A case of non-tropical pyomyositis in a healthy, adolescent, 13-year-old boy, affecting the paraspinal muscles is presented. Computerised axial tomography scan (CT scan) of the spine provided valuable information on the nature, extent of the disease and helped to plan successful surgical management. None of the reported cases of such severity of paraspinal pyomyositis had involvement of quadratus lumborum muscle or compression on retroperitoneal organ as in our case.
Purpose The purpose of this study was to assess the role of clinical examination, associated risk factors and plain radiograph of the pelvis in children who had late presentation of DDH. Methods We report on a 7-year prospective study, in children who had late presentation of developmental dysplasia of the hip (DDH). For this purpose, 740 hips in 370 referred children, age range 3-7 months (mean 3.44 months) were clinically and radiologically assessed, and the associated risk factors recorded. Results Female sex, first born, positive family history and breech presentation were confirmed as risk factors for DDH. Significant findings were an increased risk for vaginal delivery over caesarean section for breech presentation (P = 0.002). There was an increased risk for caesarean section in the absence of breech presentation. Multiple births and preterm births had a reduced risk. For breech presentation, the risk of DDH was estimated to be at least 1.6% for girls and 3.4% for boys; a combination of factors increased the risk. Limitation of abduction (43.2%) and asymmetry of the groin skin folds (72.7%) were found to be the two most common clinical findings associated with DDH. Bilateral acetabular dysplasia is more common than unilateral dysplasia. Foot deformities were rarely encountered in children with acetabular dysplasia. Conclusions The percentage of first-born babies who had DDH is lower than reported in the literature (34%), but still shows significant risk. We did find that bilateral acetabular dysplasia is more common than unilateral dysplasia. Torticollis and foot deformities are rarely found to be associated with DDH. All these findings needs further evaluation in children who had surgical treatment for DDH, to see if they are different from dysplastic groups. Limitation of abduction is an important clinical finding, but is not always associated with DDH. Asymmetry of the skin folds in the groin were found to be an important clinical finding associated with DDH for all age groups. As clinical examination depends on many factors, and most DDH cases are of the dysplastic type, it is mandatory to depend on further diagnostic tools for confirmation of DDH.
No published studies have addressed the role of hand dominance in various types of forearm fractures. The present study aims to investigate the effects of the dominant hand and gender in forearm fractures in children and adolescents. In a prospective study, 181 children aged 2-15 years presenting with unilateral forearm fracture were examined over a 6-year period, investigating the role of the dominant hand, fractured side, fractured site, and gender in different types of forearm fractures. Forearm fractures occur more often in boys and are more common on the left side (P = 0.001, 0.029, respectively). Isolated distal radius fracture is more common than distal radius and ulna fracture in right-handed children (P = 0.008). Increases in the number of middle forearm fractures in the dominant hand in left-handed children (P = 0.0056) may be due to mechanisms of injury other than a simple indirect fall or severe injury preventing the use of the dominant hand as a preventive measure. The mean age for boys and girls at the time of forearm fractures was 8.97 and 5.98 years, respectively, which may be attributed to older girls tending not to do as many outside-the-home activities as boys at this age. Overall, forearm fractures are more common in the non-dominant hand, in boys, and in both distal forearm bones.
Primary pelvic hydatid cyst rarely causes pressure on the lumbosacral plexus. This was a case of hydatid cyst in the pelvis causing sciatica and foot drop, and it indicates the pelvis as a hidden source of sciatica and foot drop. After surgical excision followed by 4 months' mebendazole therapy, there was no evidence of recurrence on long-term follow-up.
Tuberculous dactylitis is an uncommon condition which is particularly difficult to differentiate from other lesions, particularly tumors. We report the case of a 56-year-old, healthy, left-handed person who consulted for progressive painful swelling of 8-month duration in the right thumb, which had developed after direct trauma. The plain radiograph of the thumb revealed extensive destruction of the proximal phalanx associated with pathological fracture. Magnetic resonance imaging (MRI) showed replacement of the affected phalanx with prominent soft tissue mass with extension outside the bone margins. The diagnosis of tuberculous dactylitis was based on histological characteristics and positive acid fast bacilli using Ziehl-Neelsen stain. Surgical debridement and anti-tuberculous chemotherapy eradicated the infection. Seven years post treatment, the patient had good function of the thumb with no significant disability interfering with his daily activity.
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