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Papers by madalina carp

Children (Basel), Oct 12, 2021

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Children

Traumatic hip dislocation might lead to serious complications and a poor outcome. Fortunately, it... more Traumatic hip dislocation might lead to serious complications and a poor outcome. Fortunately, it is a rare condition in pediatric patients. The purpose of this study is to establish and describe the complications caused by hip dislocations associated with transphyseal femoral neck fractures. Therefore, we conducted a literature review that resulted in 11 articles, including 32 patients, older than 10 years of age, suffering from traumatic hip dislocation associated with a transphyseal femoral neck fracture. We presented a case series of three patients with hip fracture-dislocation treated in our clinic that were also evaluated and included in the study. For the 35 patients included in the study group, the percentage of avascular osteonecrosis after hip fracture-dislocation was 88.57%. Traumatic hip dislocation associated with transphyseal femoral neck fracture is a rare condition and has a poor prognosis because of the high incidence of femoral head avascular necrosis (AVN). Reduct...

Children, 2022

Background: Slipped capital femoral epiphysis is due to proximal femur physis failure in adolesce... more Background: Slipped capital femoral epiphysis is due to proximal femur physis failure in adolescent patients. Early iatrogenic closure of proximal growth cartilage in children with significant residual growth potential causes complications such as coxa breva, coxa vara, and lower limb length inequalities. The Free-Gliding SCFE Screw System is a self-extending cannulated screw used in Slipped Capital Femoral Epiphysis (SCFE) fixation and femoral neck fractures. Materials and Method: We conducted a retrospective study on 16 patients. All patients under 11 years old were treated by telescopic cannulated screws fixation. The youngest patient was 7 years old. Results: Out of the 22 operated hips, 2 screws have failed, thus resulting in a lack of telescoping of the screw. We discovered an average lengthening of approximately 10 mm at 24 months postoperative check-up in 20 hips in which lengthening took place. According to the Notzli method, none of the patients had an alpha angle value gr...

Journal of Medicine and Life, 2015

Osteogenesis imperfecta is a genetically determined pathology that implies bone variability and o... more Osteogenesis imperfecta is a genetically determined pathology that implies bone variability and osteoporosis with early onset of fractures after low energy trauma. For a better understanding of the clinical problems, Sillence and Danks created a classification. The study group consisted of 12 patients both males and females, with ages ranging from 2 years and 3 months to 12 years. All of them came to the hospital late, after walking, after several fractures occurred and the only treatment they underwent was with prolonged cast immobilization that caused rapid bone demineralization, axial deformations of the affected bones, increased number of fractures and eventually loss of ambulation. Following the discharged patients, we appreciated that the open bone alignment and Fassier Duval osteosynthesis were the best way to treat a patient with Lobstein disease. The results showed that by using these two techniques a lot of time is saved on a long term because all the great complications a...

SICOT-J, 2020

Introduction: Femoral shaft fractures in pediatric patients are treated by elastic intramedullary... more Introduction: Femoral shaft fractures in pediatric patients are treated by elastic intramedullary nailing using titanium or stainless-steel nails. The elastic stable intramedullary nailing behaves as an internal splint, promoting early mobilization. This type of treatment involves a minimally invasive approach, no damage to the growth plates, and no impairment of femoral head blood supply. Purpose: The aim of our study was to identify the negative predicting factors that might lead to an increased complication rate after elastic stable intramedullary nailing of femoral shaft fractures in children. Methods: We conducted a retrospective study on 137 patients with femoral shaft fractures treated by elastic stable intramedullary nailing. Patients’ age ranged between 4 and 17 years. We used data from the medical records of the patients to evaluate postoperative complications. Plain radiographs were analyzed to determine the fracture type, fracture location, and postoperative complication...

