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.

Thank you for

your attention