Pediatric acute leukemia presenting with osteolytic lesions and hypercalcemia is an unusual and rare occurrence. We are reporting two such cases with atypical presentations. The first case involved a 10-year-old boy who complained of progressively worsening lower back pain. Physical examination revealed restricted flexion and extension of the back due to pain, while complete blood count and peripheral blood smear were normal. CT and MRI spine indicated osteolytic lesions in all vertebrae and pelvic bones. Biopsies from the bone marrow and vertebrae confirmed the presence of lymphoblasts, with flow cytometry results positive for B-ALL. The second case involved a 2-year-old boy who presented with chronic fever, cough, and pain in the left hip region. Physical examination was unremarkable, but chest X-ray and CT thorax revealed mediastinal widening and an anterior mediastinal mass.Skeletal X-rays showed osteolytic lesions in the humerus and femur. Peripheral blood smear was suggestive of acute leukemia. Upon presentation, the child had a serum calcium level of 17 mg/dL, initially managed with fluids and furosemide, but also required zoledronate and calcitonin. Both these cases highlight that osteolytic lesions alone or combined with hypercalcemia can be the sole presentation of leukemia in children. Such cases require a high index of suspicion to diagnose this life-threatening condition promptly and initiate timely treatment for optimal outcomes.

Pediatric acute leukemia presenting with osteolytic lesions and hypercalcemia is an unusual and rare occurrence. We are reporting two such cases with atypical presentations. The first case involved a 10-year-old boy who complained of progressively worsening lower back pain. Physical examination revealed restricted flexion and extension of the back due to pain, while complete blood count and peripheral blood smear were normal. CT and MRI spine indicated osteolytic lesions in all vertebrae and pelvic bones. Biopsies from the bone marrow and vertebrae confirmed the presence of lymphoblasts, with flow cytometry results positive for B-ALL. The second case involved a 2-year-old boy who presented with chronic fever, cough, and pain in the left hip region. Physical examination was unremarkable, but chest X-ray and CT thorax revealed mediastinal widening and an anterior mediastinal mass.Skeletal X-rays showed osteolytic lesions in the humerus and femur. Peripheral blood smear was suggestive of acute leukemia. Upon presentation, the child had a serum calcium level of 17 mg/dL, initially managed with fluids and furosemide, but also required zoledronate and calcitonin. Both these cases highlight that osteolytic lesions alone or combined with hypercalcemia can be the sole presentation of leukemia in children. Such cases require a high index of suspicion to diagnose this life-threatening condition promptly and initiate timely treatment for optimal outcomes.

Pediatric acute leukemia presenting with osteolytic lesions and hypercalcemia is an unusual and rare occurrence. We are reporting two such cases with atypical presentations. The first case involved a 10-year-old boy who complained of progressively worsening lower back pain. Physical examination revealed restricted flexion and extension of the back due to pain, while complete blood count and peripheral blood smear were normal. CT and MRI spine indicated osteolytic lesions in all vertebrae and pelvic bones. Biopsies from the bone marrow and vertebrae confirmed the presence of lymphoblasts, with flow cytometry results positive for B-ALL. The second case involved a 2-year-old boy who presented with chronic fever, cough, and pain in the left hip region. Physical examination was unremarkable, but chest X-ray and CT thorax revealed mediastinal widening and an anterior mediastinal mass.Skeletal X-rays showed osteolytic lesions in the humerus and femur. Peripheral blood smear was suggestive of acute leukemia. Upon presentation, the child had a serum calcium level of 17 mg/dL, initially managed with fluids and furosemide, but also required zoledronate and calcitonin. Both these cases highlight that osteolytic lesions alone or combined with hypercalcemia can be the sole presentation of leukemia in children. Such cases require a high index of suspicion to diagnose this life-threatening condition promptly and initiate timely treatment for optimal outcomes.

Pediatric acute leukemia presenting with osteolytic lesions and hypercalcemia is an unusual and rare occurrence. We are reporting two such cases with atypical presentations. The first case involved a 10-year-old boy who complained of progressively worsening lower back pain. Physical examination revealed restricted flexion and extension of the back due to pain, while complete blood count and peripheral blood smear were normal. CT and MRI spine indicated osteolytic lesions in all vertebrae and pelvic bones. Biopsies from the bone marrow and vertebrae confirmed the presence of lymphoblasts, with flow cytometry results positive for B-ALL. The second case involved a 2-year-old boy who presented with chronic fever, cough, and pain in the left hip region. Physical examination was unremarkable, but chest X-ray and CT thorax revealed mediastinal widening and an anterior mediastinal mass.Skeletal X-rays showed osteolytic lesions in the humerus and femur. Peripheral blood smear was suggestive of acute leukemia. Upon presentation, the child had a serum calcium level of 17 mg/dL, initially managed with fluids and furosemide, but also required zoledronate and calcitonin. Both these cases highlight that osteolytic lesions alone or combined with hypercalcemia can be the sole presentation of leukemia in children. Such cases require a high index of suspicion to diagnose this life-threatening condition promptly and initiate timely treatment for optimal outcomes.

OBJECTIVETo present our experience in treatment of difficult ununited long bone fractures with locking plate.

METHODSRetrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done. Fixation was done with locking plate for femoral shaft fracture (3 patients), supracondylar fracture of femur (gap nonunion), fracture of clavicle, fracture of both forearm bones (radius and ulna) fracture of ulna, fracture of shaft of humerus, fracture of tibial diaphysis and supracondylar fracture of humerus (one patient each). Five fractures had more than one previous failed internal fixation. One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks. Seven fractures were atrophic, two were oligotrophic, and one was hypertrophic. Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients.

RESULTSMinimum follow-up was 6 months (range, 6 months to 2.5 years). Average time for union was 3.4 months (range 2.5 to 6 months). None of the patients had plate-related complications or postoperative wound infections.

CONCLUSIONAlong with achieving stability with locking compression plate, meticulous soft tissue dissection, acceptable reduction, good fixation technique and bone grafting can help achieve union in difficult nonunion cases. Though locking plate does not by itself ensure bony union, we have found it to be another useful addition to our armamentarium for treating difficult fracture nonunions.

Adult ; Bone Plates ; Child ; Female ; Fractures, Ununited ; therapy ; Humans ; Male ; Retrospective Studies ; Treatment Outcome