Blog Elements - International Journal of Paediatric Orthopaedics

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Bimodal Presentation of Septic Shoulder as Shoulder Dislocation in Children

Volume 9 | Issue 2 | May-August 2023 | Page: 02-05 | Md. Rakibul Hassan, Qaisur Rabbi, Ayesha Hasina, Mehedi Hasan, Mahfoozur Rahman DOI- https://doi.org/10.13107/ijpo.2023.v09.i02.163 Submitted: 21/11/2022; Reviewed: 20/12/2022; Accepted: 15/06/2023; Published: 10/08/2023 Authors: Md. Rakibul Hassan D-Ortho, MRCS (UK) [1], Qaisur Rabbi D-Ortho [2], Ayesha Hasina FCPS (Paed), MD (Paed), MCPS (Paed) [3], Mehedi […]

Management of Paediatric Monteggia Variant Fracture – Our Experience of Two Similar Cases

Volume 9 | Issue 2 | May-August 2023 | Page: 30-33 | Ramani Narasimhan, Vaibhav Gautam DOI- https://doi.org/10.13107/ijpo.2023.v09.i02.169 Submitted: 13/05/2023; Reviewed: 09/06/2023; Accepted: 21/07/2023; Published: 10/08/2023 Authors: Ramani Narasimhan MS Ortho Fellow Paediatric Orthopaedic Surgey (USA) , Vaibhav Gautam MS Ortho [1] Department of Paediatric Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India. Address of Correspondence […]

Bimodal Presentation of Septic Shoulder as Shoulder Dislocation in Children

Management of Paediatric Monteggia Variant Fracture – Our Experience of Two Similar Cases

Full Sized Blog Element (Big Preview Pic)

Bimodal Presentation of Septic Shoulder as Shoulder Dislocation in Children

Volume 9 | Issue 2 | May-August 2023 | Page: 02-05 | Md. Rakibul Hassan, Qaisur Rabbi, Ayesha Hasina, Mehedi Hasan, Mahfoozur Rahman

DOI- https://doi.org/10.13107/ijpo.2023.v09.i02.163

Submitted: 21/11/2022; Reviewed: 20/12/2022; Accepted: 15/06/2023; Published: 10/08/2023

Authors: Md. Rakibul Hassan D-Ortho, MRCS (UK) [1], Qaisur Rabbi D-Ortho [2], Ayesha Hasina FCPS (Paed), MD (Paed), MCPS (Paed) [3], Mehedi Hasan MRCS (UK) [4], Mahfoozur Rahman D-Ortho [5]

[1] Department of Orthopaedics, Trauma & Spine Surgery Unit, Sheikh Fazilatunnessa Mujib Memorial KPJ Specialized Hospital, Gazipur, Dhaka, Bangladesh.
[2] Department of Pediatric Orthopaedics, Centre of Rehabilitation for Paralyzed, Savar & Mirpur-14, Dhaka, Bangladesh.
[3] Department of Paediatric & Neonatology, Sheikh Fazilatunnessa Mujib Memorial KPJ Specialized Hospital, Gazipur, Dhaka, Bangladesh.
[4] Department of Orthopaedics, Ahsania Mission Cancer Hospital, Dhaka, Bangladesh.
[5] Department of Trauma & Paediatric Orthopaedics, Eastern Medical Collage & Hospital, Cumilla, Bangladesh.

Address of Correspondence

Dr. Md. Rakibul Hassan,
Consultant, Department of Orthopaedics, Trauma & Spine Surgery, Sheikh Fazilatunnessa Mujib Memorial KPJ Specialized Hospital, Gazipur, Dhaka, Bangladesh.
E-mail: rimon.rakibulhassan@gmail.com

Abstract

Introduction: The presence of a largely cartilaginous humeral head in children makes it difficult to diagnose septic arthritis of the shoulder.
Patients and methods: We conducted a case note review of five patients who presented with septic arthritis of shoulder joint.
Results: The age of the affected children ranged from 6 months to 10 years. Patients presented on average after 22 days from onset of symptoms. Staphylococcus aureus and Pseudomonas aeruginosa were obtained on pus culture. All cases were treated operatively by arthrotomy and drainage along with appropriate antibiotic administration for a period of 6 weeks.
Conclusion: Successful treatment of septic arthritis of the shoulder was achieved in all cases. At an average follow-up of 6 months, good outcome was noted with restoration of full range of shoulder movements.
Keywords: Septic shoulder, Children, Shoulder dislocation

