Osteoma osteoide: causa poco frecuente de dolor crónico en la muñeca en una niña / Osteoid osteoma: unusual cause of chronic pain in the wrist in a child

El osteoma osteoide es una lesión ósea benigna que, habitualmente, se acompaña de clínica típica caracterizada por dolor nocturno que mejora con antiinflamatorios no esteroideos. Aunque la presentación clínica es típica, con frecuencia, es común la demora diagnóstica, en especial, en los casos con localización atípica.Se presenta el caso de una paciente de 10 años con dolor en la muñeca izquierda de dos años de evolución con diagnóstico de osteoma osteoide localizado en el hueso grande del carpo. La localización atípica de la lesión conllevó un retraso diagnóstico importante

Osteoid osteoma is a benign bone lesion that is usually accompanied by a typical clinical condition characterized by night pain that improves with non-steroidal anti-inflammatory drugs. Although the clinical presentation is frequently typical, diagnostic delay is common, especially in cases with an atypical location.We report the case of a 10-year-old patient with left wrist pain of two years of evolution with diagnosis of osteoid osteoma located in capitate bone. The atypical location of the lesion led to a significant diagnostic delay.

Stress Fracture of the Capitate

Most capitate fractures occur in association with additional carpal injuries, particularly scaphoid fractures. Isolated fractures of the capitate account for only 0.3% of carpal injuries, and stress fractures are one form of this fracture. We report the case of a 20-year-old male who had a stress fracture of the capitate after serving as an honor guard in the military. Conventional radiographs and computed tomography of the right wrist revealed a minimally displaced fracture line located at the midcarpal aspect of the right capitate. A magnetic resonance imaging scan demonstrates a subarticular capitate fracture with diffuse bone marrow edema, small osteophytes, and irregularity of the midcarpal articular cartilage. We also review the carpal kinematics which possibly caused the stress fracture. Although stress fractures of the capitate are rare, they should also be accounted for with patients who perform repetitive motions of the wrist to a considerable extent.

Descripción de los estadios de maduración ósea según Bjork mediante radiografía del carpo en niños y adolescentes de dos grupos de distinta ascendencia étnica / Description of the stages of bone maturation by Bjork ́s carpal radiography of children and adolescents in two groups of different ethnic ancestry

Objective: This study described the stages of bone maturation according to Bjork ́s method through carpal radiography in chil - dren aged 8-15 year-old belonging to the indigenous population Ticuna (Amazonas) and the black population of Puerto Tejada (Cauca). Materials and methods: 72 children Ticuna indigenous community, located in Leticia (Amazonas) and 80 children of African descent in the municipality Puerto Tejada (Cauca) were studied. Children tested aged 8 to 15 year-old. Children were transferred to a specialized radiology center where car - pal radiographs of both hands were taken. The height and weight measurements were obtained by using a digital scale and Conair ® brand plastic tape, which was placed on the wall. For analysis of bone maturation, was used the method of Björk. Results: It was observed that there is a significant relationship between bone deve - lopment and sex (p=0.001), ie, that women are more likely to have more advanced stages of bone maturation that men. When bony maturation stages according to ethnic groups were related, they find that people of African descent have a higher bone deve- lopment that indigenous. It was evidenced that children at older ages presented higher bone maturation stages. Conclusion: It was determined that the African descent was significantly related to bone development (p=0.005), as com- pared to children of Amerindian descent. In addition, it was determined that there is a relation between bone development and women (p=0.001) and age groups (p=0.000). In general, when comparing these two populations was found that the ancestry, age and gender are factors that affect bone development of children and should be taken into account when starting any treatment...(Au)

