Level IV. Case series.

The aim of the present study is to present the results of the surgical management of late presenting cases of congenital muscular torticollis. Between 1990 and 2010, 31 cases of late presenting congenital muscular torticollis were managed surgically in our department. Postoperatively, head halter traction was applied for 10 days; a cervical brace was applied for 5 weeks, followed by a soft one collar for 3 months. The final result was assessed on the basis of the criteria of Cheng and Tang. In total, 84% of patients achieved an excellent final result and 16% of the patients achieved a good result. Our results indicated that in children older than 7 years, surgical release combined with appropriate orthosis and a structured physiotherapy regime can lead to satisfactory results.

IntroductionPrimary sternal osteomyelitis is extremely rare in children and only very few cases have been reported in the international literature.Case presentationA 40 days old Caucasian infant was referred to our clinic with a 4 days history of fever and malaise, accompanying a painful swelling of four days duration involving the lower end of the sternum. Examination revealed a 2 cm swelling which was fixed to the underlying bone. A full blood count, erythrocyte sedimentation rate, and C-reactive protein were measured and x-rays (Anterior and Lateral views) and Ultrasound was performed. Blood cultures were also taken. The patient was commenced empirically to Vancomycin and Cefotaxime intravenously.The values of White Blood Cell (16,720), erythrocyte sedimentation rate (132 mm) and C-reactive protein (108 mg/dl) were elevated, the X-rays showed bone destruction and dislocation of the 3rd sternal nuclei and in the U/S performed appeared a soft tissue mass measuring 2,37/1,02 cm related to the periosteum. Surgical debridement was then performed and swab cultures were taken intraoperatively. The infant grew Streptococcus Pneumoniae and Enterococcus Species. The infant was discharged after 25 days from the hospital. He gradually improved over a period of 2 months, became pain free and repeated x-rays showed significant bone resolution.ConclusionPrimary osteomyelitis in infants is a very rare condition that usually resolves with antibiotic therapy and surgical debridement.

Conservative treatment is effective for most patients with spondylolysis or spondylolisthesis. Instrumented posterolateral fusion is indicated in patients with persistent symptoms and for iatrogenic cases.