Teratologic Hip Dislocations : Controversies and Consensus

Volume 6 | Issue 2 | May-August 2020 | Page: 33-38 | Sukalyan Dey, Prerana Gogoi, Rupjyoti Gogoi, Tofile Ahmed, Roopak Patel, Diganta Phukan

Authors: Sukalyan Dey [1], Prerana Gogoi [2], Rupjyoti Gogoi [3], Tofile Ahmed [4], Roopak Patel [4], Diganta Phukan [4]

[1] Department of Orthopaedics, Fakhruddin Ali Ahmed Medical College, Barpeta, Assam, India.
[2] Resident Medical Officer, Pratiksha Hospital, Guwahati
[3] Consultant Orthopedic Surgeon, Gauhati Neurological Research Center, Six Mile, Guwahati
[4] Department of Orthopaedics, CORAS Pratiksha Hospital, Guwahati.

Address of Correspondence
Dr. Sukalyan Dey,
Department of Orthopaedics, Fakhruddin Ali Ahmed Medical College,
Barpeta, Assam, India.
E-mail: sukalyan.gmch@gmail.com

Abstract

Background: The optimal management for untreated developmental dysplasia of the hip (DDH) after walking age remains controversial.
Methods: We retrospectively reviewed 80 DDH patients (85 hips) diagnosed at one through 3 years of age who underwent gradual reduction (GR) using overhead traction (OHT) with a mean follow-up of 8.2 years. We investigated radiological severity of DDH, successful reduction, avascular necrosis (AVN) of the femoral head, residual dysplasia, secondary procedures, and Severin classification. The data were compared between patients under (42 hips) and over (43 hips) 18 months of age at diagnosis.
Results: Eighty-three hips (98%) were successfully reduced by OHT. Three hips (4%) re-dislocated later and needed closed reduction or open reduction with Salter osteotomy. No AVN occurred during follow-up. Sixty-eight hips were observed without further treatment beyond 5 years of age, of which 52 (76%) remained acetabular dysplasia and 47 (69%) underwent Salter osteotomy with or without femoral osteotomy. We could finally evaluate 69 hips using Severin classification, and 52 (75%) were classified in Group I, 10 (14%) in Group II, and seven (10%) in Group III. Radiological severity of DDH at diagnosis was the only significant variable between the groups: High hip dislocation was more frequently observed in the older age group (p = 0.0131).
Conclusions: GR using OHT is a beneficial initial treatment with a high reduction rate and a low incidence of complications for DDH after walking age, from 1 to 3 years of age. Salter osteotomy performed during preschool ages can provide a satisfactory mid-term outcome for hips with residual acetabular dysplasia after OHT.
Level of Evidence: Therapeutic studies, level IV (case series).
Keywords: Developmental dysplasia of the hip; Walking age; Gradual reduction; Overhead traction; Salter innominate osteotomy.