Objetivo: En este estudio se describen los estadios de maduración ósea según Bjork mediante radiografía del carpo en niños de 8 a 15 años pertenecientes a la población indígena Ticuna (Amazonas) y la población afrodescendiente de Puerto Tejada (Cauca). Materiales y métodos: Se estudiaron 72 niños de la comunidad indígena Ticuna, ubicada en Leticia (Amazonas) y 80 niños afrodescendientes del municipio Puerto Tejada (Cauca). Todos los niños evaluados tenían edades entre 8 a los 15 años. Los niños y niñas fueron trasladados hasta un centro radiológico especializado, donde se tomaron las radiografías carpales de las dos manos. Las medidas de talla y peso fueron obtenidas antes de la hora de almuerzo mediante el empleo de una báscula digital marca Conair® y cinta métrica plástica, la cual fue colocada en la pared. Para el análisis de la maduración ósea se utilizó el método de Björk. Resultados: Se evidenció que existe una relación significativa entre el desarrollo óseo y el sexo (p=0.001), es decir, que las mujeres presentan una mayor probabilidad de tener estadios de maduración más avan- zados que los hombres. Cuando se relacio - naron los estadios de maduración óseos en función de los grupos étnicos, se encontró que los afrodescendientes tienen a pre - sentar un desarrollo óseo más alto que los indígenas. También se pudo evidenciar que los niños con mayores edades presentaron los mayores estadios de maduración ósea. Conclusión: Se pudo corroborar que el tipo de ascendencia se relaciona significativa - mente con el desarrollo óseo (p=0.005), es decir, que los niños de ascendencia afro descendiente presentan un desarrollo ósea más avanzado que los niños de ascendencia amerindia...(Au)

Osteoid Osteoma of the Capitate with Extensor Tenosynovitis

An osteoid osteoma is a benign bone tumor. It is most commonly found in the femur and tibia but only 5% to 15% occurs in hand. Osteoid osteoma of carpal bone has vague nature of symptoms including spontaneous dull aching causing delayed diagnosis and the late treatment. We had a patient with an osteoid osteoma of the capitate bone presenting with tenosynovitis. We present clinical and radiological findings including magnetic resonance imaging, surgical result, and a review of the current literature.

Trans-scaphoid and trans-capitate perilunate fracture-dislocation of the wrist with concomitant ipsilateral fractures: a case report

All perilunate fracture-dislocations combine bone avulsions, ligament disruption and fractures in different forms. The most frequent pattern is the dorsal transscaphoid perilunate fracture-dislocation. The reported risk of missed initial diagnosis in perilunate dislocations is as high as 20%. Concerning pathomechanics of the perilunate fracture-dislocation, it should be noted that most dorsal injuries usually result from a fall on the outstretched hand or motor vehicle accidents although other mechanisms are also mentioned. We describe here a case of dorsal trans-scaphoid trans-capitate perilunate fracture-dislocation together with posterior olecranon fracture-dislocation of the left upper extremity. To the best of the authors' knowledge, such a case with this concomitant elbow fracture-dislocation has not been previously reported in the literature

Relationship between radiographic carpal indices and grip strength

The measurement of hand grip strength has several clinical applications to evaluate chronic hand disability, response to treatment, and work capacity after hand injury. We measured hand grip strength of 41 adults and compared their maximum strength with radiographic indices. There was a significant relationship between hand grip strength and carpal height, third metacarpal and capitate length [All p-values<0.05]. In addition to established factors such as sex, upper limb muscle and joint status, wrist radiographic indices are significantly determinants of hand power grip

survey on current methods of carpal height ratio measurement and suggestion of a new method

Two famous methods are commonly used for the measurement of carpal height ratio. Both methods are performed on anteroposterior radiogram and have some shortcomings. We are going to introduce a new method for measuring this index in lateral view of the wrist radiogram. This cross-sectional and case-control study was conducted on 100 anteroposterior and lateral radiograms of asymptomatic individuals and then 20 radiograms of patients with Kienbock disease in various stages of the disease. After determining new reference points on the radiograms of the [normal] group, it was tried to define the ratio by new method. In the next stage the interobserver and intraobserver agreement of the new index was assessed along with previous defined indices. All three methods had some limitations, but overall it seems that the new method has more precise reference points. With regard to inter and intraobserver variability the new index was better than the Natrass group index, but not than the Youm group index. The new index can be used as a substitute or an alternative in carpal height measurement

Fenton syndrome in an adolescent

Scapho-capitate fracture [Fenton syndrome] is a rare lesion and is even less well-documented in adolescents. The most frequent mechanism is possible forced extension and hyperextension of the wrist. We report a case of 15 years old boy with hyperextension injury to the wrist. The true diagnosis was made 2 weeks later. Treatment involved open reduction and internal fixation with K-wires and Herbert screws. It went on to heal well and at 6 months follow-up, there was no infection or avascular necrosis and wrist function was good