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Kong CW, To WWK. Precision of vacuum cup placement and its association with subgaleal hemorrhage and associated morbidity in term neonates. Arch Gynecol Obstet 2024; 309:1411-1419. [PMID: 37017783 DOI: 10.1007/s00404-023-07018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE To evaluate whether the precision of vacuum cup placement is associated with failed vacuum extraction(VE), neonatal subgaleal hemorrhage(SGH) and other VE-related birth trauma. METHODS All women with singleton term cephalic fetuses with attempted VE were recruited over a period of 30 months. Neonates were examined immediately after birth and the position of the chignon documented to decide whether the cup position was flexing median or suboptimal. Vigilant neonatal surveillance was performed to look for VE-related trauma, including subgaleal/subdural hemorrhages, skull fractures, scalp lacerations. CT scans of the brain were ordered liberally as clinically indicated. RESULTS The VE rate was 5.89% in the study period. There were 17(4.9%) failures among 345 attempted VEs. Thirty babies suffered from subgaleal/subdural hemorrhages, skull fractures, scalp lacerations or a combination of these, giving an incidence of VE-related birth trauma of 8.7%. Suboptimal cup positions occurred in 31.6%. Logistic regression analysis showed that failed VE was associated with a non-occipital anterior fetal head position (OR 3.5, 95% CI 1.22-10.2), suboptimal vacuum cup placement (OR 4.13, 95% CI 1.38-12.2) and a longer duration of traction (OR 8.79, 95% CI 2.13-36.2); while, VE-related birth trauma was associated with failed VE (OR 3.93, 95% CI 1.08-14.3) and more pulls (OR 4.07, 95% CI 1.98-8.36). CONCLUSION Suboptimal vacuum cup positions were related to failed VE but not to SGH and other vacuum-related birth trauma. While optimal flexed median cup positions should be most desirable mechanically to effect delivery, such a position does not guarantee prevention of SGH.
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Affiliation(s)
- Choi Wah Kong
- Department of Obstetrics and Gynaecology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong, China.
| | - William Wing Kee To
- Department of Obstetrics and Gynaecology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong, China
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Shah MM, Jain M, Ponugoti G, Bansal S, Shah S, Sangole C. Brachial Plexus Birth Injury due to Proximal Humeral Physeal Separation: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00081. [PMID: 37732951 DOI: 10.2106/jbjs.cc.23.00254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
CASE A 9-day-old male neonate presented with swelling over his left shoulder and reduced movements of the left upper extremity since birth. Radiographs raised a suspicion of a shoulder dislocation. Ultrasonography confirmed the diagnosis of proximal humeral physeal separation. Magnetic resonance imaging (MRI) revealed edema of the infraclavicular part of the brachial plexus. Conservative management was followed, and the injury remodeled completely at 2 years. CONCLUSION Neonatal proximal humeral physeal separation poses a diagnostic challenge. Ultrasonography is helpful for diagnosis. MRI is indicated when concurrent brachial plexus birth injury is suspected. Conservative management yields good outcome in the absence of entrapped nerves and tendons.
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Sehgal A, Fernando S, Ditchfield M. M-Mode Imaging of the Diaphragm in Phrenic Nerve Palsy Due to Birth Trauma. J Pediatr 2022; 246:281-282. [PMID: 35364096 DOI: 10.1016/j.jpeds.2022.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Arvind Sehgal
- Monash Newborn, Monash Children's Hospital; Department of Pediatrics, Monash University, Melbourne, Australia
| | | | - Michael Ditchfield
- Department of Pediatrics, Monash University, Melbourne, Australia; Diagnostic Imaging, Monash Health, Clayton, Victoria, Australia
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Vuillermin C, Bauer AS, Kalish LA, Lewine EB, Bae DS, Waters PM. Follow-up Study on the Effects of Tendon Transfers and Open Reduction on Moderate Glenohumeral Joint Deformity in Brachial Plexus Birth Injury. J Bone Joint Surg Am 2020; 102:1260-1268. [PMID: 32675676 DOI: 10.2106/jbjs.19.00685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Soft-tissue contractures about the shoulder in patients with brachial plexus birth injury are common and can lead to progressive shoulder displacement and glenohumeral dysplasia. Open or arthroscopic reduction with musculotendinous lengthening and tendon transfers have become the standard of care. The clinical function and radiographic joint remodeling beyond the first 2 years after surgery are not well understood. METHODS We performed a follow-up study of 20 patients with preexisting mild to moderate glenohumeral joint deformity who had undergone open glenohumeral joint reduction with latissimus dorsi and teres major tendon transfers and concomitant musculotendinous lengthening of the pectoralis major and/or subscapularis. Prospective collection of Modified Mallet and Active Movement Scale (AMS) scores and radiographic analysis of cross-sectional imaging for glenoid version, humeral head subluxation, and glenohumeral joint deformity classification were analyzed for changes over time. RESULTS The average duration of radiographic follow-up was 4.2 years (range, 2 to 6 years). The mean glenoid version improved from -31.8° to -15.4° (p < 0.0001). The mean percentage of the humeral head anterior to the middle of the glenoid (PHHA) improved from 9.6% to 30.4% (p < 0.0001). The mean glenohumeral joint deformity score improved from 3.7 to 2.1 (p < 0.0001). CONCLUSIONS All parameters showed the greatest magnitude of improvement between preoperative measurements and 1 year of follow-up. There were no significant changes beyond the 1-year time point in the Mallet scores, AMS scores, or radiographic outcome measures, possibly because of insufficient power, although trends of improvement were noted for some outcomes. No decline in outcome measures was found during the study period. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Carley Vuillermin
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Andrea S Bauer
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Leslie A Kalish
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts
| | | | - Donald S Bae
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Peter M Waters
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts
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Pérez Dieste JM, Castroviejo Bolíbar M, Sánchez Servate C. Obstetric tears of the Descemet membrane. Arch Soc Esp Oftalmol (Engl Ed) 2019; 94:e31. [PMID: 30377021 DOI: 10.1016/j.oftal.2018.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/28/2018] [Indexed: 06/08/2023]
Affiliation(s)
- J M Pérez Dieste
- Servicio de Oftalmología, Hospital Quirónsalud Costa Adeje, Adeje, Santa Cruz de Tenerife, Islas Canarias, España.
| | - M Castroviejo Bolíbar
- Servicio de Oftalmología, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - C Sánchez Servate
- Servicio de Oftalmología, Hospital Quirónsalud Costa Adeje, Adeje, Santa Cruz de Tenerife, Islas Canarias, España
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Varghese J, Teng M, Huang M, Balsam D. Birth injuries to growth plates: A sheep in wolves' clothing. J Clin Ultrasound 2017; 45:511-514. [PMID: 28198550 DOI: 10.1002/jcu.22444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 11/23/2016] [Accepted: 12/03/2016] [Indexed: 06/06/2023]
Abstract
Growth plate injuries (Salter-Harris type 1 or physeal fractures) of the long bones in the newborn are easily misdiagnosed as joint fractures with dislocations due to their nonossified epiphyses on plain radiographs. Diagnosis with musculoskeletal ultrasound (US) is advantageous due to its ability to visualize the nonossified epiphysis. We present two cases of humeral growth plate fractures in newborns, one at the shoulder (proximal humerus) and the other at the elbow (distal humerus). These cases emphasize the importance of quick and noninvasive diagnosis with US to avoid unnecessary intervention. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:511-514, 2017.