References 

1. Katz JF. Teratological hip dislocation. Isr J Med Sci 1980;16:238-44.
2. LeBel ME, Gallien R. The surgical treatment of teratologic dislocation of the hip. J Pediatr Orthop B 2005;14:331-6.
3. Aaro S, Gottfries B, Kraepelien T, Troell S. Teratologic congenital dislocation of the hip. Report of two cases. Acta Orthop Scand 1983;54:178-81.
4. Bamshad M, Jorde LB, Carey JC. A revised and extended classification of the distal arthrogryposes. Am J Med Genet 1996;65:277-81.
5. Hall JG. Arthrogryposis multiplex congenita: Etiology, genetics, classification, diagnostic approach, and general aspects. J Pediatr Orthop B 1997;6:159-66.
6. Stilli S, Antonioli D, Lampasi M, Donzelli O. Management of hip contractures and dislocations in arthrogryposis. Musculoskelet Surg 2012;96:17-21.
7. Gruel CR, Birch JG, Roach JW, Herring JA. Teratologic dislocation of the hip. J Pediatr Orthop 1986;6:693-702.
8. Hass J. Congenital Dislocation of the Hip. Illinois: Charles C Thomas Publisher; 1951.
9. Akazawa H, Oda K, Mitani S, Yoshitaka T, Asaumi K, Inoue H. Surgical management of hip dislocation in children with arthrogryposis multiplex congenita. J Bone Joint Surg Br 1998;80:636-40.
10. Horton WA, Rimoin DL, Lachman RS, Skovby F, Hollister DW, Spranger J, et al. The phenotypic variability of diastrophic dysplasia. J Pediatr 1978;93:609-13.
11. Coleman SS. Teratologic congenital dislocation. In: Congenital Dysplasia and Dislocation of the Hip. St. Louis, MO: CV Mosby; 1978. p. 249-56.
12. Friedlander HL, Westin GW, Wood WL Jr. Arthrogryposis multiplex congenita: A review of forty-five cases. J Bone Joint Surg Am 1968;50:89-112.
13. Gibson DA, Urs ND. Arthrogryposis multiplex congenita. J Bone Joint Surg Br 1970;52:483-93.
14. Drummond DS, Mackenzie DA. Scoliosis in arthrogryposis multiplex congenita. Spine (Phila Pa 1976) 1978;3:146-51.
15. Bernstein RM. Arthrogryposis and amyoplasia. J Am Acad Orthop Surg 2002;10:417-24.
16. Lloyd-Roberts GC, Lettin AW. Arthrogryposis multiplex congenita. J Bone Joint Surg Br 1970;52:494-508.
17. Staheli LT, Chew DE, Elliott JS, Mosca VS. Management of hip dislocations in children with arthrogryposis. J Pediatr Orthop 1987;7:681-5.
18. St Clair HS, Zimbler S. A plan of management and treatment results in the arthrogrypotic hip. Clin Orthop Relat Res 1985;194:74-80.
19. Huurman WW, Jacobsen ST. The hip in arthrogryposis multiplex congenita. Clin Orthop Relat Res 1985;194:81-6.
20. Williams P. The management of arthrogryposis. Orthop Clin North Am 1978;9:67-88.
21. Martin S, Tobias JD. Perioperative care of the child with arthrogryposis. Paediatr Anaesth 2006;16:31-7.
22. Bevan WP, Hall JG, Bamshad M, Staheli LT, Jaffe KM, Song K. Arthrogryposis multiplex congenita (amyoplasia): An orthopaedic perspective. J Pediatr Orthop 2007;27:594-600.

How to Cite this Article: Dey S, Gogoi P, Gogoi R, Ahmed T, Patel R, Phukan D | Teratologic Hip Dislocations: Controversies and Consensus | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 33-38.

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A Review of “Capture rate’’ Between Physicians and Care-giver Suspicion Leading to Diagnoses of Late-presenting DDH: A Single Centre perspective

Volume 6 | Issue 2 | May-August 2020 | Page: 7-11 | Atul Bhaskar, Purva Kansara

Authors : Atul Bhaskar [1][2], Purva Kansara [1]

[1] Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Atul Bhaskar,
Hon.Paediatric Orthopaedic Surgeon, Bombay Hospital Institute of Medical Sciences, Mumbai,
Maharashtra, India.
E-mail: arb_25@yahoo.com

Abstract

Background: The manifestations of DDH (Developmental Dysplasia of Hip) from newborn to walking age can go undetected due to several factors in the developing world. Lack of screening, reduced awareness amongst primary care physicians, socio-economic factors of family and access to healthcare facility. In many children the initial diagnosis is established only after an alert caregiver of physician notices suspicious asymmetry in gait pattern or limp.
The purpose of this review to compare the “capture’’ rate between physicians and caregivers suspicion that lead to the initial diagnosis of DDH and suggest strategies to enhance early detection of DDH.
Patient and Methods: A retrospective observational study was conducted between January 2002 and December 2018 at a single surgeon specialty centre in Mumbai, India. All children with a diagnosis of idiopathic DDH were included. Syndromic and teratologic hips were excluded. The data recorded from the charts included the following: birth history, mode and presentation of delivery, breech or normal, first born or later, age at initial presentation, demographic data, and whether hailing from urban or semi-urban and rural areas, and initial awareness by physician or caregiver. Any associated anomalies, and the side of involvement and surgical intervention was also recorded.
Results: The median age of diagnosis of DDH in the study was 22 months (one week-10 years) but in bilateral DDH it was 32 months (p<.0001). Physicians diagnosed DDH primarily in 37 children (28%) and 95 children (70.45%) were brought to the attention by caregivers especially in semi-urban and rural areas (p<0.001). Eighty-five children (64.39%) were diagnosed in the walking ages between 12 months – 48 months. Ninety-eight children (74.24%) in the entire study required surgical intervention mainly due to the late diagnosis made after infancy.
Conclusion: Delay in diagnosis of idiopathic DDH has significant implications both for surgeons, caregivers, and health care service providers. Any suspicious gait or limp in a child at walking age should alert investigation to rule out DDH.
Keywords: DDH; CAREGIVER; LIMP.

