Case Report: Unusual Presentation of Myositis Ossificans of the Elbow in a Child Who Underwent Excessive Postoperative Rehabilitation Exercise

Traumatic myositis ossificans (MO) is an unusual complication after muscle injury and is predominantly seen in young adults and adolescents. Pediatric MO cases are even rarer. We report an 8-year-old girl who was diagnosed with a lateral humeral condyle fracture. She was treated surgically, and her elbow joint was fixed with plaster. Rehabilitation exercise was administered 1 month after the operation. Due to the wrong exercise method, a palpable bony mass appeared around the elbow 1 month later. The clinical radiological diagnosis showed MO, and conservative treatment was administered. After 3 years of follow-up, the affected limb functioned well, with no sign of recurrence. Here, we report this long-term follow-up case of MO resulting from excessive rehabilitation exercise.

Repair of Fractures of the Lateral Aspect of the Humeral Condyle in Skeletally Mature Dogs with Locking and Non-Locking Plates

Objective The aim of this study was to report the functional outcome and complications following transcondylar screw and epicondylar plate fixation of skeletally mature dogs with fractures of the lateral aspect of the humeral condyle using a string of pearls, limited contact dynamic compression plate (LC-DCP) or locking compression plate (LCP). Study Design This study was a retrospective review of clinical records, radiographic images and canine brief pain inventory evaluation with a supplementary non-validated questionnaire. Results Thirty-one fractures in 29 dogs were included. The majority of dogs were Spaniels (23/29). Thirty fractures had evidence of humeral intracondylar fissure. Sixteen fractures had string of pearls, eight LCP and seven LC-DCP. There were two minor complications and three major complications. Perioperative (median: 6 weeks, range: 6–12) outcome was considered fully functional for 24 fractures and acceptable for 6 fractures. One dog had an unacceptable outcome due to the failure of an LCP that healed following revision surgery. Fractures with radiographic follow-up had a persistent visible intracondylar fracture line in 20/26. Twenty-six of twenty-seven owners perceived an excellent outcome (median: 135 weeks, range: 25–246). Conclusion Repair of fractures of the lateral aspect of the humeral condyle with a transcondylar screw and epicondylar plate has a good perioperative, mid- and long-term outcome with 10% major complication rate, despite incomplete or non-union of the intracondylar fracture in 20/26 elbows.

A Retrospective Study of Postoperative Development of Implant-Induced Osteoporosis in Radial–Ulnar Fractures in Toy Breed Dogs Treated with Plate Fixation

Objective This study aimed to evaluate implant-induced osteoporosis (IIO) development in toy breed dogs treated using internal fixation with digital radiographs as the index of pixel values. Study Design There were 226 cases (236 limbs) of toy breed dogs with radial–ulnar fractures. Pixel values were measured on radiographs immediately, 2 weeks and 1 to 12 months after surgery. The ratio of pixel values (PVR) represented the bone mineral areal density based on the humeral condyle in the same image. The dogs were grouped based on the fixation methods, age and status of destabilization. Results There was a significant decrease in the PVR at 1 to 12 months postoperatively for all cases. There were not any significant differences in PVR of antebrachial fractures between those repaired with plates using locking head screws, cortex screws or a combination of locking and cortex screws. Implant-induced osteoporosis persisted at 1 to 12 months postoperatively in dogs aged ≧6 months, while the PVR increased after 3 months in dogs aged <6 months. Based on the destabilization method, there was a significant increase in the PVR at 3 months in the plate removal group. Conclusion This study suggests that IIO occurs in small dogs treated with plates and screws. Moreover, patients aged < 6 months showed an early postoperative recovery of bone mineral areal density. Further, screw and plate removal could contribute to the recovery of bone mineral areal density.

Image Fusion of X-ray and Magnetic Resonance Imaging-Based Evaluation of the Stability of Pediatric Lateral Humeral Condyle Fracture

Background: Lateral humeral condyle fracture is the second most common intra-articular fracture in pediatric elbow. Objectives: The present study aimed to analyze the differences between X-ray and magnetic resonance imaging (MRI) in the evaluation of the stability of pediatric lateral humeral condyle fracture and the degree of fracture displacement. Methods: A total of 78 patients with acute elbow trauma were selected and hospitalized in our orthopedic department from July 2018-July 2019. All patients were examined with X-ray and MRI. The sensitivity and specificity of X-ray and MRI in the diagnosis of lateral humeral condyle fracture and the integrity of the trochlear cartilage chain fracture were calculated. The X-ray and MRI were examined respectively to check the value of lateral and posterior fracture space of lateral humeral condyle fracture. Results: Callus repair was observed according to the observation of fracture line during operation or the follow-up imaging examination of conservative treatment. It was confirmed that out of 78 patients with elbow joint trauma, 72 cases were diagnosed with the fracture of lateral condyle of humerus, and the other 6 patients were cured without fracture signs. The sensitivity of MRI in the diagnosis of pediatric lateral condylar fracture was 100%, which was significantly higher than that of X-ray (88.89%) (P<0.05). The results of X-ray and MRI in the diagnosis of pediatric lateral condylar fracture were generally consistent (kappa value = 0.465;< 0.01). Among the 72 confirmed cases, 35 subjects had a fracture of trochlear cartilage chain. The sensitivity of MRI in the diagnosis of pediatric fracture of lateral condyle of humerus was 97.14%, which was significantly higher than that of X-ray (62.86%) (P<0.05). The difference was statistically significant (P<0.05). The sensitivity of 3d-fs-fspgr or 3d-fspgr was significantly higher than that of fs-t2wi and fs-pdwi (P< 0.05). Conclusion: As evidenced by the obtained results, MRI was superior to X-ray in the diagnosis of pediatric humeral epicondylar fracture stability and evaluation of fracture displacement. Furthermore, 3d-fs-fspgr or 3d-fspgr was the best MR sequence to show the pediatric humeral epicondylar fracture. These findings can provide theoretical basis for the establishment of clinical treatment plan.