Guided Growth With Minifragment Plates for Angular Deformities in the Distal Radius in Skeletally Immature Patients. Preliminary Results.

INTRODUCTION: Growth modulation allows correction of progressive ulnar deviation of the distal radius in skeletally immature patients, which may occur as a consequence of various pathologies. The aim of this study is to evaluate the radiographic results and complication rate in a series of patients treated with minifragment plates. METHODS: The medical records of 12 patients who underwent guided growth with a minifragment plate on the radial aspect of the distal radius as a consequence of angular deformities in the distal radius were retrospectively reviewed. Demographic data, radiographic changes, and complication rate were analyzed. RESULTS: A total of 14 wrists and forearms were evaluated. The mean age at which surgery was performed was 10.5 years (interquartile range: 9.0 to 11.3). The average time between placement and removal of the material was 28.7 months (SD: 8,89). In each case, a general improvement of the radiographic parameters was obtained. There were 3 postoperative complications, but only 1 of them required reintervention (broken metaphyseal screw). CONCLUSIONS: Hemiepiphysiodesis using a minifragment plate is a treatment that respects the surgical anatomy and offers an alternative surgical option for angular deformities of the distal radius in children. LEVEL OF EVIDENCE: Level IV.

Como evitar Adlatum en las osteotomias con Fijacion Externa Monolateral / No disponible

El desplazamiento epifisario medial o lateral -ad latum- es un problema no deseado que altera el eje mecánico de la extremidad en las correcciones progresivas de deformidades angulares mediante osteotomías con aparatos de fijación externa monolateral. Los autores explican este fenómeno en modelos anatómicos y proponen una sencilla recomendación técnica para evitar dicho fenómeno. TÉCNICA: Tras la correcta colocación de los tornillos del fijador externo, el cabezal epifisario no se aprieta completamente para que permita el deslizamiento de los tornillos que se insertan en la epífisis en la mordaza del aparato. CONCLUSIONES: Esta sencilla recomendación evita el efecto ad latum no deseado cuando se realiza una osteomía y corrección gradual con fijación externa monolateral

Medial or lateral epiphyseal displacement -ad latum- is an undesired problem that alters the mechanical axis of the limb in progressive corrections of angular deformities by osteotomies with monolateral external fixation devices.The authors explain this phenomenon in anatomical models and propose a simple technical recommendation to avoid it. TECHNIQUE: After a proper placement of the screws, the epiphyseal head of the external fixator is not fully tightened in order to allow the sliding of the screws that are inserted into the epiphysis in the clamp of the device. CONCLUSION: This simple recommendation avoids the undesired ad latum effect when performing an osteomy and gradual correction with monolateral external fixation and survival status. Combined with current hip fracture management guidelines, exchange perioperative management and postoperative rehabilitation experience

Síndromes de Jarcho-Levin y Rokitansky. Una excepcional asociación / Jarcho-Levin and Rokitansky syndromes. An excepcional association

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Displasia del desarrollo de la cadera en niños con trastorno psicomotor. ¿Factor de riesgo para un mal resultado? / Developmental dysplasia of the hip in children with a psychomotor disorder. A risk factor for a poor outcome?

