A full-term neonate presented with right lower extremity ischemia at birth because of spontaneous thrombosis of the right common iliac artery. He was initially managed with supportive treatment, ...anticoagulation, and dressings; however, advanced gangrenous changes precluded salvage of the ischemic limb. A guillotine amputation was performed at day 15 of life, and the stump went on to heal well by secondary intention.
Thromboembolic events occurring in infancy are well-recognized phenomena; however, it is far rarer to encounter a neonate born with "congenital gangrene". We discuss the etiology, approach to diagnosis, and treatment of this rare but devastating condition.
Habitual anterior dislocation of the hip joint is extremely rare. We believe this is the first case reported of a habitual anterior dislocation of the hip occurring in a child with cerebral palsy. ...The dislocation was painless, voluntary and used to occur every time the child would extend and externally rotate the limb. Operative intervention in the form of a varus derotation femoral osteotomy and anterior capsulorraphy was planned, but the caregivers of the patient were unwilling for the same. Hence, the patient was given an adduction and internal rotation brace and was counselled not to perform the activity needed to dislocate the hip. This case report calls attention to a unique problem previously not reported in cerebral palsy.
Scapular involvement in childhood tuberculosis (TB) is rare. To date, only eight cases are reported in the literature in children aged <18 years. We report a case of isolated scapular TB in a ...7-year-old boy who presented with swelling and pain over right shoulder and was suspected to have malignancy based on the X-ray findings. Magnetic resonance imaging was suggestive of erosive lesion of whole scapula with normal shoulder joint, humerus and spine and conglomerate axillary lymph nodes. Histopathology and TB culture were diagnostics of TB. Patient was started on anti-TB treatment and doing well on follow-up.
The surgical approach to the brachial plexus is of great importance during surgery for brachial plexus injuries--obstetric or traumatic. A number of different approaches have been described over the ...years for these injuries, with each 1 having its own advantages and disadvantages. We describe a novel approach to the supra-clavicular and infra-clavicular aspects of the brachial plexus, which has been used by senior author successfully for the past 15 years. It involves creation of 2 windows, 1 above and 1 below the clavicle in case of adult traumatic plexus injuries. A slight variation of joining the 2 incisions and creation of a laterally based cervicopectoral flap is used for obstetric brachial plexus injuries along with the use of clavicular osteotomy. The advantages of this approach are that it gives rapid access to the brachial plexus; wide exposure can be obtained for all regions of the plexus and donor nerves such as the spinal accessory nerve can be harvested in the same incision.
Background:
The patients with healed severe progressive tubercular kyphosis may develop late-onset paraplegia. A particular subgroup of these children (Type IB progression) may benefit from the ...management principles of congenital kyphosis. Self-correction may be observed by selective continued growth of anterior vertebral epiphyseal end-plates over the posterior fused mass. We report a series of cases with posterior fusion of progressive post-tubercular kyphosis with an aim to prevent further progression of kyphosis and to assess if any gradual self correction is seen in followup.
Materials and Methods:
Twelve children fulfilling inclusion criteria of clinicoradiological, hematological diagnosis of healed spine TB having no or <2 spine at risk signs having documented progression of kyphosis and neural deficit underwent posterior fusion
in situ
without instrumentation, using autogenous iliac crest grafts as well as allograft donor bone graft. They were followed up to maximum of 5 years.
Results:
All 12 children had a progressive increase in angle preoperatively. Mean followup was 3.6 years. Post surgery, 66% showed a clinical improvement and correction, 25% had static angle, and worsening in one patient. Thus, overall 91% have a favorable result.
Conclusion:
The mechanism of correction of deformity in presence of posterior fusion is continued growth of the anterior epiphyseal end plates and hence this leads to selective differential anterior column growth giving gradual correction of kyphosis. This avoids anterior, technically demanding and complex, internal gibbus surgeries. This procedure is simple, safe, and less morbid with good results, avoiding long term disability to the patients in selected group of patients.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background Persistent infection, soft-tissue fibrosis, and damage to periosteum compound the treatment of children with a bone defect following osteomyelitis. We report on a series of twenty-six ...patients treated with nonvascularized fibular graft and intramedullary fixation. Methods The series included eleven boys and fifteen girls (mean age, 6.8 years; range, three to twelve years) with gap nonunion after osteomyelitis. Initial treatment involved thorough debridement and sequestrectomy. When the infection was quiescent as indicated by inflammatory parameters, nonvascular fibular grafting with intramedullary Kirschner wire fixation (with or without additional external fixation) was performed. The time to union was noted, and a subgroup analysis was performed to correlate the size of the bone defect with the time to union. Results The mean duration of follow-up was 3.02 ± 0.74 years (range, 1.3 to 4.2 years), and the mean time to union was 38.76 ± 12.02 weeks (range, fifteen to sixty weeks). There was a weak positive correlation between the time to union and the preoperative bone defect size (Pearson correlation coefficient, 0.699). The mean time to union was 31.7 ± 11.5 weeks for a defect of <4 cm, 36.6 ± 9 weeks for a defect of 4 to 6 cm, and 51 ± 6.7 weeks for a defect of >6 cm. Delayed union was seen at one end of the fibular graft in four (15%) of the patients and was treated with plate fixation. One patient had recurrence of infection. Limb-length discrepancy (range, 2 to 5 cm) was seen in all patients in whom the lower limb was involved and was treated with a shoe lift. Conclusions This series illustrates the potential benefits of staged sequestrectomy and nonvascular fibular grafting for the treatment of gap nonunion following osteomyelitis in children. The procedure is simple, does not require specialized training or equipment, and has a low complication rate. Level of Evidence Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
Variation of the latissimus dorsi Shah, Ishani P; Yadav, Amit; Mehta, Rujuta ...
Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India,
09/2014, Volume:
47, Issue:
3
Report
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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