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Primary Subacute Osteomyelitis of Talus: An Unusual Presentation of a Limping Child

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 24-25 | Rajib Naskar, Balgovind S. Raja, Dhanish V. Mehendiratta, Pravin Jadhav, Harshad G. Argekar Authors : Rajib Naskar [1], Balgovind S. Raja [2], Dhanish V. Mehendiratta [1], Pravin Jadhav [1], Harshad G. Argekar [1]. [1] Department of Orthopaedics, LTMC &Sion Hospital, Sion, Mumbai, Maharashtra, India, […]

Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 12-15 | Samuel K. Van de Velde, Jack Pang, Lachlan Milne, Jitendra Balakumar Authors : Samuel K. Van de Velde [1], Jack Pang [1], Lachlan Milne [1], Jitendra Balakumar [1]. [1] Department of Orthopaedics, The Royal Children’s Hospital Melbourne, Parkville (VIC) 3052, Australia Address of Correspondence […]

Primary Subacute Osteomyelitis of Talus: An Unusual Presentation of a Limping Child

Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures

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Primary Subacute Osteomyelitis of Talus: An Unusual Presentation of a Limping Child

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 24-25 | Rajib Naskar, Balgovind S. Raja, Dhanish V. Mehendiratta, Pravin Jadhav, Harshad G. Argekar

Authors : Rajib Naskar [1], Balgovind S. Raja [2], Dhanish V. Mehendiratta [1], Pravin Jadhav [1], Harshad G. Argekar [1].

[1] Department of Orthopaedics, LTMC &Sion Hospital, Sion, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, K B Bhabha Municipal Hospital, Bandra, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Rajib Naskar,
Suite no.115, College building, Sion hospital, Dr. Ambedkar Road Mumbai 400022
Email: dr.rajibnaskar@gmail.com

Abstract

A 9-year-old female presented with symptoms of limp and pain in the right ankle region along with swelling. Prominent systemic features of osteomyelitis were lacking. The delay in diagnosis from limping to diagnosis confirmation and hospital admission was 6 days. The final diagnosiswas made after adetailed radiological investigation and open sampling and curettage. It was the treated conservatively, and after 6 weeks of treatment, radiological improvement was noted. We conclude that, in a limping child with ankle pain, subacute osteomyelitis of talus should be kept in mind as a differential and it can be successfully treated in outpatient basis with conservative management.
Keywords: Osteomyelitis, Talus, Children, Ankle pain.

References

1. Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004;364(9431):369-379.
2. Krogstad P. Osteomyelitis. In: Feigin RD, Cherry JD, Demmler-Harrison GD, Kaplan SL, editors. Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA, USA: Saunders Elsevier; 2009. p. 725-742

How to Cite this Article: Naskar R, Raja B S, Mehendiratta D V, Jadhav P, Argekar H G. Primary Subacute Osteomyelitis of Talus: An Unusual Presentation of a Limping Child. International Journal of Paediatric Orthopaedics Jan-Jun 2017;3(1):24-25.

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Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 12-15 | Samuel K. Van de Velde, Jack Pang, Lachlan Milne, Jitendra Balakumar

Authors : Samuel K. Van de Velde [1], Jack Pang [1], Lachlan Milne [1], Jitendra Balakumar [1].

[1] Department of Orthopaedics, The Royal Children’s Hospital Melbourne, Parkville (VIC) 3052, Australia

Address of Correspondence
Dr. Samuel K. Van de Velde,
Department of Orthopaedics, The Royal Children’s Hospital Melbourne
50 Flemington Road, Parkville (VIC) 3052, Australia
Email : svandevelde@post.harvard.edu

Abstract

Purpose: Femoral neck fractures in children are rare injuries which are associated with a high incidence of osteonecrosis of the femoral head. We aimed to determine the predictive accuracy of bone scintigraphy for femoral head osteonecrosis after pediatric femoral neck fractures.
Materials and Methods: Thirteen scintigrams were performed in 10 children (6–15 years) at diverse moments after fixation of a femoral neck fracture.The results of the bone scintigrams were compared with the hip radiographs at final follow-up.
Results: Eight of the 10 femoral heads eventually developed osteonecrosis. Scintigrams performed within 2 weeks showed decreased uptake for these heads. However,four of the five scans that were performed more than 1 month after surgery showed normal uptake despite the subsequent collapse of these femoral heads.
Conclusions: Bone scintigraphy has a very low accuracy in predicting compromised vascularity of the femoral head when performed more than 1month after surgery of a femoral neck fracture in children. This findingquestions the value of scintigraphy performed late in the follow-up of pediatric femoral neck fractures.
Level of Evidence: Level IV.
Keywords: Pediatric Hip Fracture; Bone Scan; Outcome

