[Tumors that cause bone metastases]. / Tumores que producen metástasis óseas.

INTRODUCTION: A metastasis is the tumor cell capacity to migrate from the primary tumor and implant itself in tissues of an organ at a distance by hematogenous, lymphatic or contiguity. The main causes of bone metastases are: breast, prostate and lung cancer. It usually occurs in patients over 50 years of age. There is a predilection for metastasizing to the axial skeleton. OBJECTIVE: To determine the frequency of tumors that produce bone metastases in our institution. MATERIAL AND METHODS: Observational, cross-sectional, descriptive study, for retrospective analysis of the cases of patients diagnosed with bone metastases. RESULTS: 193 cases; 121 women and 72 men with an age range of 42 to 84 years. Cancers associated with bone metastases were breast, lung, prostate, cervical and renal cancers; to a lesser extent other such as colon, thyroid, liver and skin. The most affected bones were axial skeleton: lumbar and dorsal spine, and in appendicular skeleton the femur in the diaphysiary region and in the humerus the proximal third. At present it has not been possible to improve the effectiveness of timely detection strategies, so bone pain should begin with a protocol of tumor suspicion. CONCLUSIONS: More than 80% of the patients came for fracture. All patients had a history of pain greater than 12 months with no prior study protocol.

INTRODUCCIÓN: Una metástasis es la capacidad celular tumoral para migrar del tumor primario e implantarse en tejidos de un órgano a distancia por vía hematógena, linfática o contigüidad. Las principales causas de metástasis óseas son: cáncer de mama, próstata y pulmón. Habitualmente se da en pacientes mayores de 50 años. Existe predilección por metastatizar al esqueleto axial. OBJETIVO: Determinar la frecuencia de los tumores que producen metástasis óseas en nuestra institución. MATERIAL Y MÉTODOS: Estudio observacional, transversal, descriptivo, para análisis retrospectivo de los casos con diagnóstico de metástasis ósea. RESULTADOS: Ciento noventa y tres casos; 121 mujeres y 72 hombres con rango de edad de 42 a 84 años. Los cánceres asociados a metástasis ósea fueron cáncer de mama, pulmón, próstata, cervicouterino y renal; en menor proporción otros como colon, tiroides, hígado y piel. Los huesos más afectados fueron esqueleto axial: columna lumbar y dorsal; en esqueleto apendicular el fémur en la región diafisaria y en el húmero el tercio proximal. En la actualidad, no se ha logrado mejorar la efectividad de estrategias de detección oportuna, por lo que los cuadros de dolor óseo deben iniciar con un protocolo de sospecha tumoral. CONCLUSIONES: Más de 80% de los pacientes acudieron por fractura. Todos tenían historial de dolor mayor a 12 meses sin protocolo de estudio previo.

[Complications of supracondylar humeral fractures in children]. / Complicaciones de fracturas supracondíleas humerales en niños.

INTRODUCTION: Supracondylar fractures represent the most frequent cause of pediatric elbow injuries, at 64%, in children under eight years old. These fractures can present complications such as: A) Complications prior to treatment: 1) neurological, 2) vascular and 3) compartment syndrome. B) Complications after treatment: 1) early, in the first days after treatment: loss of reduction, neurological, vascular, compartment syndrome, infection of Kirschner wires. 2) Late complications in treatment: Angular deformity, loss of mobility, ossifying myositis, avascular necrosis of the trochlea, others. OBJECTIVE: To determine the frequency of complications in humeral supracondylar fractures in less than eight years. MATERIAL AND METHODS: A retrospective, observational cohort study was conducted in patients under 8 years of age during the period of March 2014 to February 2018. RESULTS: 277 patients were obtained with the following percentages: cubitus varus 3.97%, neurological lesions prior to surgical treatment 1.44%, early neurological complications to treatment 1.44%, infections of Kirschner needles 0.72%, cubitus valgus 0.72%, loss of mobility 0.36%. CONCLUSIONS: The most common complication of humerus supracondylar fractures in this study was cubitus varus and neurological complications prior to treatment.

