Ankle sprain injury in child and adolescent: Diagnostic pitfalls.

Introduction and importance: Sprained ankles in children and adolescents are rare. Certain diagnostic pitfalls must arise in the mind of the clinician because many differential diagnoses must be confirmed or refuted urgently. Among them, the infectious osteoarticular pathology including acute hematogenous osteomyelitis of the tibia or distal fibula and septic arthritis of the subtalar joint.The main purpose of this work, through four clinical cases, we will discuss diagnostic pitfalls in the course of ankle trauma in children and adolescents. Case presentation clinical: In this work, we have demonstrated through four cases some diagnostic errors in the context of ankle trauma in children and adolescents. Infectious and malignant tumor pathologies are real diagnostic and therapeutic emergencies. For all these cases, the initial diagnosis was a sprained ankle following a gambling or sports accident. Discussion: Ankle trauma in children and adolescents is a frequent reason for consultation in emergencies. The fear of the orthopedic surgeon is to miss a serious pathology and wrongly make the simple diagnosis of a sprained ankle. Temperature measurement must be systematic. The clinical examination must be meticulous. The interpretation of the radiograph must be cautious. Acute hematogenous osteomyelitis and malignant tumor pathology should be on the surgeon's mind. Conclusion: We have shown through these four examples that a serious pathology can simulate a sprain. Hence, a careful analysis of clinical, biological and radiological elements is the only guarantee of adequate care.

Acute hematogenous osteomyelitis in children: Management of pandiaphysitis with extensive bone destruction: A case series of thirteen child.

Introduction: and Importance: Acute hematogenous osteomyelitis (AHO) poses a public health problem in severe forms from the outset or with delayed diagnosis. The aim of this work is to describe the management of pandiaphysitis with extensive bone destruction by the Ilizarov external fixator and antibiotics and to evaluate the results. Methods: This is a retrospective, descriptive, cross-sectional and single-center study. It was performed over a seven-year period. We included children with acute hematogenous osteomyelitis complicated by pandiaphysitis of the long bones with extensive bone necrosis. All patients underwent stabilization with an Ilizarov external fixator and antibiotic therapy adapted to the antibiogram in ten cases. One patient had the induced membrane technique. All the patients underwent dynamization of the Ilizarov external fixator followed by immobilization with a cast or a splint for the lower limb. Outcomes: 13 medical files were collected during the study period. The sex ratio was 1.6, the average age was 7.56 years. Three localization sites: humerus for 3 cases, femur for 3 cases and tibia for 7 cases. The germ has been identified in ten cases. Methicillin-resistant staphylococcus aureus was the most common. Bone consolidation is obtained in all cases with an average delay of ten months. Conclusion: The Ilizarov external fixator associated with antibiotics has proven its effectiveness in the management of pandiaphysitis with extensive bone destruction. This method is an alternative in the therapeutic arsenal available to pediatric orthopedic surgeons. Level of evidence: IV, Case series.

Thromboembolic complications in children with primary nephrotic syndrome: A Tunisian series.

INTRODUCTION: Nephrotic syndrome is a common pathology in children. Despite its good prognosis, it can become complicated and threaten the patient's vital and functional prognosis. Thromboembolic complications are rare but serious. AIM: To study the main thromboembolic events and their outcome during primary nephrotic syndrome in children. METHODS: It was a retrospective study of the records of children followed for primary nephrotic syndrome who presented one or more thromboembolic events. RESULTS: Twenty thromboembolic events in 19 children were identified (15 boys and 4 girls). The average age was 5.13±3.4 years at the time of NS diagnosis. The location of the thrombosis was venous in 14 cases. Cerebral venous thrombosis was noted in seven cases, pulmonary thromboembolism in five cases. We noted deep venous thrombosis of lower limbs in three cases, occlusive mesenteric ischemia in two cases, vein portal thrombosis in one case, renal vein thrombosis in one case, and thrombosis of a peripheral artery in one case. CONCLUSION: Venous and arterial thrombotic complications can occur in children with nephrotic syndrome. Clinical features may be subtle; therefore, neuroimaging and angiographic techniques are essential for diagnosis.

Cystic adventitial disease of the popliteal artery with unusual spontaneous regression: A case report with literature review.

This report highlights the case of cystic adventitial disease of the left popliteal artery in a 45-year-old male patient. Imaging modalities confirmed the diagnosis and high resolution MRI found a cystic connection to the adjacent knee joint. The evolution was unusual with spontaneous regression of the symptoms.