Reporte de caso y revisión de la literatura: luxofractura de codo en niños / Case report and literature review: elbow fracture dislocation in children

La luxación de codo en niños es un evento traumático muy poco frecuente descrito por primera vez por Stimson en 1900 y por Tachdjian en 1990, con una incidencia estimada que va de 3 a 6% de todas las lesiones en codo, con un pico de incidencia entre los 13 y 14 años, el trauma de codo se clasifica basándose en la dirección que toma el desplazamiento de la articulación radio ulnar proximal con el húmero, dividiéndolas en luxaciones posteriores y anteriores, siendo la primera más frecuente, ocurriendo en 95% de los casos, por otra parte las luxofracturas del codo son eventos aún más raros presentándose fractura por avulsión del epicóndilo medial con una incidencia de 25 a 36%; cóndilo lateral 4%, olécranon 1.7%, cabeza radial 8%, apófisis coronoides 3.5%, y otras 3.5%, hasta el momento no existe en la literatura un consenso sobre cómo manejar este tipo de lesiones, en especial porque hay autores que respaldan el manejo no quirúrgico, y otros que proponen el manejo quirúrgico como método definitivo; sin embargo, lo que sí se tiene claro es que un diagnóstico tardío o un manejo inoportuno puede repercutir en el crecimiento del niño llevando a serias complicaciones, de esta manera con el presente estudio pretendemos dar a reconocer nuestra experiencia en el manejo quirúrgico de estos casos tan poco frecuentes obteniendo buenos resultados.

Elbow dislocation in children is a very infrequent traumatic event which was first described by Stimson in 1900 and then by Tachdjian in 1990. Its estimated incidence ranges from 3% to 6% of all elbow injuries, peaking at 13-14 years. Elbow trauma is classified considering the direction in which the proximal radioulnar joint shifts with respect to the humerus, into posterior and anterior dislocation. The former is the most frequent and accounts for 95% of cases. Elbow fracture dislocation is an even rarer event. The incidence rate of avulsion fracture of the medial epicondyle is 25-36%, of the lateral condyle 4%, of the olecranon 1.7%, of the radial head 8%, of the coronoid process 3.5%, and others, 3.5%. At present there is no consensus in the literature on how to treat this type of lesions, particularly because some authors advocate nonsurgical management, while others propose surgical management as the definitive treatment. What is clear, however, is that a late diagnosis or untimely treatment may affect the child's growth and lead to serious complications. The purpose of this study is to share our experience and good results with the surgical management of these infrequent cases.

First Case of Mycobacterium longobardum Infection

Mycobacterium longobardum is a slow-growing, nontuberculous mycobacterium that was first characterized from the M. terrae complex in 2012. We report a case of M. longobardum induced chronic osteomyelitis. A 71-yr-old man presented with inflammation in the left elbow and he underwent a surgery under the suspicion of tuberculous osteomyelitis. The pathologic tissue culture grew M. longobardum which was identified by analysis of the 65-kDa heat shock protein and full-length 16S rRNA genes. The patient was cured with the medication of clarithromycin and ethambutol without further complications. To the best of our knowledge, this is the first report of a M. longobardum infection worldwide.

Urbach-Wiethe disease (lipoid proteinosis).

Lipoid proteinosis is a rare autosomal recessive disorder of variable severity that may involve the skin, mucous membranes of the upper respiratory tract and internal organs that may display different clinical manifestations based on the site of involvement. A 34-year-old male patient was admitted to our hospital with a complaint of hoarseness present since childhood but had worsened in recent years. A dermatological examination revealed light brown papillomatous skin lesions on the dorsum of both hands and elbows present for a long duration. Endoscopic examination of the larynx revealed widespread mucosal thickening and irregularity. Microscopic examination revealed acid Schiff (PAS) positive, Congo red negative eosinophilic hyaline material deposits in the dermis and submucosal regions. The final diagnosis was lipoid proteinosis with skin and larynx involvement. This typical case has been reported to draw attention to the fact that lipoid proteinosis should be included in the differential diagnosis of patients presenting with hoarseness in childhood.

