Fracture of the proximal humerus metaphysis with coexistent dislocation of the shoulder in children is a rare injury. The injury often occurs as a consequence of high velocity trauma. Most fractures of the proximal humerus commonly associated with the epiphysis in children can be treated with closed reduction. We presented a case of 5-year-old girl who sustained this type of fracture- dislocation of the shoulder. Open reduction and internal fixation with multiple smooth K-wires was performed. At two years follow-up, the patient was pain free and regained full range of motion.
Child, Preschool ; Female ; Fracture Fixation, Internal ; Humans ; Shoulder Dislocation ; complications ; therapy ; Shoulder Fractures ; complications ; surgery

BACKGROUND/AIMS: Although proton pump inhibitors (PPIs) have been widely used for the prevention and treatment of stress gastric ulcers in hospital settings, there are concerns that PPIs increase the risk of Clostridium difficile infection (CDI). However, little is known about the risk of CDI following PPI and histamine-2 receptor antagonist (H2RA) use. We evaluated the comparative hospital-acquired CDI occurrence risk associated with the concurrent use of PPIs versus H2RAs. METHODS: A systematic search of PubMed, MEDLINE/Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Google Scholar through August 19, 2016, identified 12 studies that reported the hospital-acquired CDI occurrence following H2RA and PPI use for the prevention and treatment of stress gastric ulcers. Random-effects pooled odds ratios and 95% confidence intervals were estimated. Heterogeneity was measured using I², and a meta-regression analysis was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the overall quality of the evidence. RESULTS: A total of 74,132 patients from 12 observational studies were analyzed. Compared to H2RAs, PPIs increased the risk of CDI by 38.6% (pooled odds ratio, 1.386; 95% confidence interval, 1.152 to 1.668; p=0.001; I²=42.81%). Subgroup analyses of the purpose of study medication use, study site, and study design confirmed the consistency of a greater CDI risk with PPIs than with H2RAs. The overall quality of evidence was rated as low. CONCLUSIONS: The use of PPIs for both the prevention and treatment of stress ulcers was associated with a 38.6% increased risk of hospital-acquired CDI occurrence compared to H2RA use.
Clostridium difficile* ; Clostridium* ; Histamine Antagonists ; Humans ; Nursing ; Odds Ratio ; Population Characteristics ; Proton Pump Inhibitors* ; Proton Pumps* ; Protons* ; Stomach Ulcer ; Ulcer*

Tumoral calcinosis is rarely encountered disease, and most of reported cases involved large joints such as hip or elbow. We report two patients with tumoral calcinosis in the foot. In the 1st case, the lesion was observed at the 1st MP joint of foot, and in the 2nd case it was found at the DIP joint of 5th toe area with bony erosion which is rare in other tumoral calcinosis. They all needed evaluation with MRI, and eventually surgical excision.
Calcinosis* ; Elbow ; Foot* ; Hip ; Humans ; Joints ; Magnetic Resonance Imaging* ; Toes

Transcarpal fractures and dislocations in children are rarely reported in the orthopedics literature. This is a case report of a 10-year-old boy who sustained a trans-scaphoid perilunate dislocation with fractures across the carpal structure: these included injuries to the capitate and triquetrum bones. Treatment consists of a closed reduction for the dislocation and using the dorsal approach, an open reduction with internal fixation of the fractures. The injury healed well with a full return of good wrist function. This unusual pattern of injury is described so that it may be more readily appreciated in the future.
Carpal Bones* ; Child* ; Dislocations* ; Humans ; Male ; Orthopedics ; Triquetrum Bone ; Wrist