Advanced Physiotherapy of Supracondylar Femur Fracture with Implant In situ: A Case Report

Patient main concerns were restriction of movements of right knee and pus discharge from wound over right knee. In this case, the main clinical findings were a substantial loss in range of motion at right knee joints. There was also fixed flexion deformity seen over right knee. Diagnosis of the case was non united operated infected case of supracondylar femur fracture right side with implant in situ. In these types of circumstances, therapeutic approaches have been demonstrated to be useful. A 35-year-old male visited the orthopaedics who referred department of physiotherapy with complaints of restriction of movement of right knee and pus discharge from wound over right knee. Patient was examine in standing and supine position .On inspection, patient keeps right hip in flexion, knee in flexion patella pointing upwards and foot in equinus. According to the research, starting weight-bearing too soon can lead to failure of implant and mal-union. Supracondylar femoral fracture is a challenging condition to deal with and is associated with many secondary complications. An important role is played by physiotherapist in rehabilitation and supracondylar femur fracture management.

The PRECICE nail system: The initial Kuwaiti experience

Objectives: The PRECICE system is an implantable limb lengthening intramedullary nail with remotely magnetically controlled distractors indicated for limb length discrepancy (LLD) and short stature treatment. This study reports the initial experience of the Kuwaiti deformity correction unit in utilizing the PRECICE system. Methods: Ten patients (four females and six males) were included in this study. All cases were operated using the PRECICE nail system (five antegrade femoral nails, three retrograde femoral nails, and two tibial nails). All surgeries were performed during January 2019 to February 2020. Results: The mean age of participants was 20 years (12–33 years), with a 21.6 kg/m2 mean body mass index (17–28). LLD etiologies (mean LLD = 39 mm) were congenital (n = 2), developmental (n = 2), post-traumatic non-union (n = 1), post-traumatic malunion (n = 1), post-traumatic physeal arrest (n = 1), and post-deformity correction and lengthening of the contralateral side with circular frame (n = 3). The mean distraction rate was 0.97 mm/day (range: 0.75–1.2 mm/day). Mean lengthening was 39 mm (range: 20–60 mm). Healing was confirmed at 76 days on average (range: 50–120 days). All patients reached full consolidation to regenerate bone, normal alignment, and normal joint orientation. Antegrade femur lengthening was done in five patients. One patient with a previous knee fixed flexion deformity of 25° improved to a 5° lag of extension. No complications were observed during the lengthening procedures. All the patients were followed up for a minimum of 12 months. Conclusion: The PRECICE nail system was successful in lengthening cases with different etiologies, achieving target lengths without complications. All the patients had reported excellent functional outcomes.

Growth modulation with tension-band plates for the correction of paediatric lower limb angular deformity: current concepts and indications for a rational use

Growth modulation (GM) with tension-band plates (TBPs) by tethering part of the growth plate is an established technique for the correction of angular deformities in children, and it has increasingly supplanted more invasive osteotomies. Growth modulation with TBPs is a safe and effective method to correct a variety of deformities in skeletally immature patients with idiopathic and pathological physes. The most common indication is a persistent deformity in the coronal plane of the knee exceeding 10°, with anterior and/or lateral joint pain, patellofemoral instability, gait disturbance, or cosmetic concerns. GM has also shown good results in patients with fixed flexion deformity of the knee and ankle valgus. This paper reviews the history of the procedure, current indications, and recent advances underlying physeal manipulation with TBPs. Cite this article: EFORT Open Rev 2021;6:658-668. DOI: 10.1302/2058-5241.6.200098

Iliopsoas Abscess in Children – A Forgotten Diagnosis

Iliopsoas abscess is a rare diagnosis in children. We recently encountered two cases which were managed at our institution. A 11-year female presented with thigh and inguinal swelling while 3-year male child presented with limp and fixed flexion deformity of right leg. Due to the differing presentation, imaging studies are often important before management is planned. Ultrasound scan is the most common investigation followed by computerized tomography (CT) scan in a selected few. The girl underwent a CT scan followed by incision and drainage (I&D) of the iliopsoas abscess while the boy underwent ultrasound-guided pigtail catheter insertion. Both cases were successfully treated. Atypical presentation of iliopsoas abscess makes the diagnosis difficult and requires a high degree of clinical suspicion for making correct diagnosis. Imaging studies help with diagnosis in such cases. Less invasive techniques like image-guided aspiration and catheter drainage can be helpful in carefully selected cases. Keywords: Iliopsoas abscess, Atypical presentation, Percutaneous drainage, Pediatric.

