Background:Late presentation of humeral lateral condylar fracture in children is a surgical dilemma. Osteosynthesis of the fracture fragment or correction of elbow deformity with osteotomies and ulnar nerve transposition or sometimes both procedures combined is a controversial topic. We retrospectively evaluated open reduction and fixation cases in late presentation of lateral humeral condyle fracture in pediatric cases with regards to union and functional results.Materials and Methods:Twenty two pediatric (≤12 years) patients with fractures of lateral condyle presenting 4 weeks or more post injury between the study period of 2006 and 2010 were included. Multiple K-wires / with or without screws along with bone grafting were used. At final evaluation, union (radiologically) and elbow function (Liverpool Elbow Score, LES) was assessed.Results:There were 19 boys and 3 girls. Followup averaged 33 months. Pain (n=9), swelling (n=6), restriction of elbow motion (n=6), prominence of lateral condylar region (n=4), valgus deformity (n=4) were the main presenting symptoms. Ulnar nerve function was normal in all patients. There were nine Milch type I and 13 type II fractures. Union occurred in 20 cases. One case had malunion and in another case there was resorption of condyle following postoperative infection and avascular necrosis. Prominent lateral condyles (4/12), fish tail appearance (n=7), premature epiphyseal closure (n=2) were other observations. LES averaged 8.12 (range, 6.66-9.54) at final followup.Conclusions:There is high rate of union and satisfactory elbow function in late presenting lateral condyle fractures in children following osteosynthesis attempt. Our study showed poor correlation between patient's age, duration of late presentation or Milch type I or II and final elbow function as determined by LES.

The study reasserts functional continuity of the Achilles tendons 4 weeks after tenotomy using clinical and ultrasonographic methods.

The purpose of the series is to describe the management of tubercular osteomyelitis of metacarpals and phalanges in 11 children (range, 3-12 years) and to retrospectively analyse the relationship between radiological staging and clinical outcome following treatment. The available literature on the clinical and radiological manifestations of tubercular osteomyelitis of the hand (excluding wrist) was also reviewed. Follow-up averaged 17.7 months following completion of treatment. The different radiological descriptions of the condition could be grouped into three stages: Stage 1 (stage of soft tissue swelling and no bony changes), Stage 2 (stage of bony expansion) and Stage 3 (stage of destruction). The previously described different radiological entities of tubercular osteomyelitis of metacarpals and phalanges appear to be a sequential manifestation of the disease spectrum. Healing with non-operative treatment is excellent provided the diagnosis is made when tuberculosis presents with soft tissue swelling alone and before bony destruction occurs.

Outcome after non-operative treatment is good, provided the lesions are treated early.

Children with multifocal osteoarticular tuberculosis were usually immunocompetent. Appendicular involvement was common, but concomitant chest involvement was uncommon. Standard multidrug antitubercular therapy and nutritional supplementation achieved good outcome.