INTRODUCCIÓN: El tratamiento ortopédico de la displasia del desarrollo de la cadera (DDC) presenta un alto porcentaje de éxito en casos diagnosticados precozmente o en los primeros meses de vida. Sin embargo, se desconoce qué resultados presentan estos pacientes cuando posteriormente son diagnosticados de un trastorno psicomotor. MATERIAL Y MÉTODOS: Se realiza un estudio observacional retrospectivo de los casos de DDC con mala evolución tras tratamiento ortopédico, desconociéndose si presentaban algún tipo de trastorno psicomotor. Los pacientes fueron valorados clínica y radiológicamente, y por la Unidad de Neurología Infantil. RESULTADOS: De los 325 casos de DDC diagnosticados en 293 pacientes, 10 pacientes (3%) con 16 caderas con DDC fueron diagnosticados de algún tipo de trastorno psicomotor. Todos los casos inicialmente fueron tratados ortopédicamente. La evolución tanto clínica como radiológica en estos casos fue favorable sOlo en 4 (25%). En los 12 restantes se indicó quirúrgica para su resolución (75%). Hubo mejoría tras tratamiento quirúrgico en el índice acetabular (p = 0,005) y en el índice de extrusión de Reimers (p = 0,042). El ángulo cÉrvico-diafisario y el ángulo CE de Wiberg también mejoraron, pero su diferencia no fue estadísticamente significativa. El diagnóstico del trastorno psicomotor se realizó a los 2,5 años de edad. El inicio de la deambulación de estos pacientes estaba retrasado, iniciándose a los 2,4 años. CONCLUSIONES: El trastorno psicomotor puede condicionar una tórpida evolución en el tratamiento conservador de la DDC; el riesgo relativo de presentar un mal resultado es 7.2 veces mayor en estos pacientes. Ante una mala respuesta al tratamiento convencional de una DDC, debe sospecharse la existencia de un posible trastorno neurológico de base, especialmente si hay un retraso en la deambulación

INTRODUCTION: Orthopaedic treatment of developmental dysplasia of the hip (DDH) has a high success rate in cases that are diagnosed early. However, the outcomes of these patients are not really known when they are subsequently diagnosed with some type of cerebral impairment. MATERIALS AND METHODS: A retrospective observational study was conducted on cases of DDH with a poor outcome after orthopaedic treatment, being unknown if they had any type of psychomotor disorder. The patients were clinically and radiologically assessed, and afterwards received neurological valuation by the Child Neurology Unit. RESULTS: Of the 325 cases of DDH diagnosed in 293 patients, 10 patients (3%) with 16 hips with DDH were diagnosed of any cerebral impairment. All them were initially treated orthopedically. Clinical and radiologically evolution was succesful only in 4 cases (25%) being necessary any surgical procedure in the remaining 12 cases. After surgical treatment we got an improvement in the Acetabular Index (p = 0.005) and Reimers Extrusion Index (p = 0.042). Neck-shaft angle and Wiberg CE angle also improved but this difference was not statically significant. Cerebral impairment was diagnosed at 2,5 years of age and the begining of walking was delayed at 2.4 years of age. CONCLUSIONS: Cerebral impairment can lead to an unfavourable outcome in the treatment of DDH, with the relative risk of a poor outcome being 7.2 times higher in these patients. An unfavourable outcome with conventional treatment of DDH must make us suspect the presence of some type of neurological disorder, particularly if there is a delay in walking

[Developmental dysplasia of the hip in children with a psychomotor disorder. A risk factor for a poor outcome?]. / Displasia del desarrollo de la cadera en niños con trastorno psicomotor. ¿Factor de riesgo para un mal resultado?

INTRODUCTION: Orthopaedic treatment of developmental dysplasia of the hip (DDH) has a high success rate in cases that are diagnosed early. However, the outcomes of these patients are not really known when they are subsequently diagnosed with some type of cerebral impairment. MATERIALS AND METHODS: A retrospective observational study was conducted on cases of DDH with a poor outcome after orthopaedic treatment, being unknown if they had any type of psychomotor disorder. The patients were clinically and radiologically assessed, and afterwards received neurological valuation by the Child Neurology Unit. RESULTS: Of the 325 cases of DDH diagnosed in 293 patients, 10 patients (3%) with 16 hips with DDH were diagnosed of any cerebral impairment. All them were initially treated orthopedically. Clinical and radiologically evolution was succesful only in 4 cases (25%) being necessary any surgical procedure in the remaining 12 cases. After surgical treatment we got an improvement in the Acetabular Index (p=0.005) and Reimers Extrusion Index (p=0.042). Neck-shaft angle and Wiberg CE angle also improved but this difference was not statically significant. Cerebral impairment was diagnosed at 2,5 years of age and the begining of walking was delayed at 2.4 years of age. CONCLUSIONS: Cerebral impairment can lead to an unfavourable outcome in the treatment of DDH, with the relative risk of a poor outcome being 7.2 times higher in these patients. An unfavourable outcome with conventional treatment of DDH must make us suspect the presence of some type of neurological disorder, particularly if there is a delay in walking.