References 

1. Singh M, Sharma NK. Spectrum of congenital malformations in the newborn. Ind J Pediatr. 1980; 47: 239–244.
2. Sankar WN, Weiss J, Skaggs DL. Orthopaedic conditions in the newborn. J Am Acad Orthop Surg. 2009; 17(2): 112–122.
3. Gupta AK, Kumar S, Arora PL, et al. Hip instability in newborns in an urban community. Nat Med J India. 1992; 5: 269–272.
4. Kaushal V., Kaushal SP., Bhakoo ON. Congenital dysplasia of the hip in Northern India. Int Surg. 1976; 61: 29.
5. Rebello G, Joseph B. Late presentation of Developmental Dysplasia of the Hip in children from southwest India – will screening help. Ind J Orthop, 2003; 37(4): 210-14.
6. Kocher MS. Ultrasonographic screening for developmental dysplasia of the hip: an epidemiologic analysis (Part I) Am J Orthop. 2000; 29(12): 929–33.
7. Graf R, Tschauner C, Klapsch W. Progress in prevention of late developmental dislocation of the hip by sonographic newborn “screening”: results of a comparative follow-up study. J Pediatr Orthop B. 1993; 115–21.
8. Sochart DH, Paton RW. Role of ultrasound assessment and harness treatment in the management of developmental dysplasia of the hip. Ann R Coll Surg Engl. 1996; 78: 505–8.
9. Castelein RM, Sauter AJ, de Vlieger M, et al. Natural history of ultrasound hip abnormalities in clinically normal newborns. J Pediatr Orthop. 1992; 12: 423–427.
10. Shorter D, Hong T, Osborn DA. Screening programmes for developmental dysplasia of the hip in newborn infants. Evid Based Child Health. 2013; 8(1): 11-54.
11. Biedermann R, RiccabonnaJ, Giesinger JM et al. Results of Universal Screening for developmental dysplasia of hip: a prospective follow up of 28, 092 consecutive infants. Bone Joint Surg, 2018:100-B (10), 1399-1404.
12. Castañeda P, Moscona L, Masrouha K. The effect of femoral shortening in the treatment of DDH after walking age. J Child Orthop. 2019; 13(4): 371-6
13. Nelson SE, DeFrancesco CJ, Sankar WN. Operative reduction for developmental dysplasia of the hip: Epidemiology over 16 years. J Pediatr Orthop. 2019; 39(4): 272-6.
14. Barlow TG. Early diagnosis and treatment of congenital dislocation of the hip. J Bone Joint Surg [Br]1962;44-B:292–301.
15. Morin C, Wicart P. Congenital dislocation of hip, with late diagnosis after 1 year of age: Update and Management. Ortho & Trauma: Surg & Res.2012 98S:154-158
16. Zimri FK, Ali Shah SS, Saaiq M et al. Presentation and Management of Neglected Developmental Dyspalsia of Hip (DDH): 8 years’ experience with single stage triple procedure. Pak J Med Sci. 2018,34(3):682-686
17. Bhatti A, Kumar J, Butt SA. Outcome of one stage combined open reduction, pelvic and derotation femoral osteotomy in congenital dislocated hip of children younger than three years of age. J Pak Med Asso. 2014,64:1015-1020
18. Banskota AK, Paudel B, Pradhan I et al. Results of simultaneous open reduction and Salter innominate osteotomy for developmental dysplasia of the hip. Kathmandu Univ Med J (KUMJ), 2005, 3:6-10
19. Lindberg AW, Bompadre V, Satchell EK et al. Patient factors associated with delay in diagnosis of developmental dysplasia of hip. J Child Ortho. 2017,11:223-228
20. Ganger R, Radler C, Petje G et al. Treatment options for developmental dislocation of hip after walking age. J Pediatr Orthp B,2005,14:139-150
21. Ortolani M. Un segno poco noto e suaimportanza per la diagnosiprecoce di prelussazione congenital dell’anca. Pediatria (Napoli) 1937; 45:129–136. (In Italian).
22 Kural B, Karapinar ED, Yilmazbas P et al. Risk factor assessment and Ten-years’ experience in DDH screening in a Well-Child Population. Biomed Res Int, 2019, https://doi.org/10.1155/2019/7213681.
23. Tonnis D. Berlin, Heidelberg: Springer-Verlag; 1987. Congenital Dysplasia and Dislocation of Hip in Children and Adults.
24. Biedermann R, Eastwood DM. Universal or selective ultrasound screening for DDH? a discussion of the key issues. J Child Orthop. 2018 Aug 1;12(4):296-301
25. Choudry QA, Paton RW. Neonatal screening and selective sonographic screening in the diagnosis of DDH. Bone Joint J. 2018 Jun 1;100-B(6):806-810.
26. Broadhurst C, Rhodes AML, Harper P et al. What is the incidence of late detection of DDH in England? a 26-year national study of children diagnosed after one year. Bone Joint J. 2019 Mar;101-B(3):281-287.
27. Price KR, Dove R, Hunter JB. Current screening recommendations for DDH may lead to an increase in open reduction. Bone Joint J 2013;95-B:846–50.
28. Azzopardi T, Van Essen P, Cundy PJ et al. Late diagnosis of developmental dysplasia of hip: analysis of risk factors. J Pediatr Orthp B,2011;20:1-7
29. Gul R, Coffey JC, Khayyat G, Mc Guinness. Late presentation of DDH. Irish J Med Sci 2002; 171: 139-140.

