Male Gender and Prematurity are Risk Factors for Incarceration in Pediatric Inguinal Hernia: A Study of 922 Children.

OBJECTIVES: The purpose of this study was to document clinical features of inguinal hernia (IH) in the pediatric population. It provides data to evaluate associated risk factors of incarcerated hernia, its recurrence as well as the occurrence of contralateral metachronous hernia. MATERIALS AND METHODS: We report a retrospective analytic study including 922 children presenting with IH and operated from 2010 to 2013 in our pediatric surgery department. RESULTS: We managed 143 girls (16%) and 779 boys (84%). The mean age was 2 years; the right side was predominantly affected (66.8%, n = 616). Incarcerated hernia was documented in 16% of cases with an incidence of 33% in neonates. The incarceration occurrence was 15.5% in males versus 2.09% in females. The surgical repair was done according to Forgue technique. Postoperatively, four cases of hernia recurrence were documented, and contralateral metachronous hernia was reported in 33 children with 7.7% females versus 2.8% males. Forty-five percent of them were infants. The mean follow-up period was 4 years. We think that incarceration can be related to several risk factors such as feminine gender, prematurity, and the initial left side surgical repair of the hernia. CONCLUSION: IH occurs mainly in male infants. Prematurity and male gender were identified as risk factors of incarceration. Contralateral metachronous hernia was reported, especially in female infants and after a left side surgical repair of the hernia.

Treatment of high-energy pilon fractures using the ILIZAROV treatment.

The management of high-energy pilon fractures is still controversial. Open reduction and internal fixation are often associated with serious complications. Various methods have been used to treat these injuries, with variable results. The aim of this retrospective study was to analyze the clinical and radiographic outcome of the ILIZAROV technique in patients with high-energy pilon fractures. Thirty cases of distal tibia epiphysis fractures (pilon fractures) were managed from 1999 to 2012. The study group included 5 cases of open fractures. The mean age was 47 years. According to Rüedi and Algower classification; 11 fractures were type II, and 19 type III. All fractures were a consequence of high-energy trauma. Fractures of the lower fibula were present in 28 of the patients. An external Fixator was applied for open fractures. Closed injuries were operated on 3 to 13 days after injury, with an average of 8 days. The mean follow-up was 48 months. All fractures united. The external fixator was removed after a mean of 22 weeks (10 - 28 weeks). Two patients with a type III fracture had a delayed union and were treated with corticotomy and dynamisation of the ILIZAROV fixator. Only one secondary displacement of a type III fracture was noted after two months and was treated by adjuction of 2 olive wires. There were no cases of osteomyelitis or deep infections. Pin-tract infections occurred in ten patients. We had not any case of nervous injury due to introduction of the pins. Using radiological criteria for assessement of reduction of the articular fragments, there was excellent and good restoration of articular structure in 24 cases. The average American Orthopeadic Foot and Ankle Society ankle-hind foot score was excellent in 16, good in 6, fair in 6 and poor in 2. Soft tissue healing occurred without need for plastic surgery in all cases. The movements of the ankle ranged from 0 to 20° of dorsiflexion and 5° to 40° of plantar flexion. Twenty patients had gone back to their preinjury profession. The ILIZAROV technique is a safe and a very effective treatment for severe pilon fractures with minimum complications and good healing results.

Combined Isolated Laugier's Fracture and Distal Radial Fracture: Management and Literature Review on the Mechanism of Injury.

Introduction. Isolated fracture of the trochlea is an uncommon condition requiring a particular mechanism of injury. Its association with a distal radial fracture is rare. We aimed through this case report to identify the injury mechanism and to assess surgical outcomes. Case Presentation. We report a 26-year-old female who was admitted to our department for elbow trauma following an accidental fall on her outstretched right hand with her elbow extended and supinated. On examination, the right elbow was swollen with tenderness over the anteromedial aspect of the distal humerus. The elbow range was restricted. Standard radiographs showed an intra-articular half-moon-shaped fragment lying proximal and anterior to the distal humerus. There was a comminuted articular fracture of the distal radius with an anterior displacement. A computed tomography revealed an isolated shear fracture of the trochlea without any associated lesion of the elbow. The patient was surgically managed. Anatomical reduction was achieved and the fracture was fixed with 2 Kirschner wires. The distal radial fracture was treated by open reduction and plate fixation. The postoperative course was uneventful with a good recovery. Conclusion. Knowledge of such entity would be useful to indicate the suitable surgical management and eventually to obtain good functional outcomes.

A Rare Case of Tuberculosis with Sacrococcygeal Involvement Miming a Neoplasm.

Infection of the lumbosacral junction by tuberculosis is quite rare and occurs in only 1 to 2% of all cases of spinal tuberculosis; moreover, isolated sacrococcygeal or coccygeal tuberculosis is much rarer. Failure to identify and treat these areas of involvement at an early stage may lead to serious complications such as vertebral collapse, spinal compression, and spinal deformity. In the present paper, we report an uncommon case of spinal tuberculosis with sacrococcygeal location revealed by a chronic low back pain that was successfully managed. Computed tomography scan and magnetic resonance imaging of the pelvis revealed a lytic lesion affecting both of sacrum and coccyx causing osseous destruction and suggesting a malignant process. A surgical biopsy was performed to establish the tissue diagnosis. Histopathological report confirmed the diagnosis of skeletal tuberculosis. The patient was treated with antibacillary chemotherapy for a period of 9 months. The follow-up period was of 36 months. There was a full recovery and the patient was asymptomatic.