Fractura del hueso piramidal en un paciente pediátrico. Reporte de un caso y revisión de la literatura / Fracture of the pyramidal bone in a pediatric patient. Case report and literature review

Resumen La fractura del piramidal en una patología росо común en pacientes pediátricos. Es una lesión más frecuente en adultos, y afecta la anatomía de la muñeca, la cual amerita un diagnóstico y tratamiento óptimo a fin de evitar artrosis temprana de la articulación de la muñeca. Un tratamiento conservador con aparato de yeso antibraguipalmar corto puede ser el indicado en este tipo de lesiones; sin embargo, estas lesiones no son diagnosticadas adecuadamente debido a la compleja anatomía del carpo y son tratadas de forma incorrecta como esguinces de muñeca. Con un diagnóstico y tratamiento adecuado, estas lesiones tienden a evolucionar satisfactoriamente sin secuelas. Tomando en cuenta la baja incidencia de esta patología, en el siguiente reporte revisamos el caso de un paciente de 12 años con fractura multifragmentada del cuerpo del hueso piramidal, el abordaje diagnóstico-terapéutico y el éxito obtenido a un año de seguimiento; asimismo, realizamos una revisión de la literatura.

Abstract The fracture of the triguetrum is a slightly uncommon patholоgу in pediatrie patients. It is an injury that happens mostly in adults, affecting the anatomy of the wrist, it reguires an optimal diagnosis and treatment in order to avoid early arthritis of the wrist joints. A conservative treatment with a short plaster device can be the ideal treatment for this type of injuries; however, these injuries are not diagnosed properly due to the complex anatomy of the carpus and they are treated incorrectly as wrist sprains. With a proper diagnosis and treatment, these injuries tend to evolve satisfactory. Taking into consideration the low incidence of this pathology, in the following article we include the case of a 12 year-old patient with a multi-fragmented fracture of the triguetrum bone, its diagnosis and therapeutic approach, the success obtained through a 1-year follow-up, and a review of the literature.

Diagnostic value of triangle shadow change on lateral radiograph of the wrist joint in intractable dislocation / 实用放射学杂志

Objective To investigate the diagnostic value of triangular shadow changes in carpus dislocation.Methods 68 patients with carpal dislocation underwent frontal and lateral X-ray films.The changes of triangular shadow on lateral films were evaluated based on imaging findings of normal wrist joints.Results Changes of triangular shadow were found in 65 (95.59％)patients,while 3 (4.41％)patients had no changes.There were 17 patients with simple carpal dislocation,in which 15 cases showed triangular shadow changes, while 2 patients showed no changes.Thirty-two patients got pericarpal dislocation,in which 31 cases with triangular shadow changes and 1 case without any changes.The triangular shadow changes were observed in all 19 patients with trans-carpal carpal dislocation or trans-carpal pericarpal dislocation.Conclusion The changes of triangular shadow are helpful in the diagnosis of carpal dislocation, it is difficult to diagnose carpal lateral dislocation.

Diagnostic value of triangle shadow change on lateral radiograph of the wrist joint in intractable dislocation / 实用放射学杂志

Objective To investigate the diagnostic value of triangular shadow changes in carpus dislocation.Methods 68 patients with carpal dislocation underwent frontal and lateral X-ray films.The changes of triangular shadow on lateral films were evaluated based on imaging findings of normal wrist joints.Results Changes of triangular shadow were found in 65 (95.59％)patients,while 3 (4.41％)patients had no changes.There were 17 patients with simple carpal dislocation,in which 15 cases showed triangular shadow changes, while 2 patients showed no changes.Thirty-two patients got pericarpal dislocation,in which 31 cases with triangular shadow changes and 1 case without any changes.The triangular shadow changes were observed in all 19 patients with trans-carpal carpal dislocation or trans-carpal pericarpal dislocation.Conclusion The changes of triangular shadow are helpful in the diagnosis of carpal dislocation, it is difficult to diagnose carpal lateral dislocation.

Correlación entre los estadios de maduración carpal y los estadios de desarrollo del canino mandibular en pacientes que reciben tratamiento ortodóncico / Correlation between carpal maturation stages and mandibular canine development stages in patients subjected to orthodontic treatment

La importancia de conocer el nivel de maduración ósea de nuestros pacientes para el diagnóstico y plan de tratamiento de ortodoncia nos ha llevado a estudiar diferentes indicadores de maduración ósea; el método más utilizado en el Hospital Infantil de México Federico Gómez¹ son los indicadores carpales (método de Björk), pero para este método se requiere de otra radiografía en el expediente del paciente, ya que no se utiliza de forma rutinaria, por lo que este estudio analizó la relación que existe entre los indicadores carpales y los indicadores dentales2-5 (método de Demirjian), usando para este último una radiografía panorámica, necesaria de forma rutinaria en el tratamiento de ortodoncia. Se utilizaron un total de 144 radiografías panorámicas y carpales de pacientes del Hospital Infantil de México Federico Gómez, a los cuales se les registró su estadio carpal y del canino mandibular. Los resultados obtenidos mostraron que sí existe una correlación significativamente alta (error estándar .039) en algunos estadios pero no en todos (estadios 7, 8 y 9 mandibulares con 5, 8 y 9 carpales), por lo que no se pudo emitir la recomendación deseada de dejar de usar la radiografía carpal para sólo usar la radiografía panorámica.

