Surgical treatment of injection-induced rectus femoris muscle contracture in a child: A case report.

INTRODUCTION AND IMPORTANCE: Quadriceps contracture, characterized by the shortening of the quadriceps muscle and reduced knee flexion, poses challenges in daily activities. The etiology of this condition includes congenital, traumatic, infective, or iatrogenic factors.Treatment typically involves surgical intervention, with various techniques described in the literature. Differentiating between isolated rectus femoris contracture and combined rectus and quadriceps contractures is crucial for appropriate management. CASE PRESENTATION: A 14-year-old female presented with gait disturbance and limitations in sitting and squatting due to rectus femoris contracture secondary to repetitive intramuscular injections. Physical examination revealed restricted knee flexion and positive Ely's test. The patient underwent rectus femoris lengthening (RFL) surgery, resulting in improved knee flexion and hip extension. Postoperatively, early mobilization and physiotherapy were initiated, leading to complete recovery with no complications during a three-year follow-up. CLINICAL DISCUSSION: Quadriceps femoris muscle contracture in childhood can result from congenital factors or acquired causes such as injections, trauma, infections, or ischemia. In Syria, injection-induced contractures are prevalent due to widespread intramuscular drug administration. Differentiating between isolated rectus femoris contracture and combined quadriceps contracture is crucial for treatment selection. Surgical intervention, such as rectus femoris lengthening using the Z-plasty procedure, yields favorable outcomes. Postoperative physiotherapy is essential. Incision necrosis is a common complication, mitigated by careful incision placement. CONCLUSION: Injection-induced rectus femoris contracture is common in children due to repeated thigh injections. Healthcare providers should consider alternative administration sites and routes to prevent contractures.

Transport over a flexible nail to treat a tibial defect caused by shelling injury: A case report of a 13-year-old child.

INTRODUCTION: The care of tibial traumatic fractures brought on by shelling injuries is extremely difficult, as these fractures are frequently comminuted, leading to a bone defect, extensive soft tissue damage, and an increased risk of bacterial contamination. CASE PRESENTATION: A 13-year-old male presented with trauma to the right leg following a shelling injury. He had a Gustilo IIIa open fracture with soft tissue destruction and a 7.5 cm bone loss in the distal region of the tibial shaft. Neurovascular exams were unremarkable. Primary treatment by external fixation, wound debridement, and simple suture closure was achieved. After the external fixator was removed, distraction osteogenesis was performed to deal with the bone loss. The surgical technique chosen was transport over a flexible intramedullary nail. By the end of both distraction and consolidation phases, the patient was healed with no complications, deformities, or length discrepancies. DISCUSSION: The objective of treating tibial shelling wounds is to restore functionality and save the patient's life and limb. Neurovascular evaluation, early bone fixation, and wound care are the basic treatment. Many techniques of distraction osteogenesis can be used to restore bone loss. With lower external fixation time and complications, transport over a nail is an important one. However, using a rigid intramedullary nail in children is contraindicated, so a flexible one was used. CONCLUSION: In this case report, we highlight the value of proper management of open leg fractures and the importance of restoring bone loss to improve the quality of life for war victims, particularly children.

Large chondrosarcoma treated successfully with new surgical technique and bone grafts in a 9-year-old girl: Case report.

INTRODUCTION: Chondrosarcoma is the second most common after osteosarcoma. It mostly effects adults and elderly individuals, primarily seen in the pelvic and proximal femoral bone. Pain and pathological fractures are common symptoms. The tumor is resistant to radiotherapy and chemotherapy, so surgical excision is the most effective treatment. CASE PRESENTATION: A 9-year-old girl presented with vague pain in her left thigh. Physical examination and imaging revealed multiple osteolytic lesions in the thigh, and a biopsy confirmed classical chondrosarcoma. The patient underwent surgery, which involved excision of the tumor with a safety margin and the use of a Z-plasty technique. Synthetic graft granules were used to fill the excision area. The patient was followed-up over 8 years without complications and recurrence. DISCUSSION: Chondrosarcoma is classified based on histological characteristics and clinical behavior. Chondrosarcoma is resistant to chemotherapy and radiation. Treatment options depend on tumor characteristics, and reconstruction may be necessary. For low-grade chondrosarcomas in long bones, intralesional excision and curettage are commonly used, but wide excision may be necessary to minimize recurrence. Vascularized fibular autografts have the potential for weight-bearing, but complications such as fractures and donor site morbidity can occur. Allograft reconstruction may be associated with infection, fracture, delayed or nonunion. CONCLUSIONS: Treatment approaches vary based on factors such as tumor stage, grade, and location. Each option carries its own risks and complications, including infection, fracture, and delayed healing. This study suggests a new surgical technique using bone grafts.

