Cystic Fibrosis with Paediatric Femoral Neck Stress Fracture: A Case Report and the Review of Literature

Cystic fibrosis is a common genetic disease of the white population with autosomal recessive inheritance. It may present with sinopulmonary, gastrointestinal, genitourinary, bone and joint findings. Osteoporosis, osteopenia, and fractures are musculoskeletal problems related to the disease. Although vertebral fractures are common, non-vertebral fractures have been reported rarely. In this case report, we present the case of a 9-year-old girl with osteopenia-induced femoral neck stress fracture caused by cystic fibrosis. During hospitalization for sinopulmonary infection, the patient presented to our clinic with left thigh pain without trauma. The left hip joint was examined and found to be clear. Anterior posterior X-ray examination of the patient, who had difficulty in stepping, revealed no displaced fracture. The patient was later diagnosed with type 2 Fullerton & Snowdy fracture, and surgical fixation was ruled out. The patient was successfully treated with non-steroidal anti-inflammatory drugs and immobilization

Effect of rotational deformities after pediatric femoral fracture on clinical outcome

Femoral shaft fractures are the most common pediatric injuries that require hospitalization. Early closed reduction and spica casting are one of the most popular treatment options. One of the significant complications of spica casting is rotational deformities of the fracture. The present study aimed to determine the potential effects of rotational deformities in pediatric patients who underwent early spica casting after a femoral shaft fracture. Pediatric patients who underwent early spica casting following femoral shaft fractures were screened retrospectively. Radiological measurements were made on the patients\" initial postop radiographs who could be measured rotationally according to the defined radiological method. Twenty-three patients with more than 10 degrees of rotation in their measurements were included in the study. Differences in leg length and rotation between both legs were calculated with clinical examination methods for all patients in the study. The gaits of the patients were observed; patient and family complaints were obtained. We found a strong and positive correlation between the rotational measurement made on the X-ray and the clinical measurement (R: 0.634, P: 0.001). For measurements made on X-ray, the mean rotational value was calculated as 27.2 +/- 6.9 degrees. After the patients\" clinical examination, an average of 3.0 +/- 1.7 degrees rotational difference was found between the broken limb and the healthy limb. No patient or family complained of trauma. Early spica casting, according to the age of the patient, is an effective treatment method. There may still be certain degrees of deformity after treatment, but patients well tolerate them even at high degrees. Accordingly, it was concluded that the rotational deformities less than 30 degrees would not cause clinical problems on children under 4 years of age which may require postoperative revisions or the use of various costly imaging techniques and include radiation

Supracondylar humerus fractures in ınfants and early toddlers; characteristics, clinical and radiological outcomes compared with older children

Background Supracondylar humerus fractures (SCHF) are rarely seen in the youngest age groups (1-3 years). Although there is no difference in the context of treatment options, it has been shown that younger age groups have different characteristics. Few studies have examined toddlers, which have notably different characteristics. This study is the first to report the characteristics, diagnosis, treatment and functional results of SCHF in infants and early toddlers. Methods A retrospective analysis was made of the data of patients younger than 30 months old, who were operated on in our clinic for SCHF between 2012 and 2020 with at least 2 years of follow-up. Patient demographic and surgical data, and the functional and radiological results were documented. Results Evaluation was made of a total of 52 patients comprising 30 females (58%) and 22 males (42%), with a mean age of 20.75 +/- 5.4 months (range, 6-30 months). The injury was in the right elbow in 24 (46%) patients. The mechanism of injury was a fall from an object at home (table, chair, bed, etc.) in 41 (79%) patients. Patients who fell from a height of more than 4 meters had additional injuries (liver laceration, vertebral fracture, etc.). Only 1 patient had anterior interosseous nerve (AIN) damage before the operation, but the final follow-up neurovascular examinations for all patients were normal. The median follow-up period was 4 years (range, 2-7 years). Flynn outcome scores were (88.5%) excellent and variant Hospital for Special Surgery scores were (82.7%) excellent. Conclusions With appropriate treatment of SCHF, the clinical outcomes in infants and early toddlers are excellent. Using a medial pin to achieve and protect stability in this age group does not increase the risk of iatrogenic ulnar nerve damage. Patients younger than 20 months tend to have more varus malalignment but similar functional results

Factors affecting postmusculoskeletal tumour surgery wound problem treatment with negative pressure wound therapy

