishman EK. Advanced imaging of skeletal manifestations of systemic mastocytosis. Skeletal Radiol (2012) 41; 887-897.
3. Frieri, M, Quershi, M. Pediatric Mastocytosis: A review of the literature. Pediatric allery, immunology and pulmonology (2013) Volume 26, number 4
4. Zettinig G, Becherer A, Szabo M, Uffmann M, Dudczak R, Valent P. FDG positron emission tomography in patients with systemic mastocytosis. AJR Am J Roentgenol. (2002);179:1235–7.
5. Pieri L, Bona Donna P, Elena C et.al, Clinical presentation and management practice of systemic mastocytosis. A survey of 460 Italian patients. Am J Hematol (2016) Apr 7.
6. Chen CC.; Andrich MP., Mican JM. A retrospective analysis of Bone Scan Abnormalities in Mastocytosis: Correlation with Disease Category and Prognosis. J Nucl Med (1994) 35; 1471-1475.
7. Lawrence JB, Friedman BS, Travis WD. Hematologic manifestations of systemic mast cell disease: a prospective study of laboratory and morphologic features and their relation to prognosis. Am J Med (1991) dec;91 (6): 612-24.

How to Cite this Article:  Denil NA, Hassan SZA | Osseous Manifestation of Systemic Mastocytosis in a Paediatric Bone Scan: A Case Report | International Journal of Paediatric Orthopaedics | September- December 2021; 7(3): 46-49.

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Sternal Tuberculosis in an Infant: The Presenting Feature of Disseminated Disease

Volume 7 | Issue 3 | September-December 2021 | Page: 42-45 | Vikas R. Basa, Raghavendraswami Thete, Tanu Singhal

DOI-10.13107/ijpo.2021.v07i03.123

Authors: Vikas R. Basa DNB Orth. [1], Raghavendraswami Thete DNB Orth. [1], Tanu Singhal MD Paediatrics, MSc Infectious Disease [1]

[1] Department of Pediatric Orthopedics, Centre for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital & Medical Research Center, Mumbai, Maharashtra, India.
[2] Department of Paediatrics, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai, Maharashtra, India.

Address of Correspondence
Dr Vikas R Basa
Consultant Pediatric Orthopedics, Centre for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital & Medical Research Center, Mumbai, Maharashtra, India.
E-mail: basavikas@gmail.com

Abstract

We report here the case of a 9 month old previously healthy female infant who presented with a swelling over the anterior chest wall. Radiologic, histopathology and microbiologic tests confirmed it as a case of sternal tuberculosis. The sternal disease improved after starting anti-tubercular therapy but she then developed seizures due to a paradoxical reaction leading to unmasking of a brain tuberculoma. She is well after 1 year therapy. The case is presented in view of rarity of musculoskeletal tuberculosis in infants and even rarer phenomenon of sternal involvement.
Keywords: Infant, Sternal tuberculosis, Tuberculoma