BioMed Research International, 2020

Objectives. Meniscus repair is a challenge for a practitioner, as an injured meniscus can lead to... more Objectives. Meniscus repair is a challenge for a practitioner, as an injured meniscus can lead to osteoarthritic joint changes with a greatly disabling outcome. Platelet-rich plasma has been regarded as a promising therapy to help induce healing. The purpose of the study is to clinically assess the effectiveness of PRP treatment in adolescents with meniscal lesions. Methods. This retrospective study analyzed 30 patients with meniscal tears, aged 12 to 17 years, who had documented MRI meniscal lesion and persistent knee pain. In order to evaluate the outcome, the Lysholm knee scoring scale and numerical rating scale were used before injection and 3 months after treatment. Results. Patients had a mean age of 13.93 years, 70% girls and 30% boys. The most affected was the medial meniscus. The mean value before injection on the numerical rating scale (NRS) of pain was 7.73, after the treatment being of 2.0. After treatment, 76.7% of the patients had “excellent” and “good” outcomes, while...

Journal of International Medical Research, 2020

Objective: Acute hematogenous osteomyelitis (AHO) has declining incidence in developed countries.... more Objective: Acute hematogenous osteomyelitis (AHO) has declining incidence in developed countries. AHO can cause rapid destruction of bone that can lead to functional impairment or even death if misdiagnosed and not treated urgently. In this study, we aimed to identify the main factors that may lead to a poor outcome and to establish a profile of patients with AHO who might have a negative outcome. Methods: We conducted a retrospective single-center study including 94 patients with AHO, over a 10-year interval. Complete medical history including age at diagnosis, sex, socioeconomic status, symptoms, entry portal, pathogenic agent, location of infection, radiological features, treatment, and outcome were recorded. Results: Male predominance was observed, with boys from rural areas more prone to a poor outcome. This is likely because they are more exposed to trauma and do not have proper access to emergency medical care. Staphylococcus aureus was the most common etiologic agent, with 84 patients testing positive. Disease evolution was toward chronicity in patients diagnosed late. The most frequent complications were sepsis and pathological fractures. Conclusions: In our study, patients with negative outcomes were characterized by young age, repeated negative cultures, delayed surgery, rural residence, and male sex.

Indian Journal of Orthopaedics, 2019

Background: Nursemaid's elbow (NE) represents the most common pathology met in the pediatric ... more Background: Nursemaid's elbow (NE) represents the most common pathology met in the pediatric orthopedics ambulatory. There are two techniques of reducing the NE: the supination-flexion technique and the hyperpronation or forced pronation technique. Materials and Methods: In this randomized clinical study, we aim to compare the two reduction techniques of the NE, by measuring the effectiveness of each and scaling the pain felt by the child, by using the Faces Pain Scale. The study included 116 patients with typical presentation for NE with age under 7 years old (mean age ~3 years old), 45% of males and 55% of females. Results: Hyperpronation was found to be more successful than supination-flexion technique as a first attempt (85% vs. 53%), second attempt (50% vs. 28%), and as a crossover technique (100% vs. 50%) when supination-flexion failed. Conclusions: This study concludes that hyperpronation technique should be used as a first maneuver reduction in treating NE, a simple one-movement technique.

Chirurgia, 2019

Introducere: Osteomielita acutã hematogenã are o incidenţã în scãdere în ţãrile dezvoltate. Aceas... more Introducere: Osteomielita acutã hematogenã are o incidenţã în scãdere în ţãrile dezvoltate. Aceastã afecţiune poate duce la o distrugere rapida a structurii osoase. Întârzierea diagnosticului poate avea consecinţe nefaste precum impotenţa funcţionalã sau chiar deces. Obiectivul acestui studiu este de a identifica principalii factori ce pot duce la un prognostic negativ şi de a stabili profilul pacientului ce suferã de osteomielita acutã hematogenã care are un prognostic rezervat. Metode: Am efectuat un studiu retrospectiv unicentric, în care am evaluat datele medicale a 94 de pacienţi diagnosticaţi cu osteomielita acutã hematogenã, într-un interval de timp de 10 ani. Am analizat istoricul medical complet al pacientului, incluzând: vârsta în momentul diagnosticãrii, sexul, statusul socioeconomic, simptome, poarta de intrare, agentul patogen, localizarea infecţiei, imagini radiologice, tratamentul şi prognosticul. Am observat faptul cã pacienţii de sex masculin cu provenienţã din mediul rural, sunt predispuşi unui prognostic nefavorabil, probabil, datoritã faptului cã aceştia sunt mai expuşi la traumatisme, iar in mediul rural adresabilitatea la serviciile medicale este limitatã. Cel mai frecvent întâlnit agent patogen a fost Stafilococul auriu (84 cazuri). Tratamentul osteomielitei acute hematogene este unul complex şi de lungã duratã şi constã în antibiotico-terapie ghidatã de antibiogramã şi incizii chirurgicale de drenaj, debridarea ţesuturilor afectate.