How to Cite this Article: Bhaskar A | A Review of “capture rate’’ Between Physicians and Care-giver Suspicion Leading to Diagnoses of Late-presenting DDH: A Single Centre perspective | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 07-11.

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Beware The Negative Ultrasound: Two Cases Of Septic Arthritis Without Ultrasonographic Findings

Volume 6 | Issue 2 | May-August 2020 | Page: 4-6 | India Cox, Fergal Monsell

Authors : India Cox [1], Fergal Monsell [2]

[1] Department of Orthopaedics, Musgrove Park Hospital, Taunton, UK.

[2] Department of Orthopaedics, Bristol Royal Hospital for Children, Bristol, UK.

Address of Correspondence
Dr. India Cox,
Clinical Fellow Trauma and Orthopaedics, Musgrove
Park Hospital, Taunton, UK.
E-mail: india.cox@gmail.com

Abstract

Septic arthritis is a clinical diagnosis but ultrasound has long been used as an adjunct, with a lack of effusion on ultrasound examination being viewed as a reassuring sign. This report describes two cases of children with clinical features suggestive of septic arthritis in whom initial ultrasound failed to demonstrate a joint effusion but subsequent arthrotomy confirmed septic arthritis. We discuss some potential reasons behind this and caution that wherever clinical suspicion exists, a negative ultrasound should not be viewed as ruling out septic arthritis.
Keywords: Septic arthritis; Ultrasound, joint effusion.

References 

1. Zawin JK, Hoffer FA, Rand RR, Teele RL. Joint effusion in children with an irritable hip: US diagnosis and aspiration. Radiology 1993; 187:459-63
2. Zamzam M. The role of ultrasound in differentiating septic arthritis from transient synovitis. Journal of Pediatric Orthopedics 2006; 15:418-22
3. Chau C, Griffith J. Musculoskeletal infections: ultrasound appearances. Clinical Radiology 2005; 60:149-159
4. Jacobson JA, Andresen R, Jaovisidha S, De Maeseneer M, Foldes K, Trudell DR, Resnick D. Detection of ankle effusions: comparison study in cadavers using radiography, sonography, and MR imaging. American Journal Roentgenology 1997;170(5):1231-8
5. Gordon JE, Huang M, Dobbs M, Luhmann SJ, Szymanski DA, Schoenecker PL. Causes of false-negative ultrasound scans in the diagnosis of septic arthritis of the hip in children. Journal of Pediatric Orthopedics 2002;22:312-16.

