A Rare Case of Bilateral Spaghetti Injuries in Children due to Assault by Mother and Analysis of Functional Outcome at Three Years

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.

Keywords

pediatric spaghetti injury - bilateral - maternal child assault

Publikationsverlauf

Artikel online veröffentlicht:
20. September 2021

• References

• 1 Pressel DM. Evaluation of physical abuse in children. Am Fam Physician 2000; 61 (10) 3057-3064
• 2 Kato H, Minami A, Suenaga N, Iwasaki N, Kimura T. Long-term results after primary repairs of zone 2 flexor tendon lacerations in children younger than age 6 years. J Pediatr Orthop 2002; 22 (06) 732-735
• 3 Nietosvaara Y, Lindfors NC, Palmu S, Rautakorpi S, Ristaniemi N. Flexor tendon injuries in pediatric patients. J Hand Surg Am 2007; 32 (10) 1549-1557
• 4 Moehrlen U, Mazzone L, Bieli C, Weber DM. Early mobilization after flexor tendon repair in children. Eur J Pediatr Surg 2009; 19 (02) 83-86
• 5 Strickland JW, Glogovac SV. Digital function following flexor tendon repair in Zone II: a comparison of immobilization and controlled passive motion techniques. J Hand Surg Am 1980; 5 (06) 537-543
• 6 Noaman HH. Management and functional outcomes of combined injuries of flexor tendons, nerves, and vessels at the wrist. Microsurgery 2007; 27 (06) 536-543
• 7 Singer G, Zwetti T, Amann R, Castellani C, Till H, Schmidt B. Long-term outcome of paediatric flexor tendon injuries of the hand. J Plast Reconstr Aesthet Surg 2017; 70 (07) 908-913
• 8 Klifto CS. Pediatric fingertip injuries: association with child abuse. JHS GO 2020; 2: 31-34
• 9 Yazdanshenas H, Naeeni AF, Ashouri A. Washington ER III, Shamie AN, Azari K. Treatment and postsurgery functional outcome of spaghetti wrist. J Hand Microsurg 2016; 8 (03) 127-133
• 10 Al-Qattan MM. Flexor tendon injuries in the child. J Hand Surg Eur Vol 2014; 39 (01) 46-53
• 11 Fitoussi F, Lebellec Y, Frajman JM, Penneçot GF. Flexor tendon injuries in children: factors influencing prognosis. J Pediatr Orthop 1999; 19 (06) 818-821