A Rare Case of Bilateral Spaghetti Injuries in Children due to Assault by Mother and Analysis of Functional Outcome at Three Years

2021 ◽  
Author(s):  
Parag B. Lad ◽  
N. Venkateshwaran ◽  
M. R. Thatte ◽  
Sanket Tanpure
Keyword(s):  
Functional Outcome ◽  
Case Series ◽  
Sensory Loss ◽  
Nerve Reconstruction ◽  
Range Of Movement ◽  
Flexor Tendons ◽  
Tendon Lengthening ◽  
Flexor Tendon Injuries ◽  
Life Threatening

AbstractManagement of child abuse with flexor tendons, neurovascular injuries, and life-threatening conditions is challenging. It needs a multisectoral coordinated and synchronized team effort for successful outcomes. We present a case series of children abused by a parent with a sharp object. The children sustained multiple flexor tendon injuries, neurovascular injuries in upper limbs, and tracheal injury compromising respiration. We performed a tracheostomy to save a child and subsequently repaired numerous flexor tendons, nerves, and arteries. During follow-up, these children required secondary reconstruction (tenolysis, tendon lengthening, nerve reconstruction) for flexor contractures, stiffness, and sensory loss in distal forearms. We measured the range of movements and assessed the children’s functional outcome using the Strickland score at 3-year follow-up. The range of movement and functional outcome was excellent in both children in our series. A timely performance of surgery, aided with efficient intensive care, therapy, and consistent posttraumatic psychosocial rehabilitation, produced excellent results in our series.

CURRENT MANAGEMENT OF JERSEY FINGER IN RUGBY PLAYERS: CASE SERIES AND LITERATURE REVIEW

Hand Surgery ◽  
2010 ◽  
Vol 15 (02) ◽  
pp. 103-107 ◽  
Author(s):  
A. Goodson ◽  
M. Morgan ◽  
G. Rajeswaran ◽  
J. Lee ◽  
E. Katsarma
Keyword(s):  
Functional Outcome ◽  
Case Series ◽  
Positive Outcome ◽  
Flexor Digitorum Profundus ◽  
Type I ◽  
Tendon Lengthening ◽  
Satisfactory Outcome ◽  
Rugby Players ◽  
Jersey Finger

We discuss a combination of established and modern techniques in the investigation and management of traumatic flexor digitorum profundus rupture ('Rugger Jersey Finger') in seven cases (male rugby players ranging from 15 to 30 years of age; mean = 26). We discuss the use of X-ray and ultrasound investigation followed by various surgical repairs including intraosseous sutures, suture anchors, tendon lengthening and "pull-through suture over button" repairs. Functional outcome at outpatient follow-up is discussed in each case. Type I, II and Vb injuries were identified. Patients presenting early attained good functional outcome. Six patients received surgery within ten days of injury and attained satisfactory outcome at follow-up. One patient presented late and required a tendon lengthening procedure to manage myostatic contracture. Ultrasound imaging proved valuable in diagnosis and pre-operative planning. Numerous surgical repairs were used and all associated with a positive outcome providing there is adequate patient compliance.

Outcome of zone 2 flexor tendon injuries: Kleinert versus controlled active motion therapy regimens

Hand Therapy ◽  
2011 ◽  
Vol 16 (4) ◽  
pp. 102-106 ◽  
Author(s):  
Phoebe Prowse ◽  
Matt Nixon ◽  
Joannis Constantinides ◽  
Janet Hunter ◽  
Angela Henry ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Case Series ◽  
Tendon Injuries ◽  
Range Of Movement ◽  
Retrospective Case ◽  
Active Motion ◽  
Significant Difference ◽  
Flexor Tendon Injuries ◽  
Total Active Motion

