Salvage procedures in lower-extremity trauma in a child with hereditary motor and sensory neuropathy type I: a case report

Journal of Medical Case Reports

Thomas Klapperich¹  Thomas A Schildhauer²  Marcel Dudda²  Martin Gothner² 

[1] Department of Orthopaedic Surgery, Marienhospital Papenburg-Aschendorf, Am Hauptkanal rechts 75, Papenburg, 26871, Germany;Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle de-la-Camp Platz 1, Bochum, 44789, Germany

关键词: Infection;    Non-union;    Llizarov or Taylor spatial frame;    Neuropathy;    Childhood;    Open tibia fracture;   

Others  :  1195477
DOI  :  10.1186/1752-1947-6-276

 received in 2012-03-26, accepted in 2012-07-05,  发布年份 2012

【 摘 要 】

Introduction

Fractures of the lower extremity are a common type of childhood injury and many can be treated without surgery. Dislocated and open fractures are an indication for fracture stabilization via either intramedullary nailing or, in the case of complicated fractures, external fixation. But if complications are likely because of diseases and disabilities (for example, a neuropathy) that can complicate the post-operative procedure and rehabilitation, what options does one have?

Case presentation

We report a nine-year-old Caucasian girl who had hereditary motor and sensory neuropathy type I and who was admitted with a grade I open tibia fracture after a fall from a small height. Plain radiographs showed a dislocated tibia and fibula fracture. An open reduction with internal fixation with a compression plate osteosynthesis was performed, and soft tissue debridement combined with an external fixateur was undertaken. Three months later, she was re-admitted with localized swelling and signs of a local soft tissue infection in the middle of her tibia. Plain radiographs showed a non-union of the tibia fracture, and microbiological analysis confirmed a wound infection with cefuroxime-sensitive Staphylococcus aureus. Because of the non-union, the osteosynthesis was replaced with an Ilizarov external fixateur, and appropriate antibiotic therapy was initiated. Four months after the initial accident, the fracture was consolidated and we removed the external fixateur.

Conclusions

If there is a pre-existing neuropathy and if disease makes it difficult for a child to follow all post-operative instructions, salvage procedures should be kept in mind in case of complications. There are multiple therapeutic options, including osteosynthesis, intramedullary nailing systems, cast therapy, or an external fixateur like the Ilizarov or Taylor spatial frame system. The initial use of an external fixateur such as an Ilizarov or Taylor spatial frame in patients with pre-existing neuropathies should be kept in mind as a possible treatment option in complicated fractures, especially in a child with pre-existing neurological or endocrine pathologies.

【 授权许可】

   
2012 Gothner et al.; licensee BioMed Central Ltd.

【 图 表 】

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