Journal of Children s Orthopaedics
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|Material type||Document, Periodical|
|Document type||Journal / Magazine / Newspaper, Computer File|
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Publications in this journal
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ABSTRACT: TITLE Congenital Volkmann's ischemic contracture, a rare and challenging condition. KEYWORDS Volkmann; Ischemic contracture; PURPOSE Congenital Volkmann’s ischemic contracture is a very uncommon situation. Only around fifty cases have been described in literature. In order to minimize the devastating consequences of this condition, a therapeutic approach may be systematized. MATERIAL AND METHODS Five patients have been evaluated from 1998 to 2013. In all cases, unilateral hand and forearm were affected. The management and evolution of these cases is described, and a review of literature is made. The pathological findings during pregnancy were: one gestational diabetes with regular insulin treatment, one preeclampsia and three unspecific oligoamnios. The association of skin lesions (necrotic bedsore with a central pallor, ulcers, bullae), diffuse oedema, contractures and neuromuscular affectation(flaccid paralysis) in a newborn’s upper limb leads to the diagnosis of congenital Volkmann's ischemic contracture. This presentation may not be confused with aplasia cutis congenital, septic necrotizing fasciitis, amniotic band syndrome, epidermiolysis bullosa, neonatal gangrene, congenital varicella or vascular affectation. Radiological findings such as demineralization, metaphysis rarefaction, epiphysis affectation or even more extensive diaphysis bone affectation may be found. RESULTS An urgent approach was proposed, based on the common surgical procedures for any Volkmann’s contracture: fasciotomy, wide skin and deep tissue’s debridement, neurolysis, scar release and skin graft. In two cases, we included the use of a regional anesthetic axillary block with ropivacaine. The regional anesthetic caused a sympathetic block which generated a vasolidatating response. Later, we recommended hand therapy and splinting. Also some deferred surgical procedures were needed, such as contracture liberations, tendinous transfers, angular deformities bone corrections and neurotizations. In one patient, a digit amputation was mandatory. We evaluated wrist, metacarpophalangeal and interphalangeal mobility, as well as the thumb function with good functional results in three patients. One patient presented a deep mobility affectation. Another patient was lost during the follow-up. CONCLUSIONS There is a clear connection between some extrinsic intrauterine and intrinsic fetal factors during the last trimester of pregnancy and an increased intracompartmental pressure in these affected upper limbs. These patients require an urgent treatment, which may minimize late consequences such as disrupted upper limb functionality and, in some cases, even amputations. The use of a regional anesthetic block, which causes a sympathetic block and with that, a vasodilatation, seems to improvesubstantially the final functional results. SIGNIFICANCE Efforts among the community of pediatric hand surgeons may be joined, in order to share knowledge and to provide new ideas. The origin and the possible treatments for this devastating condition may be more studied and detailed.
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ABSTRACT: Aim. Septic arthritis of the hip in childhood is a therapeutic emergency and can result in severe long-term sequelae in terms of loss of movement, pathologic hip dislocation, growth disturbance and leg-length discrepancy. The aim of this study was to compare results of open arthrotomy of the hip versus repeated ultrasound-guided aspirations. Methods. This study was carried out during the period between October 1999 and December 2006 at Prishtina University Hospital, Kosovo. During that period 28 children with acute septic arthritis of the hip were treated in our hospital. 14 of them were treated with repeated aspiration and irrigation with normal saline solution via an anterior approach under local anesthesia using ultrasound guidance. The other fourteen children underwent open anterior hip arthrotomy as an emergency procedure immediately after ultrasound-guided needle aspiration. Parentheral antimicrobial therapy was used for a total period of 20 days. Postoperatively the patients were given simply rest with skin traction for two weeks and non-weight bearing on the affected hip for four weeks followed by partial weight bearing for another three weeks. Results. Apyrexia was obtained after a mean period of 4 days. The mean number of aspiration was 5.6 (range 5-8), and 70% of the patients resumed walking after 72 hours. The mean follow-up time was 7.4 years (range 4-12). On the last follow-up visit all patients expect one in open anterior hip arthrotomy group were totally painless and had no limitation of physical activity. US-guided aspiration allowed selection of only those with septic arthritis for operative drainage or repeated ultrasound guided aspirations. Conclusion. Ultrasound-guided percutaneous aspiration irrigation drainage gave very good results in this study populations, earlier return to normal activity with rapid clinical and biological improvement and absence of long-term sequelae.
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