Introduction No single optimal regimen for the rehabilitation of flexor tendon injuries has yet been determined. We aimed to evaluate if a change in rehabilitation from a modified Kleinert to a controlled active motion (CAM) regimen had an effect on outcomes in a regional plastic surgery unit. We did this by comparing ruptures and range of movement of zone 2 repairs following both Kleinert and CAM regimens. Methods We performed a retrospective case series review, analysing data collected prospectively between 2004 and 2007. During 2004 and 2005, patients were rehabilitated with a modified Kleinert regimen, and during 2006 and 2007 a CAM regimen was used. We looked at total active motion (TAM) and ruptures at 12-week follow-up for all zone 2 repairs, and compared the two regimens. Results There were 38 patients with 42 injured digits in the Kleinert group, and 34 patients with 39 injured digits in the CAM group. There was no statistically significant difference in TAM achieved between the Kleinert and CAM regimens overall (70% versus 72% of normal in each group respectively, P = 0.70 t-test). Patients over 30 years old achieved significantly worse outcomes in the Kleinert group than in the CAM group ( P = 0.03). One digit ruptured following a Kleinert regimen (2.6%) compared with four digits in the CAM group (11.7%). Conclusion In this study, we found no overall difference in outcome following a Kleinert or CAM rehabilitation regimen. Rupture rates were higher in the CAM group by four-fold. In our patients those over 30 years had poorer outcomes when rehabilitated with a Kleinert regimen.

scholarly journals Treatment and therapeutic strategies for pituitary apoplexy in pregnancy: a case series

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuya Kato ◽  
Yoshikazu Ogawa ◽  
Teiji Tominaga
Keyword(s):  
Pituitary Apoplexy ◽  
Clinical Symptoms ◽  
Case Series ◽  
Optimal Timing ◽  
Presenting Symptoms ◽  
Pathological Evaluation ◽  
Mother And Child ◽  
Life Threatening ◽  
In Pregnancy

Abstract Background Pregnancy is a known risk factor for pituitary apoplexy, which is life threatening for both mother and child. However, very few clinical interventions have been proposed for managing pituitary apoplexy in pregnancy. Case presentation We describe the management of three cases of pituitary apoplexy during pregnancy and review available literature. Presenting symptoms in our case series were headache and/or visual disturbances, and the etiology in all cases was hemorrhage. Conservative therapy was followed until 34 weeks of gestation, after which babies were delivered by cesarean section with prophylactic bolus hydrocortisone supplementation. Tumor removal was only electively performed after delivery using the transsphenoidal approach. All three patients and their babies had a good clinical course, and postoperative pathological evaluation revealed that all tumors were functional and that they secreted prolactin. Conclusions Although the mechanism of pituitary apoplexy occurrence remains unknown, the most important treatment strategy for pituitary apoplexy in pregnancy remains adequate hydrocortisone supplementation and frequent hormonal investigation. Radiological follow-up should be performed only if clinical symptoms deteriorate, and optimal timing for surgical resection should be discussed by a multidisciplinary team that includes obstetricians and neonatologists.

Cartilage Damage Determines Intermediate Outcome in the Late Multiple Ligament and Posterolateral Corner-Reconstructed Knee

2008 ◽  
Vol 36 (2) ◽  
pp. 267-275 ◽  
Author(s):  
Kristoff Corten ◽  
Johan Bellemans
Keyword(s):  
Functional Outcome ◽  
Cartilage Damage ◽  
Case Series ◽  
Posterolateral Corner ◽  
Reliable Technique ◽  
Sling Procedure ◽  
Time Of Surgery ◽  
Functional Scores ◽  
Reconstructed Knee