How to Cite this Article: Cox I, Monsell F | Beware The Negative Ultrasound: Two Cases Of Septic Arthritis Without Ultrasonographic Findings | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 04-06.

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Role of Proximal Femoral Osteotomy in the Management of Developmental Dysplasia of Hip

Volume 6 | Issue 2 | May-August 2020 | Page: 33-38 | Prateek Behera

Authors: Prateek Behera [1]

[1] Department of Orthopedics, All India Institute of Medical Sciences, Bhopal, 462020 India

Address of Correspondence
Dr. Prateek Behera,
Department of Orthopedics, All India Institute of Medical Sciences,
Bhopal, 462020 India
E-mail: pbehera15@outlook.com , prateek.ortho@aiimsbhopal.edu.in

Abstract

Proximal femoral osteotomy as a component of the treatment of developmental dysplasia of hip (DDH) has been used for almost a century now, after being described by Hey-Groves in 1928. Over the years, understanding of its role has evolved alongside our improved knowledge on the pathoanatomy and biomechanics of DDH. It has come a long way from being used exclusively in older walking children; being used as the only other concomitant procedure with open reduction of hip and being used with pre-determined values to be achieved on table, to its present state of being an indispensable component of the a la carte approach of the treatment of DDH. A femoral osteotomy is used for shortening, decreasing the femoral anteversion, or for producing a varus at the proximal femur. The surgical technique has remained largely unchanged over the years although proximal femoral locking plates are increasingly employed in addition to the traditional options such as angle blade plate, DCP, or one-third tubular plates. This review aims to analyze and summarize the current understanding of the role played by a proximal femoral osteotomy in the management of DDH.
Keywords: Developmental dysplasia of hip; Proximal femoral osteotomy; Varus derotation osteotomy; Avascular necrosis of femoral head.

References 

1. Murphy RF, Kim YJ. Surgical management of pediatric developmental dysplasia of the hip. J Am Acad Orthop Surg 2016;24:615-24.
2. Weinstein SL, Mubarak SJ, Wenger DR. Developmental hip dysplasia and dislocation: Part I. Instr Course Lect 2004;53:523-30.
3. Herring JA. Congenital coxa vara. In: Tachdjian’s Pediatric Orthopaedics. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014. p. 483-579.
4. Staheli LT, Corbett M, Wyss C, King H. Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am 1985;67:39-47.
5. Sugano N, Noble PC, Kamaric E, Salama JK, Ochi T, Tullos HS. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg Br 1998;80:711-9.
6. Doudoulakis JK, Cavadias A. Open reduction of CDH before one year of age. 69 hips followed for 13 (10-19) years. Acta Orthop Scand 1993;64:188-92.
7. Weinstein SL. Developmental hip dysplasia and dislocation. In: Weinstein SL, Flynn JM, editors. Lovell and Winter’s Pediatric Orthopaedics. 7th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2014. p. 983-1111.
8. Forlin E, Munhoz da Cunha LA, Figueiredo DC. Treatment of developmental dysplasia of the hip after walking age with open reduction, femoral shortening, and acetabular osteotomy. Orthop Clin North Am 2006;37:149-60.
9. Klisic P, Jankovic L. Combined procedure of open reduction and shortening of the femur in treatment of congenital dislocation of the hips in older children. Clin Orthop Relat Res 1976;119:60-9.
10. Weinstein SL, Mubarak SJ, Wenger DR. Developmental hip dysplasia and dislocation: Part II. Instr Course Lect 2004;53:531-42.
11. Moseley CF. Open reduction of a congenital dislocated hip and salter innominate osteotomy. In: Tolo VT, Skaggs DL, editors. Master Techniques in Orthopaedic Surgery: Pediatrics. 1st ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2008. p. 120-35.
12. Zadeh HG, Catterall A, Hashemi-Nejad A, Perry RE. Test of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip. J Bone Joint Surg Br 2000;82:17-27.
13. Weinstein SL, Dolan LA, Morcuende JA. The 2018 Nicholas Andry Award: The evidence base for the treatment of developmental dysplasia of the hip: The Iowa contribution. Clin Orthop Relat Res 2018;476:1043-51.
14. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980;62:876-88.
15. Hernandez RJ, Tachdjian MO, Poznanski AK, Dias LS. CT determination of femoral torsion. AJR Am J Roentgenol 1981;137:97-101.
16. Sankar WN, Neubuerger CO, Moseley CF. Femoral anteversion in developmental dysplasia of the hip. J Pediatr Orthop 2009;29:885-8.
17. Sarban S, Ozturk A, Tabur H, Isikan UE. Anteversion of the acetabulum and femoral neck in early walking age patients with developmental dysplasia of the hip. J Pediatr Orthop B 2005;14:410-4.
18. Spence G, Hocking R, Wedge JH, Roposch A. Effect of innominate and femoral varus derotation osteotomy on acetabular development in developmental dysplasia of the hip. J Bone Joint Surg Am 2009;91:2622-36.
19. Galpin RD, Roach JW, Wenger DR, Herring JA, Birch JG. One-stage treatment of congenital dislocation of the hip in older children, including femoral shortening. J Bone Joint Surg Am 1989;71:734-41.
20. Wenger DR, Lee CS, Kolman B. Derotational femoral shortening for developmental dislocation of the hip: Special indications and results in the child younger than 2 years. J Pediatr Orthop 1995;15:768-79.
21. Wenger DR, Weinstein SL. Operative Treatment of Developmental Dysplasia of the Hip with Open Reduction and Salter Osteotomy. Available from: https://www.vjortho.com/2000/12/operative-treatment-of-ddh-with-open-reduction-and-salters-osteotomy.
22. Kelly DM. Congenital and developmental abnormalities of the hip and pelvis. In: Azar FM, Beaty JH, Canale ST, editors. Campbell’s Operative Orthopaedics. 13th ed. Philadelphia, PA: Elsevier Saunders; 2017. p. 1118-54.
23. Smith BG, Kasser JR, Hey LA, Jaramillo D, Millis MB. Post reduction computed tomography in developmental dislocation of the hip: Part I: Analysis of measurement reliability. J Pediatr Orthop 1997;17:626-30.
24. Sangavi SM, Szöke G, Murray DW, Benson MK. Femoral remodelling after subtrochanteric osteotomy for developmental dysplasia of the hip. J Bone Joint Surg Br 1996;78:917-23.

