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BACKGROUND: The aim of this study was to determine whether height differences in the levels of the iliac crests and femoral heads on erect spinal radiographs can be used as indirect measurements for the screening and surveillance of limb length discrepancy (LLD) in patients with scoliosis. METHODS: Whole body posteroanterior (PA) and lateral erect radiographs of patients with adolescent idiopathic scoliosis (AIS) were retrospectively reviewed. Patients with congenital, syndromic, and neuromuscular scoliosis were excluded. A direct measurement of each limb was taken from the highest point of the femoral head to the middle of the tibial plafond; any difference between the sides was recorded as the LLD. In addition, the PACS Software tool was used to measure femoral head height difference (FHHD) and iliac crest height difference (ICHD). Pearson's correlation, linear regression, and Bland-Altman plots were used to determine the relationships between LLD and FHHD, and LLD and ICHD. RESULTS: Radiographs of 141 patients (92 women, 49 men) with an average age of 12.0±2.65 years were analyzed. A strong correlation (r=0.730, P<0.001) was found between LLD and FHHD; the correlation between LLD and ICHD was weaker (r=0.585, P<0.001). The Bland-Altman analysis showed good agreements of LLD with FHHD and ICHD. Linear regression analysis predicted an LLD of ≤10 mm based on an FHHD of ≤11.5 mm or an ICHD of ≤15.3 mm. CONCLUSIONS: FHHD and ICHD on spinal PA radiographs can be used for the screening and monitoring of LLD in patients with AIS with FHHD being the preferred indirect measurement. These measurements are readily learned and quick to perform. The FHHD and ICHD can be measured on any erect scoliosis PA radiograph. Therefore, these proxy measurements can be used to screen and monitor for LLD in patients with AIS. LEVEL OF EVIDENCE: Level III.
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BACKGROUND: The lower extremity functional scale (LEFS) is a patient-reported outcome measure for assessment of lower extremity function. It has been validated in adults but not in children or adolescents. METHODS: Patients 8 to 18 years of age who were treated for a lower limb fracture, injury, or other conditions were invited to join the study. LEFS and Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) were administered. Reliability and validity of the LEFS were determined for the entire cohort and for 2 age groups (children: 8 to 12 years; adolescents 13 to 18 years) using PedsQL as comparison. RESULTS: A total of 178 patients were recruited into this study. In the entire cohort, internal consistency of LEFS was excellent (0. 972) with acceptable floor (0%) and ceiling (12%) effects. Correlation between LEFS and PedsQL physical functioning component was high ( r =0.859). Construct validity was acceptable, with all 8 hypotheses demonstrating statistical significance. Factor analysis showed that item 15 (sitting for 1 hour) may contribute to measurement error in the pediatric population. Results remained similar when comparing the 2 age groups. CONCLUSIONS: The LEFS is overall an acceptable patient-reported outcome assessment of children and adolescents with various lower limbs disorders. LEVEL OF EVIDENCE: Level II.
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Avaliação da Deficiência , Qualidade de Vida , Adulto , Humanos , Criança , Adolescente , Reprodutibilidade dos Testes , Extremidade Inferior , Medidas de Resultados Relatados pelo Paciente , Psicometria/métodos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Cast immobilization is the mainstay of treatment for stable pediatric supracondylar humeral fractures (SCHFs). In recent years, a waterproof and breathable hybrid-mesh (HM) cast has emerged and been marketed to address common complaints such as itch, skin irritation, and malodor. Hence, this randomized controlled trial seeks to assess the overall satisfaction, comfort, and clinical outcomes of using HM casts in the conservative treatment of stable pediatric SCHF. METHODS: Seventy-nine patients (age range: 1 to 10 y) with modified Gartland's classification Type I and Type IIa SCHF were recruited and randomized for immobilization with either fiberglass or HM long-arm cast for 3 weeks. During follow-up visits, patients were assessed for any loss of reduction and skin rash. The weight of casts, the presence of cast breakage, the duration of cast application, and removal were recorded. A self-reported patient comfort and satisfaction questionnaire was also administered during the same visit. RESULTS: The final analysis included 38 patients immobilized with fiberglass casts and 39 patients with HM casts. Despite the significantly longer duration required for HM cast removal (4.18±1.25 min vs. 2.25±0.55 min, P <0.001), the HM cast was significantly lighter than its fiberglass counterpart (162.82±23.94 g vs. 203.95±36.52 g, P <0.001). The HM casts have better comfort (4.05±0.887 vs. 3.47±0.951, P =0.007) and satisfaction (3.69±1.055 vs. 3.11±0.953, P =0.012) scores as compared to fiberglass casts for immobilizing pediatric SCHF without compromising clinical outcome. CONCLUSIONS: HM casts have better comfort and overall satisfaction as compared to conventional fiberglass casts for immobilizing pediatric SCHF without compromising clinical outcomes. LEVEL OF EVIDENCE: Level II-therapeutic studies-investigating the results of treatment.
