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Pediatric Femoral Neck Fractures: Our 10 Years of Experience
Kamal Bali,Pebam Sudesh,Sandeep Patel,Vishal Kumar,Uttam Saini,M. S. Dhillon 대한정형외과학회 2011 Clinics in Orthopedic Surgery Vol.3 No.4
Background: Femoral neck fractures are rare injuries in children, but the high incidence of long term complications make it animportant clinical entity. The aim of this retrospective study was to analyze the clinical outcomes of pediatric femur neck fracturesthat we managed over a 10 year period. Methods: The study included 36 children (20 boys and 16 girls) who sustained femoral neck fractures and completed a minimumfollow-up of one year. The children were treated either conservatively, or by open reduction and internal fi xation (ORIF), or closedreduction and internal fi xation (CRIF). The outcomes were analyzed using Ratliff criteria and a detailed record of complicationswas kept for all patients. Results: The mean age of included patients was 10 years (range, 3 to 16 years) and the average follow-up was 3.2 years (range,1.1 to 8.5 years). Based on Delbet’s classifi cation system, there were 0 type I (transepiphyseal), 16 type II, 11 type III, and 9 type IVfractures. There were 8 undisplaced fractures, 4 of which later displaced after being managed initially in a hip spica. A satisfactoryoutcome was obtained in 27 (75%) children. Avascular necrosis (AVN) was the most common complication. It was seen in7 of our patients, all of whom had an unsatisfactory outcome. Other complications included three cases each of coxa vara, nonunion,and arthritic changes; and one case each of infection, primary screw perforation of head, and premature epiphyseal closure. Complications were lowest in the group treated by ORIF. Only 2 patients managed exclusively by conservative treatment ultimatelyachieved a satisfactory outcome. Conclusions: We believe that internal fi xation of pediatric femoral neck fractures is preferred whenever feasible because conservativetreatment carries a high risk of failure of reduction. Aggressive operative treatments aimed at anatomical reduction shouldbe the goal and there should be no hesitation in choosing ORIF over CRIF. Outcome of patients is infl uenced primarily by developmentof AVN which occurs as an independent entity without much relation to the mode of treatment carried out.
Glomus Tumor of Hoffa’s Fat Pad and Its Management by Arthroscopic Excision
Sharad Prabhakar,Mandeep Singh Dhillon,Rakesh Kumar Vasishtha,Kamal Bali 대한정형외과학회 2013 Clinics in Orthopedic Surgery Vol.5 No.4
We present a rare case of glomus tumor of Hoffa’s fat pad in a 42-year-old woman. Magnetic resonance imaging findings along with the characteristic clinical picture led us to suspect a glomus tumor as the possible etiology. An ischemia test was found to be positive and this further substantiated our diagnosis. An arthroscopic excision was performed and the histology confirmed the diagnosis of glomus tumor of Hoffa’s fat pad. The patient responded well to the excision with immediate complete resolution of pain and she remains asymptomatic at the last follow-up after 15 months. To our knowledge, this is the second reported case of glomus tumor of Hoffa’s fat pad and the first ever to be managed by simple arthroscopic excision. The tumor poses a great challenge to an orthopedic surgeon. However, knowledge of its characteristic clinical presentation and the recognition of such a rare entity can help achieve an early diagnosis and timely management.