INTRODUCCIÓN: Las fracturas supracondíleas representan la causa más frecuente de las lesiones del codo pediátrico (64% de la población en niños menores de ocho años). Estas fracturas pueden presentar complicaciones como: A) complicaciones previas al tratamiento: 1) neurológicas, 2) vasculares y 3) síndrome compartimental. B) complicaciones posteriores al tratamiento: 1) precoces en los primeros días tras el tratamiento: pérdida de reducción, complicaciones neurológicas, vasculares, síndrome compartimental, infección de las agujas de Kirschner, 2) complicaciones tardías en el tratamiento: deformidad angular, pérdida de movilidad, miositis osificante, necrosis avascular de la tróclea, entre otros. OBJETIVO: Determinar la frecuencia de las complicaciones en fracturas supracondíleas humerales en menores de ocho años. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo y observacional de cohorte en pacientes menores de ocho años en el período de Marzo de 2014 a Febrero de 2018. RESULTADOS: Se obtuvieron 277 pacientes con los siguientes porcentajes: 3.97% presentó lesiones de cúbito varo; 1.44%, lesiones neurológicas previas al tratamiento quirúrgico; 1.44%, complicaciones neurológicas precoces al tratamiento; 0.72%, infecciones de agujas de Kirschner; 0.72%, cúbito valgo y 0.36% con pérdida de la movilidad. CONCLUSIONES: La complicación más frecuente de las fracturas supracondíleas de húmero en este estudio fue cúbito varo y complicaciones neurológicas previas al tratamiento.

[Complex multiligament knee injury associated with patellar tendon rupture]. / Lesiones multiligamentarias de rodilla asociadas a ruptura de tendón rotuliano.

INTRODUCTION: Multi-ligament injury of the knee joint is defined as damage to two or more major ligaments. They are uncommon, with an incidence of ? 10:10,000. They constitute less than 0.02% of all orthopedic lesions. It is even less frequent to find an association of these with a complete rupture of the patellar tendon which presents with a prevalence of 2.4%. CASE REPORT: 22 year old male; he presented a high-speed accident with a diagnosis of multi-ligament left knee injury stage V of Schenck associated with complete patellar tendon rupture treated in a single surgical time with ligament reconstruction, four weeks after traumatic event. A score of 88.5 was obtained after eight months with the IKDC 2000 form for the subjective functional evaluation of the knee. DISCUSSION: The definitive surgical treatment is performed four weeks after the injury. This reduces the risk of instability. In our clinical case, the patient is integrated into the activities of his daily life after eight months. To validate this technique as effective or good for its use, a greater number of patients treated in the same way is required. It is, however, suggested to contemplate as a management option. CONCLUSION: These types of lesions are infrequent with a prognosis reserved.

INTRODUCCIÓN: La lesión multiligamentaria de la articulación de rodilla se define como el daño a dos o más ligamentos principales. Estas lesiones son poco comunes, con una incidencia de ? 10:10,000. Constituyen menos de 0.02% de todas las lesiones ortopédicas. Es aún menos frecuente encontrar asociación de éstas a una ruptura completa del tendón patelar, la cual se presenta con una prevalencia 2.4%. CASO CLÍNICO: Masculino de 22 años sufrió accidente de alta velocidad, con diagnóstico de lesión multiligamentaria de rodilla izquierda estadio V de Schenck asociada a ruptura completa de tendón patelar, fue tratado en un solo tiempo quirúrgico con reconstrucción ligamentaria cuatro semanas después de evento traumático. Se obtuvo a los ocho meses un puntaje de 88.5 con el formulario IKDC 2000 para la evaluación funcional subjetiva de la rodilla. DISCUSIÓN: El tratamiento quirúrgico definitivo se realiza a las cuatro semanas de la lesión. Con esto se disminuye el riesgo de inestabilidad. En nuestro caso clínico el paciente se logra integrar a las actividades de su vida diaria después de ocho meses. Para validar esta técnica como efectiva o buena para su uso, se requiere un mayor número de pacientes tratados de la misma forma. Sin embargo, se sugiere contemplar como una opción de manejo. CONCLUSIÓN: Lesión poco frecuente, de tratamiento quirúrgico con un pronóstico reservado.

[Benign tumors that cause fractures in children]. / Tumores benignos que producen fracturas en niños.

INTRODUCTION: A pathological fracture is defined as that which occurs through an abnormal bone. Approximately 20,000 benign neoplasms of the musculoskeletal system are diagnosed each year. Often the pain of the fracture is the first symptom of a pathological process in the bone. The site, age and radiographic appearance create a differential diagnosis for pathological fractures that remains broad. The clinical examination evaluates the condition of the skin, palpating any tissue mass and determining if there are local inflammatory signs such as erythema, heat or edema. The biopsy is highly recommended to confirm the diagnosis of a pathological fracture. OBJECTIVE: To determine which benign bone tumors and pseudotumoral lesions produce fractures in childrens bones more frequently in our institution. MATERIAL AND METHODS: Cross-sectional retrospective study, review of records of patients with diagnosis of pathological fracture, attended in the period from March 2013 to March 2017, were reviewed. Results: The benign tumors that caused fractures in previously damaged areas were: aneurysmal bone cyst 13, enchondroma 5, osteoid osteoma 3, giant cell tumor 2. CONCLUSION: At our institution, aneurysmal bone cysts were the benign tumors that most frequently produce pathological fractures in children, with predominance in males.

