Spontaneous Unilateral Chiari I Secondary to Acquired Tonsillar Hypertrophy/Pseudomass With Syringomyelia in a Juvenile With Progressive Scoliosis.

Chiari type 1 malformation (CM-1) is a structural defect of the central nervous system in which part of the cerebellar tonsils descend below the level of the foramen magnum, sometimes with associated syringomyelia. Although Chiari malformations were traditionally believed to be congenital, several cases of acquired CM-1 with syringomyelia have been reported. Usually associated with repeat lumbar puncture, increased intracranial pressure, and craniocephalic disproportion, CM-1 in the absence of an underlying etiology is rare. We report a rare case of spontaneous idiopathic tonsillar hypertrophy causing unilateral CM-1 with syringomyelia associated with progressive scoliosis in a juvenile with a previously normal neonatal MRI brain and no known underlying pathology. A 9-year-old boy was found to have scoliosis at a routine well-child visit with progression indicated on radiographs 4 months later. Whole spine MRI was performed and showed a new CM-1 with globular, mass-like configuration of the descended right tonsil with otherwise normal tonsillar characteristics. Surgical decompression via suboccipital craniectomy and C1 laminectomy with duraplasty was performed with improvement illustrated on repeat MRI 3 months postoperatively. This rare case emphasizes the importance of routine MRI spine early in select patients with idiopathic scoliosis and illustrates the favorable outcomes noted after decompressive craniectomy.

An Acute Nocardia Infection in a Pediatric Hand.

Nocardia species are aerobic gram-positive filamentous organisms that may cause cutaneous or pulmonary disease in humans. Primary cutaneous nocardiosis may manifest as an acute superficial pyogenic infection that can mimic more common organisms such as Staphylococcus or Streptococcus. Acute pyogenic Nocardia infection of the pediatric hand is a rare manifestation of this condition. We present a 17-month-old boy who presented with an acute abscess formation on his left fourth and fifth digits that was found to be secondary to Nocardia brasiliensis.

Plating of open pediatric tibia fractures.

This study is a single center retrospective chart and radiographic review of patients with open tibia fractures under the age of 16 years of age over past 10 years. The purpose of this study is to investigate the treatment of open pediatric tibia fractures with plating in regards to time to ambulation, time to union, and deformity in comparison to other treatment options. We found that plating open pediatric tibia fractures is a safe treatment option that can lead to excellent results with low risk of complications.

All-terrain vehicle injuries in children.

PURPOSE: All-terrain vehicles (ATVs) were introduced in the early 1970s. Injury rates in children and adolescents were alarming. The Consumer Products Safety Commission 2002 annual report revealed 5239 deaths attributed to ATVs between 1982 and 2002. One third (n = 1706) involved children younger than 16 years. The Consumer Products Safety Commission entered into a 10-year decree with ATV manufacturers in 1988 in an attempt to decrease ATV injuries and deaths. The purpose of this study was to assess the experience at the Oklahoma University Medical Center Level 1 Trauma Center by review of the trauma registry for patients younger than 16 years injured in ATV accidents. METHODS: A retrospective review of the trauma registry was performed in children younger than 16 years who presented as a result of injury attributed to 3- or 4-wheel ATVs since 2001. RESULTS: A total of 73 patients fit the search description. The average age was 9.9 years. The average Injury Severity Score was 10.3 (Level 1 trauma, 20.0; Level 2 trauma, 8.3). All 4 deaths were attributed to head injury (average age, 12.5 years.). The most common injuries were extremity fractures (36 fractures), head injury (33 injuries), and facial trauma (20 injuries). Of the fractures, 8 were open (6 upper extremities all around the elbow and 2 lower extremity tibia fractures). Extremity fractures occurred in nearly half of our patients with a slightly higher number of upper extremity injuries. The rate and severity of fractures about the elbow is especially alarming. CONCLUSIONS: All-terrain vehicle injuries involving children continue to be a concern. Despite the 1988 decree, ATV injuries continue to be a significant source of morbidity and mortality among children. Orthopaedic injuries of the extremities are common in these patients. In this series, the only cause of death was head injury. CLINICAL RELEVANCE: Orthopaedic injuries are the norm in children and adolescents injured in ATV accidents. Although some legislation is in place, the level of compliance is unclear. Legislation requiring helmet use and age limits failed in Oklahoma this year. Perhaps a comprehensive community education program would be the most effective in decreasing ATV morbidity and mortality in children.