Rare Injury In Children Research Articles

Arthrofibrosis after Surgical Fixation of Tibial Eminence Fractures in Children and Adolescents

Background Tibial eminence fractures are rare injuries in children and adolescents. Displaced fractures require reduction and fixation. Operative stabilization can be accomplished with either open or arthroscopic reduction and fixation. Whereas loss of extension has been reported, there are no reports in the literature that quantify loss of motion or provide guidance for treatment. Purpose To report a series of patients who developed knee stiffness after operative treatment for displaced tibial eminence fractures. Study Design Case series; Level of evidence, 4. Methods Review of medical records and imaging studies of pediatric patients with displaced tibial eminence fractures who developed arthrofibrosis after surgical intervention. Results Thirty-two patients were identified. Twenty-four required reoperation for loss of flexion (n = 9), loss of extension (n = 4), or both (n = 11). Manipulation under anesthesia resulted in distal femoral fractures and subsequent growth arrest in 3 patients. Twenty-nine patients were able to achieve near full knee motion at final follow-up. Conclusions Children with tibial spine fractures are at risk for arthrofibrosis. Stabilization of the fracture is important to allow early postoperative rehabilitation. Should stiffness occur, manipulation of the knee should be performed only in conjunction with lysis of adhesions.

Long-term result of a pure tibiotalar dislocation in a child

Pure ankle dislocation without fracture is a very rare injury in children. We report the case of a 9-year-old patient who sustained open medial dislocation of the tibiotalar joint without fracture. The management, contributive factors, and long-term results are reported with a review of the literature.

Bilateral Radial Neck Fractures in a Child

Fractures of the proximal radius are among the most common fractures and account for 9% to 25% of the elbow fractures in children. However, bilateral radial neck fractures are extremely rare injuries in children and have been reported only once before in present English literature. We report a case of bilateral radial neck fractures in a 10-year-old girl resulting from a fall on outstretched hands. Careful physical examination and proper radiographs are necessary for the diagnosis. Early recognition, proper management, and physical therapy led to complete recovery and full functional movement of the elbows.

Posteromedial dislocation of the elbow in a child with lateral condyle fracture: Case report with review of literature

Dislocation of the elbow is a rare injury in children with a reported incidence of 3-6 percent of all elbow injuries1,2,3. Posteromedial dislocation is reported to be even rarer with only three reports so far. The dislocations are associated with various associated fractures, the medial epicondyle fracture being the commonest. There are reports of lateral condyle fracture associated with posteromedial dislocation1,2,3. Our case was associated with fracture of both bones of the distal forearm and radial nerve palsy which has not been reported previously. The child with posteromedial dislocation with lateral condyle fracture was treated with open reduction of the lateral condyle. The patient had excellent recovery of elbow function. A case of posteromedial dislocation of the elbow with associated lateral condyle fracture and both bones distal forearm fracture are reported due to its rarity. Keywords : Dislocation of elbow, Lateral condyle fracture, forearm fracture Nigerian Journal of Orthopaedics and Trauma Vol. 7 (1) 2008 pp. 29-30

Calcaneal apophyseal avulsion fracture

Isolated fracture of the calcaneal apophysis is a rare injury in children and adolescents. In this study, we report on a case of a displaced calcaneal apophyseal avulsion fracture in a child treated with open reduction and internal fixation, as well as a review of the literature. A 9-year-old female child presented to the senior surgeon complaining of acute heel pain after a gymnastic injury. She was diagnosed with a displaced, isolated fracture of the proximal calcaneal apophysis for which she underwent open reduction and internal fixation. On the magnetic resonance imaging (MRI) examination, we could diagnose that her injury was not chronic but acute because there was no change of intensity in the metaphyseal area. A combination of bioabsorbable suture tacks and pins was used to anatomically fix the fragment using the tension band wiring technique. At 2 years and 6 months follow-up, she had full range of motion, complete return of strength. We report here on the successful surgical treatment and the first case evaluated by MRI of an avulsion fracture of the calcaneal apophysis in a child.