International Orthopaedics, 2018

Introduction Aneurysmal bone cyst (ABC) is a benign intraosseous lesion filled with blood that ca... more Introduction Aneurysmal bone cyst (ABC) is a benign intraosseous lesion filled with blood that can determine a blowout distension of the bone. The purpose of this study is to evaluate the efficacy of sclerotherapy by percutaneous intralesional administration of ethanol 96% for the treatment of this pathology in paediatric patients. Method The retrospective study includes 17 paediatric patients with ABC who were treated by repeated intracystic injection with ethanol 96%, 1 ml/kg, in our clinic between December 2015 and July 2017. Fluoroscopic guidance was used to inject the cyst with contrast agent. The mean follow-up period was 11 months. Results and discussion All cysts are healed or are in the healing process. The mean age was 11 years old. Seven patients needed three repeated injections and ten patients needed two injections until healing. We observed a mean reduction in the size of the lesions, measured on plain X-rays, of 68%. The complications that were observed included the following: dizziness after injection, skin pigmentation at the injection site, local inflammatory reaction, and pain after injection. The current study approves the importance of this minimally invasive treatment with no recurrence after a follow-up of 19 months. The healing rate was 100%. A limitation of this study consists in the small number of patients. Conclusion Sclerotherapy with ethanol 96% is a useful method for the treatment of ABC. It is a minimally invasive method, with no major complications, which lowers the risks of open surgical intervention and has a good rate of success.

Journal of wound care, 2018

Open fractures of the leg with large loss of tissue require extensive reconstructive methods that... more Open fractures of the leg with large loss of tissue require extensive reconstructive methods that can injure the donor area. The use of negative pressure wound therapy (NPWT) may minimise the impact of these reconstructive methods because of its capacity to create granulation tissue that will form a wound bed for the skin graft, thus reducing the volume of soft tissue defect and saving the donor region. This case study describes the effectiveness of NPWT in the treatment and reconstruction of an open fracture of the leg, with massive loss of soft tissue, associated with elastic intramedullary nailing in a 10-year-old female patient, who was a victim of a car accident. Clinical examination revealed a Gustilo-Anderson IIIB open fracture of the left leg, with the avulsion of the fifth toe, disarticulation of the fifth metatarsal bone, extensively damaged skin and subcutaneous tissue in the medium and distal third of the left leg and left foot. The bone was exposed in the distal part of...

Journal of International Medical Research, 2017

We report development of an aneurysmal bone cyst (ABC) that was located in the proximal region of... more We report development of an aneurysmal bone cyst (ABC) that was located in the proximal region of the femur in an 11-year-old girl. Over a period of 30 weeks, the ABC showed fulminant local progression, with destruction of the bone, which led to an abrupt loss of function of the left hip. The standard tumour treatment protocol was followed. We performed embolisation of the tumour followed by a biopsy, which confirmed the diagnosis of ABC. The outcome was negative with total destruction of the proximal third of the femur, despite repeating the embolisation. Because of the unfavourable local progression, a second biopsy was performed and we reconfirmed the initial diagnosis. The final decision regarding the therapeutic approach was total hip arthroplasty with femoral reconstruction with a prosthesis. Following this treatment, the patient’s outcome was favourable, with complete recovery of function and no local relapse.

Chirurgia (Bucharest, Romania : 1990)

Background: Aneurysmal bone cyst is a solitary bone tumor, expansile and lytic most often seen in... more Background: Aneurysmal bone cyst is a solitary bone tumor, expansile and lytic most often seen in the second decade of life, more frequently in men than in women (2: 1). They can occur in any bone, most common in the metaphysis of the long bones of the lower limbs. Although it is a benign tumor formation, aneurysmal cysts may have an aggressive local evolution and can cause a significant decrease in bone strength. The pacient may present local pain, the appearance of local deformation due to a tumor mass or occurrence of pathological fractures. Traditionally these lesions were treated surgically (curettage or resection and bone grafting) with a relapse rate of about 20%. Because bone resection may lead to bone defects, deformations or damage in the affected limb's function, lately the preferred treatement percutaneous sclerotherapy using fibrosing alcoholic agents. We present the case of a 14 year old pacient submitted for pain and deformity at the distal third of the right fore...

