Clinical Diagnosis of Slipped Capital Femoral Epiphysis in a Child With Negative Radiological Findings: A Case Report.

Slipped capital femoral epiphyses (SCFE) is considered to be a very common disorder among adolescent age group. Multiple risk factors have been reported such as obesity, endocrine disorders, vitamin D deficiency, and panhypopituitarism. The diagnosis of SCFE is important especially in its early stages as this would prevent complications and delay in surgical intervention. The diagnosis is mainly done by radiological imaging and clinical evaluation. However, clinical evaluation is often overlooked. Herein, we present a case of a seven-year-old with SCFE that was diagnosed late due to negative radiological imaging and received late surgical intervention. Therefore, it is recommended that orthopedic surgeons use their clinical sense and examination skills to diagnose SCFE promptly, in order to maintain a short follow-up window to prevent any delay in surgical management and to observe for any progression, even if the radiological findings are normal.

Complications associated with talectomy in paediatric patients: a comparative retrospective study of two surgical techniques.

BACKGROUND: Studies describing the surgical approaches utilized for talectomy and their associated complications are scarce. We aimed to compare the surgical techniques and associated procedures from two groups of patients who underwent talectomy using two approaches. The main purpose of this study was to describe the complications and recurrence rates associated with each technique. METHODS: Between January 2004 and December 2019, 62 talectomies were performed in 48 pediatric patients with different pathologies. All patient data were reviewed retrospectively, and data of 31 patients were included in the study. The patients were divided into two groups based on the surgical technique used, and the baseline characteristics, along with the post-operative findings, and the intervention types in relation to complications were analyzed. RESULTS: In the terms of hindfoot varus, midfoot adductus, forefoot supination, and dorsal bunions, the prevalence of these deformities was higher in group (A). Group (B) patients tolerated braces (88.9 %) better than group (A) patients (84.0 %). More adjunct procedures were required in group (A) than group (B) Furthermore, the frequency and types of complications, as well as the need for further surgeries were also higher in group (A). There was a higher rate of recurrence in group A than group B. CONCLUSIONS: Talectomy is an effective procedure for the treatment of persistent foot deformities despite associated complications. Surgical details and addressing associated deformities with adjunct surgical interventions should be considered.

Functional Outcomes of Talectomy in Pediatric Feet.

BACKGROUND: Historically, talectomy has been predominantly performed to operatively treat severely rigid equinovarus feet. A limited number of investigators have studied functional outcomes in pediatric patients posttalectomy. We aimed to assess the outcomes of pediatric patients undergoing talectomy using the American Orthopaedic Foot & Ankle Society (AOFAS) score and a subjective survey of patients' and their caregivers' satisfaction. METHODS: We performed a retrospective cohort study that included 31 patients with nonidiopathic severely rigid talipes equinovarus, in a single center, using consecutive sampling. All medical records of those patients were reviewed, and relative data were extracted. The AOFAS score was used to measure the outcomes during the last visit (April 2020). Satisfaction was evaluated in a binary manner by questioning the patients and their caregivers if they would undergo the same surgery again for the same result. RESULTS: Thirty-one patients were included. Myelomeningocele was the primary diagnosis in 13 patients (41.9%), and arthrogryposis was diagnosed in 11 patients (35.5%). Twenty-two patients had bilateral procedures. The mean age at the time of surgery was 6.0 ± 3.0 years, and the mean follow-up was 6.0 ± 1.0 years. Plantigrade feet following the primary surgery were achieved in 88.5% of cases. Postoperatively, braces were well tolerated in 86.5% of patients. Deformity recurrence was observed in 21.2% of patients, and 17.3% of patients required subsequent surgeries. Patients with arthrogryposis had significantly higher AOFAS scores than those with myelomeningocele and other diagnoses (P = .017). Further, patients who tolerated braces had higher AOFAS scores than those who did not tolerate braces (P = .006). However, patients who developed hindfoot varus and dorsal bunion postoperatively had lower AOFAS scores (P = .054 and P = .006, respectively). Patients who had recurrent deformities or required further surgeries also had lower AOFAS scores (P = .025 and P = .015, respectively). Although 17.3% of patients were not able to comment about their satisfaction due to their general medical condition, 63.5% of patients reported that they were satisfied. Furthermore, 75.0% of caregivers were satisfied with the outcomes and their children's functional status posttalectomy. CONCLUSION: The observed outcomes of primary and salvage talectomies demonstrate the general overall effectiveness of this operative intervention as an end-stage treatment for pediatric patients with severely rigid talipes equinovarus. LEVEL OF EVIDENCE: Level III; retrospective cohort study.