Management of "floating elbow" in children

Background:Supracondylar fractures associated with ipsilateral forearm fractures, aptly termed as “floating elbow” is a rare injury in children after a fall from height. The various authors have reported their results with conservative treatment of one or both injuries to aggressive emergency operative fixation of both components.Materials and Methods:During a period of three years, the author managed four cases of floating elbow in children. All cases were managed by closed reduction and pinning of both components of the injury.Results:All patients recovered full elbow range of motion at three months followup and were rated as excellent as per modified Flynn's criteria. None of the patients developed cubitus varus deformity, complications related to the pins or delayed union.Conclusions:Early closed reduction and K wire fixation of both components of this injury gives better stability and prevents development of complications like compartment syndrome and elbow deformities.

Dislocation Of The Epiphysis Of The Distal Phalanx: A Case Report And Treatment With S-Quatro

Epiphyseal dislocation of the terminal phalanx is a rare injury in children. This injury is also called mallet equivalent injury of which there are four types 1. Type A injuries are seen predominantly in young patients and are usually open injuries that may either be S-H type I or II. In type B injuries a true Bony Mallet occurs with a displaced S-H III or IV fracture. Very rarely a type C (epiphysis extrusion from the joint) injury in growing children may be seen. In toddler such injuries may be missed as epiphysis is not ossified. Even rarer is type D fracture that result in separation of the epiphysis and avulsion of the tendon from the bone. The mechanism of such injuries is usually described as hyper-flexion force and may even involve the nail plate injuries (with and without a nail bed laceration)2. Seymour3 described this angular deformity and advocated conservative approach for minimally displaced fractures. Michakinakis and Vourexaki4 described a case of completely displaced epiphysis and treated with open reduction. We describe a case of epiphysis dislocation presenting three weeks after the injury that was managed by external fixation (SQuattro).

Closed reduction and percutaneous fixation offemoral neck fractures in children

Fracture of the femoral neck is a rare injury in children but remains difficult problem and challenge with high rate of complications. Having in mind recommendations of the American Academy of Orthopaedic Surgeons, our effort was to improve treatment approach. In the period 1999 to 2004, five patients, aged 5 to 14 years, were treated by closed reduction and percutaneous pinning. All patients sustained high energy trauma and displaced femoral neck fractures, out of which two were transcervical, two cervicotrochanteric and one intertrochanteric. Procedures were performed under image amplifier. Hip decompression was achieved by needle aspiration via a subadductor approach. Three smooth Kirschner wires appeared to be stable and least aggressive fixation device, easy for applying and subsequent removal. We insisted on urgent treatment, anatomic alignment, stabile fixation and hip decompression. Excellent results were obtained in four patients who had undergone immediate treatment. Poor outcome with vascular necrosis in a five-year-old girl was attributed to five-day treatment delay. Suggested treatment, simple and applicable in practice, is aimed at reducing pathologic mechanisms crucial for development of complications.

Pediatric thoracic trauma.

Although thoracic injuries occur less frequently in children than adults, they remain a source of substantial morbidity and mortality. Disparate problems such as rib fractures, lung injury, hemothorax, pneumothorax, mediastinal injuries, and others may present in isolation or in combination with one another. Knowledge of the manner in which pediatric anatomy, physiology, and injury patterns change with age may expedite the evaluation of the pediatric chest after trauma. Differences in pulmonary functional residual capacity, blood volume, chest wall and spinal soft-tissue mobility, and cardiac function may translate into problems or benefits of important consequence. For example, although more predisposed to hypoxemia, young children may remain well compensated hemodynamically, despite significant blood loss. Rare injuries in children, such as cardiac and great vessel trauma, may remain undiagnosed precisely because of their scarcity and protean symptoms.

