Primary subacute talus osteomyelitis caused by Pasteurella canis: literature review and case report.

In this review, we would like to demonstrate the case of a 6-year-old girl who presented with progressive ankle pain and eventual inability to weight bear. She was shown to have primary acute osteomyelitis of the talus caused by Pasteurella canis, a commensal organism usually found in the oropharynx of dogs, despite the absence of any history of a dog bite or other zoonotic risk factors. We characterise the symptoms, signs, radiographic appearances and result of both the medical and surgical management, including a review of the literature. This review aims to increase awareness of this rare pathology and help guide other clinicians in accurately diagnosing and managing the condition.

Safety evaluation of providing trauma service during COVID-19 phase one lockdown.

AIMS: To evaluate the safety and transmission of COVID-19 in trauma patients during the coronavirus pandemic at a time of rapid reorganization of hospital health services. METHODS: All patients sustaining trauma requiring surgery treated in our institution during the lockdown period were included. Retrospective data for all admissions were collected, including outcomes, length of stay and complications. Telephone interviews were performed with all patients, families or their carers to assess COVID-19 transmission at minimum of 6 week post-discharge. RESULTS: 161 patients underwent surgery, 107 females and 54 males with average age of 56 (2-99). There were lower limb related procedures, upper limb related respectively. 13 people died during this period, of these one was directly attributed to COVID-19 related morbidity. 75% responded to telephone interviews and found no cases of symptomatic spread to any patient or household members. CONCLUSION: Following reorganization, our experience has shown that trauma services can be safely resumed with little to no significant adverse effect to patient or spread into community, especially as concerns of second wave risk overwhelming the NHS. We advocate that rigorous testing of COVID pre-operatively and with development of local COVID-19 standard operating protocols will also reduce and prevent the spread of COVID-19.

Paediatric lateral condyle fractures: a systematic review.

INTRODUCTION: Lateral condyle fractures of the humerus are common paediatric fractures. However, no conclusive statement has been made about their risk of complications, the management and epidemiology. MATERIALS AND METHODS: A systematic review was conducted according to PRISMA guidelines. All studies with paediatric lateral condyle fracture were included, with 2440 children. RESULTS: Most fractures had union, with 0.9% delayed union, 1.6% non-union and 1.5% malunion. Complications included valgus deformities (6.1%), varus deformities (7.8%), flexion loss (9.7%), extension loss (11.5%), prominent lateral condyle (27.3%), fishtail deformity (14.3%), avascular necrosis (1.7%), premature epiphyseal closure (5.4%) and neurological deficits (10.6%). Risk factors of complications include concomitant ipsilateral upper limb fractures, classification by Milch or Jakob, fracture displacement, fixation device, and inappropriate diagnosis and management. CONCLUSIONS: It is recommended for fractures that are non-displaced on all radiographic views to be managed conservatively, while displaced fractures of > 2 mm requires surgical intervention. Minimally displaced fractures could be treated conservatively, though follow-up is recommended to detect displacement. Radiographs are also recommended at 1-week follow-up, with serial radiographs having no clinical significance. Kirschner wires or lag screws could be employed, and it is recommended that the Kirschner wires be left exposed and removed when there is clinical and radiographic evidence of fracture consolidation, typically at the 6-week interval. These fractures need close follow-up.

Proximal femoral resection for the painful dislocated hip in cerebral palsy: does indomethacin prevent heterotopic ossification?

BACKGROUND: Painful hip displacement is difficult to treat in severe cerebral palsy. Proximal femoral resection (PFR) is an excellent procedure for pain relief but has a high rate of heterotopic ossification (HO). Indomethacin is the gold standard therapy used for prevention in hip and acetabular surgery. There is no evidence of its benefit in this complex patient group. METHODS: Forty-one consecutive patients with severe cerebral palsy underwent 52 primary PFRs for severe pain in 2 pediatric orthopaedic units in London, UK. Twenty-one patients received a prophylactic postoperative dose of indomethacin for the prevention of HO. Notes and radiographs were reviewed independently by 2 orthopaedic trainees. RESULTS: The mean age of patients was 14.3 and 14.8 years in the group administered with and administered without indomethacin, respectively, and mean follow-up was 4.5 and 4.3 years. Five patients in each group developed HO. One patient in the indomethacin group was offered reexcision for HO but declined. Two in the nonindomethacin group were offered reexcision and one accepted and made a good recovery. There was no difference in pain relief between the groups and no correlation between the degree of HO and level of postoperative pain. CONCLUSIONS: This study does not support the use of prophylactic indomethacin in severe cerebral palsy patients undergoing PFR. We also question the importance of HO in the outcome of this procedure. LEVEL OF EVIDENCE: Level III.

Malignant triton tumor of the brachial plexus invading the left thoracic inlet: a rare differential diagnosis of pancoast tumor.

Malignant triton tumor is a divergent malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation. We report a case of malignant triton tumor arising in the brachial plexus of a 28-year-old women with neurofibromatosis type 1. Fluorodeoxyglucose-positron emission tomography-computed tomography before excision demonstrated a tumor with a maximum standard uptake value of 21 at 4 hours postinjection. The patient underwent complete excision of the tumor through median sternotomy and left supraclavicular approach. Adjuvant radiotherapy and chemotherapy were planned but the patient died of metastatic disease within 3 months of surgical resection.