Aspectos epidemiológicos y de interés público-sanitario de la fibrodisplasia osificante progresiva en España / Epidemiologic and public-health issues of progressive fibrodysplasia ossificans in Spain

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Avascular necrosis of distal tibial epiphysis: report of two cases.

UNLABELLED: The authors present two cases of necrosis of the distal tibial epiphysis without evidence of trauma in either of the patients. One patient after a long follow-up showed a Charcot arthropathy. In contrast, the second patient recovered distal epiphysis ad integrum. Close follow-up and ankle protection with an orthosis may be necessary to spare the joint and prevent significant damage. The authors highlight the difficulty in diagnosing these special cases in which pain, a common finding in orthopaedics, is not present. LEVEL OF EVIDENCE: IV.

Acute compartment syndrome of the foot caused by a hemangioma.

Acute compartment syndrome is most commonly caused by trauma. Although it has been well described in adults, few have addressed this condition in the pediatric patient. The most common causes of acute compartment syndrome of the foot in children are crush syndromes with or without fractures. We present the case of an 8-year-old girl who had a congenital hemangioma on the second toe of her right foot, with persistent pain and swelling of her right lower extremity. On exploration, the limb was cold and swollen, and pulses were timidly palpable. She was admitted with a working diagnosis of cavernous hemangioma with a hematoma that affected the blood flow of the foot. After measuring the compartment pressures, acute compartment syndrome of the right foot was diagnosed and fasciotomy was performed. The current medical literature was reviewed for acute compartment syndromes secondary to hemangiomas. It appears that this could be a new complication of hemangiomas located in limbs with severe consequences if not detected in time.

Percutaneous trigger thumb release in children.

The objective of this study was to determine whether percutaneous release of the A1 pulley is an adequate treatment of trigger thumb in children. Twenty-three children under the age of 6 years with 27 trigger thumbs fixed in flexion were evaluated prospectively. All were treated with a percutaneous release of the A1 pulley in an ambulatory setting and followed for at least 1 year. Interphalangeal and metacarpophalangeal joint range of motion, pinch strength, static two-point discrimination sensibility, and triggering were examined and compared with the unaffected thumb at the end of follow-up. After a mean follow-up of 3 years, 25 of the thumbs had an excellent result without residual triggering. Two of these thumbs had mild metacarpophalangeal extension deficit 1 month after surgery that resolved completely with specific exercises. One thumb relapsed and required subsequent open release and was considered a poor result. One child was lost to follow-up. There were no sensibility defects, strength loss, interphalangeal motion loss, or metacarpophalangeal hyperextension deformities. Percutaneous release of the A1 pulley is an effective and safe option in the treatment of trigger thumb in children.

Valgus deformity after fibular resection in children.

The authors present a retrospective study of 23 patients in their growing period who underwent resection of more than 2 cm of the fibula. Long-term effects in the ankle and tibia were analyzed. The patients were radiologically studied using the contralateral side as control. Representative radiologic findings were distal migration of the fibula head in 75% (but without clinical relevance), thickening of the external tibial cortex in 20%, talar tilt in 45%, proximal migration of the lateral malleolus in 55%, and diaphyseal valgus of the tibia in 20% of the cases. Incomplete regeneration of fibula was observed in 58% of the cases. Two patients suffered a spiral diaphyseal fracture and another a slow physeal fracture of the distal tibia. In this study, many radiologic changes were observed after fibula resection. The authors suggest using reconstruction methods after fibula resection when it is possible.