Module 34, Pediatric Orthopaedist Level

Order of Xray links: 1. Internal Rotation, 2. External Rotation, 3. AP, 4. Lateral.

The patient is an 11 year old, otherwise completely healthy boy, who presented for evaluation of his left arm. He states he has always had limited range of motion of his left arm, however, his mother states that it was not until recently she became concerned. The patient is right hand dominant. This does not cause him any functional problems and he has no pain. The mother and boy are concerned because the right and left arms are different. The left arm demonstrates a shoulder with full range of motion (ROM) and strength 5/5. The elbow has a flexion from 0 to 135 degrees, but the forearm is fixed in 45 degrees of pronation without active or passive supination. The wrist has full ROM with some hyper-mobility, especially in radial and ulnar deviation. The strength is 5/5 in elbow flexion/extension, wrist flexion/extension and grip. He is neurovascularly, intact. The right arm also demonstrates normal motion at the elbow with flexion from 0-135 degrees but limited supination from 0-50 degrees and pronation from 0-20 degrees. The remainder of his exam was normal.

Question 34A

A reasonable treatment option is resection of a piece of proximal radius and insertion of swivel.

Question 34B

Derotational osteotomy distal to synostosis site is the preferred surgical treatment option if one is to consider surgery.

Question 34C

Derotational osteotomy with the Ilizarov Method is considered the safest way to obtain derotation with the least risk to the neurovascular system.

Question 34D

The inheritance pattern is usually sporadic, but can be associated with family history (autosomal dominant with variable expression).

Question 34E

This is also associated with coalescence of carpal bones, symphalangism and dislocation of radius