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Salmonella osteomyelitis in infants
INTERNATIONAL
379
A B S T R A C T S O F P E D I A T R I C SURGERY
suggests calling the impacted supracondylar fracture in poliomyelitis the paralytic fracture. The most impressive feature brought out by this review was the relationship in a large proportion of eases between plaster immobilization and fracture. The relationship has not attracted m u c h attention in the past. 25 of the 57 fractures of the paralyzed limbs in this series occurred within three months following cast removal, while the osteoporosis immobilization was still apparent. Walking in a cast, and even passive standing while immobilization is still necessary is encouraged to prevent, at least to some degree, the osteoporosis that follows immobilization. There were no open fractures in this series. All the fractures united rapidly with no serious com-
plications.--Harvard EUman. SALMONELLA OSTEOMYELITIS
IN INFANTS,
G.
].
Ebrahim and P, Grech. J. Bone and Joint Surg. 48B, 2 : 3 5 0 - 3 5 3 ( M a y ) , 1966, It is well known that patients with sickle-cell anemia are susceptible to salmonella infection of bone. T h a t it can occur also when the sickling test is negative is reported in a short series of 5 infants, 4 of whom were between six a n d ten months of age and the fifth only eighteen months old. The characteristic features of onset and radiological changes are mentioned and the rapid response to antibiotic treatment with streptomycin and ehloramphenicol is reported, associated also usually with aspiration of pus and instillation of streptomycin and in one, operative surgical drainage. T h e infecting organism was salmonella typhimurium although salmonella typhi infection was more endemic at the time. The lesions in this series seemed to have a predilection for the metaphyseal area of bones and of the upper humerus in comparison to the diaphyseal lesions of salmonella osteomyelitis seen in m a n y cases, especially those associated with red cell sickling.--F. H. Robarts. BmTI-I INJURY TO THE STERNOMASTOm MUSCLE. N. G. Sanerkin and P. Edwards. J. Bone and Joint Surg, 48B, 3:441-447 (Aug.), 1966. In the references in the literature on this topic two causal theories, of birth injury and of isehemia, are detailed; the former with muscle rupture leading to hematoma and fibrous tissue replacement; the latter with arterial or venous occlusion in relation to birth trauma producing changes similar to Volkmann's ischemic contracture.
Report of a case of a breech delivered child in a primipara of 18 years is given. A premature child of 1850 Gm. died in the respiratory distress syndrome at 42 hours. At post-mortem there was moderate jaundice, no external evidence of cervical injury. Injection of the arteries of the head and neck showed the right sternomastoid muscle to b e swollen and hemorrhagic, firm and bluish-red in color, in contrast to the pale creamy-pink color of that on the left side. There was no macroscopic abnormality of the major vessels. Histology showed intramuscular hemorrhage and rupture of the muscle fibers with broadening a n d clubbing of fibrils and tearing of endomysial sheaths. There was no evidence of arterial or venous thrombosis a n d injection material was within the vessels. There was no significant fibroblastie response. The left side was essentially normal. Tearing of the endomysial sheaths is known to lead to extensive fibrous proliferation. Probably there is a similar pathology for desmoid tumors of the abdominal muscles in women after pregnancy.
--F. H. Robarts. REPLANTATR)N OF
AN INFANT'S ARM.
J.
G.
Rosenkrantz, R. C. Sullivan, K. Welch, J. S. Miles, K. M. Sadler and B. C. Paton. New Eng. J. Med. 276:609-612 ( M a r c h ) , 1967. This is a case report of a 21 m o n t h old infant admitted to the Colorado General Hospital 20 minutes following traumatic amputation of the left arm through the u p p e r humerus. After preliminary perfusion, the arm was successfully rejoined to the patient. 18 months later nerve regeneration a n d arm function were impressive. The authors emphasize some of the physiologic effects in such cases, including the risk of postoperative hypovolemic shock from loss of large plasma volumes into a replanted limb, a n d metabolic acidosis immediately following reestablishment of circulation to an amputated extremity. They believe that t h e immediate risk of replantation of a limb may b e higher in children t h a n adults, b u t t h a t the eventual functional gain may be g r e a t e r . - - W . H. Hendren. JUXTA-EPIPHYSEAL FRACTURE OF THE TERM1NAL PHALANX OF THE FINGER. N. Seymour. J. Bone and Joint Surg. 48B, 2 : 3 4 7 - 3 4 9 ( M a y ) , 1966. The recognition b y good lateral radiography of this not u n c o m m o n injury as a variety of compound "mallet finger" is stressed. Complications
379
A B S T R A C T S O F P E D I A T R I C SURGERY
suggests calling the impacted supracondylar fracture in poliomyelitis the paralytic fracture. The most impressive feature brought out by this review was the relationship in a large proportion of eases between plaster immobilization and fracture. The relationship has not attracted m u c h attention in the past. 25 of the 57 fractures of the paralyzed limbs in this series occurred within three months following cast removal, while the osteoporosis immobilization was still apparent. Walking in a cast, and even passive standing while immobilization is still necessary is encouraged to prevent, at least to some degree, the osteoporosis that follows immobilization. There were no open fractures in this series. All the fractures united rapidly with no serious com-
plications.--Harvard EUman. SALMONELLA OSTEOMYELITIS
IN INFANTS,
G.