Background Patients with chronic ruptures of 1 or both cruciate ligaments in combination with posterolateral rotatory instability of the knee often have some degree of cartilage damage at the time of surgery. Hypothesis Chondrosis at the time of reconstruction does not influence early and intermediate functional outcome of the multiple ligament reconstructed knee. Study Design Case series; Level of evidence, 4. Methods Twenty-one patients were available from an original 27 treated between 1995 and 2000. All patients were assessed preoperatively and postoperatively by physical examination and by applying 4 different knee rating scores. All patients were assessed at a mean follow-up of 39 months (range, 14–75 months) and 87 months (range, 62–123 months). Results At the first follow-up, all knee rating scores had improved significantly ( P < .0003) compared with preoperatively; 84% of the reconstructed knees had normal to nearly normal laxities according to the International Knee Documentation Committee 2000 score. At the second follow-up, the functional scores remained significantly ( P < .0089) better than preoperatively. Patients with chondrosis at the time of surgery did not have significantly different knee rating scores at the first follow-up compared with patients without cartilage damage. Four years later, the results in the chondrosis group were significantly worse ( P < .05) for all knee rating scores compared with the patients without chondrosis. The results in 3 of 4 knee rating scores declined significantly in the chondrosis group over the 48-month interval between follow-up sessions. In the Tegner and Lysholm score, the results deteriorated to the preoperative level. Patients with different cruciate ligament reconstructions did not have significantly different knee rating scores. Conclusion The posterolateral sling procedure is a stable and reliable technique for posterolateral corner reconstruction. The presence of chondrosis at the time of surgery is an important prognosticator of functional outcome at intermediate follow-up.

Efficacy, Outcomes, and Alignment Following Isolated Fibular Sesamoidectomy via a Plantar Approach

2019 ◽  
Vol 40 (12) ◽  
pp. 1375-1381 ◽  
Author(s):  
Samuel E. Ford ◽  
Christopher R. Adair ◽  
Bruce E. Cohen ◽  
W. Hodges Davis ◽  
J. Kent Ellington ◽  
...  
Keyword(s):  
Pain Relief ◽  
Functional Outcome ◽  
Case Series ◽  
Office Visit ◽  
Administrative Database ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Tertiary Referral Center ◽  
Flexion Strength

Background: The purpose of this study was to evaluate patients for intermediate-term pain relief, functional outcome, and changes in hallux alignment following isolated, complete fibular sesamoidectomy via a plantar approach for sesamoid-related pain recalcitrant to conservative treatment. Methods: A retrospective query of a tertiary referral center administrative database was performed using the Current Procedural Terminology code 28135 for sesamoidectomy between 2005 and 2016. Patients who underwent an isolated fibular sesamoidectomy were identified and contacted to return for an office visit. The primary outcome measure was change in visual analog pain score at final follow-up. Secondary measures included satisfaction, hallux flexion strength, hallux alignment, pedobarographic assessment, and postoperative functional outcome scores. Patients who met the 2-year clinical or radiographic follow-up minimum were included. Ninety fibular sesamoidectomies were identified. Thirty-six sesamoidectomies met inclusion criteria (median 60-month follow-up). The average patient was 36 years old and underwent sesamoidectomy 1.1 years after initial diagnosis. Results: Median visual analog scale scores improved 5 (6 to 1) points at final follow-up ( P < .001). Final postoperative mean hallux valgus angle did not differ from preoperative values (10.5 degrees/8.5 degrees, P = .12); similarly, the intermetatarsal angle did not differ (8.0 degrees/7.9 degrees, P = .53). Eighty-eight percent of patients would have surgery again and 70% were “very satisfied” with their result. Hallux flexion strength (mean 14.7 pounds) did not differ relative to the contralateral foot (mean 16.1 pounds) ( P = .23). Among the full 92 case cohort, 3 patients underwent 4 known reoperations. Conclusion: Fibular sesamoidectomy effectively provided pain relief (median 5-year follow-up) for patients with sesamoid pathology without affecting hallux alignment. Level of Evidence: Level IV, retrospective case series.

scholarly journals Outcome of Unstable Thoracolumbar Fracture Following Long Segment Posterior Fixation

2021 ◽  
Vol 39 (2) ◽  
pp. 114-122
Author(s):  
Abdullah Al Mamun Choudhury ◽  
Md Shah Alam ◽  
Abul Kalam Azad ◽  
Kohinoor Akhter
Keyword(s):  
Functional Outcome ◽  
Neurological Deficit ◽  
Thoracolumbar Spine ◽  
Case Series ◽  
Fusion Rate ◽  
Spine Injury ◽  
P Value ◽  
Posterior Fixation ◽  
Thoracolumbar Region

