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Introduction: Osteosarcoma is a malignant tumor, the treatment of which is controversial between amputation and limb salvage surgery. Osteosarcoma occurring in a child is a challenge to manage due to the arrest of limb and the resultant limb length discrepancy. The management options for a child less than eight years of age are very limited. Case report: We present a case of a six year old child who was diagnosed to have osteosarcoma of proximal tibia. She was started on neoadjuvant chemotherapy, after which, she underwent wide resection and reconstruction with free vascularised fibular graft. The joint was fused using a locking compression plate and screws. The locking screws were inserted avoiding the distal femoral physis, enabling growth of the physis in future. Adjuvant chemotherapy was then given. Follow up radiographs showed Harris growth lines indicating growth to be occurring at the distal femoral physis. She was not found to have recurrence on last follow up four years after surgery. Conclusion: We found reconstruction using free fibular graft and arthrodesis using plate and screws, provided satisfactory results. An attempt can be made to preserve the distal femur physis.
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The fibular free flap is most frequently used for reconstructing the mandible owing to the adequate length of the bone with a reliable blood supply. It has a long vascular pedicle with adequate vessel diameter for anastomosis and also a good amount of skin paddle for coverage. However, the reports of post-operative complications at the donor site among pediatric patients are scarce in the literature. We present a pediatric case of ankle valgus deformity following vascularized fibular harvest.
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Introduction: Osteosarcoma (OS) is one of the most common primary malignant bone tumors in children and adolescents. OS incidence varies significantly with age and peak incidence is in adolescent age group. Telangiectatic osteosarcoma (TOS) is an unusual variant of OS, forming 3-10% of all OSs. Only few case reports of this rare variant of OS are described in the literature. Case Report: We report a 6-year-girl who presented with fracture of the left proximal humerus after a trivial trauma. X-ray left shoulder showed osteolytic lesions in the left proximal humerus with fracture of proximal humerus. Open biopsy from the left proximal humerus osteolytic lesion suggested clusters of highly atypical cells like osteoid material and focal areas of hemorrhage and necrosis suggestive of TOS. The child was started on chemotherapy followed by limb-salvage surgery with wide resection of the tumor in the left proximal humerus. She completed her adjuvant chemotherapy and is currently doing well for the past 4 years. Conclusion: OS occurs more frequently in adolescents around the knee in the metaphyses. The most common histologic type is osteoblastic/fibroblastic or chondroblastic type. Very few cases have been reported in <5 years age group and it's relatively rare in 5-10-year-old children. Rare histologic variants, especially telangiectatic variant, are more common in younger children and occur more in upper limbs. Imaging reveals mainly osteolytic lesions, unlike in conventional OS. This case highlights the utmost role of histopathology in the diagnosis of the bone tumors which would guide the management appropriately.
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INTRODUCTION: Upper limb physeal injuries are dealt with differently simply because they do not hinder with the functional abilities of an individual. Humerus lengthening was first attempted in 1978 after which it encouraged many surgeons to safely perform the procedure. Radial nerve palsy occurring as a complication of humeral lengthening was a major concern. CASE REPORT: We report a case of a 17-year-old girl with physeal arrest at the proximal physis of the humerus with etiology of post-trauma/post-infection. She presented with a shortening of 8 cm and restricted shoulder movements. We performed a lengthening of the humerus based on the principle of distraction osteogenesis. We used the paediatric limb reconstruction system to distract the corticotomy. However, postoperatively, she developed radial nerve palsy, despite our intraoperative precautionary measures. Distraction was started at 1mm/day. She then showed the progress of radial nerve recovery and full recovery was noted by 5 months post-operatively. The length of the distraction compression assembly had to be changed twice to longer sizes to accommodate the required amount of lengthening. After consolidation of regenerate was confirmed with serial radiographs, external fixator was removed. She was then maintained on a functional brace. We were able to achieve 8cm of lengthening following distraction, and the cosmetic appearance of the patient improved to the patient's and attenders' satisfaction. CONCLUSION: Humeral lengthening can safely be performed. Careful insertion of the distal pins and performance of the corticotomy will ensure the safety of the radial nerve. Even if radial nerve palsy occurs after all precautions are taken, recovery can be expected.
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Over 70 million women of reproductive age are undernourished in India. Most poverty alleviation programs have not been systematically evaluated to assess impact on women's empowerment and nutrition outcomes. National Rural Livelihoods Mission's poverty alleviation and livelihoods generation initiative is an opportune platform to layer women's nutrition interventions being tapped by project Swabhimaan in three eastern Indian states-Bihar, Chhattisgarh and Odisha. A cross-sectional baseline survey covering 8755 mothers of children under-two years of age, one of the three primary target groups of program are presented. Standardized questionnaire was administered and anthropometric measurements were undertaken from October 2016 to January 2017. 21 indicators on women's empowerment, Body Mass Index and Mid-upper Arm Circumference for nutrition status, food insecurity indicators as per the Food Insecurity Experience Scale and selected indicators for assessing women's access to basic health services were included. National Rural Livelihoods Mission operates in contexts with stark social and gender inequalities. Self-help group members exhibited better control on financial resources and participation in community activities than non-members. Using Body Mass Index, at least 45% mothers were undernourished irrespective of their enrolment in self-help groups. Higher proportion of self-help group members (77%-87%) belonged to food insecure households than non-members (66%-83%). Proportion of mothers reporting receipt of various components of antenatal care service package varied from over 90% for tetanus toxoid vaccination to less than 10% for height measurement. Current use of family planning methods was excruciatingly low (8.2%-32.4%) in all states but positively skewed towards self-help group members. Participation in monthly fixed day health camps was a concern in Bihar. Layering women's nutrition interventions as stipulated under Swabhimaan may yield better results for women's empowerment and nutrition status under National Rural Livelihoods Mission. While this opportunity exists in all three states, Bihar with a higher proportion of matured self-help groups offers more readiness for Swabhimaan implementation.
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Abastecimiento de Alimentos , Estado Nutricional , Pobreza , Salud de la Mujer , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , India , Lactante , Recién Nacido , Masculino , Servicios de Salud Materna , Encuestas Nutricionales , Embarazo , Salud Rural , Grupos de Autoayuda , Adulto JovenRESUMEN
Low back pain in children and adolescents are usually attributed to mechanical causes and faulty positions. Although most of them are self-limiting, physicians should be aware of the red flag signs that warrant complete evaluation to rule out malignant causes of back pain. As delay in the diagnosis of vertebral lytic lesion may have sequelae in the growing children, pain disproportionate to the signs should have low threshold levels for evaluation. We report a case of 6-year-old boy who presented with worsening back pain. Initially evaluated for tuberculosis spine, he was diagnosed to have Langerhans cell histiocytosis of spine. He improved symptomatically with chemotherapy and spine orthosis and is in complete remission now.