Subtrochanteric fracture in previously treated breast cancer patient handled by proximal femoral nail: A case report.

INTRODUCTION: Breast cancer (BC) is the most common and high mortality rate cancer in females. The main complication of BC is metastases, where bone metastases (BM) are present in 90 % of women with distant metastases and commonly recurrence after BC therapy. However, treatment options are numerous, and improving patients' quality of life (QoL) is a priority. PRESENTATION OF CASE: A 58-year-old female patient presented to the emergency department with pain and movement restriction in the right lower extremity after minor trauma. Clinical history included a surgically resected BC eight years ago, besides chemotherapy and radiotherapy. After clinical and radiographic examination, we encountered a subtrochanteric femoral fracture although the patient is in the end stage, the multidisciplinary team discussed the surgery option with the patient and eventually internally fixed the fracture. DISCUSSION: Subtrochanteric femur fractures represent a challenging orthopedic issue, ranging from 10 % to 34 % of all hip fractures. Hence, after a detailed discussion, the proximal femoral nail (PFN) was the procedure of choice acording to the patient's preferences and tumor prognosis. Proximal femoral metastasis treatment aims to improve the quality of life (QoL), alleviate bone pain, and rehabilitate skeletal function. CONCLUSION: In this case report, we highlight the surgical decision consequences for a patient with end-stage cancer, as it may put their life at risk or improve their QoL, likewise the patient in this report.

Femoral metastasis in previously treated bladder cancer patient: A case report.

Although treated appropriately, bladder cancer can recur and metastasize. We are reporting the case of a patient with a well-cured bladder cancer who presented after 14 months with femoral pain which turned out to be a bony metastasis. The patient underwent surgical excision followed by chemotherapy.

Ewing's sarcoma in scapula, epidemiology, clinical manifestation, diagnosis and treatment: A literature review.

Background: Ewing's sarcoma (ES) can affect any bone, but its occurrence in the scapula is extremely rare. Only 15 studies investigating this condition exist in the medical literature. Materials and methods: A literature search was conducted in PubMed and Scopus, and studies on ES of scapula published in the English medical literature were retrieved. A total of 15 studies were found and were included in our study. Results: ES prevalence was highest in Asia. Moreover, ES was predominant in males (60%), with a male-to-female ratio of 3:2. ES in 53.3% and 46.6% of the cases were found in the right and left scapula, respectively. The main presentation of patients with ES of scapula was swelling, which was observed in 73.33% of the cases. Of the included studies, 46.6% used plain radiography as the primary investigation method, and 60% used computed tomography for staging and metastasis detection. For definitive diagnosis, 86.6% of the studies used immunohistochemistry markers. Adjuvant chemotherapy was considered in most studies (80%). Neoadjuvant chemotherapy was given in 6 out of 10 cases who underwent surgical treatment. Complications included malignant pleural effusion, respiratory failure, and movement restriction. Conclusion: The scapula is an extremely rare site for ES. Local invasion was found in 63.64% of the cases, whereas pre-metastases were found in 35.71% of the cases. Magnetic resonance imaging was considered to be the best radiological method used to diagnose ES of scapula. Adjuvant chemotherapy, neoadjuvant chemotherapy, and surgery were the main treatments for ES.

Newly repairing technique of deformed hand by a posterior interosseous flap in an infant: A case report.

INTRODUCTION: Many non-surgical methods were performed to repair the deformities in the skeletal system to avoid severe complications post-open surgery, especially within the childhood stage or below. We aim, in this case, to present a new technique for repairing bony deformities in the childhood stage, which fewer studies have to instigate its efficacy versus open surgery. CASE PRESENTATION: We present a 14-months-old infant with wrist extravasation injury at the neonatal stage (day 1), end with a right wrist volar contraction and complete loss of brain homunculus of the right hand. DISCUSSION: We used a reverse posterior interosseous flap to reconstruct the soft tissue and release the flexor tendons of the hand. The flap was conducted entirely and was rapidly adapted to the recipient beds to achieve good color and texture harmonies. Within following up for 12 weeks, the patient restored hand function. CONCLUSION: More global cohort studies are required to compare precisely the efficacy between surgical options and the used technique in our case for salvaging deformities in childhood.