Management of NF-1 dystrophic scoliosis associated with rib heads dislocation into the spinal canal in neurological intact patients: a systematic literature review.

PURPOSE: The management of scoliosis and kyphoscoliosis in patients with Type 1 Neurofibromatosis (NF-1) among spinal surgeons is still challenging due to the severity of the deformity especially in dystrophic deformity types. This rapid and progressive condition is likely to be associated with dislocated rib heads into the spinal canal, hence representing a real dilemma on the decision making between its resection versus not resection during the corrective surgery, especially in patients with normal neurological status. The objective of this publication is to discuss the management options in this patient population through a literature review. METHODS: A comprehensive systematic literature search was performed for relevant studies using PubMed, Web of Science, and Scopus databases. Previous publications depicting neurologically intact patients with NF-1 and rib dislocation into the canal were reviewed. Articles reporting individual cases or case series/cohorts with patient-discriminated findings were included. RESULTS: The data collection retrieved a total of 55 neurologically intact patients with NF-1 dystrophic scoliosis and rib penetration into the canal who underwent spinal surgery. Among them, 37 patients underwent surgery without head rib resection and 18 patients with rib excision. No patient presented postoperative neurological deficit except for one case of late postoperative neurological deterioration reported in a patient within situ fusion in which the surgeons ignored the presence of previous spinal cord compression. CONCLUSION: Corrective surgery for patients with NF-1 and rib penetration into the canal in neurologically intact patients can be safely performed without the resection of the dislocated rib heads without a higher risk of neurological compromise.

Luxación anterior aislada e irreductible de la cúpula radial en un paciente pediátrico: un raro reporte de caso / Isolated irreducible anterior radial head dislocation in a child: a rare case report

La luxación de la cabeza radial suele asociarse a fractura o deformidad plástica cubital. La luxación aislada es rara. Sin tratamiento, puede evolucionar hacia deformidad cubital en valgo, lesión nerviosa, artrosis precoz y pérdida del rango de movilidad con limitación funcional. Se presenta a un paciente de 9 años que sufrió traumatismo de codo. Acudió a nuestra Institución a los 40 días y se diagnosticó luxación irreductible de la cabeza radial, primero desapercibida. La luxación era irreductible por un ojal en el ligamento anular y requirió ser reducida a cielo abierto. En ausencia de fractura, incluso sin evidencia de deformidad plástica del cúbito, debe sospecharse la luxación de la cabeza radial. La clínica, junto con el par radiográfico bilateral y el conocimiento de esta entidad poco frecuente, son el trípode necesario para alcanzar el diagnóstico y no demorar el tratamiento.

Anterior radial head dislocation in pediatric population is related to Monteggia fracture-dislocations. Isolated radial head dislocation is uncommon. Sometimes, radial head dislocation becomes irreducible. This entity can develop into chronic conditions such as nerve injuries, early osteoarthritis, limited range of motion and cubitus valgus. We describe a case of a 9-year-old patient who suffered elbow trauma. He was admitted to our institution 40 days after, where radial head dislocation was diagnosed. This condition was misdiagnosed at first stage. It was irreducible due to a tear in the annular ligament. He underwent open reduction. Radial head dislocation must be suspected even if there are no fractures or plastic deformity. Pure irreducible radial head dislocation is rare. Physical examination, together with plain bilateral radiographs and full acknowledgement of this rare condition are the basis to reach early diagnosis, which leads to proper non-delayed treatment.

[Isolated irreducible anterior radial head dislocation in a child: a rare case report]. / Luxación anterior aislada e irreductible de la cúpula radial en un paciente pediátrico: un raro reporte de caso.

Anterior radial head dislocation in pediatric population is related to Monteggia fracture-dislocations. Isolated radial head dislocation is uncommon. Sometimes, radial head dislocation becomes irreducible. This entity can develop into chronic conditions such as nerve injuries, early osteoarthritis, limited range of motion and cubitus valgus. We describe a case of a 9-year-old patient who suffered elbow trauma. He was admitted to our institution 40 days after, where radial head dislocation was diagnosed. This condition was misdiagnosed at first stage. It was irreducible due to a tear in the annular ligament. He underwent open reduction. Radial head dislocation must be suspected even if there are no fractures or plastic deformity. Pure irreducible radial head dislocation is rare. Physical examination, together with plain bilateral radiographs and full acknowledgement of this rare condition are the basis to reach early diagnosis, which leads to proper non-delayed treatment.

La luxación de la cabeza radial suele asociarse a fractura o deformidad plástica cubital. La luxación aislada es rara. Sin tratamiento, puede evolucionar hacia deformidad cubital en valgo, lesión nerviosa, artrosis precoz y pérdida del rango de movilidad con limitación funcional. Se presenta a un paciente de 9 años que sufrió traumatismo de codo. Acudió a nuestra Institución a los 40 días y se diagnosticó luxación irreductible de la cabeza radial, primero desapercibida. La luxación era irreductible por un ojal en el ligamento anular y requirió ser reducida a cielo abierto. En ausencia de fractura, incluso sin evidencia de deformidad plástica del cúbito, debe sospecharse la luxación de la cabeza radial. La clínica, junto con el par radiográfico bilateral y el conocimiento de esta entidad poco frecuente, son el trípode necesario para alcanzar el diagnóstico y no demorar el tratamiento.

Massive Osteochondral Lesion of the Talus in a Skeletally Immature Patient Associated With a Tarsal Coalition and Valgus Hindfoot.

Rarely, osteochondral lesions of the talus occur without a history of trauma. Accurate interpretation of the mechanical load distributions onto the ankle leading to potential atraumatic cartilage damage must always be studied. The published data on the optimal treatment of talar osteochondral lesions in skeletally immature patients are scarce, especially when the lesions are associated with hindfoot malalignment. We describe the case of a pediatric female with an atraumatic osteochondral lesion of the talus associated with a talocalcaneal coalition and a valgus hindfoot, which we consider the first case to be reported. She presented with prolonged bilateral ankle pain and catching during gait of approximately 2 years' duration with a restricted range of motion, with the pain more excruciating in the right ankle. Radiographs revealed a large osteochondral lesion located at the lateral talar dome. The patient underwent partial osteochondral allograft transplantation, together with hindfoot realignment and coalition resection with a fat graft interposition. At the 2-year follow-up examination, the patient was free of pain in her right foot and ankle, with no signs of radiologic failure.

Craniocervical spinal instability after type 1 Arnold Chiari decompression: a case report.

To present and describe an unusual case of spinal instability after craniocervical spinal decompression for a type-1 Chiari malformation. Type-1 Chiari malformation is a craniocervical disorder characterized by tonsillar displacement greater than 5 mm into the vertebral canal; posterior fossa decompression is the most common surgical treatment for this condition. Postoperative complications have been described: cerebrospinal fluid leak, pseudomeningocele, aseptic meningitis, wound infection, and neurological deficit. However, instability after decompression is unusual. A 9-year-old female presented with symptomatic torticollis after cervical decompression for a type-1 Chiari malformation. Spinal instability was diagnosed; craniocervical stabilization was performed. After a 12-month follow-up, spinal stability was achieved, with a satisfactory clinical neck alignment. We present a craniocervical instability secondary to surgical decompression; clinical and radiological symptoms, and definitive treatment were described.