PEDIATRIC ORTHOPAEDIC SURGEON Inter Balkan Medical Center Thessaloniki Former Assistant Professor in Pediatric Orthopaedics Aristotle University Thessaloniki Academic Degrees M.Ch.Orth ( Thesis : Gait analysis in children with Duchenne muscular dystrophy University of Liverpool UK 1992) Ph.D ( Thesis : Gait analysis in children with cerebral palsy Aristotle University Thessaloniki Greece 2000)
Neurofibromatosis is often related with severe orthopaedic disorders in children. Bone lesions are rare but pose severe difficulties in management. It affects the spine and long bones. Lesions are associated either from enlargement of neurofibromas that affect the normal growth or from primary neurofibromatosis of long bones. Dystrophic scoliosis appears with short curves, with kyphosis and rotation of the apical vertebrae. Usually affect the thoracic spine, with penciling of the ribs. Surgical treatment is challenging in cases of rapid progression. Scoliosis may appear with curvatures similar to those in idiopathic scoliosis, without dysplastic changes of the vertebrae. Anterior bowing of the tibia is manifestation of NF and is distinguished from the benign posterolateral bowing. Evaluation of the medullary canal and presence of cystic lesions in the tibia is essential. Progression to pseudoarthrosis or pathologic fracture is common. Surgical management of tibial pseudoarthrosis remains a difficult procedure. Pseudoarthrosis may appear in fibula, radius or ulna but are extremely rare. Irregular eccentric bone cysts in long bones that are commonly diagnosed after a pathologic fracture, must be differentiated for NF. Malignant transformation of neurofibromas must be considered when there is rapid progression of the lesion.
Part of the book: Clinical and Basic Aspects of Neurofibromatosis Type 1
A neonatal fracture is a severe complication creating problems regarding diagnosis and appropriate management. Diagnosis from the neonatologist occasionally is difficult. A paediatric orthopaedic surgeon is required to evaluate the neonate, and confirm diagnosis and treatment. Clavicle fracture is the most common injury that must be differentiated occasionally from neonatal brachial plexus palsy. The clinical signs are crepitus, swelling, bony prominence, with the restriction of the movements of the arm. Occasionally, the fracture is diagnosed later. Clavicle pseudoarthrosis is a rare dysplasia. Fracture of the femur or the humerus presents with swelling, crepitus and deformity of the limb, creating difficulties in clothing, bathing and feeding. Most commonly are found in urgent caesarean delivery or complicated dystocia with over-weighted neonates. Bone fragility diseases (osteogenesis imperfecta, hypophosphatasia, arthrogryposis) are diagnosed from neonatal fractures. Conservative treatment with immobilization is the method of choice. Extremely rare is surgical treatment. Premature and low-weighted babies are in high risk to sustain fractures. Epiphyseal fractures of the distal femoral or humeral epiphysis are rare fractures, difficult to be diagnosed initially. They require immediate reduction to avoid permanent lesion of the growth plate. Fractures of forearm, tibia or vertebrae are extremely rare and associated with a bone fragility disease.
Part of the book: Current Fracture Care [Working title]