Chirurgia (Bucharest, Romania : 1990)

Madelung deformity is an abnormality of the distal part of the forearm due to a growth arrest in ... more Madelung deformity is an abnormality of the distal part of the forearm due to a growth arrest in the distal radial physis creating an increase of the radial tilt angle associated with a dorsal subluxation of the distal ulna in most cases. It is a rare condition which represents only 1.7% of hand deformities being characterized by the presence of an abnormal structure, Vickers ligament, that tethers the distal radius to the lunate bone. Although it is believed to be a congenital disorder, the symptoms are absent till late childhood. We present a case of a 11 years old girl patient, who came to our clinic for deformity of both forearms, which consisted of an anteriorly curved radius, volar proeminence of the distal ulna, partial limitation of supination and pain in the last 6 months, with and insidious onsed and aggravated lately. The mother of the patient, at the age of 13, was diagnosed with the same deformity which was surgically treated at that time. Furthermore, the patient has a...

Journal of International Medical Research, 2017

Objective This study aimed to assess the principal risk factors that could lead to the most commo... more Objective This study aimed to assess the principal risk factors that could lead to the most common long-term complications of slipped capital femoral epiphysis, such as avascular necrosis, chondrolysis, and hip impingement. Methods We conducted a single-centre, retrospective study and evaluated patients (70 patients, 81 hips) who were treated for slipped capital femoral epiphysis from 2010 to 2015 and who underwent pinning. We measured the severity of displacement radiologically using the Southwick angle. Postoperative radiographs were evaluated for the most frequent long-term complications of avascular necrosis (AVN), chondrolysis, and femoral acetabular impingement (FAI). Results We found seven cases of AVN, 14 cases of chondrolysis, and 31 hips had an α angle of 60°. Sex, ambulation, and symptoms did not affect development of these complications. Patients with a normal weight were almost two times more likely to develop FAI. Patients with moderate and severe slips had a similar p...

Children (Basel), Oct 12, 2021

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Children

Traumatic hip dislocation might lead to serious complications and a poor outcome. Fortunately, it... more Traumatic hip dislocation might lead to serious complications and a poor outcome. Fortunately, it is a rare condition in pediatric patients. The purpose of this study is to establish and describe the complications caused by hip dislocations associated with transphyseal femoral neck fractures. Therefore, we conducted a literature review that resulted in 11 articles, including 32 patients, older than 10 years of age, suffering from traumatic hip dislocation associated with a transphyseal femoral neck fracture. We presented a case series of three patients with hip fracture-dislocation treated in our clinic that were also evaluated and included in the study. For the 35 patients included in the study group, the percentage of avascular osteonecrosis after hip fracture-dislocation was 88.57%. Traumatic hip dislocation associated with transphyseal femoral neck fracture is a rare condition and has a poor prognosis because of the high incidence of femoral head avascular necrosis (AVN). Reduct...

Children, 2022

Background: Slipped capital femoral epiphysis is due to proximal femur physis failure in adolesce... more Background: Slipped capital femoral epiphysis is due to proximal femur physis failure in adolescent patients. Early iatrogenic closure of proximal growth cartilage in children with significant residual growth potential causes complications such as coxa breva, coxa vara, and lower limb length inequalities. The Free-Gliding SCFE Screw System is a self-extending cannulated screw used in Slipped Capital Femoral Epiphysis (SCFE) fixation and femoral neck fractures. Materials and Method: We conducted a retrospective study on 16 patients. All patients under 11 years old were treated by telescopic cannulated screws fixation. The youngest patient was 7 years old. Results: Out of the 22 operated hips, 2 screws have failed, thus resulting in a lack of telescoping of the screw. We discovered an average lengthening of approximately 10 mm at 24 months postoperative check-up in 20 hips in which lengthening took place. According to the Notzli method, none of the patients had an alpha angle value gr...