Sternal fractures as a manifestation of abusive injury in children.

Sternal fractures are rare injuries in children. The rarity of this injury is likely due to both the relative plasticity of the pediatric thorax and to the difficulty in establishing a radiographic diagnosis without dedicated views. Current literature suggests that this injury in young children is highly specific for abusive injury. Sternal fractures are not highly specific for abusive injury. This was a retrospective radiographic and clinical chart review of all documented sternal fractures over an 11-year period at a large pediatric hospital. Of 12 children with sternal fractures identified, four were < or = 2 years of age and eight were > or = 3 years of age. The mechanism of injury was suspicious for child abuse in two children. Both of these children were < or = 2 years of age. In one toddler, an unwitnessed injury resulted in extensive initial familial anxiety until abusive injury was excluded. Sternal fractures are unusual injuries, yet they, in themselves, are not highly specific for abusive injury.

Perforation of the intrathoracic esophagus from blunt trauma in a child: Case report and review of the literature

Rupture of the intrathoracic esophagus from blunt trauma is an exceedingly rare injury in children and often presents on a delayed basis. The authors encountered a case of this unusual injury and review six additional cases found in the literature.

Supracondylar fracture of the humerus with ipsilateral fracture of the scaphoid in a child.

An 1 1 year old boy fell off a swing onto an outstretched left hand. He attended the accident and emergency department with a painful, swollen left elbow. Radiography of...

Intramalleolar Triplane Fractures of the Distal Tibial Epiphysis

The intramalleolar triplane fracture of the distal tibial epiphysis is a relatively rare injury in children. We studied five children with intramalleolar triplane fractures. Four of the five children were competitive athletes. Each child underwent computerized tomography with three-dimensional reconstruction. Delineation of the intramalleolar fracture pattern with computerized tomography with three-dimensional reconstruction demonstrated three distinct types of intramalleolar triplane fractures: I. intraarticular and within the weight-bearing zone, II. intraarticular and outside the weight-bearing zone, and III. extraarticular. Computerized tomography with three-dimensional reconstruction delineated the fracture pattern and allowed selection of the optimal treatment method. A classification scheme of the three types of intramalleolar triplane fracture is proposed.

An isolated depressed intraarticular fracture of the olecranon: Treatment with open reduction and internal fixation

Olecranon fractures accounts for approximately 5% of childhood elbow fractures and are relatively rare injuries in children.~,2 The majority of reports consider groups of patients with extraarticular fractures that respond well to nonoperat ive treatment. Intraarticular fractures involving the proximal ulna are espec ia l ly u n c o m m o n o c c u r r e n c e s , but they have been reported. Blasier described an intraarticular flap fracture associated with a spontaneously reduced elbow dislocation. 2 An entrapped olecranon fracture requiring open reduction and internal fixation has also been described. 3 Presented here is the case of an 11-year-old boy who sustained an isolated significantly depressed intraarticular fracture of the proximal ulnar articular surface requiring open reduction and internal fixation.

Peritalar dislocations in children.

Five patients with peritalar dislocations were identified in a search for injuries of the talus. We report the mechanism, management, and outcome of their injuries and compare and contrast the injuries with the same injury in adults. To our knowledge, our series is the only small series of this rare injury in children. Four of our 5 patients had acceptable results with respect to pain and gait. In two patients, the peritalar dislocation was missed, necessitating a delay in management because more attention is focused on obvious fractures, when they exist.

Blunt traumatic disruption of the thoracic aorta: A rare injury in children

Rupture of the thoracic aorta secondary to blunt chest trauma is an exceedingly uncommon injury in pediatric patients. We present a case of blunt traumatic aortic disruption in a 10-year-old child who was successfully managed by primary aortic repair using partial cardiopulmonary bypass. The epidemiology and pathophysiology of this injury, with particular reference to children, is reviewed. The ongoing controversies regarding the diagnosis and operative management of this injury are summarized.