INTRODUCCIÓN: Se define fractura patológica a la que se produce a través de un hueso anormal. Cada año se diagnostican aproximadamente 20,000 neoplasias benignas del sistema musculoesquelético. A menudo, el dolor de la fractura es el primer síntoma de un proceso patológico en el hueso. El sitio, la edad y la apariencia radiográfica crean un diagnóstico diferencial para las fracturas patológicas que sigue siendo amplio. El examen clínico evalúa la condición de la piel, palpar cualquier masa de tejido y determinar si hay signos inflamatorios locales como eritema, calor o edema. La toma de biopsia es muy recomendable para confirmar el diagnóstico de una fractura patológica. OBJETIVO: Determinar qué tumores óseos benignos y qué lesiones seudotumorales producen fracturas en huesos de niños con mayor frecuencia en nuestro hospital. MATERIAL Y MÉTODOS: Estudio retrospectivo transversal, se revisaron expedientes de pacientes con diagnóstico de fractura en terreno patológico, atendidos en el período de Marzo de 2013 a Marzo de 2017. RESULTADOS: Los tumores benignos que ocasionaron fracturas en terreno previamente dañado fueron: quiste óseo aneurismático 13, encondroma cinco, osteoma osteoide tres, tumor de células gigantes dos. CONCLUSIÓN: En nuestra institución, los quistes óseos aneurismáticos fueron los tumores benignos que con mayor frecuencia producen fracturas patológicas en niños, con predominio en el sexo masculino.

[Osteochondromas: introducing the subungual osteochondroma]. / Osteocondromas: presentación del osteocondroma subungueal.

INTRODUCTION: Subungual osteochondromas are benign tumors of the sub- or periungual region, causing lifting, ulceration and deformity at that level. OBJECTIVE: To research the incidence of subungual osteochondromas in a specific pediatric population. MATERIAL AND METHODS: Retrospective, transversal, descriptive and observational study based on the review of records with a histopathological result of osteochondroma from 2001 to 2014. RESULTS: The pathological assessment featured four osteochondromas that corresponded to the subungual presentation, with an equal gender distribution of 1:1, an average age of 9.5 years, right: left ratio of 3:1; the 4th finger was the most affected. DISCUSSION: Subungual osteochondroma has an incidence of 8.5% of all osteochondromas.

INTRODUCCIÓN: Los osteocondromas subungueales son tumoraciones benignas de la región sub- o periungueal que ocasionan elevación, ulceración y deformidad a dicho nivel. OBJETIVOS: Investigar la incidencia de osteocondroma subungueal en un segmento de población pediátrica. MATERIAL Y MÉTODOS: Estudio retrospectivo, transversal, descriptivo y observacional, basado en la revisión de expedientes con resultado histopatológico de osteocondroma de 2001 a 2014. RESULTADOS: Cuatro de los osteocondromas correspondieron a la presentación subungueal, con una distribución por sexos de 1:1 y un promedio de edad de 9.5 años, relación 3:1, derecho:izquierdo; el cuarto dedo fue el más afectado. DISCUSIÓN: El osteocondroma sunbungueal presenta una incidencia de 8.5% de todos los osteocondromas.

[Comparative study of the management of congenital brachymetatarsia with elongation with callotaxis]. / Estudio comparativo de manejo de braquimetatarsia congénita mediante elongación por callotaxis.

Brachymetatarsia is the > 5 mm shortening of the metatarsal parabolic arc of the foot, in one or more metatarsals. It is directly related with the early closure of the epiphyseal cartilage or with early fusion of the epiphyseal line of the distal end of the metatarsal. The fourth metatarsal is usually the most affected one. Females are more commonly affected, with a female to male ratio of 25:1; 72% of cases have bilateral involvement. The causes may be congenital, posttraumatic or result from specific conditions. A prospective, comparative study was conducted of patients with a diagnosis of congenital brachymetatarsia seen in 2007-2008 and 2008-2012. Seven patients were included in the former period: six girls and one boy. Eight patients were included in the latter period: five girls and three boys. The mean shortening achieved in the first group was 21.1 mm; in the second one, 18 mm, without regression. The daily distraction in both groups was 0.5 mm. Metatarsal elongation by means of callotaxis with external fixators is an appropriate procedure for adolescent patients about to achieve epiphyseal closure. The best results are obtained with gradual distraction at a rate of 0.5 mm per day.

