FUNCTIONAL OUTCOME OF DISPLACED PAEDIATRIC RADIAL NECK FRACTURE TREATED BY OPEN REDUCTION –A CASE REPORT

A pediatric radial neck fracture, is still a challenging problem for the treating orthopedic surgeon. We report a pediatric patient presenting with radial neck fracture and results of open reduction and xation with k wires. A 8-year-old right-handed boy fell on an out-stretched left arm after being tackled during playing kabaddi and had a radial neck fracture. At the rst radiologic examination, the anteroposterior and lateral radiographs were showing over 80 degrees of angulation at the radial neck and subluxation of the radiocapitellar joint. We tried to obtain a closed reduction, but we could not succeed. Then, we performed open reduction while preserving medial periosteal continuity and vascular supply of the radial head by meticulous surgical dissection. Sixth-month radiography control and clinical examination conrmed the complete healing of the fracture without any epiphyseal injury. Painless full range of motion without any restriction of pronation and supination was achieved. The patient and his parents were satised with the outcome. We conclude that, if we can preserve medial periosteal continuity and vascularity of the radial head with open reduction, satisfactory results are obtainable.

Late Presenting Pediatric Radial Neck Fracture: A Case Report and Review of the Literature

Introduction: A pediatric radial neck fracture, when the diagnosis is delayed, is still a challenging problem for the treating orthopedic surgeon. We report a pediatric patient with late presenting radial neck fracture and results of open reduction and fixation with Kirschner wires. Case Report: A 13-year-old right-handed girl fell on an out-stretched right arm after being tackled during playing basketball and had a radial neck fracture. However, the diagnosis of her fracture was delayed for 3 weeks. At the first radiologic examination, the anteroposterior and lateral radiographs were showing over 80 degrees of angulation at the radial neck and subluxation of the radiocapitellar joint. We tried to obtain a closed reduction, but we could not succeed. Then, we performed open reduction while preserving medial periosteal continuity and vascular supply of the radial head by meticulous surgical dissection. Sixth-month radiography control and clinical examination confirmed the complete healing of the fracture without any epiphyseal injury. Painless full range of motion without any restriction of pronation and supination was achieved. The patient and her parents were satisfied with the outcome. Conclusions: Even if the diagnosis of pediatric radial fractures is delayed if we can preserve medial periosteal continuity and vascularity of the radial head with open reduction, satisfactory results are obtainable. Keywords: Pediatric, radial neck fracture, open reduction, late diagnosis.

A RARE CASE OF SUPRACONDYLAR FRACTURE HUMERUS ASSOCIATED WITH IPSILATERAL DISTAL RADIUS EPIPHYSEAL INJURYCASE REPORT

Supracondylar fractures associated with ipsilateral distal radius epiphyseal injuries are a rare entity that is usually missed during preliminary clinical examination and can lead to severe complications if prompt management is not undertaken. We report a similar case which was a result of a fall on an outstretched hand and excessive energy being dissipated across both elbow and wrist which resulted in extension type of supracondylar fracture of the humerus (Gartland type-III) and ipsilateral distal radius epiphyseal injury (Salter-Harris type-II). The patient was managed with closed reduction and internal xation with k-wire pinning of both the injuries and stabilization in a posterior slab for 3 weeks. The patient had a good functional and radiological outcome following this prompt management. We recommend screening radiographs of the distal radius in cases of supracondylar fracture to exclude any epiphyseal injury or fracture for its appropriate management.

Humeral lengthening by Ilizarov technique in patients with post septic shortening

Purpose: Humeral lengthening in patients with post septic shortening is a challenging procedure for Orthopaedic surgeon. The aim of this study was to evaluate the efficacy and safety of humeral lengthening using Ilizarov fixator. We reviewed the literature on humeral lengthening using different fixators with regard to indications, operative technique, results and complications. We also retrospectively reviewed 12 patients treated with humeral lengthening using Ilizarov external fixation. The etiology was epiphyseal injury (7 cases), infection (5 cases). The average age at surgery was 14,5 years (range 12,5-23,5) with post septic humeral shortening. The patients were assessed clinically and radio-graphically. Follow up ranged from 1-10-years.The magnitude of lengthening achieved ranged from 5-15cm with an average of 7, 5cm. Functionally all the patients returned to their preoperative jobs and daily activities including sports. Complications included pin track infection in 8 patients, radial nerve palsy which recovered completely in one patient. Conclusion; Humeral lengthening is a valid method that improves the outcome following arm shortening and deformity correction including angulation and rotation. Extensive lengthening up to 100% of the original length could be achieved without increasing the risk of complications.

Chronic Dislocation of the 5th Metatarsophalangeal Joint with Physeal Injury of Metatarsal: A Case Report

Metatarsophalangeal joint dislocations are uncommon injuries. This article describes the surgical management of such injury with six months follow up report. A 13 years old boy presented with the complaints of deformity and shortening of the 5th toe of the right foot with callosity on plantar aspect since last five years. He sustained this injury by hitting a stone.He was diagnosed to have a compound dislocation of a metatarsophalangeal joint with severely angulated Salter and Harris type II epiphyseal injury of 5th toe of the left foot.Joint dislocation caused deformed shortened 5th toe, and epiphyseal malunion resulted in the plantar bony projection, callosity, ulceration, difficulty in walking and wearing the footwear. This case was managed surgically that culminated in an optimum functional and structural outcome. Malunited epiphysis was excised, the metatarsal bone was aligned and fixed with proximal phalanx by Kirschner wire to establish a pseudarthrosis. This method can be useful in such cases; however, needs to be evaluated with future studies.

Epidemiological characteristics of pediatrics fracture at tertiary care hospital, Malaysia

Background: Childhood fracture resulting from trauma has become a major cause of morbidity, disability and socio-economic burden worldwide as well as Malaysia. So, we aim to assess the various epidemiological parameters that influence the etiology of fracture among the pediatrics population at Melaka, Malaysia and to establish data to develop effective preventive strategies.Methods: A hospital based cross sectional study was conducted at Melaka General Hospital, Melaka from January 2013 to December 2013. There were total 369 pediatrics fracture cases admitted to MGH during study period.Results: Among 369 cases, (64.2%) of cases were found among school going age followed by (30.9%) among toddler and (4.9%) of cases among infant. (69.6%) of cases were males and most of them were Malay (87.3%) The incidents occurred mostly in evening around 6pm most significantly in between 10 am to 11 pm. The most common place of injury was at home (40.4%) and fall (77.2%) is the most common mechanism of injury. Left upper extremity involved majority of facture and common site of injuries were around elbow. Epiphyseal injuries account for (9.4 %) and among them distal radius epiphyseal injury account for (68.6 %) which is statically significant (P=0.00).Conclusions: We concluded that the common mechanism of fracture was fall, (low energy trauma) occurred at home involving left upper extremity around elbow. We believed that community based education by health care professionals and paediatricians on prevention strategies can be instrumental in reducing the incidence of paediatric fractures.