RESUMO
An 11-year-old girl underwent T4 to L1 posterior instrumented scoliosis correction for adolescent idiopathic scoliosis. Postoperative clinical examination revealed left-sided Horner's syndrome which was preceded by left-sided C8 paraesthesia. The Horner's syndrome resolved after 14 hours following weaning and removal of the epidural catheter. Horner's syndrome following posterior instrumented scoliosis correction associated to epidural use is extremely rare. Surgeons must be aware of the risks of epidural placement and the need for close monitoring of associated complications. Alternative aetiology producing a Horner's syndrome must always be considered because of its devastating long term sequela if missed.
RESUMO
Ankle fractures are common orthopedic injuries requiring reduction and cast immobilization or fixation. Fractures fixed in a malreduced (misaligned) position can require revision surgery. However, because this has been a relatively rare occurrence, little is known about the complications that can occur after such surgery. We reviewed all adult closed ankle fractures that underwent revision surgery for technical failure in a regional trauma hospital from January 2007 to January 2010. Those with open fractures and those who required external fixation at any point in their treatment were excluded. Nine patients underwent revision surgery during the study period. Of these 9 patients, 3 (33%) developed a deep infection, all with positive microbiology cultures for methicillin-sensitive Staphylococcus aureus. Each of these patients underwent removal of the metalwork and wound debridement, followed by plastic surgery free flap coverage. In addition to the 3 infection cases, those with noninfected complications included 1 patient (11%) with chronic regional pain syndrome, 1 (11%) with failure of plate fixation, and 1 (11%) with persistent pain requiring arthroscopy and debridement. The overall incidence of complications was 66.67% in this group of 9 patients who had undergone revision surgery for the treatment of a malreduced malleolar ankle fracture. Although our observational study involved a small subset of patients who had undergone surgical repair for ankle fracture, we suggest that if revision surgery will be undertaken, the high incidence of infection and the potential need for plastic surgery should be highlighted during the consent process before the original, open reduction internal fixation procedure.