Crecimiento guiado en extremidades inferiores / Guided growth in lower extremities

El crecimiento guiado es una opción quirúrgica de uso creciente para la corrección de las deformidades angulares de extremidades inferiores en pacientes esqueléticamente inmaduros. Es posible de realizar en múltiples planos o segmentos, con excelentes resultados. Su uso más frecuente es en deformidades del plano coronal alrededor de la rodilla. La epifisiodesis permanente se puede realizar en pacientes dentro de los dos años previos al término del crecimiento longitudinal del segmento a tratar, considerando la epifisiodesis temporal para los pacientes con más de 2 años de crecimiento restante.En casos leves a moderados las tasas de éxito llegan incluso al 100% en algunas series, en tanto, pacientes con enfermedad de Blount, obesidad, edad esquelética avanzada o deformidades severas, tienen menos posibilidades de lograr una corrección completa.Independientemente de la técnica quirúrgica, es necesario una adecuada planificación preoperatoria, educación familiar y un seguimiento estricto para así minimizar las complicaciones y permitir una excelente corrección de la deformidad con una morbilidad mínima.

Guided Growth is a surgical option of increasing use for the correction of angular deformities of the lower extremities in skeletally immature patients. It is possible to perform in multiple planes or segments, with excellent results. Its most frequent use is in deformities of the coronal plane around the knee. Permanent epiphysiodesis can be performed in patients within 2 years before the end of longitudinal growth of the segment to be treated, considering temporary epiphysiodesis for patients with more than 2 years of remaining growth.In mild to moderate cases, the success rates reach even 100% in some series, while patients with Blount's disease, obesity, advanced skeletal age or severe deformities are less likely to achieve a complete correction.Regardless of the surgical technique, adequate preoperative planning, family education and strict follow-up are necessary to minimize complications and allow excellent correction of the deformity with minimal morbidity

Progress on the Rule of Clavicle Epiphyseal Closure Using Multi-Imaging Technology / 法医学杂志

People aged 18 years could be punished lightly or diminished criminal responsibility, even be spared the death sentence, which has important meaning in Chinese judicatory adjudication. The epiphysis of long bones from human limbs and the secondary sexual characteristics almost have developed completely before 18 years old. Clavicle epiphysis is one of the articular metaphysis which has a late epiphyseal closure. The recent studies in exploring the rule of clavicle epiphyseal by multi-imaging technology shows that the development of clavicle epiphysis has some value in age estimation of 18 years old. CT, especially thin-section CT, is widely used at present. However, thin-section CT scanning has great net radiation, which is not ethically acceptable if it is not for diagnosis and treatment. MRI is nonradioactive tomographic imaging and easy to evaluate, which is one of the future research directions in forensic age estimation using the medial clavicle. This paper summarizes the progress on the rule of clavicle epiphyseal closure, and analyzes and summarizes the feasibility of rule of clavicle epiphyseal closure applies on age estimation.

The analysis of variation of Han female adolescent bone development in Henan and Zhejiang province / 法医学杂志

OBJECTIVE@#To study the difference of Han female adolescent bone development in Henan and Zhejiang province.@*METHODS@#All radiography including sternal end of clavicle and six main bone joints were taken from 599 female adolescents with age between 12 to 19 in Henan and Zhejiang province. Twenty four skeletal development indexes were analyzed based on "The Grading Standards" of skeletal growth of teenagers and then the bone age were calculated using mathematical model functions. The ratios of the bone age and the chronological age were analyzed by statistical software.@*RESULTS@#The development of Henan female adolescents' skeleton was about 0.39 years earlier than that in Zhejiang at the age of 14-15 years old. The development of Henan female adolescents' skeleton was about 0.37 years later than that in Zhejiang at the age of 15-16 years old. The development of Henan female adolescents' skeleton was about 0.38 years later than that in Zhejiang at the age of 18-19 years old. There was no statistics significance in other age group.@*CONCLUSION@#The female adolescent bone development in Henan province is faster at earlier stage and then slower than that in Zhejiang province. The results provide potential value for the forensic medicine, anthropology and clinical medicine.

Enfermedad de blount (tibia vara): a propósito de un caso / Blount disease (tibia vara): a purpose of a a case

En este trabajo presentamos el caso de una lactante menor de 2 años y 5 meses, quien es traída por sus padres a la consulta externa de Ortopedia y Traumatología por presentar dificultad para la marcha y deformidad en extremidades inferiores. Radiológicamente en esta paciente se observa una angulación medial aguda de la tibia izquierda en su región metafisiaria proximal con una zona de rarefacción y fragmentación a nivel del borde interno de la tibia izquierda con disminución del espacio de la placa epifisiaria. La enfermedad de Bount o Tibia Vara es un desorden infrecuente del crecimiento caracterizado por la osificación desordenada de la epifisis y metafisis tibial proximal. Esta deformidad progresiva es manifestada por la forma angular del varus y rotación interna de la tibia en la región de la metafisis proximal inmediatamente debajo de la rodilla. la enfermedad de Blount puede ocurrir en niños de cualquier edad y se clasifica en dos grupos: inicio temprano (en niños menores de 3 años) e inicio tardio que incluye la forma juvenil (niños 4 a 10 años) y la forma adolescente (a partir de los 11 años de edad). En vista de que esta patología es infrecuente decidimos presentar este caso y hacer una revisión detallada de la literatura internacional actual

decollement epiphysaire traumatique de l'estremite inferieure du femur a propos de 22 cas

The epiphyseal detachment of the lower extremity of the femur is a relatively rare lesion but severe as it is the cause of problems. The most frequent etiology is the highway accident: this shows the violence of the causal traumatism. It supervenes especially in the adolescent with neat male predominance. The diagnosis, generally easy is based on the clinical examination but especially on the radiographies: Radiography of the reached knee in strict face, radiography of the reached knee in strict profile, with at less doubt, comparative photographs. There are 5 stages of lesions according to SALTER and HARRIS' anatomopathologic classification. For the stages I, II, III and IV, the diagnosis is easy, whereas the stage V is still the most often unknown until the appearance of the sequelae. We notice that the stage II is, from afar the most frequent. However, inspite of the easiness of SALTER and HARRIS' classification, some elements are still dark and the prognosis of stages I and II is bad. In this case, the explanation would be physiopathologic according to SHAPIRO. The treatment must be undertaken emergently, and based on a reduction as perfect as possible whatever is orthopedic or bloodstained. A radiographic supervision, by telemensuration of all the femur is necessary during the period of setting to discolose an eventual secondary detachement. However, the sequelae are still unforeseeable and essentially the disorders of growth that can result in major handicap. This requires a radioclinical supervision in these patients until the end of their growth, in order to detect the sequelae and to treat them if necessary. The prognosis is based on several factors: the age of the patient, the epiphyseal vascularization, the nature of detachement, the quality of the therapeutic supervision. Thinking about the epiphyseal detachement in front of any traumatism of the knee, careful reading of the radiographies, an adjusted and well guided treatment, a regular radioclinical supervision until the end of growth must permit to improve the prognosis