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A nine-year-old boy fell on his outstretched hand and was diagnosed with simultaneous fractures of the scaphoid and the capitate. The patient was treated conservatively with a cast for two months. Fracture of the capitate healed, however, fracture of the scaphoid resulted in non-union. We treated scaphoid non-union with an iliac bone graft and internal fixation. Three years after surgery, the patient had neither complaints nor complications and union of the scaphoid was confirmed on the radiographs.

Fracture dislocation of the wrist is a rare injury in adolescents, and therefore it is easily ignored at the initial treatment. Once ignored, an alternative treatment such as proximal row carpectomy is indicated, but surgical outcome is not as good as that of an early reduction. We have experienced a chronic case of fracture dislocation in a 15-year-old, skeletally immature boy and treated it by scaphoid osteotomy, associated with bone grafting, screw fixation and ligament repair. The patient had no difficulties in daily activities nine years post-operatively, however the X-ray showed slight deformity of the scaphoid. Even for a chronic case, late reduction with ligamentous repair should be considered in adolescents.

Background: Clinical series of tuberculosis of elbow region in children are few. The purpose of our study was to retrospectively review the presentation, healing response and functional results of 30 children.

Methods: The pretreatment disease presentation was studied from patient’s case records. Serial radiographs of the patients were studied to see remineralization and healing of radiological lesions. For elbow’s functional evaluation, pain, range of motion and recurrence were observed at final follow up.

Results: The mean patient age was 8.2 years. The mean duration of symptoms before presentation was 47 days. A discharging sinus was present in 6 patients. Multifocal presentation was found in 7 patients. The lesion was most commonly localized in proximal ulna or lower humerus. The classical ‘ice cream scoop’ appearance of proximal ulnar metaphysis was noted in 5 elbows. Most elbows were in Martini stage 2 (70%) at the time of presentation. All patients were treated non-operatively. Average follow up after completion of antitubercular therapy was 18.97 months. The resolution of regional osteopenia, sclerosis of lytic lesions, reappearance of bony trabeculae and decrease in size of cavities was the usual sequence of radiological healing. End average elbow flexion arc deteriorated with increasing Martini stage. ‘Ice cream scoop lesions’ resulted in a worse functional outcome with formation of an irregular proximal ulnar articular surface.

Conclusions: Restriction of elbow range of motion, early discharging sinus formation and radiological ‘ice cream scoop’ appearance indicated a tubercular pathology. Late presentation with advanced disease, total joint involvement, and ‘ice cream scoop appearance’ resulted in decreased elbow flexion arc.

Deep-seated giant lipomas are rare relative to the overall incidence of the tumor and their occurrence grows more frequent with age. A case of an unusual deep-seated giant lipoma in the forearm of a four-year-old child is reported.

Osteochondromas are common benign bone tumors. They may occur on any bone preformed in cartilage, but usually are found on the metaphysis of a long bone near the physis. In this article, we report a case of the subluxation of the radial head caused by osteochondroma on the radial tuberosity. A 9-year-old female patient presented with a hard palpable mass and pain in her posterior aspect of left elbow joint. Preoperative radiography and MRI demonstrated an expansile bone lesion arising in the left radial tuberosity of the proximal radius. Resection of the bone tumor was done without any complications. Biopsy confirmed the diagnosis of osteochondroma without malignant degeneration. A one year after surgery, the elbow had full range of motion without any discomfort and complication.

Aneurysmal bone cysts associated with tubular bones of the hand are rare and even rarer in the paediatric age-group. They are rapidly growing, destructive benign bone tumors. Multiple treatment modalities for aneurysmal bone cyst have been reported in the literature, but controversy exists regarding optimal treatment. We report a case of aneurysmal bone cyst of proximal phalanx of middle finger in a 2 year old child treated at our tertiary care hospital. The diagnosis was confirmed with pre-operative MRI, FNAC and post-operative histopathology. Curettage of the lesion and autologous bone grafting was performed. The hand was immobilized in a short below elbow slab for 4 weeks followed by physiotherapy. Excellent radiological and functional outcomes were obtained with no recurrence at a 5 year of follow up.

Paediatric trigger-locked thumb (PT-LT) is a common paediatric thumb condition. It is an acquired flexion deformity of the interphalangeal joint because of a size mismatch between an enlarged flexor pollicis longus tendon and a stenotic oblique pulley. It may present clinically as paediatric locked thumb which is more common or infrequently as paediatric trigger thumb. Paediatric locked thumb is classified into two types based on the presence of metacarpophalangeal joint (MCPJ) hyperextension. Type I does not have MCPJ hyperextension, whereas type II is associated with MCPJ hyperextension. The treatment of PT-LT is determined by the patient’s age, time of onset, presentation, and type. Treatment modalities are observation, splinting, therapy, or surgery. Surgery involves dividing the A1 pulley and, most importantly, part of the oblique pulley.

Level of Evidence: V (Therapeutic)

A Galeazzi-equivalent lesion occurs in children and adolescents following a traumatic distal radius fracture when the strong radioulnar ligaments and relative weakness of the ulnar physis result in an avulsion-type Salter-Harris III fracture of the distal ulna. In unreduced fractures, the osteogenic nature of the torn periosteal sleeve may result in the formation of a bifid distal ulna. We describe two cases of bifid distal ulna that developed after missed Galeazzi-equivalent lesions. The first case was treated with resection of the volar limb and reduction of the ulnar fracture, whereas the second case was treated with simple resection of the dorsal limb. Negative ulnar variance developed in both cases.

Level of Evidence: Level V (Case report)

We present a 9-year-old girl with persistent pain and swelling of the left wrist. X-ray, magnetic resonance imaging (MRI) and bone biopsy led to the diagnosis of chronic recurrent multifocal osteomyelitis (CRMO), affecting phalangeal and metacarpal bases and distal carpal bones on the ulnar side of the wrist. She was treated with non-steroidal anti-inflammatory drugs and complete remission with no long-term sequelae was achieved. CRMO is a rare auto-inflammatory condition with infrequent involvement of the hand. The current literature is discussed. The aim of this report is to raise awareness of the condition to reduce the time to diagnosis and unnecessary antibiotic treatment and to prevent permanent disability due to the progression of the disease.

Level of Evidence: Level V (Therapeutic)