CASE: A 15-year-old girl known with osteogenesis imperfecta presented with left femoral pain. She had been treated with multiple Fassier-Duval intramedullary nails, which were still in situ. Radiographic imaging demonstrated focal osteolysis and periosteal reaction at the telescopic junction of the rod in the distal femur. She underwent implant removal. Intraoperative sampling demonstrating acute sterile inflammation and presence of brownish colored particles consistent with metal debris and osteolysis. Explant analysis confirmed corrosion of the stainless-steel telescopic nail as the underlying cause. CONCLUSION: Osteolysis and periosteal reaction because of corrosion should be considered in conjunction with other more common causes of pain, such as fracture or infection, in patients treated with telescopic intramedullary nails.
Osteolysis , Female , Humans , Adolescent , Osteolysis/diagnostic imaging , Osteolysis/etiology , Corrosion , Device Removal , Femur , Pain
Purpose: Up to 12% of paediatric supracondylar humerus fractures (SCHFs) have an associated traumatic nerve injury. This review aims to summarize the evidence and guide clinicians regarding the timing of investigations and/or surgical interventions for traumatic nerve palsies after this injury. Methods: A formal systematic review was undertaken in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews and PRISMA guidelines. Manuscripts were reviewed by independent reviewers against the inclusion and exclusion criteria, and data extraction, synthesis, and assessment for methodological quality were undertaken. Results: A total of 51 manuscripts were included in the final evaluation, reporting on a total of 510 traumatic nerve palsies in paediatric SCHFs. In this study, 376 nerve palsies recovered without any investigation or intervention over an average time of 19.5 weeks. Comparatively, 37 went back to theatre for exploration beyond the initial treatment due to persistent deficits, at an average time of 4 months. The most common finding at the time of exploration was entrapment of the nerve requiring neurolysis. A total of 27 cases did not achieve full recovery regardless of management. Of the 15 reports of nerve laceration secondary to paediatric SCHFs, 13 were the radial nerve. Conclusions: Most paediatric patients who sustain a SCHF with associated traumatic nerve injury will have full recovery. Delayed or no recovery of the nerve palsy should be considered for exploration within four months of the injury; earlier exploration should be considered for radial nerve palsies.
Purpose: Up to 4% of patients who undergo cross pinning of a pediatric supracondylar humerus fracture sustain an iatrogenic ulnar nerve palsy (IUNP). This study aims to summarize the evidence regarding the management of IUNP in this setting, and to identify if early intervention (early wire removal or exploration) leads to faster and/or more complete recovery of the ulnar nerve. Methods: A formal systematic review was undertaken, with databases searched including Ovid Medline, Embase and Cochrane central. This was performed in accordance with JBI methodology and PRISMA guidelines. Results: In all, 26 articles were included in final evaluation, reporting a total of 179 IUNP. In all, 153 cases (85%) were managed expectantly, reporting full recovery at final follow-up (average 4.5 months) in 140 cases (91%). There were 26 cases of IUNP which were managed with early wire removal and/or exploration, of which 22 had full recovery (85%). There were 17 cases of 179 (9%) which did not have full recovery. Conclusion: The majority of IUNP are managed expectantly, with approximately 90% achieving full recovery at final follow-up. The literature does not support early wire removal and/or exploration, possibly because the damage to the nerve is done at the time of wire placement.
PURPOSE: Congenital talipes equinovarus (CTEV) has a high incidence in the South Pacific, with New Zealand Maori and Polynesian rates of up to seven per 1000 live births, at least five times higher than the Caucasian population. A genetic component is suggested to explain this, however, there is little information regarding the difference of incidence between Polynesian and Melanesian ethnicity in the South Pacific. Our aim was to investigate the effects of ethnicity on the incidence of CTEV in the Solomon Islands, specifically comparing Melanesian and Polynesian ethnicity. METHODS: Between 2011 and 2017, data was collected in the Solomon Islands from over 40 clinics upon introduction of the Ponseti programme for treatment of CTEV. Records were kept using the validated Global Clubfoot Initiative data form. Ethnicity was documented, including family history. RESULTS: In total, 138 children presented during this period, with 215 affected feet reviewed and treated. In all, 74% of children had solely Melanesian parents and 6% Polynesian. Using the general population ethnic breakdown of 95.3% Melanesian and 3.1% Polynesian, the odds of CTEV in children of Melanesian parents were 0.41 times lower compared with the odds in children of Polynesian parents. CONCLUSION: The results indicate that in the Solomon Islands, CTEV in Melanesian children was less than half as likely to occur in Polynesian children. Our findings also support the theories of minimal Polynesian genetic material persisting in the Solomon Islands and a different genetic risk of CTEV between Polynesians and Melanesians. LEVEL OF EVIDENCE: III.
OBJECTIVE: The objective of this review is to evaluate the effectiveness of operative versus expectant management on recovery of nerve palsies after pediatric supracondylar fracture of the humerus or after surgery for supracondylar fracture of the humerus. INTRODUCTION: Supracondylar humerus fractures are the most common fracture of the elbow in children. These fractures have a high risk of complications from both the trauma itself and the treatment. Up to 12% of patients will have associated nerve injury, but there is insufficient information regarding the timing of investigation of and intervention in a persistent nerve palsy. This review aims to summarize the evidence and guide clinicians regarding the timing of investigation and/or surgical intervention for persistent nerve palsies after supracondylar humerus fractures in the pediatric population. INCLUSION CRITERIA: This review will include pediatric patients with ipsilateral upper limb nerve palsy after supracondylar fracture of the humerus or after surgery for a supracondylar fracture of the humerus without preexisting nerve palsies. METHODS: A comprehensive database search will be undertaken in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. The trial registers to be searched will include PROSPERO and AllTrials. The search strategy will include the keywords pediatric/paediatric, supracondylar, nerve injury/palsy/palsies, fracture, and humerus. Titles and abstracts will be screened by independent reviewers for suitability against the inclusion criteria, with accepted publications then being assessed in full with data extraction, synthesis, and assessment of methodological quality, using standardized critical appraisal tools from JBI. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019121581.
Humeral Fractures , Watchful Waiting , Child , Humans , Humeral Fractures/complications , Humerus/surgery , Paralysis , Retrospective Studies , Review Literature as Topic
