ABSTRACT
Abstract Objective To review knee magnetic resonance imaging (MRI) scans for the analysis of the location of neurovascular structures (NVSs), and to define the risk of bicortical fixation. Methods Distances between the posterior cortex and the popliteal NVSs were measured on the MRI scans of 45 adolescents (50 knees) at 3 levels (C1: center of the proximal tibial epiphysis; C2: 10 mm distal to the physis; and C3: 20 mm distal to the physis). The NVSs located between 5 mm and 10 mm from the incision were considered in a zone of moderate risk for damage, while those less than 5 mm from the incision were considered in a zone of high risk for damage, and those more than 10 mm from the incision were considered to be in a zone of low risk for damage. The independent Student t-test was used for the comparison of the NVS distance 0with gender, skeletal maturity, and the tibial tubercle-trochlear groove (TT-TG) distance. Values of p < 0.05 were regarded as statistically significant. Results The path of the C1 screw posed an increased risk of damage to the popliteal artery and vein compared with other screw paths (p < 0.001). The popliteal artery has a high risk of damage at the level of C1 (4.2 ± 2.2mm), and a moderate risk at C2 (9.6 ± 2.4mm), and the popliteal vein has a moderate risk at C1 (6.0 ± 2.7 mm), and a low risk at C2 and C3 (10.8 ± 3.1mm, and 12.05 ± 3.1mm respectively). The C3 position presented the lowest risk of damage to these structures (p < 0.001). The distance between the posterior tibial cortex and the posterior tibial nerve was < 15 mm at the 3 levels analyzed (C1: 11.0 ± 3.7 mm; C2:13.1 ± 3.8 mm; and C3:13 ± 3.9 mm). Conclusions The present study clarifies that the popliteal vessels are at risk of injury during tibial tubercle screw fixation, particularly when drilling the proximal tibial epiphysis. Monocortical drilling and screw fixation are recommended for the surgical treatment of tibial tubercle fractures. Level of Evidence III Diagnostic study.
Resumo Objetivo Revisar estudos de ressonância magnética (RM) do joelho para análise da localização das estruturas neurovasculares (ENVs) e definição do risco de fixação bicortical. Métodos As distâncias entre o córtex posterior e as ENVs poplíteas foram medidas nas RMs de 45 adolescentes (50 joelhos) em 3 níveis (C1: centro da epífise proximal da tíbia; C2:10 mm distalmente à fise e C3: 20 mm distalmente à fise). Considerou-se que as ENVs entre 5mme10mmda incisão estavam na zona de risco moderado de lesão, as ENVs a menos de 5 mm da incisão, na zona de alto risco de lesão, e as ENVs a mais de 10 mm da incisão, na zona de baixo risco de lesão. O teste t de Student independente foi usado para comparar a distância até as ENVs com o gênero, a maturidade esquelética e a distância entre a tuberosidade tibial e a garganta (fundo) da tróclea (TT-GT). Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados A trajetória do parafuso em C1 apresentou maior risco de lesão à artéria e à veia poplítea em comparação com outras trajetórias (p < 0,001). A artéria poplítea apresenta risco de lesão alto em C1 (4,2 ± 2,2 mm) e moderado em C2 (9,6 ± 2,4 mm), e a veia poplítea tem risco moderado em C1 (6,0±2,7 mm) e baixo em C2 e C3 (10,8±3,1 mm e 12,05±3,1mm, respectivamente). A posição C3 apresentou o menor risco de lesão dessas estruturas (p < 0,001). A distância entre o córtex tibial posterior e o nervo tibial posterior foi inferior a 15 mm nos 3 níveis analisados (C1: 11,0±3,7mm; C2: 13,1±3,8 mm; e C3: 13±3,9mm). Conclusões Este estudo esclarece que os vasos poplíteos correm risco de lesão durante a fixação do parafuso na tuberosidade tibial, principalmente durante a perfuração da epífise proximal da tíbia. A perfuração monocortical e a fixação com parafusos são recomendadas para o tratamento cirúrgico das fraturas da tuberosidade tibial. Nível de Evidência III Estudo diagnóstico.
Subject(s)
Humans , Child, Preschool , Child , Tibial Fractures , Fracture Fixation, InternalABSTRACT
La incurvación anterolateral congénita de la tibia asociada con polidactilia (congenital anterolateral tibial bowing associated with polydactyly) es una deformidad extremadamente rara. Solo se han documentado 21 casos en la bibliografía inglesa. Aunque existe una estrecha relación entre la incurvación anterolateral de la tibia, la seudoartrosis congénita de la tibia y la neurofibromatosis tipo 1, la incurvación anterolateral congénita de la tibia asociada con polidactilia es una entidad específica con un pronóstico más favorable. Comunicamos otro caso y también revisamos los casos de este cuadro ya reportados con respecto a las deformidades asociadas, el diagnóstico y el tratamiento. Nivel de Evidencia: IV
The congenital anterolateral tibial bowing associated with polydactyly (CABTP) is an extremely rare deformity. To the best of our knowledge, only 21 cases have been documented in the English literature. Although there is a strong relationship between anterolateral bowing of the tibia, congenital pseudoarthrosis of the tibia (CPT), and neurofibromatosis type 1 (NF1), CATBP is a specific entity associated with a more favorable prognosis. We report a new CABTP case and our literature review on the previously reported cases of CABTP concerning its associated deformities, diagnosis, and treatment. Level of Evidence: IV
Subject(s)
Infant , Hallux , PolydactylyABSTRACT
Los tumores óseos y de partes blandas localizados en el pie son muy poco frecuentes. El lipoblastoma es una neoplasia benigna de partes blandas rara que se presenta exclusivamente en la población pediátrica, con predilección por el sexo masculino. Su asiento preferente son las extremidades, pero raramente afecta el pie. Presentamos un caso de lipoblastoma de pie en un niño de 13 meses de edad y una revisión de la bibliografía. Nivel de Evidencia: IV
Bone and soft tissue tumors of the feet are uncommon. Lipoblastoma is a rare benign soft tissue tumor, exclusive to the pediatric population, with predilection for boys. Lipoblastomas most commonly occur in the extremities, but rarely affect the foot. We present a case of lipoblastoma occurring in the foot of a 13-month-old boy, as well as our literature review. Level of Evidence: IV