The importance of assessing bone maturation levels in our patients (so as to be able to emit a proper diagnosis and design suitable orthodontic planning) has led us to study different bone maturation indicators. The most extensively used method at the Mexico Children's Hospital Federico Gomez¹ is the carpal indicator method (Björk method). Nevertheless, for this method, an additional X-ray is required in the patient files. This additional X-ray is not routinely included in the files; therefore, the present study analyzed the relationship between carpal and dental indicators² (Demirjian method). This method requires the use of a panoramic X-ray, which is routinely requested for orthodontic treatment. 144 carpus and panoramic X-rays of Mexico Children's Hospital Federico Gomez patients were used in the study. Carpus and mandibular canine stages were recorded. The results obtained revealed presence of significantly high correlation (standard error 0.39) at some but not all stages (mandibular stages 7, 8 and 9, carpus stages 5, 8 and 9). Bearing these facts in mind we found ourselves unable to advise, as was desired, the use of only panoramic X-rays, discarding carpal X-rays.

Evolución de lesiones podales en lechones lactantes / Evolution of injuries in the limbs of suckling piglets

En un estudio de pseudocohortes se inspeccionaron los miembros craneales y caudales de 3142 lechones lactantes de 5 a 27 días de vida, para evaluar prevalencia de lesiones y su evolución, clasificándolas por edad y región anatómica. El trabajo se desarrolló en un establecimiento porcino de crianza intensiva, de ciclo completo, todo adentro-todo afuera, con 1200 madres totales y un promedio de 50 partos semanales, con una edad de destete promedio de 24 días. De los 3142 lechones, 249 (7.92%) no presentaron lesiones, en los restantes 2893 (92.8%) se observaron 8415 lesiones, correspondiendo 3869 (46%) a fibrosis, 4314 (51.20%) a heridas y 232 (2.8%) a artritis. De ese total 5165 (61.4%) correspondieron a los carpos, 737 (8.8%) a los tarsos y 2513 (29.9%) a las pezuñas. En lechones de 5-9 días de edad las heridas representaron el 73.8% del total de lesiones, las que tuvieron dos formas de evolución, hacia la fibrosis o la artritis. Esta evolución de las heridas mayormente tiende a la fibrosis en el carpo y a la artritis en el tarso. Se concluye que los miembros de lechones en maternidad presentan alta prevalencia de lesiones bilaterales desde la edad temprana y principalmente en los miembros craneales.

The purpose of this work was to study the prevalence, evolution and type of lesions occurring in the front and back legs of 3142 suckling piglets from 5 to 27 days of age, also classifying ithem according to age and anatomical region. From the total 3142 piglets, 249 (7.92%) did not have any visible lesions. In the other 2893 (92.08%) piglets, a total of 8415 different lesions were observed. Over this total, an amount of 3869 (46%) piglets showed fibrosis, 4314 (51.20%) had different type of injuries and 232(2.8%) presented arthritis. Over the total of 8415 lesions, 5165 (61.4%), 737 (80.8%), and 2513 (29.9%) had lesions on the carpus, tarsus and hoofs, respectively. Injuries represented 73.8% of the total lesions in 5 to 9 days old piglets, which evolved either towards fibrosis or arthritis. Fibrosis was the product of evolution on lesions mainly in the carpus, whereas arthritis evolved mainly in the tarsus.

Determination and padronization of normal values of bone mineral density (BMD) of the acessory carpus bone in young Thoroughbred horse using optical densitometry in radiographic image / Determinação e padronização dos valores normais da densidade mineral óssea (DMO) do carpo acessório de eqüinos em crescimento da raça puro sangue inglês (PSI) por meio da densitometria óptica em imagem radiográfica

The bone mineral density (BMD) of the accessory carpus bone was measured (in aluminum milimeters - mmAl) in 12 female and 12 male thoroughbred horses aging from 12 months old until the moment of complete closure of the radio distal epiphysis, using optical densitometry in radiographic images. Evaluation was made using a software specially developed for optical density measurement in X-ray films, containing the radiographic image of the accessory carpus bone, the region of soft parts adjacent to the accessory carpus and the degrees of an aluminum stepwedge, used to measure BMD value (average of the interest region established on the accessory carpus bone corresponding to the value on the stepwedge in milimeters). BMD values did not show differences between sexes (p=0.86). BMD value (in mmAl) was 3.109 + 0.056 x age (in months) at this age interval.