How to Cite this Article: Behera P | Role of Proximal Femoral Osteotomy in the Management of
Developmental Dysplasia of Hip | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 27-32.

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Elbow Dislocation with Ipsilateral Fracture both Bones Forearm in a Pediatric Age: A Rare Case Report

Volume 6 | Issue 2 | May-August 2020 | Page: 23-26 | Naveen Kumar Singh, Sunny Chaudhary, Nishat Setia, Prateek Girotra

Authors: Naveen Kumar Singh [1], Sunny Chaudhary [2], Nishat Setia [1], Prateek Girotra [1]

[1] Department of Orthopaedics, Hindurao Hospital,Delhi, India.
[2] Department of Orthopaedics, AIIMS Rishikesh, Uttarakhand, India.

Address of Correspondence
Dr. Sunny Chaudhary,
Department of Orthopedics,AIIMS Rishikesh,India
E-mail: dr.sunny.ortho@gmail.com

Abstract

An elbow dislocation with ipsilateral fracture both bones forearm in a pediatric age group is a very rare injury. Although fracture both bones forearm alone in same age group is very common. These injuries in conjunction usually resulted from a high energy trauma and can be missed if clinician is not aware of such injuries so these injuries need to be addressed carefully. Success of functional outcome depends on concentric reduction of dislocated elbow with anatomical restoration of fractured both bones forearm. Here, we report a case of right-sided elbow dislocation with ipsilateral fracture of both bones forearm in a 11-year-old girl. In this case, closed reduction was performed for dislocated elbow in emergency department using reduction maneuver followed by closed reduction of both bones of forearm. Post-reduction neurovascular status of affected limb was checked and found to be uneventful. Active finger movements were present. Patient was followed-up for a period of 1 year. There was good clinical, radiological, and functional outcome. Previously, only two similar cases were reported and the last reported case had an additional finding of fracture lateral humeral condyle. Our case is an elbow dislocation with ipsilateral fracture both bones forearm in the pediatric age group and it was completely managed conservatively which makes our case-report unique in its presentation.
Keywords: Elbow dislocation; Both bone forearm fracture; Paediatric age.

