Surgical Management of a Displaced Posterior Column Pelvic Fracture Involving the Triradiate Cartilage in a 15-Year-Old Adolescent Boy: A Case Report.

CASE: A 15-year-old adolescent boy sustained a displaced acetabular fracture involving the ilioischial physis of the triradiate cartilage after a ground-level fall. The patient was managed operatively with open reduction and internal fixation and was followed for 9 months postoperatively. At 4 months postoperatively, the patient had resumed full weight bearing on the injured extremity and was participating in sports with no difficulties. CONCLUSION: Pediatric pelvic fractures through the triradiate cartilage are rare, and no consensus exists on the treatment of these injuries. Previous authors largely described nonoperative management with suboptimal outcomes. We present the case of a patient treated with initial operative fixation who successfully returned to full activities.

Infections Associated with Temporary External Fixation.

Infections associated with external fixation are thought to be related to the fixator construct, the length of time a fixator is on the limb and the injury severity score (ISS). Patients who had temporary external fixation applied for lower extremity fractures were included. Charts were reviewed for prevalence of infection, loss of reduction or other external fixator modification. Other variables were length of time the fixator was applied and the length of hospitalization. Seventy-five patients with 80 fractures met our study criteria. Of 80 fractures, 23 (28.8%) were associated with infection at the fracture site. Average time to conversion from external fixation to definitive fixation was 13.23 ± 19.8 for infected fractures and 20.03 ± 17.08 (p = 0.137) for those without infection. We did not find that the length of time a fixator was applied was associated with an increased infection rate of the fracture site, the pin sites or other regions. (Journal of Surgical Orthopaedic Advances 29(2):73-76, 2020).

Multiple Schwannomas of the Median Nerve: A Case Report and Review of the Literature.

INTRODUCTION: Schwannomas are rare benign tumors affecting the peripheral nerves. They can grow in clusters when associated with neurofibromatosis Type II or with schwannomatosis. Typically, patients present with a palpable painless mass. However, some patients, on the other hand, present with symptomatic lesions that resemble a focal nerve compression caused by the encapsulating nature of these tumors. Surgical excision is an excellent solution for solitary symptomatic lesions. However, multiple schwannomas affecting the same nerve add another level of complexity to the surgery since these secondary masses can be too small to be detected on physical examination. A high index of suspension for schwannomatosis complemented with magnetic resonance imaging (MRI) ensures a more efficient pre-operative workup that can save the patient potentially an additional visit to the operating room. CASE REPORT: This is a case of a 36-year-old right-handed female presented to our clinic with a several-years history of a painful mass in her forearm. On physical examination, she had a palpable painful mass that was Tinel positive with pain and paresthesia radiating distally over the median nerve distribution. A subsequent MRI scan showed a second smaller mass distally adjacent to the main lesion along with the median nerve, both appearing to be schwannomas of the median nerve. In this case report, we discuss the patient presentation, diagnostic workup and radiographic finding, surgical technique, and pathological findings in addition to a review of the literature regarding multiple schwannomas affecting the upper extremity. CONCLUSION: Schwannomas are rare benign tumors affecting the peripheral nerves. Despite their solitary nature, a handful of cases are reported in the literature that describes multiple masses encapsulating the same nerve. MRI is utilized to allow proper pre-operative planning and more accurate localization of these tumors to avoid an unplanned return to the operating room.