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Moldes Cirúrgicos , Fraturas do Úmero , Criança , Pré-Escolar , Humanos , Lactente , Tratamento Conservador , Próteses e ImplantesRESUMO
PURPOSE: Bracing for adolescents with idiopathic scoliosis (AIS) is a treatment option to prevent curve progression to surgical level. This study aimed to assess the efficacy of a 3D fully customized over corrective brace, "ScoliBrace," an orthosis treatment for AIS. METHODS: This was a prospective pilot study of AIS female patients with inclusion criteria followed recommended Scoliosis Research Society (SRS) Guidelines. Cobb angles measured at: baseline (T0), 21 months (T5-2), skeletal maturity (T6), 6 months post-brace (T7), along with hours of brace wear using a thermal sensor and health-related quality of life (HRQoL) using the SRS-22r questionnaire. RESULTS: A total of 30 female AIS patients with mean age 11.85 ± 0.68 years, predominantly Risser 0 (70%), and median Cobb angle 29° were recruited; 21 patients were included for the final analysis. Results showed significant difference in Cobb angle between T0 and T5-2 (median = 22.5° vs. 28.5°, p = 0.0082). 57.14% had reduction in Cobb angle by ≥ 5° at skeletal maturity. Cobb angle reduced 0.794° for each additional hour of dosage (p = 0.036, 95% CI = - 1.532°, - 0.056°). Although pain level was increased at T6 (4.37 ± 0.51vs.4.70 ± 0.41, p = 0.014), patients reported significantly greater satisfaction with management of their condition (3.90 ± 0.90vs.3.29 ± 0.88, p = 0.020). CONCLUSION: Results show similar findings to the BRAIST study, whereby curves remained under surgical threshold and showed improvement. More than half had curve reduction of ≥ 5° at skeletal maturity. Increased dose was also associated with improved outcomes. Using "ScoliBrace" as a non-surgical treatment, maintained curves below surgical threshold and showed curve reduction, improving patient satisfaction with management.
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Braquetes , Qualidade de Vida , Escoliose , Humanos , Escoliose/terapia , Feminino , Projetos Piloto , Estudos Prospectivos , Criança , Adolescente , Resultado do Tratamento , Satisfação do PacienteRESUMO
PURPOSE: To determine if the novel 3D Machine-Vision Image Guided Surgery (MvIGS) (FLASH™) system can reduce intraoperative radiation exposure, while improving surgical outcomes when compared to 2D fluoroscopic navigation. METHODS: Clinical and radiographic records of 128 patients (≤ 18 years of age) who underwent posterior spinal fusion (PSF), utilising either MvIGS or 2D fluoroscopy, for severe idiopathic scoliosis were retrospectively reviewed. Operative time was analysed using the cumulative sum (CUSUM) method to evaluate the learning curve for MvIGS. RESULTS: Between 2017 and 2021, 64 patients underwent PSF using pedicle screws with 2D fluoroscopy and another 64 with the MvIGS. Age, gender, BMI, and scoliosis aetiology were comparable between the two groups. The CUSUM method estimated that the MvIGS learning curve with respect to operative time was 9 cases. This curve consisted of 2 phases: Phase 1 comprises the first 9 cases and Phase 2 the remaining 55 cases. Compared to 2D fluoroscopy, MvIGS reduced intraoperative fluoroscopy time, radiation exposure, estimated blood loss and length of stay by 53%, 62% 44%, and 21% respectively. Scoliosis curve correction was 4% higher in the MvIGS group, without any increase in operative time. CONCLUSION: MvIGS for screw insertion in PSF contributed to a significant reduction in intraoperative radiation exposure and fluoroscopy time, as well as blood loss and length of stay. The real-time feedback and ability to visualize the pedicle in 3D with MvIGS enabled greater curve correction without increasing the operative time.