References

1.Saavedra J, Falup-Pecurariu O & Faust Set al. ESPID bone and joint infection guidelines, 2017. https://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/INF/C/INF_36_8_2017_05_10_SAAVEDRA_217-327_SDC1.pdf (date last accessed 25 November 2020 ).
2.Montgomery NI, Epps HR. Pediatric septic arthritis. Orthop Clin North Am 2017; 48:209–216 .
3.Arnold JC, Bradley JS. Osteoarticular infections in children. Infect Dis Clin North Am 2015; 29:557–574 .
4.Krogstad P. Osteomyelitis and septic arthritis. In: Feigin RD, Cherry JD, editors. Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA: Saunders; 2009:725–748.
5. Lejman T., Strong M., Michno P., Hayman M. Septic arthritis of the shoulder during the first 18 months of life. Journal of Pediatric Orthopaedics. 1995;15(2):172–175. doi: 10.1097/01241398-199503000-00008.
6. Perlman M. H., Patzakis M. J., Kumar P. J., Holtom P. The incidence of joint involvement with adjacent osteomyelitis in pediatric patients. Journal of Pediatric Orthopaedics. 2000;20(1):40–43. doi: 10.1097/00004694-200001000-00009.
7. Melville J. M., Moss T. J. M. The immune consequences of preterm birth. Frontiers in Neuroscience. 2013;7, article 79 doi: 10.3389/fnins.2013.00079.
8. Ogden J. A. Pediatric osteomyelitis and septic arthritis: the pathology of neonatal disease. The Yale Journal of Biology and Medicine. 1979;52(5):423–448.
9. Sen E. S., Clarke S. L. N., Ramanan A. V. The child with joint pain in primary care. Best Practice & Research: Clinical Rheumatology. 2014;28(6):888–906. doi: 10.1016/j.berh.2015.04.008.
10. Pääkkönen M., Kallio M. J. T., Kallio P. E., Peltola H. Sensitivity of erythrocyte sedimentation rate and C-reactive protein in childhood bone and joint infections. Clinical Orthopaedics and Related Research. 2010;468(3):861–866. doi: 10.1007/s11999-009-0936-1.
11. Belthur M. V., Palazzi D. L., Miller J. A., Phillips W. A., Weinberg J. A clinical analysis of shoulder and hip joint infections in children. Journal of Pediatric Orthopaedics. 2009;29(7):828–833. doi: 10.1097/BPO.0b013e3181b76a91.
12. Schallert E. K., Herman Kan J., Monsalve J., Zhang W., Bisset G. S., Rosenfeld S. Metaphyseal osteomyelitis in children: how often does MRI-documented joint effusion or epiphyseal extension of edema indicate coexisting septic arthritis? Pediatric Radiology. 2015:45 (8):1174–1181. doi: 10.1007/s00247-015-3293-0.
13. Volberg FM, Sumner TE, Abramson JS, Winchester PH. Unreliability of radiographic diagnosis of septic hip in children. Pediatrics 1984;73:118–20
14. Zamzam MM. The role of ultrasound in differentiating septic arthritis from transient synovitis of the hip in children. J Pediatr Orthop B 2006;15:418–22.
15. Gordon JE, Huang M, Dobbs M, et al. Causes of false-negative ultrasound scans in the diagnosis of septic arthritis of the hip in children. J Pediatr Orthop 2002;22:312–16.
16. Zawin JK, Hoffer FA, Rand FF, Teele RL. Joint effusion in children with an irritable hip: US diagnosis and aspiration. Radiology 1993;187:459–63.
17. Mazur JM, Ross G, Cummings J, Hahn GA Jr, McCluskey WP. Usefulness of magnetic resonance imaging for the diagnosis of acute musculoskeletal infections in children. J Pediatr Orthop 1995;15:144–7.
18. Gillespie R: septic arthritis of childhood. Clin Orthop 96:152-159. 1973
19. Griffin PP: Bone and joint infections in children. Pedi11tr Clin North Am 14:533-548. 1967
20. Lloyd-Roberts GC: Suppurative arthritis of infancy: Some observations upon prognosis and management. J Bone and Joi111 Surg [Br] 42:706-720. 1960
21. Morrey BF. Bianco AJ Jr. Rhodes RH: Septic arthritis in children. Ortho C/in North Am 6:923-934. 1975
22. Nelson JD: The bacterial etiology and antibiotic management of septic arthritis in infants and children. Pediatrics 50:437-440. 1972
23. Tuson CE, Hoffman EB, Mann MD. Isotope bone scanning for acute osteomyelitis and septic arthritis in children. J Bone Joint Surg [Br] 1994;76-B:306–10
24. Sundberg SB, Savage JP, Foster BK. Technetium phosphate bone scan in the diagnosis of septic arthritis in childhood. J Pediatr Orthop 1989;9:579–85
25. Bos CF, Mol LJ, Obermann WR, Tjin a Ton ER. Late sequelae of neonatal septic arthritis of the shoulder. J Bone Joint Surg Br 1998; 80:645–650.
26. Ernat J, Riccio AI, Fitzpatrick K, Jo C, Wimberly RL. Osteomyelitis is commonly associated with septic arthritis of the shoulder in children. J Pediatr Orthop 2017; 37:547–552
27. Xu G, Spoerri M, Rutz E. Surgical treatment options for septic arthritis of the hip in children. Afr J Paediatr Surg 2016; 13:1–5.

