Pseudoarthrosis of second metatarsal fracture

Metatarsal fractures make up the greatest portion of foot fractures in children. Most of them are treated with closed reduction and non-weightbearing cast immobilization.Usually, these fractures heal uneventfully and delay union and pseudoarthrosis are rare. We report a case of a 10-year-old child with non-union of the second metatarsal following a traumatic fracture, caused by an accident 10 months before, and treated successfully by osteosynthesis with plate and screws. Good clinical outcome was achieved at 2 years follow-up

transient femoral nerve palsy in spica cast treatment for developmental dysplasia of the hip

A 4 months and half female child come to our attention for congenital dislocation of the left hip, previously treated in another hospital with abduction bracing, without satisfactory results. After progressive longitudinal bilateral traction, closed reduction under general anesthesia was performed and a spica cast was applied in the so-called human position. The patients remained in the spica cast for 6 weeks and then the plaster cast was renewed in narcosis for another 6 weeks. Once the second cast has been removed left femoral nerve palsy was detected. Orthopaedic treatment was interrupted and in 3 months the nerve completely recovered, while the hip was still stable. We followed the child regularly since then, she is now five years old, she is totally asymptomatic, X-rays shows a residual acetabular dysplasia, with no sign of avascular necrosis

Argomenti di ortopedia pediatrica

Il testo si articola in tre parti. La prima, di carattere generale, discute le modalità di sviluppo dell'apparato locomotore e i più frequenti quadri clinici di normalità (dalla nascita al periodo puberale), spesso motivo di consultazione specialistica; per ciascuno di questi temi vengono indicati i criteri per la diagnosi differenziale con le patologie vere e proprie. Nella seconda parte, con approccio estremamente pratico, il lettore è guidato verso la diagnosi di alcune malattie, a partire dal sintomo principale lamentato dal paziente. Nella terza parte si trattano in modo sistematico le principali patologie di carattere ortopedico, a partire dall'eziologia, proseguendo con le modalità diagnostiche, il quadro clinico e le proposte terapeutiche. Delle tecniche chirurgiche non sono illustrati i dettagli, ma le finalità e i tempi consigliati. Destinato agli studenti, al medico di medicina generale e al pediatra di libera scelta nella pratica ambulatoriale, il testo non comprende la trattazione di argomenti specialistici come i tumori maligni o le deformità congenite rare

Study on changes in bone metabolism in a cohort of HIV-infected pregnant women and their uninfected children

Osteopenia and osteoporosis are frequent in HIV-infected patients, because of disease itself and therapy. This study evaluated the incidence of bone disorders in 18 infected pregnant women treated with antiretroviral drugs and in their uninfected children. Biochemical markers of bone metabolism were obtained every three months in pregnant women and at 1, 6 and 12 month of age in children. Serum levels of calcium, inorganic phosphate, bone specific alkaline phosphatase were collected; moreover serum levels of osteocalcin and urinary CTX concentrations were evaluated as bone synthesis and bone resorption index respectively. Ultrasonographic bone densitometry was performed in women once in pregnancy and in children at 1, 6, 12 months of age. In order to critically analyze these data, a normal line was generated from data obtained from a cohort of 80 italian children aged 0-12 months: this is the first study ever performed on newborns and infants, in the aim to identify the normal values of reference in this cluster of age. Lower bone density values, compared with control subjects, were detected in 7/18 women (38.8%): osteopenia was found in 3 women and osteoporosis in 4. Normal serum levels of osteocalcin were detected in osteopenic patients while the serum concentrations were low (< 2.5 ng/ml) all over pregnancy in the four cases of osteoporosis. High CTX urinary concentration was observed in 3 cases of osteoporosis. In just 2 children (born to women who had started an antiretroviral therapy with PIs before conception and have been treated for more than 30 months) low bone density was diagnosed by ultrasonographic densitometry at the first month, but it was found normal both at 6 and 12 months of age. Only in these two cases high CTX urinary concentration was observed at the first month, and was found normal at the following evaluations

Proposal of an innovative casting technique for correction of clubfoot according to Ponseti method: a pilot study

A total of 70 clubfeet were treated by a posterior above-knee cast (pressure points on the talus and on the first metatarsal) according to Ponseti method. At diagnosis, average Pirani score was 4.44, and mean time of treatment was 50.32 days. Overall, 27 (38.6%) clubfeet had only conservative treatment (5.29 casts) and 43 (61.4%) also had Achilles tenotomy (6.38 casts). At the end 61/70 feet (87,14%) had Pirani score 0; 10/70 feet (5,71%) had Pirani score 0,5 . The Pirani score gain/cast was β=-0.432 (P<0.001). This new casting technique is safe and effective at avoiding some adverse issues related to the removal of the conventional cast