Effect of pelvic fixation on ambulation in children with neuromuscular scoliosis.

BACKGROUND: The effect of posterior spinal fusion (PSF) incorporating the pelvis on an ambulatory patient's ability to mobilize after the fusion is not well understood. AIM: To see whether a posterior spinal fusion with pelvic fixation using iliac or sacral alar iliac screws in ambulatory neuromuscular scoliosis (NMS) patients influences postoperative ambulatory ability. METHODS: A retrospective review of all patients with NMS that underwent PSF with fixation incorporating the pelvis between January 1, 2012 and February 29, 2019. A total of 118 patients were eligible, including 11 ambulatory patients. The primary outcome was the maintenance of ambulatory status postoperatively. Secondary outcomes included postoperative curve magnitude, pelvic obliquity, and complications, comprising infections, instrumentation failure, and any unplanned returns to the operative room. RESULTS: The ambulatory function was maintained in all 11 ambulatory NMS patients. One patient had an improvement in functional status with equipment-free ambulation postoperatively. An average postoperative follow-up was 19 mo. The overall complication rate was 19.4% (n = 23) with no significant differences between the groups in infection (P = 0.365), hardware failure (P = 0.505), and reoperation rate (P = 1.0). Ambulatory status did not affect complication rate (P = 0.967). CONCLUSION: Spinal fusion to the pelvis in ambulatory patients with NMS provides effective deformity correction without the reduction in ambulatory capabilities.

Self-Mutilation of the Fingers After a Supracondylar Humerus Fracture: The Deleterious Effects of a Median Nerve Palsy: A Case Report.

CASE: A toddler underwent percutaneous pin fixation for a type III supracondylar humerus fracture (SHF). At home, her cast fell off and her k-wires pulled out. Subsequently, she presented to the emergency department for biting the tip of her index finger off and chewing on her thumb and middle fingers. She was diagnosed with a median nerve (MN) palsy with associated paresthesia. CONCLUSION: In very young children, it may be difficult to cope with the sensation of paresthesias after a MN palsy after a SHF. Self-mutilation of the fingers may be an unfortunate complication from these paresthesias.