A 42-month-old girl presented with a history of sudden onset swelling of the left shoulder of 4-5 days duration with no preceding history of significant trauma or fall. The child was irritable and mildly febrile on examination. A tense globular swelling measuring 6 x 5 x 5 cm was present in the left shoulder region which was tender and fluctuant on palpation (figure 1). There was an increase in the local temperature and the skin overlying the swelling was stretched and glossy. Shoulder movements were painful and restricted. There was no regional lymphadenopathy nor any distal neurovascular compromise. Other joints were normal and no abnormality was detected in other systems. The child had chronic non-pitting oedema of both legs and was reluctant to walk. There was no history of a bleeding disorder nor was any such family history elicitable. An X-ray of the left shoulder revealed a complete separation of the proximal humeral epiphysis with osteopenia and surrounding soft tissue swelling (figure 2).Haemogram revealed anaemia (haemoglobin 5.3 g/dl) but a normal leucocyte count of 7.2 x 109/l (polymorphs 44%, lymphocytes 48%, and eosinophils 8%). Reticulocyte count was 1%, platelet count was adequate, and the erythrocyte sedimentation rate was 10 mm at one hour. Bleeding time, clotting time and other tests for bleeding profile were within normal limits. Serum calcium and phosphorus levels were normal but alkaline phosphatase level was elevated to 306 IU/l (normal range 80-180 IU/l).Needle biopsy of the swelling resulted in the evacuation of approximately 20 ml of altered blood and a few soft tissue and bony fragments which on microscopic examination revealed the presence of proliferating fibroblasts, spicules of necrotic bone and abundant vascular proliferation. A single X-ray of the knee (figure 3), however, showed typical changes which aided in the diagnosis of this condition.
A 14-week-old girl was brought in with a history of painful swelling of both legs since the age of one month. The onset was insidious and was not associated with trauma or fall. There was no history of fever or associated constitutional symptoms. The birth history was normal and the infant was apparently asymptomatic until the age of one month. Examination revealed a healthy and alert infant. Both legs were bowed anteriorly and a uniform bony thickening of both tibiae was palpable throughout their lengths (figure 1). Both legs were extremely tender and the infant would withdraw both lower limbs and cry incessantly if any attempt was made to touch them. There was no increase in local temperature nor redness of the overlying skin. Knees and ankle joints were normal and demonstrated a full range of motion. Regional lymph nodes were not enlarged and other bones and joints were normal on examination. X-Rays of both legs revealed peri-osteitis of both tibiae with extensive subperiosteal new bone formation involving the entire diaphysis (figure 2).Questions
Skin necrosis and wound problems complicate surgical release of severe neglected clubfoot. This is primarily the result of excessive tension on the skin edges and a poor understanding of the abnormal vascular anatomy in clubfoot. We report a technique of primary skin closure by using a local-rotation fasciocutaneous flap. Posteromedial skin incision is taken. Posterior tibial artery perforators supplying the medial flap and saphenous vein are preserved. After soft-tissue release and correction of deformity, a defect appears in the posteromedial part of wound. Horizontal backcut is taken at proximal part of the incision and entire medial fasciocutaneous flap is rotated inferiorly to cover the defect. Triangular defect appearing proximally is sutured primarily or covered with skin graft. Primary uncomplicated wound healing was achieved within 2 weeks in all 20 rigid and neglected clubfeet (1-7 years) operated on with this technique. This flap is scientifically logical, technically easy, and ensures primary wound healing.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.