].
Ebrahim and P, Grech. J. Bone and Joint Surg. 48B, 2 : 3 5 0 - 3 5 3 ( M a y ) , 1966, It is well known that patients with sickle-cell anemia are susceptible to salmonella infection of bone. T h a t it can occur also when the sickling test is negative is reported in a short series of 5 infants, 4 of whom were between six a n d ten months of age and the fifth only eighteen months old. The characteristic features of onset and radiological changes are mentioned and the rapid response to antibiotic treatment with streptomycin and ehloramphenicol is reported, associated also usually with aspiration of pus and instillation of streptomycin and in one, operative surgical drainage. T h e infecting organism was salmonella typhimurium although salmonella typhi infection was more endemic at the time. The lesions in this series seemed to have a predilection for the metaphyseal area of bones and of the upper humerus in comparison to the diaphyseal lesions of salmonella osteomyelitis seen in m a n y cases, especially those associated with red cell sickling.--F. H. Robarts. BmTI-I INJURY TO THE STERNOMASTOm MUSCLE. N. G. Sanerkin and P. Edwards. J. Bone and Joint Surg, 48B, 3:441-447 (Aug.), 1966. In the references in the literature on this topic two causal theories, of birth injury and of isehemia, are detailed; the former with muscle rupture leading to hematoma and fibrous tissue replacement; the latter with arterial or venous occlusion in relation to birth trauma producing changes similar to Volkmann's ischemic contracture.
Report of a case of a breech delivered child in a primipara of 18 years is given. A premature child of 1850 Gm. died in the respiratory distress syndrome at 42 hours. At post-mortem there was moderate jaundice, no external evidence of cervical injury. Injection of the arteries of the head and neck showed the right sternomastoid muscle to b e swollen and hemorrhagic, firm and bluish-red in color, in contrast to the pale creamy-pink color of that on the left side. There was no macroscopic abnormality of the major vessels. Histology showed intramuscular hemorrhage and rupture of the muscle fibers with broadening a n d clubbing of fibrils and tearing of endomysial sheaths. There was no evidence of arterial or venous thrombosis a n d injection material was within the vessels. There was no significant fibroblastie response. The left side was essentially normal. Tearing of the endomysial sheaths is known to lead to extensive fibrous proliferation. Probably there is a similar pathology for desmoid tumors of the abdominal muscles in women after pregnancy.
--F. H. Robarts. REPLANTATR)N OF
AN INFANT'S ARM.
J.
G.
Rosenkrantz, R. C. Sullivan, K. Welch, J. S. Miles, K. M. Sadler and B. C. Paton. New Eng. J. Med. 276:609-612 ( M a r c h ) , 1967. This is a case report of a 21 m o n t h old infant admitted to the Colorado General Hospital 20 minutes following traumatic amputation of the left arm through the u p p e r humerus. After preliminary perfusion, the arm was successfully rejoined to the patient. 18 months later nerve regeneration a n d arm function were impressive. The authors emphasize some of the physiologic effects in such cases, including the risk of postoperative hypovolemic shock from loss of large plasma volumes into a replanted limb, a n d metabolic acidosis immediately following reestablishment of circulation to an amputated extremity. They believe that t h e immediate risk of replantation of a limb may b e higher in children t h a n adults, b u t t h a t the eventual functional gain may be g r e a t e r . - - W . H. Hendren. JUXTA-EPIPHYSEAL FRACTURE OF THE TERM1NAL PHALANX OF THE FINGER. N. Seymour. J. Bone and Joint Surg. 48B, 2 : 3 4 7 - 3 4 9 ( M a y ) , 1966. The recognition b y good lateral radiography of this not u n c o m m o n injury as a variety of compound "mallet finger" is stressed. Complications