Subcutaneous Calcification and Fixed Flexion Deformity of the Right Elbow Joint in a Child with a GNAS Mutation, the First Case Report

Introduction: The art of medicine glorifies when a clinician listens carefully to the patient’s story, gives a thorough examination, performs appropriate investigations, and finally links findings together to reach a definite diagnosis. An interesting case was reported here, highlighting the integration of different symptoms and manifestations with some relevant biochemical investigations to reach a final diagnosis. To the best of our knowledge, fixed flexion deformity, as a complication of subcutaneous calcification, has not been previously reported in a child with Albright hereditary osteodystrophy (AHO). Case Presentation: A 2.5-year-old boy was born at term with a birth weight of 3.5 kg (-0.49 SDS). The child was referred to a general pediatrician with a history of right elbow joint swelling noticed initially at six months of age. He then developed the limitation of right upper arm movement, which slowly progressed afterward. The patient had no history of trauma. At nine months of age, he was diagnosed with hypothyroidism, preceded by cold skin, dry hair, and constipation. At nine years of age, he presented with a fixed flexion deformity of the right elbow, associated with markedly limited joint movement and symmetrical hands with hyperpigmented knuckles of right metacarpal bones. Subcutaneous masses were felt along the right forearm, showing tenderness on palpation. Investigations revealed elevated serum parathyroid hormone and normal calcium, indicating parathyroid hormone resistance. Further genetic testing revealed GNAS mutation. The child was obese throughout his childhood. Conclusions: This case report describes an obese child with subcutaneous calcification that led to fixed flexion deformity of the elbow, starting at an incredibly early age. Hypothyroidism and pseudohypoparathyroidism raised the suspicion of AHO, which was later confirmed by genetic testing. This is the first case report on fixed flexion deformity in a patient with GNAS mutation (c.719-1G > A Chr20: 57484737) in West Asia.

More than meets the naked eye: an unusual psoriatic arthritis mimicry and the important role of dermoscopic examination

Background Psoriatic arthritis (PsA) can manifest in various forms. This includes mimicry of other diseases. We describe an unusual mimicry of PsA. Case presentation We report a case of a middle-aged lady who presented with severe pain and morning stiffness over the small joints of the left hand for 3 months and painless deformity of the affected joints 1 year before. She was under treatment for pruritic rash over her ankles and knees for the past 1 year as well. Physical examination revealed a fixed flexion deformity, swelling and tenderness of the left ring and little fingers’ distal interphalangeal (DIP) joints. Left hand radiograph showed sclerotic joint margin, narrowed joint space and marginal osteophytes of the affected DIP joints. Dermoscopic examination showed red- violaceous, flat-topped papules and plaques with minimal scales on both ankles; hyperpigmented scaly plaques over both knees and vertical fingernail ridges. Serum autoimmune screening and inflammatory markers were unremarkable. Left ankle skin biopsy showed features consistent of psoriasis. PsA was diagnosed. Weekly titrated oral methotrexate and topical steroid were started. The patient showed significant improvement after 1 month of treatment. Conclusion PsA is a great mimicker. Dermoscopy is an accessible and valuable tool to assess skin lesions in greater detail. Clinicians should be aware of coexisting diseases or misdiagnosis when patients do not respond to treatment.

Ulnar longitudinal deficiency: a rare case report and review

<p class="abstract">Ulnar hemimelia is a rare postaxial partial or complete longitudinal deficiency of ulna. It has an estimated incidence of 1/100,000-150,000 live births, with a male to female ratio of 3:2. There is usually ulnar deviation of hand and shortening of forearm. Radial head subluxation and fixed flexion deformity of the hand may be associated with it. Complex carpal, metacarpal, and digital abnormalities including absence of triquetrum, capitate and three fingered hand (tridactyly) are additional findings commonly found in association. Here, we present a case of a 17-year-old female with left sided ulnar club hand due to isolated partial ulnar aplasia.</p>

Operative Treatment of Fixed Flexion Deformity of Elbow by Anterior Release: A Case Report

A 20-year-old male presented to our OPD with stiffness in his right elbow. He gave a history of sustaining a fracture around the same elbow when he was 4 years old. He was treated operatively for the same. In the post-operative period, he did not undergo any physiotherapy. On examination, he had a fixed flexion deformity in his right elbow with a range of motion between 90 and 110 degrees. X-ray did not show any bony abnormalities and MRI revealed susceptibility artifacts in posterior aspect. The elbow was approached anteriorly releasing all the soft tissue contractures. The elbow was immobilised in extension in a plaster cast for 4 weeks. The patient was under regular physiotherapy after plaster removal in the post-operative period. At one year follow up, he has an elbow range of motion between 20 and 120 degrees.

Fixed Flexion Deformity of the Middle and Ring Fingers in Adult Caused by Intramuscular Hemangioma of the Forearm: A Case Report

Intramuscular hemangioma (IMH) of the upper extremity is extremely rare and mostly found in children. The authors presented a 39-year-old female with an unusual case of fixed flexion deformity of the middle finger and ring finger with deep forearm pain for three years. The patient was diagnosed with IMH of the flexor digitorum superficialis muscle. Excision of the IMH was performed and intra-operatively passive extension of PIP joints was achieved. After 12 months follow-up, the patient was satisfied with the outcomes with no recurrence of flexion contracture. IMH of the upper extremity is an uncommon disease, especially in adults. It should be considered in patient who presented with deep forearm pain and finger flexion deformity. Early investigation should be performed and surgical removal remains the treatment of choice. Furthermore, tendon transfer should be reserved in case of functional deficits. Keywords: Intramuscular hemangioma, Flexion contracture, Forearm, Soft tissue tumor