[Relative clavicle shortening in pediatric fractures: its importance when selecting conservative treatment]. / Acortamiento relativo de clavícula en fracturas pediátricas: Su importancia en la decisión del tratamiento conservador.

BACKGROUND: Clavicle fractures represent 2-15% of pediatric fractures. The literature suggests operating on patients over 9 years of age with major shortening or severe comminution in the fracture line. However, no one establishes shortening or angulation parameters for conservative treatment in children. In pediatric patients it is important to take into account relative shortening, that is, the one caused by a fracture when compared with the length of the healthy clavicle. OBJECTIVE: To know the effect of relative clavicle shortening on movement in pediatric fractures treated conservatively. MATERIAL AND METHODS: Retrospective, longitudinal, observational study. We radiographically measured the relative shortening of the fractured clavicle comparing it with the healthy side at the time of the fracture and after fracture healing. Shortening was expressed in percentages. The following views were used: comparative anteroposterior view of the shoulders and panoramic view of both shoulders. Patients were divided into 2 groups: under 9 years and 9-15 years of age. RESULTS: We analyzed 94 fractures; 31 in females and 63 in males. No pseudoarthrosis or symptomatic malunion occurred. The prognosis was good regardless of the initial shortening percentage. Age and shortening are proportionally related with the rehabilitation period and the restoration of painless ranges of motion. The value ranges recorded for shortening were 9.5 to 28%. CONCLUSIONS: The surgical indications for shortening resulting from pediatric clavicle fractures should be revised. We have observed good results despite major shortening and total displacement.

[Infected pseudoarthrosis of the tibia, a pediatric case. Case report and literature review]. / Seudoartrosis infectada en tibia, un caso infantil. Caso clínico y revisión de la literatura.

Chronic posttraumatic osteomyelitis and infected pseudoarthrosis of the tibia are complex problems associated with considerable morbidity which may compromise the viability of the involved limb. The most frequent age of presentation is 2 to 6 years, with predominance in males at a 2:1 ratio. We present the case of a male 4 year-old patient with diagnosis of infected pseudoarthrosis. During the physical exam a fistula was detected in the anterior aspect of the right leg, with discharge of purulent material, and inability for weight bearing and gait. X-rays, culture of the exudate and biopsy were performed. Treatment consisted of antimicrobial therapy, surgical debridement's, and application of an autologous bone graft. The infection was controlled, the tibia healed, and function was restored.

[Proximal focal femoral deficiency complicated by a proximal femur fracture]. / Deficiencia femoral focal proximal complicada con fractura de fémur proximal.

Proximal focal femoral deficiency (PFFD) is a rare skeletal condition characterized by development failure of the subtrochanteric region of the femoral axis, with several degrees of shortening of the proximal region. There are no case reports of patients with this condition associated with a subtrochanteric fracture. We therefore describe herein the case of a newborn patient with clinical and radiographic diagnosis of proximal focal femoral deficiency complicated by a proximal femur fracture, and managed conservatively with pelvipodalic immobilization, which led to bone healing. The patient will continue to be managed in the long-term to assess and treat the sequelae of PFFD according to the growth stage he is in.

[Elongation with callotaxis for congenital brachymetatarsia]. / Elongación por callotaxis en braquimetatarsia congénita.

OBJECTIVE: To present 10 cases of congenital brachymetatarsia treated with elongation by means of callotaxis with external minifixators. INTRODUCTION: Brachymetatarsia of one or more of the matatarsals involving one or both extremities is a congenital condition, more frequent in the right foot, with the 4th metatarsal most commonly affected. MATERIAL AND METHODS: From May 2007 to September 2008, 7 patients with congenital brachymetatarsia, ages 8 to 15 years, were operated on. Two metatarsals were involved in 3 of them and thus the series included 10 procedures. All of them underwent lengthening through callotaxis with a monoaxial external mini-fixator. RESULTS: Mean lengthening was 21.1 mm, with a range of 17 to 25 mm. The complications included two cases of lengthening regression of 5 mm each. Delayed healing was reported in one of these two cases, and healing occurred spontaneously at 6 months. Nine metatarsals healed without any problems; no infections or material intolerance occurred. CONCLUSION: Lengthening of metatarsals through callotaxis with external mini-fixators is an appropriate procedure for pediatric and adolescent patients with congenital brachymetatarsia.