ABSTRACT
A relevância do relato de caso em questão está em sua raridade de acometimento durante a infância (período em que se observa um sinal clássico em uma das radiografias solicitadas). Trata-se de uma luxação perilunar em punho direito, associada à fratura fisária do rádio em criança de onze anos, após acidente com laço. Foi feita a redução fechada e colocação de tala gessada no membro, o qual também apresentava áreas de sofrimento da pele causadas pela corda. O quadro clínico do paciente evoluiu com dor, edema e diminuição da perfusão. Nesse momento, foi encaminhado para o centro cirúrgico onde foi realizada redução aberta com incisão dorsal em S, fixação da luxa-ção e fasciotomia. Após o ato cirúrgico, paciente evoluiu bem. Atualmente, após algumas sessões de fisioterapia, tem movimento quase total de flexão e extensão do punho, restando apenas limitação no desvio ulnar e radial. As crianças do século XXI se mostram muito ativas em vista disso têm aumentado os casos de fratura e luxação na pediatria, tanto pelo aumento do impacto quanto pela exposição a possíveis mecanismos de lesão. (AU)
The relevance of this case report is its rarity of involvement during childhood (the period in which there is a classic sign in one of the required x-rays). This is a case of perilunate dislocation in right wrist associated with physeal fracture of radius in an eleven-year-old child, after a rope accident. The closed reduction and placement of a plas-ter splint were performed, which also presented areas of skin suffering caused by the rope. The patient's medical condition evolved for pain, edema, and decreased perfusion. At that time, he was transferred to a surgical center where it was performed an open reduction with a dorsal incision in S, dislocation fixation and fasciotomy. After the surgical procedure, the patient's medical condition developed well. Currently, after some physical therapy sessions, he has almost total movement of flexion and extension of his wrist, there is the only limitation in ulnar and radial deviation. Children of the 21st century are very active, and there has been an increase in the cases of fracture and dislocation, in pediatrics, both by increasing impact and exposure to possible mechanisms of injury (AU)
Subject(s)
Child , Carpal Bones , Scaphoid Bone , Joint DislocationsABSTRACT
Vitamin D plays a major role in bone metabolism, and its deficiency has an impact on fracture risk and healing. Low vitamin D levels are a cause of poor bone mineralization and have been associated with a significantly higher risk of physeal injury in children. This paper presents a case of a 13-year-old boy with a vitamin D deficiency, who sustained multiple sequential epiphyseal injuries at various areas. This report suggests that vitamin D deficiency is not only a significant cause of the clinical disease itself, but also an important factor affecting the successful recovery of injuries.
Subject(s)
Adolescent , Child , Humans , Male , Calcification, Physiologic , Metabolism , Vitamin D Deficiency , Vitamin D , VitaminsABSTRACT
Epiphyseal fractures are frequently associated with knee trauma during sports in children and adolescents. Usually, Salter-Harris types I and II fractures are conservatively treated. However, failed closed reduction of displaced fractures suggest the presence of trapped periosteum, with indication for surgery. The present report describes a case of Salter-Harris type I fracture of the distal femur in a child, complicated with trapped periosteum detected at magnetic resonance imaging.
Fraturas epifisárias são frequentemente relacionadas a traumatismo do joelho durante práticas esportivas em crianças e adolescentes. Fraturas Salter-Harris tipos I e II são tratadas conservadoramente, no entanto, quando irredutíveis, sugerem interposição de fragmento periosteal, sendo indicada cirurgia. Este trabalho relata fratura epifisária Salter-Harris tipo I do fêmur distal de uma criança, com interposição de periósteo detectado no exame de ressonância magnética.
Subject(s)
Humans , Female , Child , Epiphyses/injuries , Femur , Knee Injuries , Magnetic Resonance Spectroscopy , RadiographyABSTRACT
This study is performed to investigate whether free transplanted iliac physis can grow in the resected epiphyseal plate and prevent growth arrest secondary to an injury of epiphyseal plate. Growth arrest, angulation and regeneration of epiphyseal plate after free physeal transplantation from iliac crest in the partial resection of epiphyseal plate on the lateral aspect of the distal femoral epiphysis were analysed in process of time and compared with those of the simple partial resection of epiphyseal plate of distal femur. Seventy-six skeletally immature, three month-old rabbits with an initial weight of about 1200 to 1400gm were used for this study. The following experimental groups were made after partial resection of epiphyseal plate on lateral aspect of distal femoral epiphysis(2×7×3mm). Group A: partial resection alone(19 rabbits); Group B: muscle piece interposition(19 rabbits); Group C: free autogenous iliac crest physeal transplantation (38 rabbits). The opposite side of the leg was used as a control. Animals were killed and examined at the following time-intervals(14, 21, 30, 60 and 90 days after operation). The following results were obtained. 1. In the group of partial resections alone, the bone-brige formation between the femoral epiphysis and metaphysis revealed as early as 14 days, and this bridging was found consistently in all anlmals, which led to the growth arrest and valgus deformity. 2. In the group of muscle piece interpositions, the interposition materials were found temporarily effective for the prevention of epiphysiometaphyseal bone-bridge formation, but the effect was not significant to regain bone growth. 3. Histological studies showed that the grafted physis united with the residual part of the original femoral physis at 14 days after transplantation, and regained its columnar arrangement. The physeal graft appeared to be viable and contribute endochondral bone formation in following section (60, 90 days). 4. In the grodp of free autogenous iliaccrest physeal transplantations, the transplanted physis prevented or minimized the formation of a bone brige, growth arrest, and valgus deformity in most animals. Although not all of the physeal transplants were successful, physeal grafts would be most suceessful method regaining bone growth after focal injury of epiphyseal plate.