The aim of the study is to investigate the risk factors identified in literature that have been associated with prolonged Negative Pressure Wound Therapy (NPWT). Our study included patients who developed local wound problems after bone or soft tissue sarcoma surgery with negative margin at our clinic between 2012 and 2018 and treated with NPWT. All patients were followed up of at least 6 months. Sex, albumin level, skin infiltration, type of wound problem, postoperative intensive care unit (ICU) requirement, and intraoperative blood loss were found to be influential factors on NPWT > 10 sessions. We conclude that treatment may be prolonged and the necessary precautions need to be taken in patients with an impaired preoperative nutritional condition, with intraoperative high amount of blood loss, and with long postoperative stays in the ICU as well as if the underlying cause for wound problem is an infection

Diz bölgesi intraartiküler ve periartiküler kitlelere retrospektif bakış; güncel bir algoritma oluşturma

Amaç: Az rastlandıklarından dolayı tıbbi literatürde diz eklem içi ve Hoffa yastığındaki kitleler genellikle vaka takdimi şeklinde ortaya çıkmıştır. Bu çalışmanın amacı diz bölgesinde kitle ile kliniğimize başvurmuş ve opere edilmesi kararlaştırılmış hastaları retrospektif olarak değerlendirerek patoloji sonuçlarını ortaya koymak ve bu hastalara güncel bir yaklaşım algoritması oluşturmaktır. Yöntem: Çalışmaya 2014-2019 yılları arasında kliniğimize diz eklem içi veya Hoffa yastığında kitle ile başvurmuş ve opere edilmiş, yaş ortalaması 34 olan 28 hasta dahil edilmiştir. Cerrahi tedavi uygulanmayan hastalar çalışma dışı bırakılmıştır. Hastaların klinik ve fizik muayene bulguları, radyolojik olarak X-ray ve MR görüntülemeleri ve uygulanan cerrahi sonrası patoloji sonuçları retrospektif olarak değerlendirilmiştir. Buna göre kitlenin boyutu, semptomatik olması ve MR da kontrast madde tutulum miktarı parametre olarak kullanılarak hastalara bir yaklaşım algoritması kurulmuştur. Bu algoritmaya göre tamamen iyi görünüşlü semptomatik kitleler intraartiküler yaklaşımla çıkarılabilir ama habis kitlelere ekstraartiküler rezeksiyon yapılmalıdır. Radyolojik görünümü şüpheli lezyonlara ise eklem kontaminasyonundan kaçınmak için kapalı biopsi işlemi yapılmaz, mümkünse kitle üzerinde bir bir miktar sinoviyal doku bırakarak intraartiküler olarak çıkartılırlar. Asemptomatik tamamen selim görünüşlü lezyonlar ise klinik ve radyolojik olarak konservatif olarak takip edilebilirler. Bulgular: Patoloji sonucu 28 hastadan 15’inde sinoviyal dev hücreli tümör, 5 çocuk hastada sinoviyal hemanjiyom, yine 2 çocuk hastada kapiller hemanjiyom, 2 hastada sinoviyal kondromatozis, 1 hastada intraartiküler osteokondrom,1 hastada intraartiküler ganglion kisti ve dikkat çekici olarak bir tanesi başka bir merkezden refere edilmiş olan 2 hastada sinoviyal sarkom olarak gelmiştir. Bu 2 hastaya medikal onkoloji ve radyasyon onkolojisi ile yapılan konsey sonrası ekstraartiküler rezeksiyon ve endoprotez uygulaması yapılmıştır. Çıkarımlar: Diz bölgesi kitlelerinde nadir de olsa başta sinoviyal sarkom olmak üzere habis lezyonların da ayırıcı tanıda olabileceği akılda tutulmalıdır. Bu lezyonların karakteristik radyolojik ve klinik bulgularının olmayabileceği ihtimali de göz önüne alınırsa hastalara çok dikkatli yaklaşılması gerekir. Özellikle habis olan intraartiküler bir kitleye preoperatif yapılacak biopsi işleminin tüm eklemi kontamine edebileceği ve tüm tedavinin kaderini değiştirebileceği gerçeği dikkatten kaçırılmamalıdır

Pros and cons of botulinum toxin injection therapy in cerebral palsy: A qualitative study exploring caregivers' perspective

Background To describe and understand the experiences and beliefs of caregivers of children with cerebral palsy following botulinum toxin injection. Methods A descriptive case study approach with focus group interviews was employed. A semi-structured questionnaire was conducted to collect data. Twenty-one caregivers of children (3-13 years old) with cerebral palsy were recruited with a maximum variation sampling strategy to gain insight through different perspectives. Qualitative analysis with verbatim transcripts was analysed using a thematic approach. Findings Four themes emerged from qualitative analyses: acceptance of diagnosis, perceptions about treatment, caregivers' experiences with the health environment, and feelings and thoughts after the treatment. Conclusions This study highlights caregivers' requests for information about the possible long-term effect of botulinum toxin, as well as information and support to provide the best rehabilitation programme immediately after injection