A Rare Case of Bilateral Spaghetti Injuries in Children due to Assault by Mother and Analysis of Functional Outcome
Parag B Lad1, N Venkateshwaran2, M R Thatte3
1Department of Orthopaedics, Jupiter Hospital, Thane, Maharashtra, India.
Insights
Child abuse involving sharp object injuries requires a coordinated team approach. Prompt surgical repair and rehabilitation led to excellent functional recovery in pediatric patients with severe flexor tendon and neurovascular damage.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Reconstructive Surgery
Background:
- Child abuse presenting with severe flexor tendon, neurovascular, and life-threatening injuries poses significant management challenges.
- Multisectoral, coordinated team efforts are crucial for successful outcomes in these complex pediatric cases.
Observation:
- A case series detailing the management of children with sharp object-inflicted injuries, including multiple flexor tendon, upper limb neurovascular, and tracheal damage.
- Interventions included tracheostomy, primary flexor tendon, nerve, and artery repair, followed by secondary reconstruction for contractures and sensory loss.
Findings:
- Excellent range of movement and functional outcomes, assessed by the Strickland score at 3-year follow-up, were achieved in both patients.
- Timely surgical intervention, intensive care, therapy, and psychosocial rehabilitation were key factors in the positive results.
Implications:
- This case series highlights the importance of a comprehensive, multidisciplinary approach in managing severe pediatric trauma resulting from abuse.
- Successful outcomes are achievable with prompt surgical management, intensive post-operative care, and dedicated rehabilitation, underscoring the need for specialized pediatric trauma centers.
Abstract:
Management of child abuse with flexor tendons, neurovascular injuries, and life-threatening conditions is challenging. It needs a multisectoral coordinated and synchronized team effort for successful outcomes. We present a case series of children abused by a parent with a sharp object. The children sustained multiple flexor tendon injuries, neurovascular injuries in upper limbs, and tracheal injury compromising respiration. We performed a tracheostomy to save a child and subsequently repaired numerous flexor tendons, nerves, and arteries. During follow-up, these children required secondary reconstruction (tenolysis, tendon lengthening, nerve reconstruction) for flexor contractures, stiffness, and sensory loss in distal forearms. We measured the range of movements and assessed the children's functional outcome using the Strickland score at 3-year follow-up. The range of movement and functional outcome was excellent in both children in our series. A timely performance of surgery, aided with efficient intensive care, therapy, and consistent posttraumatic psychosocial rehabilitation, produced excellent results in our series.
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