Hangman's fracture caused by suspected child abuse. A case report.

This report highlights the difficulties associated with diagnosing cervical spine injuries in children especially as the history and mechanism of injury may often be unclear and the normal variations in roentgenographic appearance may be confusing. As far as we are aware this is only the second case of traumatic Hangman's fracture in a child under the age of 3 years and the only case where there is a strong probability of child abuse. A female child aged 23 months was admitted with a 5-day history of irritability and general malaise. Her father reported noticing that she was reluctant to move her neck. He denied any possibility of trauma. On admission she had neck stiffness with a temperature of 37 degrees C and supported her neck with her hands. There was evidence of otitis media of her right ear. Her physical examination was otherwise normal. A full blood count and lumbar puncture were within normal limits. Cervical spine x rays suggested a Hangman's fracture of C2 with slight anterior subluxation of C2 on C3 and a kyphus at that level. Computerized Tomography demonstrated no significant canal encroachment. An isotope bone scan was non-diagnostic. She was treated in a moulded cervical collar with neck held in slight extension. Her symptoms resolved and further radiographs showed improved alignment. Repeat CT scans seven weeks post admission showed callus formation. At follow-up at one year she remains asymptomatic. Hangman's fracture is very rare in children under 3 years and the considerable normal variations further complicate diagnosis. Swischuk described the posterior cervical line connecting the spinous process of C1-C3 vertebrae on the lateral projection to differentiate a true fracture dislocation from physiological anterior displacement. A detailed history, roentgenograms, bone scans, CT scans and MRI scans are often required for accurate diagnosis.

Long-term functional outcome of bilateral spontaneous and simultaneous Achilles tendon ruptures.

Bilateral simultaneous ruptures are rare comprising less than 1% of all Achilles tendon ruptures. Risk factors for bilateral ruptures include chronic diseases and medications such as corticosteroids and fluoroquinolones. There is little in the literature on the long-term functional outcome of bilateral Achilles tendon ruptures. This article present a series of 3 cases of simultaneous and spontaneous bilateral Achilles tendon ruptures with a minimum of 5-year follow up suggesting a good functional outcome.

Popliteal angle as an indicator for successful closed reduction of developmental dysplasia of the hip.

PURPOSE: To evaluate the use of the popliteal angle as an indicator for successful closed reduction of developmental dysplasia of the hip (DDH) in children with delayed presentation. METHODS: 29 patients aged 6 to 18 months underwent successful closed reduction for unilateral DDH under general anaesthesia. Using a graduated goniometer, the popliteal angle was measured with the hip abducted within the safe zone (to avoid redislocation and injury to the femoral capital epiphysis) before and after reduction and after 6 weeks of spica casting. RESULTS: The mean popliteal angles before and after reduction and after 6 weeks of spica casting were 5.1, 37.5, and 17.9 degrees, respectively (p<0.0001, paired t test). Because of discomfort, the spica casts were altered in 3 patients (2 at week 1 and one at week 3). CONCLUSION: Reduction of the hip in DDH results in an increased popliteal angle of >20 degree. This may be used to indicate the diagnosis and safe closed reduction.

Routine recovery room radiographs after total hip arthroplasty: ineffective for screening and unsuitable as baseline for longitudinal follow-up evaluation.

To assess the usefulness of traditional recovery room check radiographs after total hip arthroplasty, we retrospectively analysed 2,065 consecutive hip arthroplasty patients. We found a 0.1% rate of radiologic diagnosis of dislocation in the population screened. In 100 patients randomly selected for comparison, the image quality in the recovery room radiographs was significantly inferior to standardized departmental radiographs (P<.001), with further significant differences between cup version (P<.001), and stem alignment assessments (P=.002). We found good agreement between the authors in the assessments of these radiographs with a weighted kappa statistic of 0.8653 (P<.0001). Seven recovery room radiographs needed repetition for poor quality versus none of the departmental films (P=.007). With such poor information and diagnostic yield for follow-up and screening, these investigations should only be performed when clinically indicated.