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Parafusos Pediculares , Escoliose , Fusão Vertebral , Cirurgia Assistida por Computador , Humanos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Estudos Retrospectivos , Perda Sanguínea Cirúrgica/prevenção & controle , Fusão Vertebral/métodos , Fluoroscopia/métodos , Cirurgia Assistida por Computador/métodos , Radiação IonizanteRESUMO
BACKGROUND: Osteomyelitis in immunocompromised children can present differently from immunocompetent children and can cause devastating sequelae if treated inadequately. We aim to review the aetiology, clinical profile, treatment and outcomes of immunocompromised children with osteomyelitis. METHODS: Retrospective review of all immunocompromised children aged < 16 years and neonates admitted with osteomyelitis in our hospital between January 2000 and January 2017, and referred to the Paediatric Infectious Disease Service. RESULTS: Fourteen patients were identified. There were 10 boys (71%), and the median age at admission was 70.5 months (inter-quartile range: 12.3-135.0 months). Causal organisms included, two were Staphylococcus aureus, two were Mycobacterium bovis (BCG), and one each was Mycobacterium tuberculosis, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Burkholderia pseudomallei and Rhizopus sp. One patient had both Clostridium tertium and Clostridium difficile isolated. Treatment involved appropriate antimicrobials for a duration ranging from 6 weeks to 1 year, and surgery in 11 patients (79%). Wherever possible, the patients received treatment for their underlying immunodeficiency. For outcomes, only three patients (21%) recovered completely. Five patients (36%) had poor bone growth, one patient had recurrent discharge from the bone and one patient had palliative care for underlying osteosarcoma. CONCLUSIONS: Although uncommon, osteomyelitis in immunocompromised children and neonates can be caused by unusual pathogens, and can occur with devastating effects. Treatment involves prolonged administration of antibiotics and surgery. Immune recovery also seems to be an important factor in bone healing.
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Mycobacterium bovis , Mycobacterium tuberculosis , Osteomielite , Antibacterianos/uso terapêutico , Criança , Humanos , Recém-Nascido , Masculino , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Estudos RetrospectivosRESUMO
PURPOSE: To report short-term results and clinical outcomes of arthroscopic deepening trochleoplasty combined with medial patellofemoral ligament (MPFL) reconstruction utilizing standard arthroscopic instruments in patients of recurrent patellar dislocation and trochlear dysplasia. METHODS: This is a case series of 13 patients between the ages of 14 and 20 years who presented with recurrent patellar dislocation and severe trochlear dysplasia (Dejour grade D). They were treated surgically using an arthroscopic technique from February 2017 to January 2019 and were followed for 18 months. Patients were assessed preoperatively and postoperatively (at 6, 12, and 18 months) with clinical scores (Tegner Activity Score, Lysholm Knee Score, and Kujala Score). RESULTS: There were 69.2% females, and the mean age was 16.4 â± â2.0 years. There were statistically significant improvements in the mean Lysholm and Kujala scores when comparing pre-operative and post-operative scores at every follow-up landmark (p â< â0.05). Comparing the preoperative and 18-month postoperative scores-the Lysholm score improved from 68.2 â± â10.3 to 98.7 â± â2.1 (p â< â0.001), and the Kujala score improved from 50.3 â± â12.0 to 95.4 â± â4.8 (p â< â0.001). Five patients were able to achieve premorbid Tegner activity levels at 12 months, with an additional 5 patients achieving the same premorbid Tegner activity at the 18-month mark. The remaining 3 patients were able to attain >90% of their activity level at 18 months' follow-up. No complications were observed during the follow-up period. CONCLUSIONS: This proposed arthroscopic deepening trochleoplasty technique combined with MPFL reconstruction has demonstrated excellent and reproducible early clinical outcomes. LEVEL OF EVIDENCE: IV.