Introduction: Fractures of the thoracolumbar region are the most common injuries of the vertebral column and burst fractures are the most frequent. The purpose of this study was to see the radiological and functional outcome after long segment posterior fixation in unstable thoracolumbar spine injury with incomplete neurological deficit. Methods: A total of 146 cases were included in this prospective case series from January 2014 to December 2018 through non randomized purposive sampling. All the patients were operated with long segment posterior fixation and postero-lateral fusion by Autogenous cancellous bone graft. Postoperative functional outcome was assessed both clinically by ODI, VAS, ASIA and radiologically by Bridwell criteria. Postoperative follow up was conducted at 2nd, 6th,12th and finally 6 monthly. Results: The mean Cobb angle at pre-operative was 21.5 ±8.9 and at final follow-up was 11±4.57 in this study (p-value<0.05). At final follow up 1 grade improvement occurred in 116(79.5%) patients and 2 grade improvement in 36 (20.5%). Regarding ODI and VAS, moderate disability (25%) with mild pain (16%) was found at final follow up with a Bridwell fusion grade II (48%). Conclusion: Long segment transpedicular screw fixation in unstable thoracolumbar spine injury with incomplete neurological deficit is an effective method of treatment. This method enhances neurological and functional recovery with an acceptable fusion rate J Bangladesh Coll Phys Surg 2021; 39(2): 114-122

scholarly journals Open reduction in neglected elbow dislocation in children: a case series

2019 ◽  
Vol 38 (1) ◽  
pp. 63
Author(s):  
Komang Agung Irianto ◽  
Raymond Parung ◽  
William Putera Sukmajaya
Keyword(s):  
Functional Outcome ◽  
Performance Index ◽  
Open Reduction ◽  
Case Series ◽  
Elbow Dislocation ◽  
Elbow Flexion ◽  
Range Of Movement ◽  
Average Improvement ◽  
Fracture Management ◽  
Average Loss

Background<br />Elbow deformity in children due to neglected proper fracture management is a devastating condition. The stiffness and pain complicated the function in daily activity. Successful management of neglected elbow dislocation is a challenging problem for orthopedic surgeons. In this study, we aimed to evaluate results of open reduction for neglected elbow dislocation in children.<br /><br />Case Description<br />This is a case series of 13-14 years old neglected elbow dislocations, for up to 15 months. Open reduction after external distractor and followed by intensive rehabilitation was implemented. Clinical and functional outcome were evaluated within 4-7 years. Initial average elbow flexion was 53,3°, extension was 0°, arc of flexion was 53,3°, arc of pronation-supination was 150° and Mayo Elbow Performance Index (MEPI) was 80. Clinical and functional outcome were evaluated within 4-7 years. At follow-up after open reduction, the improvement in whole range of movement was significant. Average elbow flexion was 118,3°, extension was 36,67°, arc of flexion was 81,67°, arc of pronation-supination was 133°. The average improvement of flexion was 65°, arc of flexion was 31,67°, and arc of pronation-supination was 8,3°. The average loss of flexion was 15,5%, arc of flexion was 44,2%, and arc of pronation-supination was 10,7% compared with uninjured side. The average Mayo Elbow Performance Index (MEPI) was 96,67; all with excellent results.<br /><br />Conclusion<br />Planned and well execution open reduction in pediatric neglected elbow dislocation may bring back the painless movement within normal daily function.

scholarly journals Clinical and Radiological Outcomes of Subtalar Kalix II Arthroereisis for a Symptomatic Pediatric Flexible Flatfoot

2019 ◽  
pp. 193864001989206 ◽  
Author(s):  
Robin T. A. L. de Bot ◽  
Jasper Stevens ◽  
Joris P. S. Hermus ◽  
Heleen M. Staal ◽  
Lodewijk W. van Rhijn ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Functional Outcome ◽  
Revision Surgery ◽  
Clinical Symptoms ◽  
Case Series ◽  
Postoperative Phase ◽  
Levels Of Evidence ◽  
Flexible Flatfoot ◽  
Subtalar Arthroereisis

