Carpal fractures in children are uncommon injuries, with the scaphoid being fractured most frequently. Thirty-three children with scaphoid fractures and one child each with fractures of triquetrum, trapezoid, hamate, and capitate were retrospectively reviewed. The mean age was 13 years, 4 months. The mechanism of injury was of low energy in most cases, with > 80% of injuries involving a fall. Localizing tenderness was present in 100% of cases. Of fractures, 97.3% were evident on the initial radiographs. One patient required a bone scan to confirm the diagnosis. All but one scaphoid fracture went on to union with conservative treatment in a long-arm thumb spica cast or short-arm thumb spica cast at a mean of 7.1 weeks. All other carpal fractures healed at a mean of 4.5 weeks. The one scaphoid nonunion was attributed to noncompliance by the patient.
H eterotopic ossification (HO) is the formation of normal or lamellar bone in soft tissue locations where bone does not normally exist. Many acquired causes exist, including postsurgical, central nervous system injury, musculoskeletal injury, burns, vasculopathies, and arthropathies including hemarthrosis. Genetic and developmental causes also exist, including fibrodysplasia ossificans progressiva and progressive osseous heteroplasia. 1 Posttraumatic HO can occur in any site but most commonly forms in soft tissues surrounding the hip after total hip arthroplasty or open reduction and internal fixation of acetabular fractures, with an incidence between 18% and 90%. 2 Approximately 20% to 25% of patients with spinal cord injury and 10% to 20% of patients with brain injury develop HO and again, the hip is the most common location, followed by the knee and other joints. 3 Clinical and physiologic evidence suggests that patients with both severe brain injury and extremity fracture are at increased risk for developing HO. 4 -6 Children develop less HO after central nervous system injury than adults do but are at a higher risk after burns. HO frequently resolves spontaneously in children. 7,8 Overall, men are at a higher risk of developing HO and develop a larger amount of bone. 2 Male patients with spinal cord injury are twice as likely to develop HO compared with female patients. 9 Race has not been correlated with HO. Genetic predisposition has not been defined for injury-related HO.HO rarely develops in the abdomen or in abdominal scars. The few cases of abdominal HO that have been reported are primarily in general surgery patients after laparotomy. 10 -12 The exact cause of HO development in the abdomen is not well understood but is thought to relate to the migration of liberated osteoblasts from known or presumed occult bony injury, typically to the pelvis or xiphoid process. 11 Early diagnosis of HO within 3 to 5 days after injury often allows for medical treatment with a combination of nonsteroidal anti-inflammatory medications (NSAIDs), specifically indomethacin or naproxen, in conjunction with gentle physical therapy to prevent progression. 13,14 Recent studies have shown that radiation followed by physical therapy is also effective in early treatment of HO and prevention of further HO. 15,16 In cases of clinically significant or painful HO, surgical excision followed by radiation therapy or NSAIDs is the treatment of choice. 14 We report the case of a 29-year-old man who developed HO in his rectus sheath, abdomen, iliac, sub-xiphoid, and elbow after multiple injuries sustained in a motor vehicle crash. CASE REPORTA 29-year-old Hispanic man was involved in a motor vehicle crash. He sustained multiple injuries including blunt abdominal trauma with blow-out perforations of the small intestine, a right iliac wing fracture, a traumatic inguinal hernia, a skull fracture, a right medial condyle humerus fracture, and bilateral rib fractures. He underwent a damage control laparotomy at the time of admission and was...
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