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Affiliation(s)
- Jerrin Varghese
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Matthew Teng
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Mingqian Huang
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Dvorah Balsam
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
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Bauer AS, Shen PY, Nidecker AE, Lee PS, James MA. Neonatal Magnetic Resonance Imaging Without Sedation Correlates With Injury Severity in Brachial Plexus Birth Palsy. J Hand Surg Am 2017; 42:335-343. [PMID: 28318741 DOI: 10.1016/j.jhsa.2017.01.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/24/2017] [Accepted: 01/29/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Which infants with brachial plexus birth palsy (BPBP) should undergo microsurgical plexus reconstruction remains controversial. The current gold standard for the decision for plexus reconstruction is serial clinical examinations, but this approach obviates the possibility of early surgical treatment. We hypothesize that a new technique using 3-dimensional volumetric proton density magnetic resonance imaging (MRI) without sedation can evaluate the severity of BPBP injury earlier than serial clinical examinations. METHODS Infants were prospectively enrolled prior to 12 weeks of age and imaged using 3 Tesla MRI without sedation. Clinical scores were collected at all visits. The imaging findings were graded based on the number of injured levels and the severity of each injury, and a radiological score was calculated. All infants were followed at least until the decision for surgery was made based on clinical examination. RESULTS Nine infants completed the MRI scan and clinical follow-up. The average Toronto score at presentation was 4.4 out of 10 (range, 0-8.2); the average Active Movement Scale score was 50 out of 105 (range, 0-86). Four infants required surgery: 2 because of a flail limb and Horner syndrome and 2 owing to failure to recover antigravity elbow flexion by age 6 months. Radiological scores ranged from 0 to 18 out of a maximum score of 25. The average radiological score for those infants who required surgery was 12 (range, 6.5-18), whereas the average score for infants who did not require surgery was 3.5 (range, 0-8). CONCLUSIONS Three-dimensional proton density MRI can evaluate spinal nerve roots in infants without the need for radiation, contrast agents, or sedation. These data suggest that MRI can help determine the severity of injury earlier than clinical examination in infants with BPBP, although further study of a larger sample of infants with varying severity of disease is necessary. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- Andrea S Bauer
- Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California, Sacramento, CA.
| | - Peter Y Shen
- Division of Neuroradiology, University of California Davis Medical Center, Sacramento, CA
| | - Anna E Nidecker
- Division of Neuroradiology, University of California Davis Medical Center, Sacramento, CA
| | - Paul S Lee
- Division of Neuroradiology, University of California Davis Medical Center, Sacramento, CA
| | - Michelle A James
- Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California, Sacramento, CA
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van de Bunt F, Pearl ML, Lee EK, Peng L, Didomenico P. Analysis of normal and dysplastic glenohumeral morphology at magnetic resonance imaging in children with neonatal brachial plexus palsy. Pediatr Radiol 2017; 47:1337-1344. [PMID: 28676895 PMCID: PMC5574959 DOI: 10.1007/s00247-017-3882-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/28/2017] [Accepted: 04/27/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Glenoid version and percentage of the humeral head anterior to the scapular line are commonly used 2-D measures to assess deformity of the glenohumeral joint of children with neonatal brachial plexus palsy. OBJECTIVE To assess whether glenoid version and percentage of the humeral head anterior to the scapular line would be altered by standardizing the measurements to the orientation of the scapula. MATERIALS AND METHODS Twenty-one bilateral magnetic resonance imaging (MRI) scans were evaluated by four reviewers. Measurements were performed on the axial image slices and again after applying 3-D reformatting. RESULTS Three-dimensional reformatting led to intrapatient corrections up to 25° for version and -30% for percentage of the humeral head anterior to the scapular line. The mean difference on the involved side between clinical and anatomical version across all subjects from all reviewers was 2.2° ± 3.9° (range: -4.5° to 11.5°). The mean difference in the percentage of the humeral head anterior to the scapular line after reformatting was -1.8% (range: -15.9% to 5.2%). CONCLUSION Measurements can differ greatly for the same child depending on technical factors of image acquisition and presentation in the clinical setting. With this study, we present a clinically accessible protocol to correct for scapular orientation from MRI data of children with neonatal brachial plexus palsy.
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Affiliation(s)
- Fabian van de Bunt
- VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Michael L Pearl
- Kaiser Permanente, 4760 Sunset Blvd Ste. 1213, Los Angeles, CA, 90027, USA
| | - Eric K Lee
- Kaiser Permanente, 4760 Sunset Blvd Ste. 1213, Los Angeles, CA, 90027, USA
| | - Lauren Peng
- Kaiser Permanente, 4760 Sunset Blvd Ste. 1213, Los Angeles, CA, 90027, USA
| | - Paul Didomenico
- Kaiser Permanente, 4760 Sunset Blvd Ste. 1213, Los Angeles, CA, 90027, USA
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Frik S. Management of birth-associated subtrochanteric femur fractures. Acta Orthop Belg 2016; 82:850-853. [PMID: 29182128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In daily clinical practice most orthopedic surgeons suffer from doubt about treatment of rare injuries. The aim of this study is to enlighten the management of birth related femoral subtrochanteric fractures of neonates. Four birth-related femoral subtrochanteric fractures of neonates were treated and followed up. Difficult caesarian breech delivery seems to be a risk factor. All patients were treated with Pavlik harness and union was achieved by the fourth week. None of the patients suffer any angulation or limb length discrepancy. Adequate management of this type of fractures lead to good results.
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Abstract
Distal humeral epiphyseal separations are rare and treatment strategies are not well defined. The case of a full-term male newborn with a distal humeral epiphyseal separation as the result of a birth trauma was reviewed. A literature review of this topic was undertaken to better understand its occurrence, diagnosis, and treatment options. The patient sustained a distal humeral epiphyseal separation during a vaginal delivery. Deformity and decreased movement in the elbow were observed. Radiographs and subsequent ultrasound were used to make the diagnosis of distal humeral epiphyseal separation. Given the displaced and acute nature of the fracture, a closed reduction and percutaneous pinning was performed. Intraoperatively, this was greatly facilitated by an elbow arthrogram. Immobilization consisted of a posterior plaster splint and swathe. Postoperative follow-up with clinical and radiographic examination showed abundant bony healing and early restoration of function. Ultrasound is useful to confirm the diagnosis of a distal humeral epiphyseal separation for elbow injuries in very young patients. However, once the diagnosis is confirmed, an intraoperative elbow arthrogram helps highlight the fracture fragments and ensures proper reduction and fixation of the fracture. [Orthopedics. 2016; 39(4):e764-e767.].
