RESUMEN
Paediatric amputation is one of the treatment options for various indications, namely, trauma, infection, tumour and congenital problems, and some may be born with congenital problems. It differs from adult amputation as they have higher physical demands, and special complications may arise. Stump overgrowth by far is the commonest complication in paediatric transosseous amputation, while varus deformity of the tibia stump was reported sparsely in the literature. The growth discrepancy of the proximal tibia and fibula physis coupled with distal tibiofibular synostosis may have resulted in proximal migration of the fibula, which later resulted in varus deformity of the stump. This will cause difficulty in prosthesis fitting and lead to painful stumps due to the pressure at the abnormal bony prominence. We report a case of congenital limb deficiencies in a 12-year-old male who was treated with below-knee amputation (BKA) and experienced progressive varus deformity of the stump that caused pain during prosthetic wear, which interfered with his gait. He had a varus deformity of 15 degrees of the stump, distal tibiofibular synostosis and proximal migration of the fibula head. As the conservative management by modification of the prosthesis had failed, he underwent open wedge proximal tibia corrective osteotomy, division of the synostosis and reduction of the fibula head. The surgical intervention was successful in alleviating his problem. All efforts must be made to ensure optimum prosthetic fitting in paediatric amputation patients to maintain the patient's daily lifestyle and activities.
RESUMEN
Al-Fashdu is a well-known Islamic medicine-based alternative treatment, and it has been widely practiced with the aim of treating certain health issues in various countries. Unfortunately, this therapy can lead to certain complications, including life-threatening infections. We report a case of a 12-year-old male patient who developed a disseminated Staphylococcus aureus infection following Al-Fashdu therapy. He was treated with surgical drainage and intravenous antibiotics. To our knowledge, this is the first report of a disseminated Staphylococcus aureus infection following Al-Fashdu therapy in an adolescent patient.
RESUMEN
Growth plate injuries over the distal femur typically occur due to high-energy trauma. It is commonly associated with serious complications such as growth disturbance. Its occurrence in children undergoing limb-lengthening procedures is uncommon. We report a case of distal femur growth plate injury in a 13-year-old boy undergoing a limb-lengthening procedure for femoral hypoplasia. Conservative treatment yielded a good functional outcome in this patient.
RESUMEN
Primary non-Hodgkin lymphoma arising from the spine is exceedingly rare. Spinal cord compression can be the first presentation of a patient with primary spinal non-Hodgkin lymphoma. Due to its rarity and vague clinical presentation, the diagnosis can be confused with tuberculosis of the spine, a more common disease in this country. We present a case of primary thoracic spine B-cell lymphoma in a 45-year-old lady who presented with spinal cord compression. This case highlights the importance of obtaining histopathological samples for examination and the treating physician should be vigilant on this rare cause of spinal cord compression. Treatment can be initiated promptly once the diagnosis is established as primary spinal non-Hodgkin lymphoma carries a dire prognosis.
RESUMEN
Ascorbic acid (vitamin C) is an essential micronutrient that the human's body cannot synthesize endogenously. Scurvy, a disease of ascorbic acid deficiency, can manifest in a myriad of presentations. Due to its rarity in the modern world, scurvy is considered as a disease of the past. We present a paediatric case of scurvy with musculoskeletal manifestations as a result of picky eating behavior. We report a previously healthy nine-year-old boy who presented with unexplained progressive bilateral lower limb generalized weakness and pain for two months. All initial biochemical and radiological investigations were unremarkable. Upon further history taking, he had severe picky eating behavior which raised the suspicion of scurvy. The diagnosis was confirmed with a serum ascorbic acid test. After ascorbic acid supplementation, his symptoms resolved immediately. Further food behavioral modification counselling to his family members helped to change his diet in a lasting way. As a result, he had no recurrence of symptoms. This case highlights the importance of having a high index of suspicion for an uncommon disease and emphasizes the need for a detailed dietary history upon patient's presentation.
RESUMEN
Introduction This appears to be the first biomechanical study that compares the stability of various locations of the crossing points in crossed pinning Kirschner wiring (K-wire) construct in treating pediatric supracondylar humerus fracture (SCHF). Additionally, this study compared the biomechanical stability between crossed pinning K-wire construct and the three-lateral divergent K-wire construct. Methods For the study purpose, 30 synthetic humerus bones were osteotomised at mid-olecranon fossa, anatomically reduced, and pinned using two 1.6-millimeter K-wires in five different constructs. A total of six samples were prepared for each construct and tested for extension, flexion, valgus, varus, internal rotation, and external rotation forces. Results As for crossed pinning K-wire construct, the center crossing point emerged as the stiffest construct in both linear and rotational forces, in comparison to the lateral crossing point, superior crossing, and medial crossing point Conclusion Based on this analysis, it is highly recommended that, if the crossed pinning construct is selected to treat supracondylar humerus fracture, the surgeon should aim for center crossing point as it is the most stable construct. Nevertheless, if lateral and superior crossing points are obtained during the initial attempt of fixation, the fixation may be accepted without revising the K-wire as the stability of these two constructs are comparable and portrayed no significant difference when compared to that of the center crossing point. Additionally, it is essential to avoid the medial crossing point as it is significantly less stable in terms of rotational force when compared to the center crossing point.