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Artroscopia , Luxação Patelar , Humanos , Feminino , Artroscopia/métodos , Masculino , Adolescente , Adulto Jovem , Luxação Patelar/cirurgia , Resultado do Tratamento , Procedimentos de Cirurgia Plástica/métodos , Articulação Patelofemoral/cirurgia , Ligamentos Articulares/cirurgia , RecidivaRESUMO
STUDY DESIGN: Prospective cohort study. OBJECTIVE: The purpose of this study was to evaluate the relationship between patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) in adolescent idiopathic scoliosis (AIS) managed nonsurgically with bracing or observation. SUMMARY OF BACKGROUND DATA: PREMs and PROMs are increasingly used to assess the effectiveness of patient-centered health care provision. To date, no study has attempted to study the relationship between PREMs and PROMs in AIS. METHODS: All patients who visited our one-stop, tertiary center for AIS between 2020 and 2021, were asked to complete pairs of PREMs and PROMs questionnaires. PREMs were evaluated using our institution's outpatient experience survey adapted from Hospital Consumer Assessment of Healthcare Providers and Systems survey. PROMs were determined via the Scoliosis Research Society-22 revised (SRS-22r) and European Quality of Life Five-Dimension Five-Level (EQ-5D-5L) forms. RESULTS: In total, we included 730 patients who completed pairs of PREMs and PROMs questionnaires. 451 patients were treated by observation and 279 were braced. In the observation group, there was no association between patient experience and SRS-22r or EQ-5D-5L scores. In the brace group, improved SRS-22r were associated with higher PREM scores. In particular, having confidence and trust in treating physicians ( r =0.34), reporting that their worries and concerns were addressed during treatment ( r =0.34) and being taught self-care ( r =0.33, P <0.0001 for all) were most highly correlated with better SRS-22r scores. CONCLUSIONS: In patients with AIS treated with bracing, improved patient experience was positively correlated with better patient reported outcomes, especially if patients' concerns were addressed during treatment and they received supportive care and education on self-care. In contrast, patient experience did not correlate with PROMs in children and adolescents with AIS who were under observation.
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Cifose , Escoliose , Criança , Humanos , Adolescente , Qualidade de Vida , Estudos Prospectivos , Escoliose/terapia , Inquéritos e Questionários , Medidas de Resultados Relatados pelo Paciente , Pacientes AmbulatoriaisRESUMO
CASE: A 7-year-old boy with severe congenital scoliosis and impending thoracic insufficiency syndrome underwent uneventful single magnetically controlled growing rod (MCGR) insertion and removal of his ipsilateral rib-based distraction implants at our institution. Intraoperative fluoroscopy imaging revealed an artifactual bend (S-distortion) of the rod actuator after placement. This artifact was eliminated by moving the image intensifier further from the patient. CONCLUSION: We attributed the S-distortion to influences of magnetic fields within the MCGR actuator onto the image intensifier. Surgeons should be aware of such implications which can lead to misleading imaging artifacts. This is a first reported case of such incident with MCGR.