Surgical management of medial and lateral elbow instability secondary to acute atypical complex elbow dislocation: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Elbow dislocation is common in adults, and complex elbow dislocations are generally associated with bone fractures. Anteromedial coronoid fracture, in association with lateral collateral ligament (LCL) disruption, often results from varus posteromedial forces. "Terrible triad" injuries are more likely to result from valgus posterolateral forces. However, our case presentation has combined medial and lateral elbow instability in addition to "terrible triad" injury of the elbow with no radial head injury. CASE PRESENTATION: The patient was a 38-year-old man with an atypical complex elbow dislocation. He was successfully treated by stabilizing the medial epicondyle and coronoid anterolateral facet fractures, in addition to LCL repair and medial collateral ligament (MCL) reconstruction. A radial head fracture was unnoted. The procedure yielded satisfactory functional outcome, with a stable and painless full elbow range of motion. CLINICAL DISCUSSION: Multi-ligament injuries with coronoid fractures result in highly unstable elbow joints, forming a variant of the "terrible triad" injury. Surgical options vary according to the surgeon's experience and equipment availability. In this case, direct LCL repair and MCL reconstruction were performed and were well tolerated. Elbow stability improved and the patient experienced improved functionality with minimal pain. However, it may be premature to report a definite outcome in this case because of short follow-up time postoperatively. CONCLUSION: The injury described in this case has a unique presentation as a multi-ligamentous injury will make the elbow very unstable. Thus, careful clinical judgment, knowledge, and experience are needed to identify the underlying injury and for optimal management.

Psoas Hematoma and Late Femoral Nerve Palsy After Extreme Lateral Interbody Fusion and Posterior Spinal Fusion with Instrumentation: A Case Report.

INTRODUCTION: Psoas hematoma is an uncommon complication following spinal surgeries. It has been reported in both extreme lateral interbody fusion (XLIF) and posterior spinal fusion with instrumentation. Minimally invasive techniques are gaining popularity in recent years due to the appealing advantages of reduced operative time, blood loss, hospital stay, and faster recovery. CASE PRESENTATION: We are presenting a case of a 77-year-old male with chronic low back pain, diagnosed to have multilevel degenerative disc disease with central and foraminal disc protrusion at L2-L3, L3-L4, L4-L5 with secondary spinal stenosis, underwent XLIF at L3-L4, L4-L5 and then 2nd stage with posterior L3-L5 fusion with pedicle screws. On the fourth day post-operatively, the patient had flank pain and dropping hemoglobin with femoral nerve palsy symptoms, a CT scan revealed a large psoas hematoma. Conservative management was decided on; a follow-up CT scan and examination showed complete resolution of the hematoma and femoral nerve recovery. DISCUSSION: The approach to iliopsoas hematoma post spinal surgeries remains controversial. Iliopsoas hematoma should be suspected in any patients post spinal surgeries even with delayed presentations. The decision to proceed with either surgical intervention or conservative management depends on multiple factors, including patient hemodynamic status, progression of collection and femoral nerve palsy. CONCLUSION: The exact cause of iliopsoas hematoma post different spinal surgery approaches remains vague. In our opinion, other causes including pre- and post-operative anticoagulants should be investigated. Rushing to drain iliopsoas hematomas in case of femoral nerve palsy might not be the ideal option. Instead, monitoring patient responses to resuscitation and taking a watch and wait approach for femoral nerve palsy might be the proper approach.