Atypical injury of radial nerve after humeral shaft fracture.

As general opinion, conservative treatment is usually suggested for closed humeral shaft fractures with radial nerve palsy; however, some authors advocate early surgical exploration, particularly for spiral fractures of the humerus accompanied with radial nerve palsy. In this article, we present a case of radial nerve palsy after fracture of the proximal-middle third of humeral shaft. A surgical exploration of the nerve revealed that the sharp tip of the bony fragment at fracture site was penetrated into the nerve and separated the nerve as two bands, almost like a ″buttonhole″ injury. We think that this kind of an atypical injury of the radial nerve would most probably not recover with conservative management; or the nerve may even be damaged worse by the fragment in case of a possible movement on the nerve's fracture line or by being trapped by callus formation during healing. In this case report, we aimed to raise awareness among orthopedists regarding such and similar atypical injuries of the radial nerve.

A rare case of 3C disease: Ritscher-Schinzel syndrome presenting with recurrent talipes equinovarus.

INTRODUCTION: Club foot (CF) is characterized by multiple deformities such as varus, adductus and internal rotation of the forefoot. It is well-known and a frequent congenital disorder. CF can concurrently be seen with several diseases but it can rarely manifest as a component of any other syndrome. Ritscher-Schinzel syndrome, or cranio-cerebello-cardiac syndrome, is rarely seen and has autosomal recessive inheritance. It is characterized by cranio-facial, cerebellar and cardiac abnormalities. We report a case diagnosed as Ritscher-Schinzel syndrome concurrent with persistent CF. PRESENTATION OF CASE: A two-year-old boy with persistent CF and concurrent congenital hip dysplasia. Despite successful serial casting and subsequent achilloplasty a clinical relapse was observed in our patient. After a detailed phenotypic evaluation, genetical tests and imaging technique the patient was diagnosed 3C Ritscher-Schinzel syndrome. DISCUSSION: A comprehensive literature review did not show any reports about concurrent hip dysplasia and clubfoot in Ritscher-Schinzel syndrome. We report that CF may be associated with rare genetical abnormalities. CONCLUSION: With this report we would like to raise awareness about the possible association of persistent CF with this rare genetical disorder, Ritscher-Schinzel syndrome. It should be included in differential diagnosis of patients with persistent CF.