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Escoliose , Criança , Fluoroscopia , Humanos , Masculino , Próteses e Implantes , Escoliose/diagnóstico por imagem , Escoliose/cirurgiaRESUMO
BACKGROUND: Reports in the media suggest that escalator-related foot injuries are on the rise. Trendy, bright-colored rubber clogs have been implicated in a significant number of these incidents involving children. We review the children who sustained severe foot injuries on escalators, were wearing rubber clogs at the time of injury, and who were admitted to hospital for emergency surgery. METHODS: A list of children who sustained foot injuries on escalators was generated from the hospital database and included for study. From clinical chart review, demographic data, footwear type, and injuries sustained were recorded. Inpatient or outpatient treatment rendered was also recorded for each patient. RESULTS: Between September 2006 and September 2008, we treated 17 children for escalator-related foot injuries. There were 10 boys and 7 girls who were between 2 and 9 years of age (mean: 5.5). Thirteen children (76.5%) from this group were wearing rubber clogs at the time of injury. Nine of these 13 (69.2%) children sustained severe foot injuries that required admission to hospital for emergency surgery and are the focus of this study. One child had an unsalvageable traumatic amputation of the great toe at the level of the interphalangeal joint. Two children sustained crush injuries to the great toe: 1 with severe degloving and the other with an open fracture of the proximal phalanx. One child had an open fracture-dislocation of the second metatarsophalangeal joint with a comminuted fracture of the second metatarsal. Five children sustained multiple deep lacerations in the foot and 2 of them had associated cut tendons that required repair. In the group not wearing rubber clogs, 3 of 4 children had severe foot injuries. In this series, 4 children with rubber clogs and another child with a different footwear sustained minor injuries; they were treated as outpatients. CONCLUSIONS: Escalator-related foot injuries involving rubber clogs can result in severe crushing of the foot and even traumatic amputation. The broad toe-box design may give a false perception of the distance between the foot and the side of the escalator, whereas the 'softness' of these rubber clogs makes them vulnerable to crush by moving escalator steps. This is the first report in the literature describing escalator-related severe foot injuries in children who were wearing rubber clogs. Injuries sustained can be significant and permanent. The potential dangers of escalators and rubber clogs must not be underestimated. LEVEL OF EVIDENCE: Level IV, Case Series.
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Elevadores e Escadas Rolantes , Traumatismos do Pé/epidemiologia , Traumatismos do Pé/etiologia , Sapatos/efeitos adversos , Distribuição por Idade , Amputação Traumática/epidemiologia , Amputação Traumática/etiologia , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Medição de Risco , Borracha , Distribuição por Sexo , Singapura/epidemiologia , Lesões dos Tecidos Moles/epidemiologia , Lesões dos Tecidos Moles/etiologia , Dedos do Pé/lesõesRESUMO
Cast immobilization is a noninvasive and effective option in the treatment of fractures in children. However, its use can be associated with complications, such as pressure sores, skin infections, thermal injuries, and joint stiffness. In clinical practice, retained foreign objects in casts are not uncommon. This study aims to ascertain reasons for foreign objects being retained in casts and their effects on the skin. Eighteen children with retained foreign objects in their casts were identified and interviewed. Patient demographics, type of fracture and cast applied, nature of foreign body, and medical complications caused directly by the foreign object were also recorded for analysis. The foreign objects retained included coins, stationery, toy parts, cutlery, and hygiene items. The most common reason for their retention was to relieve itch, followed by accidental insertion and deliberate play. More than half of the children did not suffer complications, and the rest were all skin complications, with the most severe one being an infected skin ulcer that required oral antibiotics. Although the complications of retained foreign bodies are limited to the skin, they can worsen with delayed treatment. Cast care and itch reduction advice must be clearly communicated to patients and their caregivers. Foreign objects in casts must be emergently removed. Level of Evidence: Level 4 Evidence.