Background. The purpose of this study is to evaluate functional and radiological outcomes of subtalar arthroereisis in the treatment of symptomatic pediatric flexible flatfeet. Methods. A total of 16 patients (26 feet) were treated with a Kalix II as subtalar motion blocker between 2009 and 2014. Calcaneal pitch (CP) and Meary’s angle (MA) were measured on radiographs preoperatively, directly postoperatively, and at follow-up 47 ± 17 (range 19-79) months. Patient satisfaction surveys were used to assess functional outcome and patient satisfaction. Results. Surgery was performed mostly for pain, walking problems, or a combination of both at a mean age of 12.5 ± 1.5 (range 10-15) years. Symptoms were relieved in 62.5% of patients in the postoperative phase and increased to 68.75% at follow-up. A statistically significant increase in CP of 2.8° and decrease in MA of 14.0° was observed directly postoperatively, which persisted during the follow-up period irrespective of Kalix removal. Revision surgery was necessary in 6 cases (23%) because of arthroereisis migration. Conclusion. Subtalar Kalix II arthroereisis significantly reduced clinical symptoms and improved the CP and MA directly postoperatively, which persisted during follow-up, irrespective of Kalix removal. Therefore, subtalar arthroereisis is a considerable intervention to reduce symptoms in children with symptomatic flexible flatfeet. Levels of Evidence: Level IV: Case series

scholarly journals Correction of Carpal Valgus and Flexural Deformity with z-Tenotomy and Anastomosis Procedure in a Dog

VCOT Open ◽  
2020 ◽  
Vol 03 (01) ◽  
pp. e28-e32
Author(s):  
Mikaela Gondolfe ◽  
Mark Garneau
Keyword(s):  
Case Report ◽  
Weight Bearing ◽  
Small Animal ◽  
Tendon Injuries ◽  
Successful Outcome ◽  
Flexor Tendons ◽  
Tendon Lengthening ◽  
Flexor Carpi Ulnaris

AbstractThis study aimed to describe a staged bilateral z-tenotomy and anastomosis procedure of flexor carpi ulnaris and superficial digital flexor tendons for the correction of carpal valgus and flexural deformity in a 1-year-old male-neutered Akita dog. Bilateral carpal valgus and flexural deformity were observed with palpably taut flexor carpi ulnaris tendons. The dog had a mild, weight-bearing bilateral forelimb lameness with the left forelimb more severely affected. Both forelimbs were treated with staged z-tenotomy and anastomosis procedure of both flexor carpi ulnaris and superficial digital flexor tendons. Successful tendon lengthening and correction of carpal valgus were achieved via z-tenotomy and anastomosis of affected tendons. No complications were observed. An 18-month follow-up revealed no evidence of lameness or carpal valgus. Though tendon injuries commonly occur in small animal patients, there is a shortage of reported cases, especially involving musculotendinous contractures. There are even fewer reports of successful tenotomy procedures. This case report supports successful outcome of the z-tenotomy procedure in a canine patient.

scholarly journals Disfiguring high-flow cervicofacial arteriovenous malformations

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Alaa Nabawi ◽  
Nader Abraham ◽  
Ayman Nabawi
Keyword(s):  
Oral Cavity ◽  
Vascular Malformation ◽  
Arteriovenous Malformations ◽  
Case Series ◽  
High Flow ◽  
Vascular Anomalies ◽  
Maxillofacial Region ◽  
Clinical Onset ◽  
Life Threatening

Abstract Arteriovenous malformations (AVMs) are congenital vascular anomalies resulting from defects in angiogenesis. Approximately 40% of AVMs go undetected after birth and only experience the delayed clinical onset of symptoms in adulthood. AVMs are rare, representing only 1.5% of all vascular anomalies. The most common sites for the aberrant vascular nidus are the oral cavity and maxillofacial region, which represent 50% of the cases. AVMs are the most challenging and life-threatening form of vascular malformation. Exsanguination, thrombus detachment and embolization are the most hazardous operative risks. Small case series revealed a 75% recurrence rate during a 5-year follow-up, which adds another layer of complexity to their management. Large lesions in the head and neck cause deformation to the patient and present a challenge to the surgeon during their excision among vital structures and reconstruction of the 3D complex defects.

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