[Monoarthritis of the elbow revealing an intraarticular osteoid osteoma]

Osteoid osteoma is one of the unusual causes of musculoskeletal pain. Its diagnosis is usually not difficult in classic diaphyseal localization. However, the diagnosis of juxta or intraarticular osteoid osteoma is challenging because of atypical clinical presentation responsible for long diagnosis delay. Report a new case. We report herein the case of a 22-year-old woman presenting an intraarticular osteoid osteoma of the elbow. Diagnosis has been established on imaging findings [MRI and CT-scan] after 10 months because of atypical clinical presentation as a chronic monoarthritis of the elbow. The picture of an osteoid osteoma of the lower extremity of the humerus associated to a synovitis and a joint effusion was suspected on MRI. It had been confirmed on CT-scan which showed the nidus. Surgical removal of the tumor allowed pain relief and functional restoration in postoperatively. Regarding an unexplained chronic monoarthritis, the diagnosis of intraarticular osteoid osteoma should be evoked. CT-scan remains the investigation of choice for identifying the nidus. Surgical exicision permits the relief of symptoms

Granulocytic sarcoma masquerading as Ewing's sarcoma: a diagnostic dilemma.

An eleven-year-old boy presented with a swelling in his left elbow. Radiologically the features were that of an Ewing's sarcoma involving the ulna. Histopathology showed small round cell tumor strongly positive for Monoclonal Imperial Cancer research fund 2 (MIC2) antigen. Similar cells in the bone marrow were involved with MIC2 positivity. The patient developed skin lesions, which on biopsy were found to be chloromas. The initial biopsies were reevaluated with special stains revealing granulocytic sarcomas in acute myeloid leukemia masquerading as Ewing's due to its MIC2 positivity. The possibility of myeloid neoplasms should be considered routinely with known MIC2 positive round cell tumors.

Tuberculosis arthritis of the elbow, a diagnostic problem

Recently, there has been an epidemic of tuberculosis, with increasing incidence of infected persons in UK. In the past 20 years, with the pandemic of the human immunodeficiency virus and the increase in immunocompromised people, we have observed a resurgence of tuberculosis. Tuberculosis arthritis of the elbow joint is not commonly seen by orthopaedic surgeons. Spinal and monoarthritis of weight-bearing joints such as the hip or knee are most frequently involved. The aim of this case report is to describe a rare case of occult tuberculous arthritis of the elbow in young Indonesian lady and the diagnostic problems that may arise and lead to a delay in treatmen. It is a case report where we used different laboratory test as CBC, ESR, CRP, hepatitis screening and AIDS Antibody test to help in diagnosis.Plain X-ray for elbow and chest used. CT scan for elbow, aspiration of synovial fluid for culture and synovial biopsy taken. Tuberculous arthritis remains low on the index of suspicion of many clinicians working outside the field of respiratory or infection diseases3 Involvement of the skeletal system is relatively rare. Musculoskeletal TB is responsible for between 1.3% and 5% of all cases of TB. Osteoarticular TB should be suspected in patients of south Asian and African origin presenting with bony and soft tissue infective lesions

B cell lymphoma with unusual clinical cutaneous presentation.

Cutaneous B cell lymphoma (CBCL) is a lymphoproliferative disorder of neoplastic B cell of the skin. These are rarer than T cell lymphomas. Commonly, the presenting features of CBCL are plaques or nodules. Here is a case report of CBCL with a very unusual presentation of cutaneous horns. The patient was managed by a combination chemotherapy and local radiotherapy only. He is disease-free for about the last five years. The case has been presented because of its rarity and its management protocol.

Hiperplasia angiofibroblástica lateral del codo: técnica de infiltración local con sangre autóloga vs. técnica de infiltración local con corticoesteroides / Hyperplasia angiofibroblástica lateral elbow: technique of local infiltration with autologous blood vs. technique of local infiltration with corticosteroids

El propósito del estudio es comparar prospectivamente la eficacia de la infiltración con sangre autóloga y la corticoesteroides en el tratamiento de la hiperplasia angiofibroblástia. Treinta pacientes recibieron infiltración con sangre autóloga y veintiséis con corticoesteroides. Se evaloraron previo y a las ocho semanas del tratamiento mediante Escala de fase de dolor modificada de Nirschl y Pettrone y escala visual análoga. Con la infiltración con sangre se obtuvo un 0,87 de efectividad contra un 0,62 de los corticoesteroides (p= 0,0303). La infiltración de sangre parece ser más eficaz en el tratamiento de la hiperplasia angiofibroblástica.