References 

1. Ramesh S, Lim YJ. Complex elbow dislocation associated with radial and ulnar diaphyseal fractures: A rare combination. Strateg Trauma Limb Reconstr 2011;6:97-101.
2. Madhar M, Saidi H, Fikry T, Cermak K, Moungondo F, Schuind F. Dislocation of the elbow with ipsilateral forearm fracture. Six particular cases. Chir Main 2013;32:299-304.
3. Goni V, Behera P, Meena UK, Gopinathan N, Akkina N, Arjun RH. Elbow dislocation with ipsilateral diaphyseal forearm bone fracture: A rare injury report with literature review. Chin J Traumatol 2015;18:113-115.
4. Hung SC, Huang CK, Chiang CC, Chen TH, Chen WM, Lo WH. Monteggia Type I equivalent lesion: Diaphyseal ulna and radius fractures with a posterior elbow dislocation in an adult. Arch Orthop Trauma Surg 2003;123:311-313.
5. Frazier JL, Buschmann WR, Insler HP. Monteggia Type I equivalent lesion: Diaphyseal ulna and proximal radius fracture with a posterior elbow dislocation in a child. J Orthop Trauma 1991;5:373-375.
6. Kose O, Durakbasa MO, Islam NC. Posterolateral elbow dislocation with ipsilateral radial and ulnar diaphyseal fractures: A case report. J Orthop Surg (Hong Kong) 2008;16:122-123.
7. Rijal L, Kc KM, Sagar G. Elbow dislocation with ipsilateral radius and ulna fracture: Is it so common? Nepal Med Coll J 2012;14:163-164.
8. Ring D, Jupiter JB. Fracture-dislocation of the elbow. J Bone Joint Surg Am 1998;80:566-580.
9. Fleming FJ, Flavin R, Poynton AR. Elbow dislocation with ipsilateral open radial and ulnar diaphyseal fractures–a rare combination. Injury 2004;35:90-92.
10. Kumar P, Manjhi LB, Rajak RL. Open segmental fracture of both bone forearm and dislocation of ipsilateral elbow with extruded middle segment radius. Indian J Orthop 2013;47:307-309.
11. Bryce CD, Armstrong AD. Anatomy and biomechanics of the elbow. Orthop Clin North Am 2008;39:141-154.

How to Cite this Article: Singh NK, Chaudhary S, Setia N, Girotra P | Elbow Dislocation with Ipsilateral Fracture both Bones Forearm in a Pediatric Age: A Rare Case Report | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 23-26.

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Posterior Dislocation of Sternoclavicular Joint- A Case Report

Volume 6 | Issue 2 | May-August 2020 | Page: 18-22 | Shikhar Yadav, Renjit John Mathew, Dileep Sasi, John Thayyil John

Authors : Shikhar Yadav [1], Renjit John Mathew [1], Dileep Sasi [1], John Thayyil John [1]

[1] Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Shikhar Yadav,
Bombay Hospital Institute of Medical Sciences,
Mumbai, Maharashtra, India.
E-mail: dr.shikhar.yadav@gmail.com

Abstract

Background: Traumatic sternoclavicular joint dislocation is a very rare occurrence worldwide and is seen in only 0.5-3% of all injuries to the shoulder girdle . It is seen in high-velocity injuries resulting mostly from road traffic accidents or usually in contact sports such as rugby which is a game not played in our country. The sternoclavicular joint has a lot of important structures belonging to the cardiovascular, nervous, respiratory, and digestive system posterior to it and hence it creates a major challenge to the orthopedic surgeon while dealing with the same. With the lack of incidence and experience on this subject, the surgeon might often miss the diagnosis by not suspecting it or struggle to manage the patient after its diagnosis.
Case Report: A case report of a 12 year old male who has history trauma to the chest which resulted in a posterior dislocation of left sternoclavicular joint and the same was reduced successfully using a closed technique without any complications. A one year follow up of the patient shows complete range of left shoulder with no pain and no history of subsequent instability of the sternoclavicular joint.
Keywords: Posterior dislocation; Sternoclavicular joint; Closed reduction.

