Humeral lengthening: Case report

Introduction. Difference in length of upper extremities has mainly esthetic significance and is therefore not so often a subject of operative treatment, compared to lower extremities. Case Outline. We are presenting a case of a 16­year­old patient in whom a shortening of 9 cm of the right humerus was determined at the end of growth. This shortening was the result of surgical treatment of solitary bone cyst at the proximal end of the humerus done at the age of 10 years. In order to correct the length of the humerus we applied distraction osteogenesis with a compressive­distracting device according to Mitkovic (Traffix), and we achieved the lengthening of 7.5 cm. During the period of distraction we encountered the following complications: minimal suppuration at the site of the wedges that was successfully resolved with intensive local treatment, while pain and paresthesias along the N. radialis were resolved with a temporarily slowing of the distraction process. Fixation with a plate, i.e. bone grafting was not necessary, and final functional and esthetic result was excellent. Conclusion. Successful lengthening of the shortened humerus can be achieved with a unilateral compressive­distracting device according to Mitkovic as its application up to a complete bone reconstruction does not require additional plate fixation or bone grafting. The patient was capable of performing usual daily activities during application of the device

A case of severe type of cerebro-costo-mandibular syndrome

Introduction. Cerebro-costo-mandibular syndrome (CCMS) is a rare disorder, with only 75 cases described in the literature to date. CCMS is characterized by association of micrognathia and specific multiple rib defects. It is accompanied by mental deficiency in considerable number of cases. Sometimes, there are associated anomalies and problems, such as spine deformities, brain, heart, kidney or ear anomalies, feeding difficulties, delayed psychomotor development, and growth impairment. Depending on severity of deformities and consecutive respiratory insufficiency, in about 35-50% of CCMS cases, death occurs during the first year of life. These cases are referred to as severe types of CCMS. Case Outline. In this paper we present a female infant with severe type of CCMS. Diagnosis was established in the first day of life, based on micrognathia and findings of posterior rib-gap defects on the chest X-ray, accompanied by dyspnea. Progressive severe respiratory insufficiency caused by chest and air-way deformities and exacerbated by episodes of pneumonia, led to respiratory failure and death at the age of 7.5 months. Conclusion. CCMS should be considered in every infant with micrognathia and rib-gap defects on chest X-ray

Pediatric femur fractures, epidemiology and treatment

Background/Aim. Femur fractures in children most often occur as a consequence of traffic accidents, during play and sport activities, and due to different pathological states. Diagnosis is rather simple and it includes physical and radiographycal examination. Femur fractures treatment in children can be operative and unoperative, depending on several facts: age, localisation and type of fracture, joint injuries of soft tissues, the presence of other injuries (in polytrauma), economical and social aspects, ect. The aim of this study was to present epidemiological characteristics of pediatric femur fractures, that is in the stage of development, including a special analysis of the used treatment techniques, as well as the comparison of the obtained data with those from the literature. Methods. The evaluation included following parameters: age, gender, cause, localisation and type of femur fracture, applied treatment and hospitalisation duration. Results. Among the presented 143 patients with femur fracture, 109 were boys and 34 were girls (3.2 : 1 ratio; p = 0.0001). Average age for both genders was 8.6 years, and no difference between boys and girls were found for the age (p = 0.758). In total, the most common fracture was diaphyseal fracture of femur in 93 (65.03%) patients. The second was proximal fracture in 30 (20.98%) patients, and the last distal fracture of the femur in 20 (13.99%) patients (p = 0.0001). Three main causes of femur fracture can be distinguished: during play and sport activities in 67 (46.8%) children, in traffic accidents in 64 (44.8%) children, and pathological fractures in 12 (8.4%) children. Inoperative treatment was applied in 82 (57.3%) patients, and operative one in 61 (42.7%) patients. The most common tretament was traction, in 71 (49.6%) patients, followed by immobilization by hip spica cast mostly in young children. Intramedullar elastic nailing was applied in 16 (11.2%) cases, and intramedullar rigid nailing (Küntscher) in 19 (13.3%) cases. Significantlly longer hospitalization period was detected after traction (21 days) comparing to other ways of treatment, mainly operative or hip spica cast (5 to 10 days). Conclusion. In young children the standard treatment was hip spica cast after traction. Intramedullar elastic nailing is a modern trend accepted as standard in our approach to femur fracture treatment in children

Case report UDC: 616.428:616.071:616-053.2 Archive of Oncology 2004;12(1):75-7.

Pigmented villonodular synovitis of the knee in a child- case repor

Pigmented villonodular synovitis of the knee in a child: Case report

Pigmented villonodular synovitis (PVS) is a destructive fibrohistiocytic proliferation with production of villus and nodular protrusions in synovial membrane. A boy, aged 12 years, had a knee injury during a football game with severe pane, swelling, decreased range of motion, and presence of hemarthrosis. Magnetic resonance imaging revealed, in the projection of the suprapattelar recessus, tumefaction of irregular shape; the largest diameter 11x5 cm. Upper pole of tumefaction was partly impressed in m. vastus intermedius. In general endotracheal anesthesia partial synovectomy was done with complete extirpation of tumefaction. The diagnosis of pigmented villonodular synovitis was established histologically. This type of tumefaction is rare in children, but the adequate treatment is necessary because of its aggressive growth with possible bone destruction and propensity of recidivism. The suspicion of malignant neoplasm is often present. Due to various clinical presentation of villonodular synovitis, early detection and adequate treatment is necessary