Use of arthroscopy in the treatment of fragmented medial coronoid process of the ulna: case report in a dog

O termo displasia de cotovelo (DC) descreve um estado anormal da articulação úmero-rádio-ulnar, causada por desenvolvimento inadequado da mesma. As lesões mais comumente encontradas são fragmentação do processo coronóide medial (FPCM) da ulna, osteocondrite dissecante (OCD) da porção medial do côndilo umeral, não união do processo ancôneo (NUPA) e incongruência articular (IA). O tratamento para FPCM pode ser conservativo ou cirúrgico. As técnicas cirúrgicas empregadas são variadas, mas em geral se baseiam na remoção de flaps cartilaginosos ou ósseos da articulação. Este trabalho relata o êxito do tratamento da FPCM da ulna utilizando-se a técnica de artroscopia.

olmsted syndrome: a case report

Olmsted syndrome is a rare congenital palmoplantar keratoderma distinguished by presence of massive palmoplantar hyperkeratosis and periorificial hyperkeratotic lesions. To date, 16 cases have been described in literature. Our case is a thirteen years old boy with massive palmoplantar hyperkeratosis and deep fissuring and horn-like lesions together with hyperkeratotic plaques on extensor surface of elbows and knees and periorificial hyperkeratotic plaques. Physical and mental development was normal and his family history was unremarkable. Routine laboratory tests were also normal. Radiological findings included osteoporosis of the bones of extremities and acro-osteolysis in the distal phalanx of fingers. Pathological samples showed massive hyperkeratosis, considerable acanthosis, focal parakeratosis, hypervascularity and mild lymphocytic infiltration in the upper dermis. Palmoplantar keratoderma is seen in different congenital palmoplantar keratodermas but the presence of other signs helps to differentiate these syndromes

La para-osteopathie neurogene du coude: resultat de l'arthrolyse chirurgicale

This retrospective review covers 24 cases of elbow stiffness treated by arthrolysis. The average age was 24.5 years. Fifty nine per cent had a head trauma and stayed in resuscitation. In 70.8% the range of motion was reduced on flexion; 58.3% were severe to very severe cases. For 58% the range of movement was -30 extension up to 130

Acroqueratosis paraneoplásica de Bazex: caso clínico: revisión bibliográfica / Acrokeratosis paraneoplastica of Bazex: clinic case: bibliographic review

Se comunica el caso de un paciente masculino, de 61 años,fumador crónico con su consiguiente enfermedad pulmonar obstructiva crónica (EPOC),que presentó lesiones escamosas en nariz,codos,orejas,alteraciones ungueales,hiperqueratosis plantar y adenomegalia cervical izquierda de tipo metastásico. Se diagnostica Acroqueratosis de Bazex y se inicia la búsqueda de tumor primitivo,sin éxito.Se hace revisión bibliográfica de este síndrome paraneoplásico

Artroscopia de codo en pacientes atletas y no atletas / Arthroscopy of the elbon in patients were athletes and the other were non athletes

Se presenta nuestra experiencia en la cirugía artroscópica de codo reportando cincuenta casos. La mitad fueron atletas y el resto no atletas. Se realizó disección del área del codo en cuatro cadáveres y se analizó cuidadosamente la anatomía de cada uno de los portales. Todos los hallazgos fueron recopilados y evaluados en una gráfica especial. El dolor y la sensación de bloqueo se constituyeron en las causas principales de consulta. Todos los pacientes estuvieron satisfechos con los resultados, siendo la extracción de fragmentos osteo-cartilaginosos una de las intervenciones que produce resultados más dramáticos, en cuanto a mejoría y sensación de felicidad en el paciente

improved surgical technique for treating chronic olecranon bursitis in buffaloes

The pessimistic results of excision of chronic olecranon bursitis in buffalos were a debating matter. This article assigned an improved technique for avoidance of infection, wound breakdown and ulceration which might occur postoperatively. The surgical technique was ameliorated by lateral placement of the skin incision and the use of grooved rubber drain