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Septic Elbow and Osteomyelitis after Closed Reduction and Internal Fixation in Lateral Humeral Condylar Fracture
Department of Orthopaedic Surgery, College of Medicine, Dong-A University, Busan, Korea
Sung Soo Kim, M.D.
Chief Complaint M / 6YSwelling and pus discharge for 1 week in
left elbow P/Ex) swelling (+) pus discharge (+) ROM – limitation distal motor / sensory – intact / insensitivity to pain
PHx5 weeks ago : fall down Fx, lateral condyle humerus, Lt - 5 days after injury : closed reduction
and internal fixation
preop postop
• POD 2 weeks : 1 K-wire migration
• POD 4 weeks Pin site infection –
pin removal & oral antibiotics
POD 4 weeks
POD 4 weeks
POD 2 weeks
General Appearance
. multiple healed scars of self-inflicted
bite injuries at the apices of the fingers and tongue
. poorly healing wound due to burn injury on arm
CASE Birth Hx) 1st/full term/ 2.9kg/ NSVD
FHx) non-specific
PHx) recurrent episodes of tongue laceration
from birth multiple healed scar of self-inflicted bite
injuries recurrent fractures insensitivity to pain inability to sweating - 5 years ago : Dx as Congenital
Insensitivity to Pain with Anhidrosis (CIPA)
CASE PHx of recurrent fractures 5 years ago - Fx 1st metatarsal base, Rt 4 years ago - Fx calcaneus, Rt Old fx cuboid, Rt Fx 3rd ,4th metatarsal base, Rt
CASE Past /Hx of recurrent fractures 3 years ago Fx 1st metatarsal base, Lt Fx 3rd ,4th metatarsal neck,Lt
CASE PHx of recurrent fractures 2 years ago Fx 3rd ,4th ,5th metatarsal neck, Rt 1 years ago R/O Fx capitellum, Rt
• POD 5 weeks Pus culture &
sensitivity test : S. aureus & sensitive to most antibiotics
Admission and IV antibiotics
• POD 6.5 weeksI & D
Congenital insensitivity to pain with anhidrosis
• Congenital insensitivity to pain with anhidrosis(CIPA) is a rare inherited disorder first described in 1932 by Dearborn
• This disorder was classified by Dyck and Ohta as type IV hereditary sensory neuropathy
Congenital insensitivity to pain with anhidrosis
• CIPA is characterized by insensitivity to pain, normal tactile sense , recurrent episodes of hyperpyrexia, inability to sweating and autonomic nerve system abnormality
• Presentation in childhood is commonly at the time of tooth eruption , with biting and self-mutilation of lips, tongue, digits and fractures
Conclusion
• Early diagnosis, prevention and prompt treatment of
fractures, burns, infection and other injuries is essential in management of the children with congenital insensitivity to pain with anhidrosis.