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Somashekar DK, Di Pietro MA, Joseph JR, Yang LJS, Parmar HA. Utility of ultrasound in noninvasive preoperative workup of neonatal brachial plexus palsy. Pediatr Radiol 2016; 46:695-703. [PMID: 26718200 DOI: 10.1007/s00247-015-3524-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ultrasound has been utilized in the evaluation of compressive and traumatic peripheral nerve pathology. OBJECTIVE To determine whether US can provide comprehensive evaluation of the post-ganglionic brachial plexus in the setting of neonatal brachial plexus palsy and whether this information can be used to guide preoperative nerve reconstruction strategies. MATERIALS AND METHODS In this retrospective cohort study, preoperative brachial plexus ultrasonography was performed in 52 children with neonatal brachial plexus palsy who were being considered for surgery. The 33 children who had surgery compose the patient cohort. The presence and location of post-ganglionic neuromas were evaluated by US and compared to the surgical findings. US evaluation of shoulder muscle atrophy was conducted as an indirect way to assess the integrity of nerves. Finally, we correlated glenohumeral joint laxity to surgical and clinical management. RESULTS Ultrasound correctly identified 21 of 25 cases of upper trunk and middle trunk neuroma involvement (84% sensitivity for each). It was 68% sensitive and 40% specific in detection of lower trunk involvement. US identified shoulder muscle atrophy in 11 of 21 children evaluated; 8 of these 11 went on to nerve transfer procedures based upon the imaging findings. US identified 3 cases of shoulder joint laxity of the 13 children evaluated. All 3 cases were referred for orthopedic evaluation, with 1 child undergoing shoulder surgery and another requiring casting. CONCLUSION Ultrasound can provide useful preoperative evaluation of the post-ganglionic brachial plexus in children with neonatal brachial plexus palsy.
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Affiliation(s)
- Deepak K Somashekar
- Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Department of Radiology, Section of Neuroradiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Michael A Di Pietro
- Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Jacob R Joseph
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Lynda J-S Yang
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Hemant A Parmar
- Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Department of Radiology, Section of Neuroradiology, University of Michigan Health System, Ann Arbor, MI, USA.
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Radovanović T, Spasojević S, Stojanović V, Doronjski A. Severe neonatal subgaleal hemorrhage as the first presentation of hemophilia A. SRP ARK CELOK LEK 2016; 144:204-206. [PMID: 27483567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION Subgaleal hemorrhage is a rare but potentially fatal birth trauma. It is caused by rupture of the emissary veins (connections between the dural sinuses and scalp veins), followed by the accumulation of blood between the epicranial aponeurosis and the periosteum. Usually, it is associated with instrumental delivery (vacuum extraction, forceps delivery), but it may also occur spontaneously, suggesting the possibility of congenital bleeding disorder. CASE OUTLINE A full term male neonate was born at 40 weeks gestation by spontaneous vaginal delivery, with birth weight of 3,700 g. The Apgar scores were 9 and 10 at 1 and 5 minutes, respectively. At the age of 23 hours, the baby became pale and lethargic. Large fluctuant swelling on his head was noted. He developed severe anemia and hypovolemia as a result of massive subgaleal hemorrhage. After successful treatment, the baby fully recovered. Follow-up and further evaluation revealed hemophilia A as a result of a de novo mutation. CONCLUSION This case illustrates that subgaleal hemorrhage may be the first presentation of hemophilia A. Infants without obvious risk factors for developing subgaleal hemorrhage should be evaluated for congenital bleeding disorder. Successful outcome in affected infants requires early diagnosis, careful monitoring and prompt treatment.
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Han BH, Song MJ, Lee KS, Kim YH, Ko SY, Jung G, Park SB, Lee SK. Superficial Echogenic Lesions Detected on Neonatal Cranial Sonography: Possible Indicators of Severe Birth Injury. J Ultrasound Med 2016; 35:477-484. [PMID: 26839370 DOI: 10.7863/ultra.15.04012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/17/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the characteristics and importance of superficial echogenic lesions around cranial sutures on neonatal cranial sonography. METHODS We retrospectively reviewed the clinical records and neuroimaging studies of 40 neonates who had superficial echogenic lesions around sutures on neonatal cranial sonography. Magnetic resonance imaging (n = 18) and computed tomography (n = 2) were performed within 2 weeks after sonography. We correlated sonographic findings with computed tomographic and magnetic resonance imaging findings and analyzed them. We also evaluated the associated lesions, neurologic signs, and follow-up changes. RESULTS Sonographically, the superficial echogenic lesions involved both sulci and perisulcal parenchyma in 39 neonates and were located in the frontal and parietal areas around the sagittal suture in 38 neonates. Magnetic resonance imaging revealed a pattern of hypoxic ischemic encephalopathy in 9 neonates, birth trauma in 3 neonates, a mixed pattern of hypoxic ischemic encephalopathy and trauma in 3 neonates, nonspecific single infarctions in 2 neonates, and lack of a defined lesion in 1 neonate. The associated lesions were subdural hemorrhage (n = 12), epidural hematoma (n = 4), germinal matrix hemorrhage (n = 3), intraventricular hemorrhage (n = 2), and periventricular leukomalacia (n = 1). All epidural hematomas were associated with scalp hematoma, and 2 patients had skull fractures. One neonate with epidural hematoma associated with a hypoxic ischemic encephalopathy pattern showed mild spasticity in both ankles until 16 months. CONCLUSIONS Superficial echogenic lesions detected around cranial sutures on neonatal sonography may be an indicator of more serious intracranial lesions such as more extensive hypoxic ischemic encephalopathy and intracranial hematomas, including epidural hematoma.
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Affiliation(s)
- Byoung Hee Han
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.)
| | - Mi Jin Song
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.).
| | - Kyung Sang Lee
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.)
| | - Young-Hwa Kim
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.)
| | - Sun Young Ko
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.)
| | - Goun Jung
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.)
| | - Sung Bin Park
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.)
| | - Seung-Koo Lee
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.)
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Zakanj Z. [Skull fracture and cephalhematoma in a newborn--a case report]. Lijec Vjesn 2014; 136:335-338. [PMID: 25647994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Skull fractures and cephalhematoma in newborns belong to the group of birth injuries of the head and neck, accounting for 11.4 to 15% of the total number of birth injuries. We presented a fracture of the parietal bones in a newborn, associated with parietal cephalhematoma. The newborn had transient and mild neurological symptoms: vomiting and changes in muscle tone. Clinical examination confirmed a positive "ping-pong" phenomen, craniogram confirmed the fracture of parietal bones and shown cephalhematoma, as well as ultrasound (US) examinations of the brain showed peri-interventricular bleeding grade II. After the disappearance of all clinical symptoms in a newborn, we observed total bone healing at the end of the second week of life, and good perinatal outcome. Successful recovery from injury contributes to the ability of rapid bone modeling and remodeling, and brain plasticity. Further interdisciplinary monitoring is very important.