References

1. Held MFG, Hoppe S, Laubscher M, Mears S, Dix-Peek S, Zar HJ, Dunn RN. Epidemiology of Musculoskeletal Tuberculosis in an Area with High Disease Prevalence. Asian Spine J. 2017 Jun;11(3):405-411.
2. WALLGREN A. The time-table of tuberculosis. Tubercle. 1948 Nov;29(11):245-51.
3. Behr MA, Edelstein PH, Ramakrishnan L. Revisiting the timetable of tuberculosis. BMJ. 2018 Aug 23;362:k2738.
4. Rodrigues LC, Diwan VK, Wheeler JG. Protective effect of BCG against tuberculous meningitis and miliary tuberculosis: a meta-analysis. Int J Epidemiol. 1993 Dec;22(6):1154-8. doi: 10.1093/ije/22.6.1154. PMID: 8144299.
5. Saifudheen K, Anoop TM, Mini PN, Ramachandran M, Jabbar PK, Jayaprakash R. Primary tubercular osteomyelitis of the sternum. Int J Infect Dis. 2010 Feb;14(2):e164-6.
6. Mushkin AIu, Maliarova EIu, Dzhankaeva OB, Kirillova ES, Il’ina NA. Tuberculosis of the sternum in children]. Vestn Khir Im I I Grek. 2010;169(2):52-6.
7. Sharma S, Juneja M, Garg A. Primary tuberculosis osteomyelitis of the sternum. Indian J Pediatr 2005; 72: 709-10.
8. Joshi P, Bavdekar SB, Save SU. A Swelling over Sternum in a Child: Reminder of an Uncommon Diagnosis. Case Rep Pediatr. 2016;2016:3765786.
9. Bohl JM, Janner D. Mycobacterium tuberculosis sternal osteomyelitis presenting as anterior chest wall mass. Pediatr Infect Dis J 1999; 18: 1028-9.
10. Kutty S, Bennett D, Devitt A, Dowling FE. Tuberculous osteomyelitis of the sternum in an infant: a case report and review of the literature. Pediatr Int. 2002 Apr;44(2):186-8.
11. Kato Y, Horikawa Y, Nishimura Y, Shimoda H, Shigeto E, Ueda K. Sternal tuberculosis in a 9-month-old infant after BCG vaccination. Acta Paediatr 2000;89:1495—7.
12. Carazo Gallego B, Moreno-Pérez D, Nuñez Cuadros E, Mesa Fernandez A, Martin Cantero M, Obando Pacheco P, Urda Cardona A. Paradoxical reaction in immunocompetent children with tuberculosis. Int J Infect Dis. 2016 Oct;51:15-18.
13. Bell LC, Breen R, Miller RF, Noursadeghi M, Lipman M. Paradoxical reactions and immune reconstitution inflammatory syndrome in tuberculosis. Int J Infect Dis. 2015 Mar;32:39-45.
14. Wen H, Li P, Ma H, Lv G. Diagnostic accuracy of Xpert MTB/RIF assay for musculoskeletal tuberculosis: a meta-analysis. Infect Drug Resist. 2017 Sep 28;10:299-305.
15. Kumar A, Gupta D, Nagaraja SB, Singh V, Sethi GR, Prasad J; Indian Academy of Pediatric. Updated national guidelines for pediatric tuberculosis in India, 2012. Indian Pediatr. 2013 Mar;50(3):301-6.
16. Bains L, Lal P, Chand T, Gautam KK, Beg MY, Kumar P. Isolated primary cold abscess of the sternum: a case report. J Med Case Rep. 2019 Aug 25;13(1):267.

How to Cite this Article:  Basa VR, Thete R, Singhal T | Sternal Tuberculosis in an Infant: The Presenting Feature of Disseminated Disease | International Journal of Paediatric Orthopaedics | September- December 2021; 7(3): 42-45.

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Infantile Tuberculous Osteomyelitis of Proximal Tibia-Rare Occurrence: Case Report and Review of Literature

Volume 7 | Issue 3 | September-December 2021 | Page: 35-37 | Jamsheed T, John T John, Dileep S, Divya G

DOI-10.13107/ijpo.2021.v07i03.121

Authors: Jamsheed T DNB Ortho. [1], John T John MCH Ortho. [1], Dileep S DNB Ortho. [1], Divya G DNB Ortho [1]

[1] Department of Orthopedics, KMCT Medical College, Manassery, Calicut, Kerala, India.

Address of Correspondence
Dr Jamsheed T
Department of Orthopedics, KMCT Medical College, Manassery, Calicut, Kerala, India.
E-mail: jamsheedthottiyan@gmail.com

Abstract

Skeletal tuberculosis (TB) is uncommon compared to pulmonary tuberculosis, representing 1 – 3% of all cases. Of these, the spine and hips are more involved. Solitary bone tuberculosis is a rare condition in infancy, has non-specific findings and can be misdiagnosed easily.
In our case report, we present tuberculosis osteomyelitis of the proximal tibia in a boy aged nine months who visited our outpatient department with painless swelling in the right leg. Diagnosis was done with radiographs, magnetic resonance imaging (MRI), open biopsy and TB-Polymerase Chain Reaction (PCR). The lesion was managed with debridement and curettage and 9 months of antitubercular chemotherapy.
Bone tuberculosis must be considered in the differential diagnosis of lytic lesions of the proximal tibial metaphysis in infancy.
Keywords: Skeletal tuberculosis, Solitary bone tuberculosis, Tuberculous osteomyelitis, Proximal tibia metaphysis