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Moldes Cirúrgicos , Corpos Estranhos , Adolescente , Comportamento do Adolescente , Criança , Comportamento Infantil , Feminino , Humanos , Masculino , Projetos Piloto , Úlcera Cutânea/etiologiaRESUMO
BACKGROUND: Pediatric supracondylar humerus fractures have traditionally been reduced and fixed with conventional C-arm (CCA) fluoroscopy guidance. With the increase in popularity of the newer mini C-arm (MCA) system within other fields of surgery due to its ease of use and lower radiation emission, the same adoption should be explored in pediatric orthopedic surgeries. The purpose of this study is to compare the MCA and CCA primarily in reduction and fixation outcomes and secondarily in other perioperative parameters. METHODS: Retrospective analysis of 193 patients who underwent surgical fixation for displaced supracondylar humerus fractures. 44 and 149 cases were performed with the MCA and CCA respectively. Baumann's angle and the intersection of anterior humeral line (AHL) were assessed on postoperative anterior posterior and lateral radiographs and adequate reduction was defined by an angle between 64 and 81Ë, and AHL intersecting middle third of the capitellum. Surgical time, fluoroscopy duration, number of images and radiation exposure were obtained from the surgical notes. RESULTS: Amongst the CCA cases, there were greater satisfactory coronal plane reduction (pâ¯<â¯0.05), while no difference in sagittal plane accuracy (pâ¯>â¯0.05) was seen. In MCA group, longer surgical (pâ¯<â¯0.05) and fluoroscopy times (pâ¯<â¯0.05), and greater number of shots (pâ¯<â¯0.05) was noted. However overall radiation exposure in the MCA group was still lower (pâ¯<â¯0.05). CONCLUSION: The MCA system is potentially less accurate in coronal plane reduction and more challenging to use. However, pitfalls can easily be avoided. Usage should be advocated as overall radiation exposure can be reduced. LEVEL OF EVIDENCE: Level III retrospective comparative study.
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Articulação do Cotovelo/cirurgia , Fluoroscopia , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fraturas do Úmero/cirurgia , Amplitude de Movimento Articular/fisiologia , Adolescente , Fenômenos Biomecânicos , Criança , Pré-Escolar , Articulação do Cotovelo/fisiopatologia , Feminino , Fixação Intramedular de Fraturas/instrumentação , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/fisiopatologia , Masculino , Exposição à Radiação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: Stable distal radius fractures in children are frequently treated by immobilisation with a cast and heal readily without complications. This randomised clinical trial aimed to assess patient satisfaction and casting-related clinical outcomes when using polyolefin cast, a new cast material, compared to the conventional fibreglass cast. METHODS: A total of 80 patients (age range 7-16 years) with radiograph-confirmed stable distal radius fractures were recruited. They were randomised to either the fibreglass group or polyolefin group, with short arm cast immobilisation for 20-30 days. After cast removal, the incidence of skin rash, growth of hair and cast breakage was recorded along with the administration of patient satisfaction questionnaires. Mann-Whitney U test or Fisher's exact test was applied to compare results. RESULTS: Overall, 34 patients from the fibreglass group and 31 patients from the polyolefin group were included in the final analysis. Significantly fewer patients from the polyolefin group reported itchiness during the casting period (p = 0.038). However, significantly more cast breakages were observed for the polyolefin group in the palmar bar region (p = 0.009). Patients from the polyolefin group were overall more satisfied (fibreglass group = 3.15/5 vs. polyolefin group = 3.74/5; p = 0.002). CONCLUSION: Polyolefin cast reduces itchiness during casting and provides higher overall patient satisfaction during the treatment of stable distal radius fractures in children in tropical climates. However, patients should be counselled regarding potential cast breakage, which did not compromise safety, and the higher costs involved.
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Moldes Cirúrgicos , Fraturas do Rádio/terapia , Adolescente , Criança , Feminino , Vidro , Humanos , Masculino , Satisfação do Paciente , Polienos , Singapura , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Ingrowing toenail (IGTN) or onychocryptosis is not uncommon in children and adolescents. However, there is a dearth of evidence in the literature on the management of IGTN in this age group. This study aimed to compare the results of nonoperative treatment for IGTN with that of operative treatment among children and adolescents. METHODS: All children and adolescents who were treated for IGTN at our institution between 2010 and 2014 were included for this retrospective study. Demographic data, treatment prescribed and outcome at six months after presentation were analysed. RESULTS: Overall, 199 patients were recruited. There were 123 (61.8%) boys and 76 (38.2%) girls. Median age was 14 years. Among 199 toes, 162 (81.4%) were treated nonoperatively, with nail care advice, topical antibiotics and daily cleansing. Only 37 (18.6%) toes were treated operatively. In the operative group, 23 (62.2%) patients underwent wedge resections, while the remaining 14 (37.8%) had total nail avulsions; for all patients, germinal matrices were preserved. At the six-month follow-up, there were 5 (3.1%) cases of recurrence in the nonoperative group when compared to 3 (8.1%) recurrences in the operative group. CONCLUSION: We recommend that IGTN in children and adolescents be treated in the first instance by nonoperative methods. Operative options can be considered for resistant cases or in case of recurrence of IGTN.