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Olatunji AA, Thanni LOA. Radiographic pattern of skeletal trauma in children seen in a tertiary hospital in Sagamu, South West Nigeria. Niger Postgrad Med J 2013; 20:14-19. [PMID: 23661204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIMS AND OBJECTIVES The study was aimed at identifying the pattern of skeletal trauma in the paediatric age group as it relates to the causes. MATERIALS AND METHODS A retrospective analysis of the records on the request cards, case notes, radiographs and reports (where available) of all children aged one day to 15 years who were referred to the radiology department of Olabisi Onabanjo University Teaching Hospital, Sagamu was carried out. Fractures were analysed with respect to sex, age, causes, type and location of fracture. RESULTS The analysis spanned a period of twenty-eight months during which a total of three hundred and twenty eight radiographs were analysed. The mean ages of male and female patients were 5.4±4.6 and 5.1±4.6 years, respectively, with a range of 0.2-15 years. Normal radiographs were found in 124 (37.80%) patients,53.1 (16.1%) had 55 fractures, and 39 (11.9%) had soft tissue swelling. Fractures were found most commonly in male children and in the age range 4-6 years. Fractures occur three times more in the upper limbs, and the bones most frequently affected are the humerus, radius, and the ulna in descending order. Most of the fractures were due to Road Traffic Injury (RTI) seen in 18.9%, falls seen in 18.9%, and birth trauma, which was responsible for 7.5%. The most frequently involved bone in fractures is the humerus followed by the femur bone. Skull fractures occur mostly in the parietal bone. CONCLUSIONS Fractures are still mostly investigated with plain radiographs. Fractures are more frequent in male children and in the 4-6 year age range; it is seen more in the upper limb bones especially in the humerus. Skull fractures are relatively rare. Half of the fractures occur in the distal and mid portions of long bones. This study has also high lighted the importance of road traffic injury and falls as aetiological factors in fracture occurring in children. Effort should be made to ease deliveries in order to reduce the incidence of birth trauma.
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Affiliation(s)
- A A Olatunji
- Department of Radiology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
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Yoon SD, Cho BM, Oh SM, Park SH. Spontaneous resorption of calcified cephalhematoma in a 9-month-old child: case report. Childs Nerv Syst 2013; 29:517-9. [PMID: 23292440 DOI: 10.1007/s00381-012-2008-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 12/16/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Sang-Duck Yoon
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, #445, Gil-dong, Gangdong-gu, Seoul 134-701, South Korea
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17
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Paul SP, Williamson DM. Community case: clavicle fracture in the newborn. J Fam Health Care 2012; 22:44-45. [PMID: 23342711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Fette A, Mayr J. Slipped distal humerus epiphysis in tiny infants easily detected and followed-up by ultrasound. Ultraschall Med 2012; 33:E361-E363. [PMID: 22274908 DOI: 10.1055/s-0031-1281660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abstract
AIM The purpose of this study was to evaluate long-term shoulder functional outcomes from a triangle tilt procedure on obstetric patients, who initially presented with medial rotation contracture and scapular deformity secondary to obstetric brachial plexus injury. METHODS We retrospectively studied long-term outcomes both functionally and anatomically in 61 patients (age ranging from 2 to 12 years). Functional movements were evaluated and scored using a modified Mallet scale at different time intervals: preoperatively, 1 year and 2 year following triangle tilt surgery. Shoulder anatomy was examined on radiologic images to evaluate the severity of shoulder deformities preoperatively and anatomical improvement after the surgery. RESULTS All shoulder functional movements were significantly improved at 1 and 2 year follow-ups. Functional improvements were maintained in shoulder abduction, external rotation and hand-to-mouth movements beyond the first year, and continued in hand-to-neck and hand-to-spine movements past 2 years. Remarkable glenohumeral remodeling or reservation of glenoid congruence was observed in all patients over a mean time of 27 months postoperatively. CONCLUSION The triangle tilt procedure, which addresses scapular and glenohumeral joint abnormalities characteristic of Erb's palsy, improves shoulder functional movements and anatomical structure in patients over the long-term.
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Affiliation(s)
- Rahul K Nath
- Texas Nerve and Paralysis Institute, Houston, USA.
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20
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Drakonaki EE, Garbi A. Sonographic diagnosis of a clavicular fracture in a neonate with upper limb pseudoparalysis. J Ultrasound Med 2010; 29:671-672. [PMID: 20375390 DOI: 10.7863/jum.2010.29.4.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Eleni E Drakonaki
- Department of Radiology, Venizeleio Hospital, Knossou Avenue, Heraklion, Crete 71107, Greece.
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21
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22
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Jean D, Picandet V, Macieira S, Beauregard G, D'Anjou MA, Beauchamp G. Detection of rib trauma in newborn foals in an equine critical care unit: a comparison of ultrasonography, radiography and physical examination. Equine Vet J 2007; 39:158-63. [PMID: 17378445 DOI: 10.2746/042516407x166657] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Previous studies have shown that in man ultrasonography is more accurate than radiography for detecting rib fractures. OBJECTIVES To describe clinical, radiographic and ultrasonographic findings related with rib fractures in newborn foals in an equine critical care unit; and to compare diagnostic accuracy of ultrasonography to radiography. METHODS A prospective ultrasonographic study was performed on 29 foals presented to the emergency unit. This study was performed at the Centre Hospitalier Universitaire Vétérinaire (CHUV), University of Montreal. Physical examination as well as radiographic and ultrasonographic examinations were performed. RESULTS Thoracic radiographs revealed 10 rib fractures in 5 of 26 (19%) foals. Ultrasonography revealed 49 fractures in 19 of 29 (65%) foals of which fillies (n = 13; 68%) were significantly over represented as were fractures to the left thorax (n = 15; 78%). Seventeen of 19 foals (90%) had rib fractures located 3 cm or less from the costochondral junction, the distal part of the rib being displaced laterally in all cases. In 2 foals, where both thoracic radiographs and ultrasonography detected rib fractures, the site of fractures was located on the mid portion of the rib. Rib fractures were detected only by thoracic radiographs in one foal. Sixty-five percent (32/49) of fractured ribs had a moderate displacement (1-4 mm). CONCLUSIONS Rib fractures are seen frequently in newborn foals in equine critical care units. Ultrasonography is more accurate than radiography and reveals fractures in most patients presented in emergency. The position (costochondral junction) of rib fractures and of the fragments suggest that most thoracic trauma probably occurs during parturition. POTENTIAL RELEVANCE Ultrasound imaging increases awareness and improves the diagnosis of rib fractures in newborn foals.
