Mejoría de la función cardio-respiratoria en paciente con circulación de fontán tras la intervención quirúrgica de su escoliosis / Improvement of the cardio-respiratory function in fontan patients after surgery of scoliosis

La escoliosis puede tener un impacto negativo sobre la función cardio-respiratoria en pacientes con cirugía de Fontán. Cuando las consecuencias de la progresión de la deformidad sobre la calidad de vida y la supervivencia potencial a largo plazo del paciente superan los riesgos de la intervención se aconseja el tratamiento quirúrgico de la curva. Desafortunadamente, este grupo de pacientes presenta un elevado riesgo anestésico y un difícil manejo durante el procedimiento quirúrgico, debido a la necesidad de mantener una presión venosa central elevada que garantice un adecuado flujo pulmonar, circunstancia que dificulta la consecución de una hipotensión controlada, habitual en estos procedimientos para el control del sangrado. Presentamos el caso de una paciente de 13 años con enfermedad congénita cardiaca (ECC) y fisiología de Fontán sometida a corrección quirúrgica de su escoliosis tóraco-lumbar, su manejo y mejora de la función cardiaca tras la cirugía raquídea mediante fusión raquídea posterior

Scoliosis can negatively impact the cardio respiratory function in patients with Fontan anatomy. Surgical treatment of the spinal curvature is advised when the consequences of the progression of the deformity on the survival and quality of life at the long term overcome the risks of the intervention. Unfortunately, this group of patients presents a high anesthetic risk and a difficult management during the surgical procedure, because they need to support a high central venous pressure to ensure an adequate pulmonary flow, circumstance which makes difficult to achieve a controlled hypotension, usual in these procedures for control of bleeding. We report here about a 13 years old patient with congenital heart disease (CHD) and Fontan physiology presented for posterior spinal fusion for the treatment of thoracolumbar scoliosis, her management and later progress of her cardiac function after the spinal fusion surgery

Island nail flap in the treatment of foot macrodactyly of the first ray in children: report of two cases.

PURPOSE: We evaluated the result of a combined single-stage surgery in the treatment of first ray macrodactyly in children. INTRODUCTION: Macrodactyly is a rare congenital abnormality that involves thickening of both the soft tissue and bone of the affected digits. It is more frequent in fingers than toes, where there is less neural involvement. Increased growth is also seen in neurofibromatosis, hemangiomatosis, arteriovenous malformations, congenital lymphedema, and syndromes such as Klippel-Trenaunay-Weber syndrome and Proteus syndrome. The goal of treatment is to obtain a pain-free, functional foot that can accommodate normal shoes. Treatment of macrodactyly of the first ray generates numerous difficulties since ray resection, which has been recommended for other toes as a means to of shortening and narrowing the foot, cannot be performed. In addition to this, cosmetic results are better if the nail is preserved. METHODS: We retrospectively reviewed our cases of first ray macrodactyly treated by a single-stage multiple-technique procedure. RESULTS: We obtained satisfactory results, in that same-sized shoes could be worn on by our patients and patients and family were happy with the outcome. However, one of our cases patients lost the nail 10 months postoperatively. CONCLUSIONS: We believe that island-nail transfer in children obtains excellent results.

Uso de yeso pelvipédico inmediato en fracturas femorales pediátricas / Inmediate use of spica in pediatric femoral fractures

Objetivo: Evaluar los resultados del tratamiento con yeso pelvipédico inmediato en fracturas diafisarias de fémur en pacientes con edades comprendidas entre los 6 y 24 meses. Material y métodos: Realizamos un estudio observacional analizando pacientes tratados entre 2009 y 2012 por fractura de fémur, mediante yeso pelvipédico inmediato, con edades entre 6 y 24 meses. Se recopilaron 46 pacientes. Registrando tipo de fractura, acortamiento inicial, demora hasta la colocación del yeso, tipo de anestesia, angulaciones y discrepancia de longitud entre miembros inferiores. Resultados: Se observa un predominio de fracturas espiroideas (63%). Un acortamiento inicial de 6 mm de mediana, que guarda relación con la angulación frontal y sagital finales. No se ha constatado relación entre el peso y discrepancia de longitud y/o angulaciones. En el 61% de los pacientes no fue precisa la anestesia general, no existiendo relación entre su uso, y la obtención de mejores resultados radiográficos. La media de la demora en la aplicación del yeso fue de 15 horas. No se han detectado complicaciones graves. Conclusiones: El uso del yeso pelvipédico inmediato en el manejo de la fracturas de fémur en pacientes menores de 24 meses y mayores de 6 ofrece resultados óptimos con escasas complicaciones

Objetive: To evaluate the treatment results with immediate hip spica in diaphyseal femur fractures in patients age between 6 and 24 months. Methods: This was an observational study that retrospectively analyzed patients between 6 and 24 months of age who had suffered a femur fractures and were treated with immediate spica casting in our hospital between 2009 and 2012. Forty six patients were collected. The data recorded were: fracture type, initial shortening, delay until casting, general anesthesia requirement or not, degree of angulation in the frontal and sagittal plane, and leg length discrepancy at follow up. Results: We analyzed the data obtained and observed a predominance of spiral fractures (63%). An initial shortening of 6 mm median that relates with the frontal and sagittal angulation. Five patient's angles were initially out of tolerance range but did not require treatment at the end of follow up. There was no relationship between weight and leg length discrepancy or angulations. Sixty one percent of the patients did not require general anesthesia, with no relationship between its use and better radiographic results. Average in casting delay was 15 hours. No serious complications were detected. Conclusions: The use of immediate hip spica cast in the management of femur fractures in patients younger between 6 and 24 months of age provides optimal results with few complications

Nota clínica. Complicaciones del método Ponseti: Edema de miembro por efecto ventana / Complication of Ponseti’s method: Edema member for windows effect

El pie equinovaro es la deformidad congénita más frecuente, afectando a 1 de cada 1000 recién nacidos vivos. El método más aceptado para su tratamiento es el método Ponseti, que consiste en la utilización de yesos seriados, encaminados a corregir las deformidades asociadas a dicha deformidad. Varias son las complicaciones que pueden aparecer durante el enyesado seriado, aunque la mayoría son banales. En nuestro centro hemos diagnosticado 5 casos de edema de miembro por efecto ventana asociado a este tratamiento. En todos los casos, esta complicación ha aparecido tras retirar el yeso post-tenotomía, previo a la colocación de la férula de abducción. Asociamos esta complicación con la rigidez de las vendas de algodón utilizadas, lo que nos ha llevado a cambiarlas por otras sin trenzado, mucho más distensibles. Actualmente no ha aparecido ningún nuevo caso

The clubfoot is the most common birth defect, affecting 1 in 1000 live births. The most accepted method for treatment is the Ponseti method which consists of serial casting, which corrects all the deformities associated with this deformity. There are several complications that can arise during serial casting, although most are banal. In our center we have diagnosed 5 cases of edema member for windows effect with this treatment. In all cases, this complication has appeared after removal of the post-tenotomy cast, prior to using the abduction brace. We associate this complication with the rigidity of the cotton bandages used, which has led us to change them for other without mesh, much more distensible. Currently, no new caseshave appeared