br Osteochondritis dissecans OCD is a subchondral bone

Osteochondritis dissecans (OCD) is a subchondral bone lesion that mainly affects juveniles and young adults. Healing rates of stable OCD lesions treated by nonoperative methods are reported to be between 50% and 94%. The clinical staging system of OCD is mainly based on the findings of arthroscopy, magnetic resonance imaging, and radiography, as first published by Dipaola et al. The stage I OCD lesion is classified as a stable lesion. Stage II and III lesions are classified as unstable lesions. Stage II is defined as the Ketorolac tromethamine salt of time with articular cartilage breached with a definable but not displaceable fragment. Stage III is defined to be the same as stage II, but with a displaceable fragment. Stage IV is for a loose body. Unstable lesions are thought to require surgical fixation, including drilling, debridement, bone grafting, and fixation with implant. Wang et al had collected eight cases that had been diagnosed with OCD and had undergone Herbert screw insertion. In the short-term follow-up, seven out of the eight patients demonstrated a satisfactory result according to the Knee injury and Osteoarthritis Outcome Score. Several methods of management exist for stable and unstable OCD lesions. For stable lesions, drilling the subchondral bone with intention to stimulate vascular ingrowth and subchondral bone healing is thought to be effective for stable OCD lesion healing. For unstable lesions, Smillie has developed open reduction and internal fixation with a nail. Surgical interventions for fixation of the loose body of the knee include Kirschner wires, cannulated screws, Herbert screws, and bone pegs. Johnson et al have performed fragment fixation with cannulated AO-type screws via an arthroscopic method for treating 35 knees. The results, compared with other methods, were good or excellent in 90% of cases. The Herbert screw, bone pegs, and biodegradable screw fixation method have the advantage of not requiring removal of the implant. I believe using Herbert screw fixation for unstable OCD is a good option to treat troublesome disease.
Introduction Sigmoid volvulus is quite rare in children, but its true incidence is unknown. There have been many reports of this condition in adults. In the United States, sigmoid volvulus accounts for 3–8% of all cases of intestinal obstruction. In Eastern Europe it is the cause of 30–50% of all intestinal obstructions. The most important predisposing factor, both in children and in adults, is the presence of a large redundant sigmoid loop with a narrow mesenteric base of attachment. Chronic constipation is often present and may be a contributing factor. In addition, a high-roughage diet and mental illness have been implicated in adults. We report here a case of sigmoid volvulus in a 14-year-old girl with intellectual disability.
Case report A 14-year-old girl with intellectual disability and a 1-year history of chronic diarrhea despite supportive treatment, was brought to the emergency department because ofintermittent abdominal pain associated with vomiting of bile and passage of bloody stools. She complained of abdominal discomfort on physical examination. Her temperature was 37°C; pulse, 104 beats/minute; and respirations, 16 breaths/minute. The abdomen was soft without rebound tenderness, and bowel sounds were increased. A digital rectal examination disclosed a bloody stool. Laboratory test results indicated hemoglobin, 15.3 gm/dL; white blood cell count, 17,960 mm3; and normal urinalysis. A plain X-ray showed dilated bowel loops (Figure 1). A contrast-enhanced computed tomography (CT) scan showed a markedly dilated bowel loop with both limbs tapering and inferiorly forming a round soft-tissue mass with a whirled configuration in the left colonic compartment (Figure 2).
Discussion Sigmoid volvulus occurs more often in adults than in children. In 1961, Drapanas and Stewart reported 88% of cases in a series occurred in patients 50 years and older. Since 1964, in the United States, the largest series of children with sigmoid volvulus was reported by Allen and colleagues, who observed seven cases at the Denver Children’s Hospital; six of them occurred during the time that 190 cases of intussusception were diagnosed in the same hospital. Carter and Hinshaw reported a case of an infant whose abdomen became distended on the second day of life. He required daily enemas; at age 2 weeks laparotomy revealed he had a sigmoid volvulus.