Open Reduction of a Fracture-Dislocation of the Shoulder in an 11-Month-Old Child: A Case Report.

CASE: An 11-month-old boy was brought to the emergency department because he was refusing to use his right arm. X-rays demonstrated an anteroinferior Salter-Harris I fracture-dislocation of the proximal humeral epiphysis. Closed reduction with sedation was unsuccessful, so open reduction under general anesthesia was pursued. At 2 years, the patient has made a full recovery. CONCLUSION: Pediatric shoulder fracture-dislocations are rare. Clinicians must have a high index of suspicion for nonaccidental trauma when evaluating such injuries. When this injury is encountered in patients younger than 1 year, open reduction of the proximal humeral epiphysis can be a successful treatment option.

Team Approach: Developmental Dysplasia of the Hip.

Developmental dysplasia of the hip (DDH) encompasses a wide spectrum of hip disorders, including neonatal instability, acetabular dysplasia, hip subluxation, and frank dislocation of the hip. It is a common disorder, with a reported incidence of between 0.1% and >10% of live births. Coordinated, interdisciplinary care is important to achieving successful outcomes. This starts with accurate assessment of risk factors in the prenatal period, thorough clinical examination by the primary care provider at all well-child visits, and early referral to a pediatric orthopaedic surgeon for prompt diagnosis and treatment. Early diagnosis and prompt treatment is critical for an excellent outcome. Ongoing, open communication between clinicians is essential for the effective coordination of care. Treatment options vary depending on the age of presentation. A Pavlik harness (dynamic hip abduction orthosis) is used for children up to 6 months of age. A more rigid abduction orthosis may be used if treatment with a Pavlik harness is unsuccessful, with a closed reduction and spica cast being the next step if needed for children up to 18 months of age. Finally, open reduction with possible concomitant femoral and/or pelvic osteotomies is the surgical option in an older child, when necessary. In general, the later the child is diagnosed with and treated for DDH, the greater the risk of a nonoptimal outcome. Depending on the severity of the condition, children with DDH may need to be followed closely until skeletal maturity so as not to miss the diagnosis of asymptomatic residual hip dysplasia, which can predispose patients to early hip arthritis.