Journal of Medicine and Life, 2015

Osteogenesis imperfecta is a genetically determined pathology that implies bone variability and o... more Osteogenesis imperfecta is a genetically determined pathology that implies bone variability and osteoporosis with early onset of fractures after low energy trauma. For a better understanding of the clinical problems, Sillence and Danks created a classification. The study group consisted of 12 patients both males and females, with ages ranging from 2 years and 3 months to 12 years. All of them came to the hospital late, after walking, after several fractures occurred and the only treatment they underwent was with prolonged cast immobilization that caused rapid bone demineralization, axial deformations of the affected bones, increased number of fractures and eventually loss of ambulation. Following the discharged patients, we appreciated that the open bone alignment and Fassier Duval osteosynthesis were the best way to treat a patient with Lobstein disease. The results showed that by using these two techniques a lot of time is saved on a long term because all the great complications a...

SICOT-J, 2020

Introduction: Femoral shaft fractures in pediatric patients are treated by elastic intramedullary... more Introduction: Femoral shaft fractures in pediatric patients are treated by elastic intramedullary nailing using titanium or stainless-steel nails. The elastic stable intramedullary nailing behaves as an internal splint, promoting early mobilization. This type of treatment involves a minimally invasive approach, no damage to the growth plates, and no impairment of femoral head blood supply. Purpose: The aim of our study was to identify the negative predicting factors that might lead to an increased complication rate after elastic stable intramedullary nailing of femoral shaft fractures in children. Methods: We conducted a retrospective study on 137 patients with femoral shaft fractures treated by elastic stable intramedullary nailing. Patients’ age ranged between 4 and 17 years. We used data from the medical records of the patients to evaluate postoperative complications. Plain radiographs were analyzed to determine the fracture type, fracture location, and postoperative complication...

BioMed Research International, 2020

Objectives. Meniscus repair is a challenge for a practitioner, as an injured meniscus can lead to... more Objectives. Meniscus repair is a challenge for a practitioner, as an injured meniscus can lead to osteoarthritic joint changes with a greatly disabling outcome. Platelet-rich plasma has been regarded as a promising therapy to help induce healing. The purpose of the study is to clinically assess the effectiveness of PRP treatment in adolescents with meniscal lesions. Methods. This retrospective study analyzed 30 patients with meniscal tears, aged 12 to 17 years, who had documented MRI meniscal lesion and persistent knee pain. In order to evaluate the outcome, the Lysholm knee scoring scale and numerical rating scale were used before injection and 3 months after treatment. Results. Patients had a mean age of 13.93 years, 70% girls and 30% boys. The most affected was the medial meniscus. The mean value before injection on the numerical rating scale (NRS) of pain was 7.73, after the treatment being of 2.0. After treatment, 76.7% of the patients had “excellent” and “good” outcomes, while...

Journal of International Medical Research, 2020

Objective: Acute hematogenous osteomyelitis (AHO) has declining incidence in developed countries.... more Objective: Acute hematogenous osteomyelitis (AHO) has declining incidence in developed countries. AHO can cause rapid destruction of bone that can lead to functional impairment or even death if misdiagnosed and not treated urgently. In this study, we aimed to identify the main factors that may lead to a poor outcome and to establish a profile of patients with AHO who might have a negative outcome. Methods: We conducted a retrospective single-center study including 94 patients with AHO, over a 10-year interval. Complete medical history including age at diagnosis, sex, socioeconomic status, symptoms, entry portal, pathogenic agent, location of infection, radiological features, treatment, and outcome were recorded. Results: Male predominance was observed, with boys from rural areas more prone to a poor outcome. This is likely because they are more exposed to trauma and do not have proper access to emergency medical care. Staphylococcus aureus was the most common etiologic agent, with 84 patients testing positive. Disease evolution was toward chronicity in patients diagnosed late. The most frequent complications were sepsis and pathological fractures. Conclusions: In our study, patients with negative outcomes were characterized by young age, repeated negative cultures, delayed surgery, rural residence, and male sex.