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Antibacterianos/uso terapêutico , Unhas Encravadas/tratamento farmacológico , Unhas Encravadas/cirurgia , Adolescente , Criança , Feminino , Hospitais Pediátricos , Humanos , Masculino , Unhas , Recidiva , Estudos Retrospectivos , Singapura , Dedos do PéRESUMO
Osteogenesis imperfecta, is a genetically and clinically heterogeneous connective tissue disorder that disrupts bone architecture, making it fragile and more prone to fractures. While more than 85% of cases are due to variants in COL1A1 and COL1A2, variants in noncollagen genes have been identified in the remaining cases. The recurring heterozygous variant in IFITM5 (c.-14C>T) leads to osteogenesis imperfecta type V, a second missense variant in IFITM5 (c.119C>T, p.Ser40Leu) leads to phenotype resembling osteogenesis imperfecta type VI. In this report, we describe the first patient with Ser40Trp variant in IFITM5, who presented with multiple fractures in the prenatal period. She remained fracture free after birth (except for trauma-related fractures during puberty) with normal bone mineral densitometry. Her mother, who did not have a history of fracture, was noted to have somatogonadal mosaicism for this variant and became pregnant with a second child with multiple prenatal fractures, found to have the same variant. To our knowledge, this is the first case of somatogonadal mosaicism in IFITM5. In addition, we have summarized the literature on patients presenting with variant in codon 40 (serine) of IFTIM5 protein.
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Proteínas de Membrana/genética , Proteínas de Membrana/metabolismo , Osteogênese Imperfeita/genética , Osso e Ossos , Criança , Colágeno Tipo I/genética , Família , Feminino , Heterozigoto , Humanos , Mutação , Osteogênese Imperfeita/metabolismo , Linhagem , FenótipoRESUMO
In this article, we report a case of tuberculosis spondylodiscitis in a 2-year-old child. Imaging of her spine showed a paraspinal abscess. The diagnosis of spinal tuberculosis remains difficult, and we discuss its salient features and current management within the pediatric population.
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INTRODUCTION: The cross Kirschner wire (K-wire) configuration in closed reduction and percutaneous pinning of paediatric supracondylar humeral fracture affords superior stability. However, medial pin placement presents a risk of iatrogenic ulnar nerve injury. This study describes, in step-by-step detail, another safe method of percutaneous medial pin insertion. METHODS: The technique involved placing the patient's arm in external rotation, with elbow flexed no more than 45° after closed reduction. The surgeon held the K-wire close to its sharp end to pass it percutaneously onto the medial epicondyle, then adjusted his grip toward the blunt end. After fluoroscopy check, the wire driver was engaged and an anteriorly directed force was applied to the distal humerus fragment using the thumb of the surgeon's free hand. The K-wire was inserted at a 45° angle to the longitudinal axis of the humerus shaft. Clinical notes and radiographs of patients who underwent surgery with this technique from 2006 to 2008 were reviewed. RESULTS: A total of 125 patients (84 boys, 41 girls) were included, with a mean age of 7.1 (range 2-14) years. Most injuries were left-sided (72.8%, n = 91, vs. right: 27.2%, n = 34). 72 (57.6%) patients had two-pin cross K-wire configuration, while 53 (42.4%) patients had an additional lateral pin inserted. No patient had postoperative ulnar neuropathy. There were no complications of non-union, malunion or infection. CONCLUSION: This safe method of medial pin placement for surgical stabilisation of paediatric supracondylar humeral fractures is easily learnt and reproducible, and produces excellent results.