References

1. Rasool MN. Osseous manifestations of tuberculosis in children. J Pediatr Orthop. 2001;21:749–55.
2. Agarwal A, Qureshi NA, Khan SA, Kumar P, Samaiya S. Tuberculosis of the foot and ankle in children. J Orthop Surg (Hong Kong) 2011;19:213–7.
3. Scott ML, Robert EL, Catherine NP. Cortical Lesions of the Tibia: Characteristic Appearances at Conventional Radiography. RadioGraphics 2003 23:1,157-77.
4. Malik S, Joshi S, Tank JS. Cystic bone tuberculosis in children-a case series. Indian J Tuberc. 2009;56:220–4.
5. Kao HK, Yang WE, Shih HN, Chang CH. Physeal change after tuberculous osteomyelitis of the long bone in children. Chang Gung Med J. 2010; 33(4):453-60.
6. Morris BS, Varma R, Gang A et al. Multifocal musculoskeletal tuberculosis in children: appearances on computed tomography. Skeletal Radiol 2002; 31:1-8.
7. Teo HEL, Peh WCG. Skeletal tuberculosis in children. Pediatric Radiol 2004; 34:853-60.
8. Vohra R, Kang HS, Dogra S, Saggar RR, Sharma R. Tuberculosis osteomyelitis. J Bone Joint Surg [Br] 1997; 79:562-66.
9. Vallejo JG, Ong LT, Starke JR. Tuberculous osteomyelitis of the long bones in children. Paediatr Infect Dis J 1995; 14:524-26.
10. Martini M, Adjrad A, Boudjemaa A. Tuberculous osteomyelitis. A review of 125 cases. Int Orthop. 1986; 10:201–7.
11. Chen SC, Huang SC, Wu CT. Non-spinal TB osteomyelitis in children. J Formos Med Assoc 1998; 97(1):26-31.
12. Hosalkar HS, Agrawal N, Reddy S, Sehgal K, Fox EJ, Hill RA. Skeletal tuberculosis in children in the Western world: 18 new cases with a review of the literature. J Child Orthop 2009; 3(4):319-24.
13. Gunasekera TMR, Karunathilake DH, Jayaweera KAHM. A rare presentation of tuberculous osteomyelitis in childhood. Sri Lanka J Child Health 2008; 37:61-62.
14. Monach PA, Daily JP, Rodriguez-Herrera G, Solomon DH. Tuberculous osteomyelitis presenting as shoulder pain. J Rheumatol 2003; 30(4):851-56.
15. Hiddema WB, Barnard BW, Bouaicha W, Hurter D, van der Linde GD, van der Westhuizen CA et al . Infantile tuberculous osteomyelitis of the proximal tibia involving the growth plate. SA orthop. j. 2012 ; 11( 3 ):84-87.

How to Cite this Article:  Jamsheed T, John T John, Dileep S, Divya G | Infantile Tuberculous Osteomyelitis of Proximal Tibia-Rare Occurrence: Case Report and Review of Literature | International Journal of Paediatric Orthopaedics | September-December 2021; 7(3): 35-37.

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Walking Age of Infants Treated with Ponseti Method for Idiopathic Clubfoot

Volume 7 | Issue 3 | September-December 2021 | Page: 08-12 | Devashis Barick, Nilesh Joshi, Nikhil Tiwari, Amit Nemade, Ameya Sawarkar

DOI-10.13107/ijpo.2021.v07i03.115

Authors: Devashis Barick MS Ortho. [1], Nilesh Joshi MS Ortho. [1], Nikhil Tiwari MS Ortho. [1], Amit Nemade MS Ortho. [1], Ameya Sawarkar MS Ortho. [1]

[1] Department of Orthopaedics, NKP SIMS & RC, Nagpur, Maharashtra, India.