Indian Journal of Orthopaedics, 2019

Background: Nursemaid's elbow (NE) represents the most common pathology met in the pediatric ... more Background: Nursemaid's elbow (NE) represents the most common pathology met in the pediatric orthopedics ambulatory. There are two techniques of reducing the NE: the supination-flexion technique and the hyperpronation or forced pronation technique. Materials and Methods: In this randomized clinical study, we aim to compare the two reduction techniques of the NE, by measuring the effectiveness of each and scaling the pain felt by the child, by using the Faces Pain Scale. The study included 116 patients with typical presentation for NE with age under 7 years old (mean age ~3 years old), 45% of males and 55% of females. Results: Hyperpronation was found to be more successful than supination-flexion technique as a first attempt (85% vs. 53%), second attempt (50% vs. 28%), and as a crossover technique (100% vs. 50%) when supination-flexion failed. Conclusions: This study concludes that hyperpronation technique should be used as a first maneuver reduction in treating NE, a simple one-movement technique.

Chirurgia, 2019

Introducere: Osteomielita acutã hematogenã are o incidenţã în scãdere în ţãrile dezvoltate. Aceas... more Introducere: Osteomielita acutã hematogenã are o incidenţã în scãdere în ţãrile dezvoltate. Aceastã afecţiune poate duce la o distrugere rapida a structurii osoase. Întârzierea diagnosticului poate avea consecinţe nefaste precum impotenţa funcţionalã sau chiar deces. Obiectivul acestui studiu este de a identifica principalii factori ce pot duce la un prognostic negativ şi de a stabili profilul pacientului ce suferã de osteomielita acutã hematogenã care are un prognostic rezervat. Metode: Am efectuat un studiu retrospectiv unicentric, în care am evaluat datele medicale a 94 de pacienţi diagnosticaţi cu osteomielita acutã hematogenã, într-un interval de timp de 10 ani. Am analizat istoricul medical complet al pacientului, incluzând: vârsta în momentul diagnosticãrii, sexul, statusul socioeconomic, simptome, poarta de intrare, agentul patogen, localizarea infecţiei, imagini radiologice, tratamentul şi prognosticul. Am observat faptul cã pacienţii de sex masculin cu provenienţã din mediul rural, sunt predispuşi unui prognostic nefavorabil, probabil, datoritã faptului cã aceştia sunt mai expuşi la traumatisme, iar in mediul rural adresabilitatea la serviciile medicale este limitatã. Cel mai frecvent întâlnit agent patogen a fost Stafilococul auriu (84 cazuri). Tratamentul osteomielitei acute hematogene este unul complex şi de lungã duratã şi constã în antibiotico-terapie ghidatã de antibiogramã şi incizii chirurgicale de drenaj, debridarea ţesuturilor afectate.

International Orthopaedics, 2018

Introduction Aneurysmal bone cyst (ABC) is a benign intraosseous lesion filled with blood that ca... more Introduction Aneurysmal bone cyst (ABC) is a benign intraosseous lesion filled with blood that can determine a blowout distension of the bone. The purpose of this study is to evaluate the efficacy of sclerotherapy by percutaneous intralesional administration of ethanol 96% for the treatment of this pathology in paediatric patients. Method The retrospective study includes 17 paediatric patients with ABC who were treated by repeated intracystic injection with ethanol 96%, 1 ml/kg, in our clinic between December 2015 and July 2017. Fluoroscopic guidance was used to inject the cyst with contrast agent. The mean follow-up period was 11 months. Results and discussion All cysts are healed or are in the healing process. The mean age was 11 years old. Seven patients needed three repeated injections and ten patients needed two injections until healing. We observed a mean reduction in the size of the lesions, measured on plain X-rays, of 68%. The complications that were observed included the following: dizziness after injection, skin pigmentation at the injection site, local inflammatory reaction, and pain after injection. The current study approves the importance of this minimally invasive treatment with no recurrence after a follow-up of 19 months. The healing rate was 100%. A limitation of this study consists in the small number of patients. Conclusion Sclerotherapy with ethanol 96% is a useful method for the treatment of ABC. It is a minimally invasive method, with no major complications, which lowers the risks of open surgical intervention and has a good rate of success.