Em 12 fêmeas e 12 machos da raça Puro Sangue Inglês com idade média de 12 meses, avaliou-se os valores normais da densidade mineral óssea do carpo acessório em milímetros de alumínio (mmAl) até o momento do fechamento completo da epífise distal do rádio, por meio do método de densitometria óptica em imagens radiográficas. A avaliação foi realizada por meio de um programa computacional (software) especialmente desenvolvido para medida de densidade óptica em filmes de raios-X, o qual contém a imagem radiográfica do osso carpo acessório, região de partes moles adjacente ao carpo acessório e os degraus de uma escala de alumínio (phatom), que permitiu a medida de densidade mineral óssea, sendo esta a média aritmética da região de interesse determinada no osso carpo acessório correspondente ao valor em milímetros da escala. Os valores da densidade mineral óssea em mmAl do acessório do carpo em função da idade não apresentaram diferenças entre os sexos (p=0,86) permitindo que uma equação de reta fosse ajustada para ambos os sexos (densidade mineral óssea (DMO) mmAl = 3.109 + 0,056 x idade em meses), na faixa etária estudada.

Incidência e localização de fraturas osteocondrais "chip" na região rádio cárpica de cavalos Puro Sangue Inglês em atividade turfísta / lncidence and locations of osteochondral chip fractures in Thoroughbred racing houses' carpus

Os autores registram a incidência e localização de 30 casos de fraturas osteocondrais "chip" na região rádio cárpica de cavalos Puro Sangue Inglês, com idade variando entre 2 e 6 anos, e concluem que o membro direito apresentou maior ocorrência. Os ossos mais afetados, em ordem decrescente, foram o carporradial, o terceiro osso cárpico, o rádio e o carpo intermédio. Quanto à localização da fratura, encontraram, em primeiro a borda distal do carporradial, em segundo a borda proximal do terceiro osso cárpico, em terceiro a equivalência entre a borda distal do rádio e a borda proximal do carporradial, em quarto a borda proximal do carpo intermédio e por último a borda distal deste mesmo osso. Os autores observaram ainda que, tanto para o membro quanto para o osso e para o local mais afetado, os resultados encontrados são semelhantes às informações da literatura consultada, o que permite concluir que as condições de traumatismo, às quais os cavalos estão submetidos durante os treinamentos e as corridas no Jockey Club Brasileiro, são semelhantes a de outros locais do mundo.

The incidence and location of 30 cases of osteochondral chip fractures in equine carpus of Thoroughbred racing horses between 2 and 6 years of age were registered. This study showed that the right limb was the most affected one and, in a decreasing order, os carpi radiale, os carpale III, os radii and os carpi intermedium were the most affected bones. Concerning the location of chip fractures, also in a decreasing arder of incidence, the distal edge of the os carpi radiale, proximal edge of os carpale III, equivalence between the distal edge of os radii and proximal edge of os carpi radiale, proximal edge of os carpi intermediumi and distal edge of the same bone were reported. Comparing to the literature review, similar results were obtained at the present study including both limb and bones and respective affected areas described. This allows the authors to conclude that the traumatic conditions to which the horses are submited during the training and racing are similar to those found in other racing centers around the world.

A Clinical Study of Fractures and Dislocations of the Carpus / 대한정형외과학회잡지

In the fractures and dislocations of the carpus, prompt and accurate diagnosis is the prime prerequisite for restoring function to this most complicated joint in the body. And then, early precise reduction and continuous maintenance of the reduced position until ligamentous and bone healing is complete provide the best chance of achieving a satisfactory restoration of function. We analysed forty five cases of fractures and dislocations of the carpus which were treated for 5 years from Jan. 1984 to Dec. 1988 at the Department of Orthopedic Surgery, College of Medicine, Hallym University. The following results were obtained; l. Of the total 45 injuries, scaphoid fractures were seen in 32(71.1%), other carpal bone fractures except scaphoid in 13 patients(28.9%), and carpal bone dislocation and fracture- dislocations in 11 patients(24.4%). 2. Carpal scaphoid fracture 1) 19 of the 32 patients(59.4%) had an associated ipsilateral upper extremity injury. 2) This fracture was common in the young male. 3) A union rate(95.6%) was achieved using a usual conservative treatment for undisplaced racture(14), operative treatment for displaced(18). 4) The mean time to radiological union for all fractures was 11.1 weeks. Old fracture by SotoHall classification took the longest time to union(18.2 weeks), subacute fracture 13 weeks, and acute fracture 9 weeks. 5) 10 cases were treated for nonunion, 5 of 10 nonunions were classified as type (50%). 2 cases showed ultimately nonunion in spite of various sorts of treatment, which belonged to waist fracture. 3. Other carpal bone fractures except scaphoid were seen in 13(15 bones) of 45 injuries, and pisiform(4) and triquetrum(4) fractures were common. 4. Carpal dislocation and fracture-dislocations were seen in 11 of the 45 injuries and dorsal transscaphoid perilunate dislocations(4) were common. These were treated by C.R. and cast immobilization or O.R. and K-wire fixation relatively good results were obtained.