1. Septic Elbow and Osteomyelitis after Closed Reduction and Internal Fixation in Lateral Humeral Condylar Fracture
Sung Soo Kim, M.D.
Department of Orthopaedic Surgery, College of Medicine, Dong-A University, Busan, Korea

2. Chief Complaint
M / 6Y
Swelling and pus discharge for 1 week in left elbow
P/Ex)
swelling (+)
pus discharge (+)
ROM – limitation
distal motor / sensory
– intact / insensitivity to pain

3. PHx 5 weeks ago : fall down Fx, lateral condyle humerus, Lt
- 5 days after injury : closed reduction and internal fixation
preop
postop

4. POD 2 weeks : 1 K-wire migration
Pin site infection – pin removal & oral antibiotics
POD 2 weeks
POD 4 weeks
POD 4 weeks

5. General Appearance
. multiple healed scars of self-inflicted bite injuries
at the apices of the fingers and tongue
. poorly healing wound
due to burn injury on arm

6. CASE Birth Hx) 1st/full term/ 2.9kg/ NSVD FHx) non-specific PHx)
recurrent episodes of tongue laceration from birth
multiple healed scar of self-inflicted bite injuries
recurrent fractures
insensitivity to pain
inability to sweating
- 5 years ago : Dx as Congenital Insensitivity to Pain with Anhidrosis (CIPA)

7. CASE PHx of recurrent fractures 5 years ago
- Fx 1st metatarsal base, Rt
4 years ago
- Fx calcaneus, Rt
Old fx cuboid, Rt
Fx 3rd ,4th metatarsal base, Rt

8. CASE Past /Hx of recurrent fractures 3 years ago
Fx 1st metatarsal base, Lt
Fx 3rd ,4th metatarsal neck,Lt

9. CASE PHx of recurrent fractures 2 years ago
Fx 3rd ,4th ,5th metatarsal neck, Rt
1 years ago
R/O Fx capitellum, Rt

10. POD 5 weeks
Pus culture & sensitivity test : S. aureus & sensitive to most antibiotics
Admission and IV antibiotics
POD 6.5 weeks
I & D

11. Congenital insensitivity to pain with anhidrosis
Congenital insensitivity to pain with anhidrosis(CIPA) is a rare inherited disorder first described in 1932 by Dearborn
This disorder was classified by Dyck and Ohta as type IV hereditary sensory neuropathy

12. Congenital insensitivity to pain with anhidrosis
CIPA is characterized by insensitivity to pain, normal tactile sense , recurrent episodes of hyperpyrexia, inability to sweating and autonomic nerve system abnormality
Presentation in childhood is commonly at the time of tooth eruption , with biting and self-mutilation of lips, tongue, digits and fractures

13. Conclusion Early diagnosis, prevention and prompt treatment of
fractures, burns, infection and other injuries is essential in management of the children with congenital insensitivity to pain with anhidrosis.

14. Thank you
for
your attention