Address of Correspondence
Dr Amit Nemade
Assistant Professor, Department of Orthopaedics, NKP SIMS & RC, Nagpur, Maharashtra, India.
E-mail: kidsorth@gmail.com

Abstract

Aim- Parents of children affected with idiopathic clubfoot are anxious that motor development should progress normally. Treatment using Ponseti Method involves cast immobilization, bracing and tenotomy which inhibit the normal movement thereby increasing parental concern. The purpose of this study was to evaluate age at which independent walking was established in infants with idiopathic clubfoot treated using Ponseti method.
Materials & Methods- There were 70 patients in this prospective longitudinal study. All subjects were full term at birth, less than 12 weeks of age at the initiation of treatment for clubfoot and no prior outside treatment had been provided. Patients were treated using the Ponseti method. The children were evaluated prospectively for the commencement of independent walking.
Results- The mean age at which independent walking started was 13.64 + 2.74 months (9 months-22 months). Fifty percent of the affected children were walking by the age of 14 months. Children with relapse walked later by 2.8 months (p=0.017). Children with a family history walked at 11.7 months (p=0.049) which was significantly earlier than the patients without a family history. Other variables had no significant influence on walking age.
Conclusion- A delay of 1.5 months in independent walking age is expected in children with idiopathic clubfoot, which is helpful while counselling the parents at the start of treatment. Relapse during treatment delays walking age further.
Keywords: CTEV, Motor milestone, Independent walking.

References

1. Bacino CA, Hecht JT. Etiopathogenesis of equinovarus foot malformations. Eur J Med Genet [Internet]. 2014;57(8):473–9. Available from: http://dx.doi.org/10.1016/j.ejmg.2014.06.001
2. Dobbs MB, Gurnett CA. Update on clubfoot: Etiology and treatment. Clin Orthop Relat Res. 2009;467(5):1146–53.
3. Ponseti I, Smoley E. Congenital Club Foot: The Results of Treatment. J Bone Jt Surg. 1963;45(2):261–344.
4. Sala DA, Chu A, Lehman WB, Van Bosse HJP. Achievement of gross motor milestones in children with idiopathic clubfoot treated with the Ponseti method. J Pediatr Orthop. 2013;33(1):55–8.
5. Andriesse H, Westbom L, Hägglund G. Motor ability in children treated for idiopathic clubfoot. A controlled pilot study. BMC Pediatr. 2009;9(December).
6. Garcia NL, McMulkin ML, Tompkins BJ, Caskey PM, Mader SL, Baird GO. Gross motor development in babies with treated idiopathic clubfoot. Pediatr Phys Ther. 2011;23(4):347–52.
7. Hughes K, Gelfer Y, Cokljat M, Wientroub S, Yavor A, Hemo Y, et al. Does idiopathic congenital talipes equinovarus have an impact on attainment of developmental milestones? A multicentre international study. J Child Orthop. 2019;13(4):353–60.
8. Zionts LE, Packer DF, Cooper S, Ebramzadeh E, Sangiorgio S. Walking age of infants with idiopathic clubfoot treated using the ponseti method. J Bone Jt Surg – Am Vol. 2014;96(19):e164.
9. Dillmann J, Schwarzer G, Peterlein CD. Motor and cognitive functioning in children treated for idiopathic clubfoot at the age of 3 years. BMC Pediatr. 2019;19(1):4–9.
10. Zapata KA, Karol LA, Jeans KA, Jo CH. Gross Motor Function at 10 Years of Age in Children with Clubfoot Following the French Physical Therapy Method and the Ponseti Technique. J Pediatr Orthop. 2018;38(9):e519–23.
11. Kenmoku T, Kamegaya M, Saisu T, Ochiai N, Iwakura N, Iwase D, et al. Athletic ability of school-age children after satisfactory treatment of congenital clubfoot. J Pediatr Orthop. 2013;33(3):321–5.
12. Aulie VS, Halvorsen VB, Brox JI. Motor abilities in 182 children treated for idiopathic clubfoot: A comparison between the traditional and the ponseti method and controls. J Child Orthop. 2018;12(4):383–9.
13. Gundawar CS, Desai SS, Borkar SS, Ranade A, Patel S, Oswal A V. Prospective Study of Gross Motor Milestones in Children with Severe Idiopathic Clubfoot Treated by Ponseti Method. Indian J Orthop [Internet]. 2021;55(1):183–7. Available from: https://doi.org/10.1007/s43465-020-00214-3
14. Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Jt Surg – Ser B. 2006;88(8):1082–4.
15. Bhaskar A, Patni P. Classification of relapse pattern in clubfoot treated with Ponseti technique. Indian J Orthop. 2013;47(4):370–6.
16. Zanardi A, Fortini V, N. Abati C, Bettuzzi C, Salvatori G, Prato E, et al. Standing and walking age in children with idiopathic clubfoot: French physiotherapy versus ponseti method. J Child Orthop. 2019;13(5):471–7.
17. Capute AJ, Shapiro BK, Palmer FB, Ross A, Wachtel RC. Normal Gross Motor Development: the Influences of Race, Sex and Socio‐Economic Status. Dev Med Child Neurol. 1985;27(5):635–43.
18. Davis BE, Moon RY, Sachs HC, Ottolini MC. Effects of sleep position on infant motor development. Pediatrics. 1998;102(5):1135–40.
19. De Onis M. WHO Motor Development Study: Windows of achievement for six gross motor development milestones. Acta Paediatr Int J Paediatr. 2006;95(SUPPL. 450):86–95.
20. Prudham GND. Norms for Four Standard Developmental Milestones by Sex, Social Class and Place in Family. Dev Med Child Neurol. 1969;11(4):413–22.
21. Lööf E, Andriesse H, André M, Böhm S, Iversen MD, Broström EW. Gross Motor Skills in Children with Idiopathic Clubfoot and the Association between Gross Motor Skills, Foot Involvement, Gait, and Foot Motion. J Pediatr Orthop. 2019;39(7):359–65.
22. Karol LA, Jeans KA, Kaipus KA. The Relationship Between Gait , Gross Motor Function , and Parental Perceived Outcome in Children With Clubfeet. J Pediatr Orthop. 2016;36(2):145–51.
23. Majnemer A, Rosenblatt B. Reliability of parental recall of developmental milestones. Pediatr Neurol. 1994;10(4):304–8.