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Affiliation(s)
- D Jean
- Département de Sciences Cliniques Vétérinaires, Faculté de Médecine Vétérinaire, Université de Montréal, Québec, Canada
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Miranda P, Vila M, Alvarez-Garijo JA, Perez-Nunez A. Birth trauma and development of growing fracture after coronal suture disruption. Childs Nerv Syst 2007; 23:355-8. [PMID: 17021730 DOI: 10.1007/s00381-006-0182-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Revised: 02/19/2006] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A growing fracture is a rare complication of skull fractures characterized by progressive diastatic enlargement of the fracture line. Growing skull fractures related to birth trauma were only occasionally reported. As far as we know, only one previous case of a neonatal growing fracture secondary to coronal suture disruption has been reported. CASE REPORT We present the case of a full-term infant born after a nontraumatic, forceps-assisted spontaneous delivery, who developed an increasing cystic swelling over the left frontoparietal area that crossed over coronal and sagittal sutures. The lesion was initially misinterpreted as cephalhematoma. Clinical and radiological follow-up established the correct diagnosis of leptomeningeal cyst. OUTCOME The collection was initially tapped. Surgical treatment was undertaken thereafter, consisting of decompression and resection of the cyst and dural repair. Two months after follow-up, the patient remains asymptomatic and the porencephalic cavity remains isolated from the extradural space, with no evidence of new fluid collections.
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Affiliation(s)
- Pablo Miranda
- Department of Pediatric Neurosurgery, Hospital Infantil La Fe, Avda. Campanar s/n., 46009 Valencia, Spain.
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Affiliation(s)
- Ruth Eliahou
- Department of Radiology, Hadassah-Hebrew University Medical Center, PO Box 12000, 92110 Jerusalem, Israel.
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Abstract
A variety of traumatic lesions can occur during the neonatal period. Some of those lesions are clearly birth injuries due to delivery and others are caused by necessary procedures during intensive care in critically ill neonates. As usual patient history must be known and knowledge about the typical complications is necessary in order to select the appropriate imaging modality and thus enabling correct interpretation of those investigations by the radiologist. The purpose of this article is to present typical neonatal injuries, describe the underlying pathomechanisms and aetiology as well as the imaging findings.
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Affiliation(s)
- Erich Sorantin
- Division of Pediatric Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, A8036 Graz, Austria.
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Tung GA, Kumar M, Richardson RC, Jenny C, Brown WD. Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. Pediatrics 2006; 118:626-33. [PMID: 16882816 DOI: 10.1542/peds.2006-0130] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Mixed-density convexity subdural hematoma and interhemispheric subdural hematoma suggest nonaccidental head injury. The purpose of this retrospective observational study is to investigate subdural hematoma on noncontrast computed tomography in infants with nonaccidental head injury and to compare these findings in infants with accidental head trauma for whom the date of injury was known. PATIENTS AND METHODS Two blinded, independent observers retrospectively reviewed computed tomography scans with subdural hematoma performed on the day of presentation on 9 infant victims of nonaccidental head injury (mean age: 6.8 months; range: 1-25 months) and on 38 infants (mean age: 4.8 months; range: newborn to 34 months) with accidental head trauma (birth-related: 19; short fall: 17; motor vehicle accident: 2). RESULTS Homogeneous hyperdense subdural hematoma was significantly more common in children with accidental head trauma (28 of 38 [74%]; nonaccidental head trauma: 3 of 9 [33%]), whereas mixed-density subdural hematoma was significantly more common in cases of nonaccidental head injury (6 of 9 [67%]; accidental head trauma: 7 of 38 [18%]). Twenty-two (79%) subdural hematomas were homogeneously hyperdense on noncontrast computed tomography performed within two days of accidental head trauma, one (4%) was homogeneous and isodense compared to brain tissue, one (4%) was homogeneous and hypodense, and four (14%) were mixed-density. There was no statistically significant difference in the proportion of interhemispheric subdural hematoma, epidural hematoma, calvarial fracture, brain contusion, or subarachnoid hemorrhage. CONCLUSIONS Homogeneous hyperdense subdural hematoma is more frequent in cases of accidental head trauma; mixed-density subdural hematoma is more frequent in cases of nonaccidental head injury but may be observed within 48 hours of accidental head trauma. Interhemispheric subdural hematoma is not specific for inflicted head injury.
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Affiliation(s)
- Glenn A Tung
- Department of Diagnostic Imaging, Rhode Island Hospital, Brown Medical School, 593 Eddy St, Providence, Rhode Island 02903, USA.
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Surendrababu NRS, Rao A. Clinical image. Transection of the spinal cord: a rare birth-related trauma. Pediatr Radiol 2006; 36:719. [PMID: 16607508 DOI: 10.1007/s00247-006-0141-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Revised: 02/05/2006] [Accepted: 02/13/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Narayanam R S Surendrababu
- Radiodiagnosis, Christian Medical College and Hospital, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India.
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28
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Abstract
BACKGROUND Derotational humeral osteotomies have been used in older children with brachial plexus birth palsy and glenohumeral joint deformity to place the upper extremity in a more functional position. The purpose of this study was to determine the effects of these procedures on shoulder function and joint morphology. METHODS Forty-three patients underwent a derotational humeral osteotomy for functional impairment in the setting of internal rotation contracture and/or glenohumeral joint deformity at our institution from 1996 to 2004. Osteotomies were performed proximal to the deltoid insertion and were stabilized with plate-and-screw fixation. The average age of the patients at the time of surgery was 7.6 years (range, 2.3 to 17.0 years). Shoulder function was graded according to the modified Mallet classification system. Glenohumeral deformity was graded according to the classification scheme of Waters et al. The results for twenty-seven patients who were followed for a minimum of two years (average, 3.7 years) are reported. RESULTS The average amount of external rotation achieved with osteotomy was 64 degrees (range, 35 degrees to 90 degrees). The mean aggregate Mallet classification score improved from 13 to 18 points (p < 0.01). The mean Mallet classification scores for the individual elements similarly demonstrated improvement following osteotomy, with the greatest gains in hand-to-mouth, hand-to-neck, and external rotation motions. The mean classification of the glenohumeral deformity was type IV preoperatively and postoperatively, signifying the persistence of glenohumeral dysplasia. There were no nonunions. One patient required a revision osteotomy for inadequate initial correction. One patient sustained a humeral fracture distal to the plate fixation because of sports-related trauma. CONCLUSIONS Derotational humeral osteotomy improves shoulder function in patients with brachial plexus birth palsy, internal rotation contracture, and/or advanced glenohumeral joint deformity. This osteotomy provides an attractive treatment option for patients with brachial plexus birth palsy who have advanced glenohumeral dysplasia precluding soft-tissue releases and tendon transfers.