How to Cite this Article: Hassan MR, Rabbi Q, Hasina A, Hasan M, Rahman M | Bimodal Presentation of Septic Shoulder as Shoulder Dislocation in Children | International Journal of Paediatric Orthopaedics | May-August 2023; 9(2): 02-05 | https://doi.org/10.13107/ijpo.2023.v09.i02.163

(Article Text HTML) (Full Text PDF)

Management of Paediatric Monteggia Variant Fracture – Our Experience of Two Similar Cases

Volume 9 | Issue 2 | May-August 2023 | Page: 30-33 | Ramani Narasimhan, Vaibhav Gautam

DOI- https://doi.org/10.13107/ijpo.2023.v09.i02.169

Submitted: 13/05/2023; Reviewed: 09/06/2023; Accepted: 21/07/2023; Published: 10/08/2023

Authors: Ramani Narasimhan MS Ortho Fellow Paediatric Orthopaedic Surgey (USA) , Vaibhav Gautam MS Ortho

[1] Department of Paediatric Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India.

Address of Correspondence

Dr. Vaibhav Gautam,
Department of Paediatric Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India.
E-mail: vaibhavgtm1@gmail.com

Abstract

Introduction: The common mechanism of injury for Monteggia fracture is fall on outstretched hand with elbow extended and forearm in pronation causing a proximal fracture of ulna with dislocation of radial head. Monteggia injuries were classified by Bado into 4 sub-types based on the direction of displacement of the radial head and the presence of associated fracture (type 1 with anterior dislocation of radial head being most common). We managed two cases of Monteggia type 1 variant injury consisting of a fracture of the radial neck and anterior displacement of distal radial shaft without dislocation of the radiocapitellar joint.
Case report: We operated two children (5 and 9 years old respectively) with this Monteggia variant injury; displaced ulna shaft fracture with volar angulation, and fracture neck radius with anterior displacement of radial shaft. Ulna fracture was fixed by elastic nailing and radial neck fracture was managed by closed means (with or without fixation). At final follow up (2 and 7 years later respectively), both the children had excellent outcomes with good range of pronation and supination movements.
Conclusion: In the management of Monteggia equivalent lesions, an understanding of the direction of displacement of radial shaft will help in formulating the appropriate method of fracture reduction. Closed reduction of the radial neck fracture is preferred since the results of open reduction are poor especially in terms of regaining pronation and supination movements.
Keywords: Monteggia, Forearm fracture, Monteggia variant

