Upper extremity and rib stress fractures in a child

History of diagnostics and treatment of scapular fractures in children and adolescents and its clinical importance

Almost 70 scapular fractures in children and adolescents, up to the age of 17 years, have been described in detail in the literature since 1839. The diagnosis of these injuries was based on autopsy, radiographs, CT and MRI examinations. The most frequent findings were fractures/epiphyseolyses of the coracoid, followed by fractures of the infraspinous part of the body and avulsion of the inferior angle of the scapular body. Less common were fractures of the acromion. Intra-articular fractures of the glenoid, or separation of an intact glenoid along the line of the anatomical or surgical necks, were reported only sporadically. Scapulothoracic dissociation was also recorded in several cases. The majority of fractures were treated non-operatively; operative treatment was used in glenoid fractures, certain fractures of the coracoid and fractures of the scapular body with intrathoracic penetration. Except for scapulothoracic dissociation, outcomes of treatment of these injuries were very good.

Diagnosis and Treatment of Scapular Fractures in Children and Adolescents: A Critical Analysis Review

»

Fractures of the growing scapula account for about 0.1% of all pediatric fractures, with the majority occurring at an age of ≥10 years.

»

Radiographic diagnosis requires a detailed knowledge of the ossification sequence of the growing scapula. Computed tomography examination is indicated for displaced fractures of the glenoid fossa, the scapular neck, and complex fractures; magnetic resonance imaging should be performed in cases of suspected injury to the physis and with stress fractures, depending on patient age and the potential need for general anesthesia during the scanning process.

»

Separation of the base of the coracoid process is often associated with acromioclavicular dislocation. Clavicular fractures rarely occur in combination with injuries to the growing scapula.

»

The majority of scapular fractures can be treated nonoperatively. Indications for surgery are displaced intra-articular fractures, scapular neck fractures with a displacement of >2 cm, coracoid base separation associated with acromioclavicular dislocation, and scapulothoracic dissociation.

»

Displaced intra-articular fractures of the glenoid fossa should be followed after healing until skeletal maturity. Complications are rare and occur most frequently with scapulothoracic dissociation.

Tibia stress fracture secondary to obsessive compulsive disorder

Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder characterized by obsessions and compulsions. Early-onset OCD is one of the most common mental illnesses of children and adolescents, with a prevalence of 1% to 3%. It is related to worse lifespan symptoms and prognosis. Therefore, the treatment of OCD in children and adolescent has gained importance. If it is not treated successfully, the compulsive behaviors may cause extreme stress for children and their parents. Although minor complications of OCD are commonly observed, major complications are considerably rare due to the nature of compulsive behaviors. Apparently, loss of vision, autocastration, rectal prolapse are examples of major complications secondary to OCD. As far as we know, it is the first case of tibia stress fracture secondary to OCD. In the present case report, we will discuss tibia stress fracture developing secondary to compulsive behavior due to OCD.

First rib fractures in abused infants: a report of three cases

The authors describe 4 first rib fractures in 3 infants, highlighting the difficulty in detecting first rib fractures on skeletal survey. All 4 fractures were the result of physical abuse. A literature search does not find a case of first rib fracture in a healthy infant that is not the result of child abuse. The diagnosis of first rib fracture in an infant should prompt a thorough medical and social evaluation for child abuse.

Juvenile first rib fracture caused by morning stretching

BACKGROUND

First rib fractures are very rare, being primarily associated with external blunt trauma. Related conditions, such as sudden contraction of the neck muscle, stress fractures, and fatigue fractures, have been reported sporadically. These fractures are mostly related to repetitive or explosive physical training. However, anatomical relationships and related injury mechanisms may cause first rib fractures without repetitive sports activity.

OBJECTIVE

To present a case of juvenile first rib fracture caused by morning stretching without sports activity. CASE 

REPORT

We present a rare case report of juvenile atraumatic first rib fracture.

CONCLUSION

Physicians should be aware that even morning stretching with yawning can cause a first rib fracture in children. Awareness is important for early recognition, and proper management is critical for a pain-free return to normal life. An understanding of the mechanism of atraumatic first rib fracture is important.

Stress fracture of the peroneal bone secondary to a complex tic

Complex tics have been widely reported in literature, especially in children with Tourette syndrome. We describe the case of a fracture line of both peroneal bones in a 13-year-old child with Tourette syndrome and obsessive-compulsive disorder. He was admitted to our hospital because of pain in his legs. Radiography showed fractures of both peroneal bones, more marked on the left side. The clinical history was strongly suggestive of obsessive-compulsive disorder and Tourette syndrome with associated simple and complex motor tics. Radiographic follow-up showed spontaneous resolution of the fractures.

Stress fracture of the clavicle associated with sternocostoclavicular hyperostosis

We report a case of stress fracture of the clavicle associated with sternocostoclavicular hyperostosis. A 60-year-old man sustained a stress fracture of the right clavicle with no history of trauma. On radiography, hyperostosis of the anterior chest wall and ankylosis of the sternoclavicular joint were evident in addition to the fracture. Fracture healing was uneventful after 2.5 months. Ankylosis of the sternoclavicular joint may have caused increased stress at the midshaft of the clavicle by daily activity or minor trauma. Such a fracture is a rare complication of sternocostoclavicular hyperostosis.

Callus resection for brachial plexus compression following stress-induced first rib fracture

A 27-year-old man presented with a lower trunk brachial plexus injury due to excessive callus formation following a stress-induced first rib fracture. The callus, but not the first rib, was resected through a supraclavicular approach. His symptoms resolved in 2 months, and no recurrence was seen at 2 years follow-up.