Abstract: BACKGROUND: In children, acute leukemia (AL) at presentation can mimic several orthopaedic pathologies, so that a variable delay of the correct diagnosis is often reported. METHODS: To define more clearly the clinical and radiological musculoskeletal manifestations of leukemia in children, 122 affected children referred from 1984 to 1999 to our Pediatric Onco-Hematologic Clinic were retrospectively reviewed. Average age at diagnosis was 6.6 years (from 7 months to 17 years). Seventy-three (60%) were boys and adolescent boys, 49 (40%) were girls and adolescent girls. One hundred two (83.6%) had acute lymphoblastic leukemia, 20 (16.4%) had acute myeloid leukemia. The mean follow-up was 8.2 years for the 104 survivors and 2.5 years for the 18 nonsurvivors. The chi2 test was used to perform the statistical analyses. RESULTS: At presentation, complaints related to the musculoskeletal system were frequent (38.3%), including pain (34.4%), functional impairment (22.9%), limping (12.3%), swelling (10.6%), and joint effusion (5.7%). At presentation, 40.2% of children had at least 1 radiographic abnormality. In order, they were osteolysis (13.1%), metaphyseal bands (9.8%), osteopenia (9%), osteosclerosis (7.4%), permeative pattern (5.7%), pathological fractures (5.7%), periosteal reactions (4.1%), and mixed lysis-sclerosis lesions (2.5%). Different from previous reports, late radiographic lesions were uncommon (5.7%), probably because of milder newer medication protocols. They included avascular necrosis (3.3%), vertebral collapses (1.6%), and osteolysis (0.8%). CONCLUSIONS: Both clinical and radiological changes had various and no uniform localization. Poor correlation was found between symptoms and radiological lesions. Survival rates in children with AL were 95.8% at 1 year, 89.6% at 3 years, 85.8% at 5 years, and 83.4% at 10 and at 13 years. Radiographic abnormalities (P = 0.400), type of leukemia (P = 0.291), sex (P = 0.245), and white blood cell count at presentation (P = 0.877) were not prognostic factors. The presence of multiple bone lesions did not affect the survival rate (P=0.632). As early diagnosis significantly decreases morbidity and mortality of AL, the orthopaedist should suspect AL in any child with unexplained persistent skeletal pain or radiographic alterations. Accurate history, general physical examination, and complete blood cell count tests should address the suspicion, which is confirmed by a peripheral and/or iliac crest bone marrow biopsy.
Abstract: Our purpose is to report a very rare case of proximal tibia triplane fracture, focusing the particular pattern of fracture and the long-term follow-up result. The triplane fracture is an exceptional fracture that occurs in the 3 planes (coronal, sagittal and transverse) close to the end of the growth period. A 15-year-old boy was admitted to our Center for a left femoral diaphyseal fracture and an ipsilateral lateral proximal tibia triplane fracture following a road accident. The femur was fixed with an intramedullary nail, the triplane fracture was anatomically reduced and percutaneously fixed. After 4 years follow-up, the knee was stable and with no complaints. Its range of motion was complete. Radiographs and MRI did not show any abnormality on the left leg and knee. In order to stabilize a proximal tibia triplane fracture a surgical internal fixation is usually required, with the possibility of a good long-term outcome also due to the growth potential remaining, if physeal arrest does not occur.
Abstract: We underwent this retrospective study to evaluate effectiveness, complaints, long term results and prognostic factors of Halo-Vest Fixation (HVF) for upper cervical spine fractures. Clinical and radiographs records were reviewed for 33 of the 40 patients treated with HVF for C1 and/or C2 fractures between 1995 and 2004 in our Center. Follow-up studies included imaging, a satisfaction survey and clinical evaluation with measurement of cervical ROM, successively confronted with a normal control group. Mean follow-up was 57 months, with all patients having a greater than 1-year follow-up. Bony radiographically fusion rate was 93.9%. After 12 weeks the fusion rate was 33.3%, after 18-20 weeks was 90.9%. Complications occurred in 36.4% of patients (usually minor). Type of fracture (p = 0.713), diagnostic delay (p = 0.507), age (p = 0.856), and gender (p = 0.397) were not prognostic factor for healing rate. C1-C2 associated fractures was the only negative prognostic factor for healing time (p = 0.006). The long term results showed reduction of cervical ROM versus the normal control group. Type of fracture and age were prognostic factor for outcome cervical ROM. Patients were satisfied in 90.6%.
Abstract: BACKGROUND CONTEXT: The management of tumors of the C2 body remains controversial. In cancer patients, major procedures may be contraindicated, and nonoperative treatment could fail. PURPOSE: To describe a new surgical technique, the transoral kyphoplasty, that we performed in 3 cases of tumors in C2 after nonoperative treatment failure. STUDY DESIGN: Case series of three patients. PATIENT SAMPLE: Three patients from the senior author's practice. OUTCOME MEASURES: To reduce pain and avoid both C2 collapse and prolonged immobilization, transoral kyphoplasties were performed. METHODS: From February 2004 to January 2006, three cases of tumors in C2 did not show healing after nonoperative treatments. RESULTS: No complications and/or complaints were related to the procedure. There were no C2-related symptoms or neurological problems. The first patient died 8 months after surgery. The second and the third are alive with follow-ups of 2 years and 6 months, respectively. In all cases, cervical motion was restored, and patients are pain free, with no findings regarding pathologic mobility/instability on X-ray and computed tomography scan. CONCLUSIONS: Transoral kyphoplasty proved to be safe, quick, and effective in reducing pain and avoiding vertebral collapse in patients with tumors in C2 not responding to nonoperative treatment.