References

1. Shah AS, Waters PM. Monteggia fracture-dislocation in children. In: Flynn JM, Skaggs DL, Waters PM, editors. Rockwood and Wilkins’: Fractures in Children. Philadelphia, PA: Wolters Kluwer (2014). p. 527–63.
2. Evans EM. “Pronation injuries of the forearm, with special reference to the anterior Monteggia fracture.” The Journal of bone and joint surgery. British volume vol. 31B,4 (1949): 578-88, illust.
3. Bado, José Luis. “The Monteggia Lesion.” Clinical Orthopaedics and Related Research (1976-2007) 50 (1967): 71-86.
4. Salter, Robert Bruce and W. Robert Harris. “Injuries Involving the Epiphyseal Plate.” Journal of Bone and Joint Surgery, American Volume 45 (1963): 587-622.
5. Cepela, Daniel J et al. “Classifications In Brief: Salter-Harris Classification of Pediatric Physeal Fractures.” Clinical orthopaedics and related research vol. 474,11 (2016): 2531-2537. doi:10.1007/s11999-016-4891-3
6. Güven, Melih et al. “Cocuklardaki Monteggia eşdeğer lezyonlarinda tedavi sonuçlari” [The results of treatment in pediatric Monteggia equivalent lesions]. Explore when to use sildenafil for your health needs. Discover the generic option for Viagra in sildenafil tablets. Find more information on safe usage and benefits at https://www.treasurevalleyhospice.com/how-long-does-50mg-viagra-stay-in-your-system.pdf Empower your health decisions today. Acta orthopaedica et traumatologica turcica vol. 42,2 (2008): 90-6.
7. Alrashidi, Yousef. “A Monteggia variant associated with unusual fracture of radial head in a young child: A case report.” International journal of surgery case reports vol. 78 (2021): 42-47. doi:10.1016/j.ijscr.2020.11.142
8. Silva, Rómulo & Pinto, Luis & Fernandes, José & Costa, Francisca & Freitas, Joana & Coutinho, Jorge. (2022). A Rare Pediatric Monteggia Equivalent Fracture: Case Report, Literature Review and a New Proposed Pediatric Bado Classification. Case Reports in Clinical Practice. 7. 10.18502/crcp.v7i1.9630.
9. Li, Ming-Lei et al. “Monteggia type-I equivalent fracture in a fourteen-month-old child: A case report.” World journal of clinical cases vol. 9,30 (2021): 9228-9235. doi:10.12998/wjcc.v9.i30.9228
10. Younus, A., N. Ncobela, and A. Kelly. “New Bado Type IV Monteggia fracture dislocation variant occurring in a child: a case report.” East African Orthopaedic Journal 13.2 (2019): 88-91.
11. ElKhouly, Amr et al. “The Monteggia Fracture: literature review and report of a new variant.” Journal of orthopaedic case reports vol. 8,4 (2018): 78-81. doi:10.13107/jocr.2250-0685.1170
12. Olney, B W, and M B Menelaus. “Monteggia and equivalent lesions in childhood.” Journal of pediatric orthopedics vol. 9,2 (1989): 219-23.
13. Čepelík, M., et al. “Monteggia lesion and its equivalents in children.” Journal of Children’s Orthopaedics 13.6 (2019): 560-568.
14. Xu L, Ye W, Li H, et al Monteggia equivalent lesion in children: a narrative review World Journal of Pediatric Surgery 2021;4:e000283. doi: 10.1136/wjps-2021-000283
15. Falciglia, Francesco et al. “Radial neck fractures in children: results when open reduction is indicated.” Journal of pediatric orthopedics vol. 34,8 (2014): 756-62. doi:10.1097/BPO.0000000000000299
16. J.H. Newman, Displaced radial neck fractures in children, Injury, Volume 9, Issue 2, 1977, Pages 114-121, ISSN 0020-1383, https://doi.org/10.1016/0020-1383(77)90004-3.

How to Cite this Article: Narasimhan R, Gautam V | Management of Paediatric Monteggia Variant Fracture – Our Experience of Two Similar Cases| International Journal of Paediatric Orthopaedics | May-August 2023; 9(2): 30-33 | https://doi.org/10.13107/ijpo.2023.v09.i02.169

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Bimodal Presentation of Septic Shoulder as Shoulder Dislocation in Children

Management of Paediatric Monteggia Variant Fracture – Our Experience of Two Similar Cases

Bimodal Presentation of Septic Shoulder as Shoulder Dislocation in Children

Management of Paediatric Monteggia Variant Fracture – Our Experience of Two Similar Cases

Full Sized Blog Element (Big Preview Pic)

Bimodal Presentation of Septic Shoulder as Shoulder Dislocation in Children

Abstract

(Article Text HTML) (Full Text PDF)

Management of Paediatric Monteggia Variant Fracture – Our Experience of Two Similar Cases

Abstract

(Article Text HTML) (Full Text PDF)

License

Publisher