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Affiliation(s)
- Peter M Waters
- Department of Orthopaedic Surgery, Children's Hospital, 300 Longwood Avenue, Hunn 2, Boston, MA 02115, USA.
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29
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Abstract
To describe the presentation and outcome of infants who develop subgaleal hematoma (SGH), we compared perinatal factors, clinical and head imaging findings, and outcome in a cohort (N = 34) of all infants admitted to Saint Louis Children's Hospital neonatal intensive care unit with SGH from January 1991 to June 2003. All except three of the infants admitted with SGH had instrumental deliveries (31 of 34; 91.2%): 21 vacuum, eight vacuum followed by forceps, two forceps). There was also a high frequency of occurrence of associated intracranial hemorrhage (17 of 34; 50%: subarachnoid hemorrhage, n = 4; intraventricular hemorrhage, n = 4; intraparenchymal hemorrhage, n = 4; subdural hemorrhage, n = 11), and skull fracture (six of 34; 19.4%; three of six [50%] of them depressed fractures). There was mortality associated with SGH (four of 34, 11.8%); those who died had significant volume loss with anemia, coagulopathy, and shock requiring large volumes of blood and blood products transfusions. The presence of ICH did not correlate with the severity of SGH or mortality, but the severity of SGH correlates with mortality. Minor neurological abnormalities were noted in only four infants at discharge. In conclusion, SGH is an uncommon type of birth trauma, and is associated with delivery or attempted delivery by instrumentation (vacuum and/or forceps). Severe hypovolemia and coagulopathy, but not intracranial hemorrhage, were the most commonly associated clinical problems with mortality. ICH does not correlate with severity of SGH. A brain computed tomography or magnetic resonance imaging should be considered in evaluating a clinically symptomatic SGH. There is associated mortality in severe cases but short-term outcome in survivors is good.
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Affiliation(s)
- Ramzi A Kilani
- Edward Mallinckrodt Department of Pediatrics, Division of Newborn Medicine, Saint Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Durani Y, DePiero AD. Images in emergency medicine. Fracture of left clavicle and left posterior rib due to birth trauma. Ann Emerg Med 2005; 47:210, 215. [PMID: 16431238 DOI: 10.1016/j.annemergmed.2005.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Revised: 07/29/2005] [Accepted: 08/01/2005] [Indexed: 11/23/2022]
Affiliation(s)
- Yamini Durani
- Division of Emergency Medicine, Department of Pediatrics, Alfred I. duPont Hospital for Children, Wilmington, DE, USA
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Tu YF, Chen CY, Lin YJ, Chang YC, Huang CC. Neonatal neurological disorders involving the brainstem: neurosonographic approaches through the squamous suture and the foramen magnum. Eur Radiol 2005; 15:1927-33. [PMID: 15809827 DOI: 10.1007/s00330-005-2737-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Accepted: 03/01/2005] [Indexed: 12/01/2022]
Abstract
Brainstem damage which often indicates a critical condition is usually underestimated by trans-anterior-fontanel neurosonography (NS) owing to the far-field limitations. Instead, NS alternately scanning through the squamous suture of the temporal bones and the foramen magnum could provide a better visualization of the brainstem structures. The NS characteristics of brainstem lesions caused by various neonatal neurological disorders, such as hypoxic-ischemic encephalopathy (HIE), metabolic encephalopathy, birth trauma and bacterial meningoencephalitis, can be depicted at the acute stage. An echogenic change in the midbrain was found in patients with HIE or metabolic encephalopathy. In addition to the echogenic change, bilateral transtentorial temporal lobe herniation distorting the contour of the midbrain was observed in a patient with group B streptococcus meningoencephalitis, whereas echogenic changes at the level of the pons and/or the medulla oblongata, mainly localized in the dorsal part, could be observed in newborns with severe HIE, maple syrup urine disease or birth trauma. In this pictorial assay, we demonstrate the feasibility of NS imaging in evaluating the entire brainstem structure of critically ill neonates in the near field and illustrate the characteristic features of brainstem involvement in various neonatal neurological disorders along with computed tomography or magnetic resonance imaging correlation.
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Affiliation(s)
- Yi-Fang Tu
- Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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Abstract
BACKGROUND Femoral fractures due to birth trauma are extremely rare. External cephalic version is considered a relatively safe alternative when dealing with breech presentation, but it can be associated with complications. CASE This patient underwent elective cephalic version for breech presentation at 36 weeks of gestation. Due to concerns of fetal distress after the version, a cesarean delivery was performed. The newborn had a bruised leg at delivery, and X-ray studies confirmed a distal femoral corner fracture. CONCLUSION This case demonstrates another risk of external cephalic version. Physicians and patients should be aware of this potential complication.
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Affiliation(s)
- Steven Papp
- Department of Orthopedics, Queen's University, Kingston, Ontario, Canada
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33
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Abstract
Perinatal clavicle fractures typically heal without complication, and subsequent refracture of the same clavicle during infancy or toddlerhood has not been reported. This is a case report of a fracture of the clavicle in a 9-month-old child who had previously suffered a fracture of the same clavicle at birth. A review of the evaluation and management of neonatal and post-neonatal clavicle fractures is also presented.
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Affiliation(s)
- Linda S Nield
- Associate Professor of Pediatrics, West Virginia University, Morgantown, West Virginia, USA
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Alfonso I, Papazian O, Shuhaiber H, Yaylali I, Grossman JAI. Intrauterine shoulder weakness and obstetric brachial plexus palsy. Pediatr Neurol 2004; 31:225-7. [PMID: 15351026 DOI: 10.1016/j.pediatrneurol.2004.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Accepted: 02/09/2004] [Indexed: 10/26/2022]
Abstract
Obstetrical brachial plexus injury occurs when the forces preventing the stretch of the brachial plexus are overcome by the forces stretching it. This report describes an 8-day-old male delivered by uncomplicated cesarean section with right obstetrical brachial plexus palsy and congenital arm atrophy. The patient had a history of decreased right arm movement detected by fetal ultrasound at 18 to 20 weeks of gestation. The purpose of this article is to report that stretching of brachial plexus at birth sufficient to produce a plexus injury may occur in a patient with a vulnerable plexus even in the absence of traction during delivery.
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Affiliation(s)
- Israel Alfonso
- Brachial Plexus Palsy Program, Department of Neurology, Miami Children's Hospital, Florida 33155, USA
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35
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Abstract
Secondary surgery following obstetric brachial plexus palsy is usually performed between two and six years of age, but also later when the patient presents later. Surgery consists of contracture releases and transpositions of muscles and tendons. Indication for surgery must be assessed and discussed individually. Only a real functional improvement in ADL is a success. We describe usual techniques according to topography and present an overview of our results. This knowledge should influence all decisions about reconstructive surgery in these children.
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Affiliation(s)
- J Bahm
- Bereich Plastische Wiederherstellungschirurgie am St. Franziskus Krankenhaus Aachen.