How to Cite this Article:  Barick D, Joshi N, Tiwari N, Nemade A, Sawarkar A Walking | Age of Infants Treated with Ponseti Method for Idiopathic Clubfoot | International Journal of Paediatric Orthopaedics | September-December 2021; 7(3): 08-12.

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Dysosteosclerosis – A Rare Sclerosing Bone Dysplasia

Volume 7 | Issue 3 | September-December 2021 | Page: 26-28 | Akanksha Parikh, Vikas Basa

DOI-10.13107/ijpo.2021.v07i03.119

Authors: Akanksha Parikh MD DNB Paediatrics [1], Vikas Basa DNB Ortho. [2]

[1] Department of Paediatrics, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.

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Address of Correspondence
Dr Akanksha Parikh
Consultant Paediatric & Adolescent Endocrinology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.
E-mail: gandhi.akanksha@gmail.com

Abstract

Dysosteosclerosis (DOS) is a rare inherited sclerosing bone disorder caused by lack of osteoclast differentiation. A nine-month-old infant presented with a past history of pathological fracture, developmental delay and facial dysmorphisms. The sclerotic radiographic changes along with histologically observed increased bone deposition on clavicular bone biopsy led to the initial suspicion of osteopetrosis. However, a genetic analysis revealed a mutation in the SLC29A3 gene confirming the diagnosis of DOS. Due to the close clinical and radiological resemblance most infants with DOS are misdiagnosed as osteopetrosis, a related skeletal dysplasia. The presence of purplish skin rash, platyspondyly on radiographs and absence of bone marrow involvement differentiates DOS from the latter. Treatment is supportive and overall prognosis is poor with the eventual neurological deterioration and recurrent fractures.
Keywords: Skeletal dysplasia, Osteopetrosis, Platyspondyly, SLC29A3

References

1. Kobayashi K, Goto Y, Kise H, Kanai H, Kodera K, Nishimura G et al. A case report of dysosteosclerosis observed from the prenatal period. Clin Pediatr Endocrinol 2010;19:57-62.
2. Campeau PM, Lu JT, Sule G, Jiang MM, Bae Y, Madan S et al. Whole-exome sequencing identifies mutations in the nucleoside transporter gene SLC29A3 in dysosteosclerosis, a form of osteopetrosis. Hum Mol Genet 2012 Nov 15;2:4904-9.
3. Noavar S, Behroozi S, Tatarcheh T, Parvini F, Foroutan M, Fahimi H. A novel homozygous frame-shift mutation in the SLC29A3 gene: A new case report and review of literature. BMC Med Gen 2019;20:147.
4. Boudin E, Van Hul W. Sclerosing bone dysplasias. Best Pract Res Clin Endocrinol Metab 2018;32:707-23.
5. Howaldt A, Nampoothiri S, Quell LM, Ozden A, Fischer-Zirnsak B, Collet C et al. Sclerosing bone dysplasias with hallmarks of dysosteosclerosis in four patients carrying mutations in SLC29A3 and TCIRG1. Bone 2019;120:495-503.
6. Elcioglu NH, Vellodi A, Hall CM. Dysosteosclerosis: A report of three new cases and evolution of the radiological findings. J Med Genet 2002;39:603-7.