References 

1. Groh GI, Wirth MA. Management of traumatic sternoclavicular joint injuries. J Am Acad Orthop Surg 2011;19:1-7.
2. Choo C, Wong H, Nordin A. Traumatic floating clavicle: A case report. Malays Orthop J 2012;6:57-9.
3. Cruz MF, Erdeljac J, Williams R, Brown M, Bolgla L. Posterior sternoclavicular joint dislocation in a division I football player: A case report. Int J Sports Phys Ther 2015;10:700-11.
4. Inman VT, Saunders JB, Abbott LC. Observations of the function of the shoulder joint. 1944. Clin Orthop Relat Res 1996;330:3-12.
5. Spencer EE, Kuhn JE, Huston LJ, Carpenter JE, Hughes RE. Ligamentous restraints to anterior and posterior translation of the sternoclavicular joint. J Shoulder Elbow Surg 2002;11:43-7.
6. Giphart JE, Brunkhorst JP, Horn NH, Shelburne KB, Torry MR, Millett PJ. Effect of plane of arm elevation on glenohumeral kinematics: A normative biplane fluoroscopy study. J Bone Joint Surg Am 2013;95:238-45.
7. Booth CM, Roper BA. Chronic dislocation of the sternoclavicular joint: An operative repair. Clin Orthop Relat Res 1979;140:17-20.
8. Rajaratnam S, Kerins M, Apthorp L. Posterior dislocation of the sternoclavicular joint: A case report and review of the clinical anatomy of the region. Clin Anat 2002;15:108-11.
9. Morell DJ, Thyagarajan DS. Sternoclavicular joint dislocation and its management: A review of the literature. World J Orthop 2016;7:244-50.
10. Howard FM, Shafer SJ. Injuries to the clavicle with neurovascular complications. A study of fourteen cases. J Bone Joint Surg Am 1965;47:1335-46.
11. Jain S, Monbaliu D, Thompson JF. Thoracic outlet syndrome caused by chronic retrosternal dislocation of the clavicle. Successful treatment by transaxillary resection of the first rib. J Bone Joint Surg Br 2002;84:116-8.
12. Nakayama E, Tanaka T, Noguchi T, Yasuda J, Terada Y. Tracheal stenosis caused by retrosternal dislocation of the right clavicle. Ann Thorac Surg 2007;83:685-7.
13. Gardner MA, Bidstrup BP. Intrathoracic great vessel injury resulting from blunt chest trauma associated with posterior dislocation of the sternoclavicular joint. Aust N Z J Surg 1983;53:427-30.
14. Bicos J, Nicholson GP. Treatment and results of sternoclavicular joint injuries. Clin Sports Med 2003;22:359-70.
15. Court-Brown CM, Heckman JD, McQueen MM, Ricci WM, Tornetta P, McKee MD. Rockwood and Green’s Fractures in Adults. Phildelphia, PA: Lippincott Williams and Wilkins; 2015. p. 1623-25.
16. Buckerfield CT, Castle ME. Acute traumatic retrosternal dislocation of the clavicle. J Bone Joint Surg Am 1984;66:379-85.
17. Lehmann W, Laskowski J, Grossterlinden L, Rueger JM. Refixation of sternoclavicular luxation with a suture anchor system. Unfallchirurg 2010;113:418-21.
18. Abiddin Z, Sinopidis C, Grocock CJ, Yin Q, Frostick SP. Suture anchors for treatment of sternoclavicular joint instability. J Shoulder Elbow Surg 2006;15:315-8.
19. Franck WM, Jannasch O, Siassi M, Hennig FF. Balser plate stabilization: An alternate therapy for traumatic sternoclavicular instability. J Shoulder Elbow Surg 2003;12:276-81.
20. Burrows HJ. Tenodesis of subclavius in the treatment of recurrent dislocation of the sterno-clavicular joint. J Bone Joint Surg Br 1951;33B:240-3.
21. Castropil W, Ramadan LB, Bitar AC, Schor B, De Oliveira D’Elia C. Sternoclavicular dislocation–reconstruction with semitendinosus tendon autograft: A case report. Knee Surg Sports Traumatol Arthrosc 2008;16:865-8.
22. Spencer EE, Kuhn JE. Biomechanical analysis of reconstructions for sternoclavicular joint instability. J Bone Joint Surg Am 2004;86:98-105.

How to Cite this Article: Yadav S, Mathew RJ, Sasi D, John JT | Posterior Dislocation of Sternoclavicular Joint- A Case Report | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 18-22.

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