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Aydin A, Mersa B, Erer M, Ozkan T, Ozkan S. [Early results of nerve surgery in obstetrical brachial plexus palsy]. Acta Orthop Traumatol Turc 2004; 38:170-7. [PMID: 15347916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVES To present surgical techniques and early postoperative results of patients who underwent nerve surgery for obstetrical brachial plexus palsy. METHODS Twenty-four infants (12 girls, 12 boys; mean age 7.9 months; range 4 to 14 months) with obstetrical brachial plexus palsy underwent nerve repair following a surgical algorithm that showed inadequate spontaneous nerve regeneration and muscle function. Neurolysis was performed in five cases, intraplexial neurotisation in 17 cases, and extraplexial transfer of the spinal accessory nerve to the suprascapular nerve in seven cases. Seventeen patients (70%) had total palsy (C5, C6 and/or C7 rupture and C8, T1 avulsion), four patients (17%) had C5, C6 involvement, and three patients (13%) had C5-7 involvement. Pre- and postoperative evaluations were made according to the grading system of the Hospital for Sick Children (HSC). The mean follow-up period was 15.8 months (range 8 to 31 months). RESULTS The mean HSC grades of the patients followed at least for 12 months were as follows: shoulder abduction 4, elbow flexion 4.5, wrist extension 2.3, and finger flexion 3.3. Compared to patients who underwent neurolysis alone, improved nerve regeneration was noted in patients who underwent neuroma excision and nerve grafting. No severe complications occurred postoperatively, including respiratory problems, metabolic acidosis, and hypothermia. CONCLUSION Early diagnosis and nerve surgery in patients having insufficient muscle activity and requiring surgical intervention may prevent atrophy of the muscles and provide a more functional upper extremity.
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Affiliation(s)
- Atakan Aydin
- Department of Plastic and Reconstructive Surgery, Medicine Faculty of Istanbul University, Capa, Turkey.
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Ozkan T, Aydin A, Onel D, Ozkan S. [Reconstruction of shoulder abduction and external rotation in obstetric brachial plexus palsy]. Acta Orthop Traumatol Turc 2004; 38:161-9. [PMID: 15347915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVES We evaluated the results of the subscapularis and pectoralis major muscle releases and the transfer of the latissimus dorsi/teres major muscles to the rotator cuff in patients with internal rotation contractures due to obstetric brachial plexus palsy. METHODS Seventy patients (44 boys, 26 girls; mean age 7.6 years; range 2 to 16 years) underwent transfer of the latissimus dorsi/teres major muscles to the rotator cuff. Spinal root involvement was at C5-C6 in 19 patients, at C5-C7 in 16 patients, and at C5-T1 in 35 patients. In 46 patients, the subscapularis muscle was released from the anterior surface of the scapula, and in 55 patients, the pectoralis major muscle was released by fractional tenotomy. The glenohumeral joint was evaluated by anteroposterior direct graphies and axial magnetic resonance scans. According to the Waters-Peljovich grading system, all the patients had type I or type II deformities. Pre- and postoperative range of motion values and Mallet scores were compared. The mean follow-up period was 37.9 months (range 24 to 64 months). RESULTS The mean shoulder abduction increased to 132.6 degrees (range 90 degrees to 170 degrees; mean gain 60.3 degrees) and external rotation increased to 81.1 degrees (range 30 degrees to 100 degrees; mean gain 58.7 degrees). The mean postoperative Mallet scores for global abduction and external rotation were 3.9; hand-to-head, to-mouth, and to-back scores were 3.7, 3.4, and 2.5, respectively. No serious complications were seen during the follow-up period. CONCLUSION The results of reconstruction techniques employed in our study show satisfactory increases in shoulder abduction and external rotation in patients with a minimal glenohumeral deformity.
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Affiliation(s)
- Türker Ozkan
- Department of Plastic and Reconstructive Surgery, Medicine Faculty of Istanbul University, Capa, Turkey.
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Cakmakci H, Gulcu A, Zenger MN. Mirror-image artifact mimicking epidural hematoma: usefulness of power Doppler sonography. J Clin Ultrasound 2003; 31:437-439. [PMID: 14528443 DOI: 10.1002/jcu.10194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
During sonographic examination, a mirror-like interface can scatter the ultrasound beam, producing mirror-image artifacts. We describe a case of bilateral parietal cephalhematoma in the parietal region of a 2-day-old neonate that mimicked bilateral epidural hematoma on routine sonographic examination. Forceps had been used during delivery, and the neonate had been experiencing episodes of apnea since birth. Gray-scale coronal sonograms showed anechoic structures resembling epidural hematomas in the left and right parietal regions. However, color and power Doppler sonography showed normal vascular findings, thus permitting identification of the mirror-image artifact.
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Affiliation(s)
- Handan Cakmakci
- Department of Radiology, Dokuz Eylül University Medical School, Inciralti, 35600 Izmir, Turkey
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Abstract
BACKGROUND The most common neonatal complications associated with shoulder dystocia include transient brachial plexus palsy, clavicular fracture, and humeral fracture. Fracture of the fetal radius has not been previously reported. CASE We encountered a shoulder dystocia with the fetal head in the right occiput anterior position that necessitated the McRoberts maneuver, suprapubic pressure, the Wood and Rubin maneuvers, and extraction of the posterior fetal arm to effect delivery. The 4610-g infant experienced a spiral fracture of the right (anterior) radius and a fracture of the left (posterior) midhumeral shaft. CONCLUSION Neonatal radial fracture can result from shoulder dystocia or the maneuvers employed for the alleviation of the shoulder dystocia.
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Affiliation(s)
- Kay Ann Thompson
- Division of Maternal/Fetal Medicine, Department of Obstetrics and Gynecology, National Naval Medical Center, Bethesda, Maryland 20889, USA
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Abstract
We report a case of an otherwise healthy neonate diagnosed at birth with a classic metaphyseal lesion of the proximal tibia following external cephalic version for frank breech presentation and a subsequent urgent cesarean section. Although the classic metaphyseal lesion is considered highly specific for infant abuse, this case demonstrates the importance of obtaining a history of obstetric trauma for neonates presenting to the imaging department for suspected non-accidental injury.
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Affiliation(s)
- John T Lysack
- Department of Diagnostic Radiology, Queen's University, Kingston General Hospital, 76 Stuart Street, K7L 2V7, Kingston, Ontario, Canada.
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Abstract
A case of epiphyseal separation of the distal humerus is presented, emphasizing the clinical and radiological features of this rare birth trauma. Conservative treatment resulted in complete recovery.
