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

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

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

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

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

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)

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

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

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

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

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

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

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.

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