How to Cite this Article:  Parikh A, Basa V| Dysosteosclerosis – A Rare Sclerosing Bone Dysplasia | International Journal of Paediatric Orthopaedics | September- December 2021; 7(3): 26-28.

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Outcomes of Closed Reduction Percutaneous Pinning in Paediatric Supracondylar Humerus Fractures Using “Arm Board” Technique “

Volume 7 | Issue 3 | September-December 2021 | Page: 02-07 | Sandeep Patwardhan, Bismaya Sahoo, Vivek Sodhai, Parag Sancheti, Ashok Shyam, Mrunal Kodape
DOI-10.13107/ijpo.2021.v07i03.114

Authors: Sandeep Patwardhan MS Ortho. [1], Bismaya Sahoo MS Ortho. [1], Vivek Sodhai MS Ortho. [1], Parag Sancheti MS Ortho. [1], Ashok Shyam MS Ortho. [1, 2], Mrunal Kodape D. Ortho. [1]

[1] Department of Orthopaedic, Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
[2] Research department, Indian Orthopaedic Research Group, Thane [W], Maharashtra, India.

Address of Correspondence
Dr Bismaya Sahoo
Department of Orthopaedic, Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
E-mail: bismay.ltmc.bs@gmail.com

Abstract

Introduction: Closed reduction percutaneous pinning (CRPP) is the standard treatment for displaced supracondylar fractures of humerus (SCH) in children. The purpose of our study is to analyze the functional outcomes of percutaneous Kirschner wire fixation of SCH fractures in paediatric population using a novel “arm board” technique.
Materials and Methods: A prospective study was carried out between October 2015 to October 2017 which included 71 patients of SCH fracture. Outcome evaluation was performed using Flynn’s score and Skagg’s grading. Age, gender, type of fracture, position of k-wires and time to surgery were also recorded. All patients were followed up for a minimum period of one year
Results: 90% were graded as excellent, 8.5% good, 1.5% fair according to Flynn’s score. By Skagg’s grading there was no loss of reduction in any patient. There were no significant differences in the outcomes based on age, gender, type of fracture, position of k-wires and time to surgery.
Conclusion: Good functional outcomes can be achieved with the “arm board” technique irrespective of age, gender, type of fracture, duration between injury and procedure if satisfactory reduction of the fracture can be achieved. Our technique uses a simple, locally fabricated radiolucent arm board that can be adapted to any standard operating table. It is a novel and innovative method that is safe, effective and can be easily replicated by orthopedic surgeons managing paediatric fractures.
Level of evidence: Therapeutic, Level III
Keywords: “arm board” technique, closed reduction percutaneous pinning, Paediatric; Supracondylar humerus fracture

References

1. Lee BJ, Lee SR, Kim ST, et al (2011) Radiographic Outcomes after treatment of pediatric supracondylar humerus fractures using a treatment-based classification system. J Orthop Trauma. 2011 Jan;25(1):18-25 https://doi.org/10.1097/BOT.0b013e3181db7d70
2. Minkowitz B, Busch MT (1994) Supracondylar humerus fractures. Current trends and controversies. Orthop Clin North Am 1994 Oct;25(4):581-94
3. Scott J. Mubarak, Jon R. Davids. Closed Reduction and Percutaneous Pinning of Supracondylar Fractures of the Distal Humerus in the Child. In: The Elbow. Editor: Bernard F. Morey. LippincottWilliams& Wilkins. Pages 54-65.
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How to Cite this Article:  Patwardhan S, Sahoo B, Sodhai V, Sancheti P, Shyam A, Kodape M | Outcomes of Closed Reduction Percutaneous Pinning in Paediatric Supracondylar Humerus Fractures using “Arm Board” Technique ” | International Journal of Paediatric Orthopaedics | September- December 2021; 7(3): 02-07.

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