X ray 18

X ray 17

pt at presentation

Initial x ray

3D CT of left shoulder

Clinical examination

Patient is a 14 yr old male who presented to ER with 10 day old history of fall from tree with pain in the Left shoulder

Patient is right handed.

History of massage therapy of one sitting. 

Now on examination the patient has good range of movements as seen by the clinical photographs.

Whats your plan of mangement??

X ray 16

A 14 yr Female Child presented with multiple deformities of all the four limbs and spine.

History of surgery on left lower limb 11/2 year back.

Whats the role of surgical intervention in overall rehabilitation of this child?

please comment...

Discussion 

Surgery in Osteogenesis imperfecta

Metal rods can be surgically inserted in the long bones to improve strength, a procedure developed by Harold A. Sofield, MD, at Shriners Hospitals for Children in Chicago. During the late 1940s, Sofield, Chief of Staff at Shriners Hospitals in Chicago, worked there with large numbers of children with OI and experimented with various methods to strengthen the bones in these children. In 1959, with Edward A. Miller, MD, Sofield wrote a seminal article describing a solution that seemed radical at the time: the placement of stainless steel rods into the intramedullary canals of the long bones to stabilize and strengthen them. His treatment proved extremely useful in the rehabilitation and prevention of fractures; it was adopted throughout the world and still forms the basis for orthopedic treatment of OI.

Spinal fusion can be performed to correct scoliosis, although the inherent bone fragility makes this operation more complex in OI patients. Surgery for basilar impressions can be carried out if pressure being exerted on the spinal cord and brain stem is causing neurological problems.