Journal of wound care, 2018

Open fractures of the leg with large loss of tissue require extensive reconstructive methods that... more Open fractures of the leg with large loss of tissue require extensive reconstructive methods that can injure the donor area. The use of negative pressure wound therapy (NPWT) may minimise the impact of these reconstructive methods because of its capacity to create granulation tissue that will form a wound bed for the skin graft, thus reducing the volume of soft tissue defect and saving the donor region. This case study describes the effectiveness of NPWT in the treatment and reconstruction of an open fracture of the leg, with massive loss of soft tissue, associated with elastic intramedullary nailing in a 10-year-old female patient, who was a victim of a car accident. Clinical examination revealed a Gustilo-Anderson IIIB open fracture of the left leg, with the avulsion of the fifth toe, disarticulation of the fifth metatarsal bone, extensively damaged skin and subcutaneous tissue in the medium and distal third of the left leg and left foot. The bone was exposed in the distal part of...

Journal of International Medical Research, 2017

We report development of an aneurysmal bone cyst (ABC) that was located in the proximal region of... more We report development of an aneurysmal bone cyst (ABC) that was located in the proximal region of the femur in an 11-year-old girl. Over a period of 30 weeks, the ABC showed fulminant local progression, with destruction of the bone, which led to an abrupt loss of function of the left hip. The standard tumour treatment protocol was followed. We performed embolisation of the tumour followed by a biopsy, which confirmed the diagnosis of ABC. The outcome was negative with total destruction of the proximal third of the femur, despite repeating the embolisation. Because of the unfavourable local progression, a second biopsy was performed and we reconfirmed the initial diagnosis. The final decision regarding the therapeutic approach was total hip arthroplasty with femoral reconstruction with a prosthesis. Following this treatment, the patient’s outcome was favourable, with complete recovery of function and no local relapse.

Chirurgia (Bucharest, Romania : 1990)

Background: Aneurysmal bone cyst is a solitary bone tumor, expansile and lytic most often seen in... more Background: Aneurysmal bone cyst is a solitary bone tumor, expansile and lytic most often seen in the second decade of life, more frequently in men than in women (2: 1). They can occur in any bone, most common in the metaphysis of the long bones of the lower limbs. Although it is a benign tumor formation, aneurysmal cysts may have an aggressive local evolution and can cause a significant decrease in bone strength. The pacient may present local pain, the appearance of local deformation due to a tumor mass or occurrence of pathological fractures. Traditionally these lesions were treated surgically (curettage or resection and bone grafting) with a relapse rate of about 20%. Because bone resection may lead to bone defects, deformations or damage in the affected limb's function, lately the preferred treatement percutaneous sclerotherapy using fibrosing alcoholic agents. We present the case of a 14 year old pacient submitted for pain and deformity at the distal third of the right fore...

Chirurgia (Bucharest, Romania : 1990)

Madelung deformity is an abnormality of the distal part of the forearm due to a growth arrest in ... more Madelung deformity is an abnormality of the distal part of the forearm due to a growth arrest in the distal radial physis creating an increase of the radial tilt angle associated with a dorsal subluxation of the distal ulna in most cases. It is a rare condition which represents only 1.7% of hand deformities being characterized by the presence of an abnormal structure, Vickers ligament, that tethers the distal radius to the lunate bone. Although it is believed to be a congenital disorder, the symptoms are absent till late childhood. We present a case of a 11 years old girl patient, who came to our clinic for deformity of both forearms, which consisted of an anteriorly curved radius, volar proeminence of the distal ulna, partial limitation of supination and pain in the last 6 months, with and insidious onsed and aggravated lately. The mother of the patient, at the age of 13, was diagnosed with the same deformity which was surgically treated at that time. Furthermore, the patient has a...

Journal of International Medical Research, 2017

Objective This study aimed to assess the principal risk factors that could lead to the most commo... more Objective This study aimed to assess the principal risk factors that could lead to the most common long-term complications of slipped capital femoral epiphysis, such as avascular necrosis, chondrolysis, and hip impingement. Methods We conducted a single-centre, retrospective study and evaluated patients (70 patients, 81 hips) who were treated for slipped capital femoral epiphysis from 2010 to 2015 and who underwent pinning. We measured the severity of displacement radiologically using the Southwick angle. Postoperative radiographs were evaluated for the most frequent long-term complications of avascular necrosis (AVN), chondrolysis, and femoral acetabular impingement (FAI). Results We found seven cases of AVN, 14 cases of chondrolysis, and 31 hips had an α angle of 60°. Sex, ambulation, and symptoms did not affect development of these complications. Patients with a normal weight were almost two times more likely to develop FAI. Patients with moderate and severe slips had a similar p...