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Affiliation(s)
- Sherif K Khalil
- Department of Ophthalmology and Visual Science, The University of Texas-Houston Medical School, Houston, TX 77030-5204, USA
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Demirhan M, Erdem M, Uysal M. [Treatment of residual obstetrical brachial plexus palsy with tendon transfer]. Acta Orthop Traumatol Turc 2003; 36:295-302. [PMID: 12510063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVES We evaluated the results of the correction of adduction and internal rotation deformities of the shoulder associated with residual obstetrical brachial plexus palsy (OBPP) by the transfer of latissimus dorsi and teres major muscles to the rotator cuff. METHODS In order to correct adduction and internal rotation deformities associated with residual OBPP, 10 patients (7 males, 3 females; mean age 8.1 years; range 4 to 19 years) underwent transfer of the latissimus dorsi and teres major muscles to the rotator cuff and lengthening of the pectoralis major tendon with Z-plasty. The right and left extremities were affected in seven and three patients, respectively. Involvement of the C5-C6 nerve roots was detected in four, and C5-C6-C7 nerve roots in six patients. In two patients with a positive Putti sign, axillary roentgenograms showed posterior subluxation of the humeral head, and magnetic resonance and computed tomography scans revealed type III glenohumeral deformity. Functional evaluations were made using a 5-point scoring system proposed by Mallet. The mean follow-up was 23.6 months (range 5 to 42 months). RESULTS Postoperatively, the mean abduction and external rotation were 134.5 degrees (range 95 degrees to 170 degrees ) and 70 degrees (range 45 degrees to 90 degrees ), respectively. The mean global abduction score was 4, external rotation score was 4.2, and the scores assigned to the ability to move hand to the neck and mouth were 3.5. Of two patients with type III glenohumeral deformity, whose ages were four and 19 years, abduction and external rotation were 150 degrees and 45 degrees in the former, 135 degrees and 70 degrees in the latter, respectively. CONCLUSION The transfer of the latissimus dorsi and teres major tendons is a necessary procedure to restore external rotation and abduction functions of paralysed shoulders. Compared to other techniques employed, it offers obvious advantages in terms of ease and cost, as well.
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Affiliation(s)
- Mehmet Demirhan
- Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji Anabilim Dali), Medicine Faculty of Istanbul University, 34390 Capa, Turkey.
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Abstract
After atraumatic birth, three neonates presented with muscle hypotonia and weakness. Flaccid paresis of the upper extremities, spasticity of the lower extremities, dissociate sensory loss and autonomic dysfunction developed later. This ruled out the initial, tentative diagnoses of cerebral palsy, spinal muscular atrophy or hereditary neuropathy. Diagnostic imaging revealed marked thinning of the cervical spinal cord in all patients. The possible aetiology of these lesions is considered. In all cases, an antenatal or perinatal infarction is thought to be the most probable cause. Different clinical pictures following intrauterine spinal cord ischemia are discussed. Spinal cord lesion must be considered even after atraumatic birth.
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Affiliation(s)
- F Ebinger
- Kinderklinik, Abt. Pädiatrische Neurologie, Klinikum der Ruprecht-Karls-Universität Heidelberg, Germany.
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Abstract
AIM To describe the radiological features and natural history of sub-aponeurotic fluid collections presenting after the neonatal period. MATERIALS AND METHODS All cases of sub-aponeurotic scalp fluid collection presenting to the radiology department between June 1996 and June 2000 were reviewed. Note was made of the birth history, the radiographic and ultrasound features and the natural history (including any treatment) of the collection. RESULTS Seven cases of sub-aponeurotic fluid collections were identified. There were six infants who presented 3.5-18 weeks (mean nine weeks) after delivery, four of whom had had ventouse-assisted delivery. The last case was in a seven-year-old child who presented one month after minor head trauma. Clinical examination revealed non-tender, soft, mobile and fluctuant scalp swellings in all patients. Ultrasound identified sonolucent fluid collections of between 5 and 24 mm depth in the sub-aponeurotic space. No skull fractures were identified. Six patients were treated conservatively and one had fluid aspirated and a compression bandage applied. All cases resolved 2-24 weeks after diagnosis and there were no long-term sequelae. CONCLUSION Sub-aponeurotic scalp collections presenting after the neonatal period are usually associated with ventouse-assisted delivery ultrasound is useful for diagnosis. The condition is benign and resolution occurs with conservative treatment.
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Affiliation(s)
- R E Hopkins
- Department of Radiology, Bristol Hospital for Sick Children, Bristol, UK
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Affiliation(s)
- T Nakazato
- Department of Orthopedics, Chita Kosei Hospital, Aichi, Japan
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Abstract
BACKGROUND In the infant, shoulder injury due to birth trauma and infection in joint and bone may be difficult to detect radiographically. Shoulder ultrasound provides a dynamic, noninvasive method of evaluation. OBJECTIVE To develop a technique to evaluate the infant shoulder and to successfully demonstrate pathology. MATERIALS AND METHODS Using a multiplanar, dynamic technique, 24 normal and 12 symptomatic infants (age range, 3 days to 9 months) were examined (49 shoulders). RESULTS Sonographic findings were normal in 41 shoulders and abnormal in 8 shoulders. Abnormalities included subluxation, fracture, abnormal cartilage, soft-tissue mass, and inflammatory collections, including effusion. CONCLUSION Ultrasound can be used successfully to evaluate the infant shoulder for instability, fracture, and infection.
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Affiliation(s)
- L E Grissom
- Department of Medical Imaging, Alfred I. duPont Hospital for Children, P. O. Box 269, Wilmington, DE 19899, USA.
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Abstract
BACKGROUND Occipital osteodiastasis (OOD) is a form of birth injury characterized by a tear along the innominate (posterior occipital or supraoccipital-exoccipital) synchondrosis with separation of the occipital squama from the lateral or condylar parts of the occipital bone. The condition, frequently mentioned in the older literature as relatively common and invariably fatal, has been attributed to excessive pressure exerted over the subocciput during delivery, resulting in a forward and upward displacement of the anterior margin of the occipital squama into the posterior cranial fossa, with posterior fossa hemorrhage and other intracranial complications. Most likely as the result of improved obstetric techniques, this severe form of OOD has become quite rare or non-existent. A less severe form compatible with survival has been suggested, but so far only one case has been reported in some detail. MATERIALS AND METHODS This paper reports the occurrence of this less severe form of OOD diagnosed roentgenographically in two infants who survived: a newborn and a 3-month-old child. Two additional cases of a similar lesion but of postnatal onset are also described: a 3-month-old infant with the diagnosis of child abuse who also survived and a 2-year-old girl who was involved in a fatal motor-pedestrian collision. RESULTS Based on cases in the literature and the present material, three forms of OOD can be considered: a classic, fatal form; a less severe variant compatible with survival; and OOD of postnatal onset. The diagnosis can be made on lateral skull or cervical spine roentgenograms showing specific changes in the area of the innominate synchondrosis.
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Affiliation(s)
- G Currarino
- Department of Radiology, Texas Scottish Rite Hospital for Children, 2222 Welborn, Dallas, TX 75219, USA
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