References

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2. Moon ES, Mehlman CT. Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. J Orthop Trauma 2006;20:323-9.
3. Kim HK, Aruwajoye O, Stetler J, Stall A. Effects of non-weight-bearing on the immature femoral head following ischemic osteonecrosis: An experimental investigation in immature pigs. J Bone Joint Surg Am 2012;94:2228-37.
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5. Arora A, Agarwal A, Sharma J. Outcomes in pediatric femoral neck fractures. Delhi J Orthop 2004;1:25-49.
6. Hajdu S, Oberleitner G, Schwendenwein E, Ringl H, Vécsei V. Fractures of the head and neck of the femur in children: An outcome study. Int Orthop 2011;35:883-8.
7. Bali K, Sudesh P, Patel S, Kumar V, Saini U, Dhillon MS. Pediatric femoral neck fractures: Our 10 years of experience. Clin Orthop Surg 2011;3:302-8.
8. Shrader MW, Jacofsky DJ, Stans AA, Shaughnessy WJ, Haidukewych GJ. Femoral neck fractures in pediatric patients: 30 years experience at a level 1 trauma center. Clin Orthop Relat Res 2007;454:169-73.
9. Kaushik A, Sankaran B, Varghese M. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures. Eur J Radiol 2010;75:364-75.
10. Pierce TP, Jauregui JJ, Cherian JJ, Elmallah RK, Mont MA. Imaging evaluation of patients with osteonecrosis of the femoral head. Curr Rev Musculoskelet Med 2015;8:221-7.
11. Bauer G, Weber DA, Ceder L, Darte L, Egund N, Hansson LI, et al. Dynamics of Technetium-99m methylenediphosphonate imaging of the femoral head after hip fracture. Clin Orthop Relat Res 1980;152:85-92.
12. D’Ambrosia RD, Shoji H, Riggins RS, Stadalnik RC, DeNardo GL. Scintigraphy in the diagnosis of osteonecrosis. Clin Orthop Relat Res 1978;130:139-43.
13. Alberts KA, Dahlborn M, Ringertz H. Sequential scintimetry after femoral neck fracture. Methodologic aspects and prediction of healing complications. Acta Orthop Scand 1987;58:217-22.
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16. Juréus J, Geijer M, Tiderius CJ, Tägil M. Vascular evaluation after cervical hip fractures in children: A case series of eight children examined by scintigraphy after surgery for cervical hip fracture and evaluated for development of secondary radiological changes. J Pediatr Orthop B 2016;25:17-23.
17. Mortensson W, Rosenborg M, Gretzer H. The role of bone scintigraphy in predicting femoral head collapse following cervical fractures in children. Acta Radiol 1990;31:291-2.
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How to Cite this Article: Van de Velde SK, Pang J, Milne L, Balakumar J.Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures. International Journal of Paediatric Orthopaedics Jan-June 2017;3(1):12-15.

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Primary Subacute Osteomyelitis of Talus: An Unusual Presentation of a Limping Child

Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures

Primary Subacute Osteomyelitis of Talus: An Unusual Presentation of a Limping Child

Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures

Full Sized Blog Element (Big Preview Pic)

Primary Subacute Osteomyelitis of Talus: An Unusual Presentation of a Limping Child

Authors : Rajib Naskar [1], Balgovind S. Raja [2], Dhanish V. Mehendiratta [1], Pravin Jadhav [1], Harshad G. Argekar [1].

Abstract

References

(Abstract) (Full Text HTML) (Download PDF)

Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures

Authors : Samuel K. Van de Velde [1], Jack Pang [1], Lachlan Milne [1], Jitendra Balakumar [1].

Abstract

References

(Abstract) (Full Text HTML) (Download PDF)

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