Fractures of the lateral condyle of the humerus associated with elbow dislocation in children. A systematic review of the literature. / Fracturas del cóndilo lateral del húmero asociadas a luxación de codo en niños. Una revisión sistemática de la literatura.

BACKGROUND: Lateral humeral condyle fractures are the second most common fracture around the elbow in children. However, the association of an elbow dislocation is a rare entity. Therefore, literature on young patients with this uncommon combination is sparse. We aimed to perform a systematic review of the literature searching for pediatric lateral condyle humerus fractures associated to elbow dislocation. METHODS: A systematic review of the PubMed and Embase databases was conducted for peer-reviewed literature between 1960 and 2020. Two reviewers filtered the results, looking for articles in English and Spanish that reported fractures of the lateral condyle of the humerus associated to elbow dislocation in skeletally immature patients. Outcomes included patient and injury characteristics, treatment strategies, complications, and final outcomes including range of motion. RESULTS: The initial search yielded a total of 851 studies. After initial screening, 16 studies were included, with 67 patients available for review. Age reported at the time of injury ranged from 2 to 12 years. The lesion occurred more commonly in males (60%) with Milch II, and Jakob type 3 fractures. The direction of the dislocation was posteromedial in most cases. Open reduction by lateral approach and Kirschner pin placement was the most performed treatment. The reported follow-up ranged from 3 to 156 months. Fourteen studies reported complications in 1/3 of the patients including: limited range of motion, cubitus varus, instability, hardware prominence, delayed union, nonunion, malunion, heterotopic ossification, neurological injury, and hardware failure. Thirteen studies reported clinical outcomes, which were rated as fair or poor in 2out of 10patients. CONCLUSIONS: Current evidence is level IV and suggests that the complication rate after surgical management of lateral condyle fractures is substantial in the context of an associated elbow dislocation, with an elevated percentage of suboptimal results. The most frequent complications in this series were elbow stiffness and cubitus varus.

Fracturas del cóndilo lateral del húmero asociadas a luxación de codo en niños. Una revisión sistemática de la literatura / Fractures of the lateral condyle of the humerus associated with elbow dislocation in children. A systematic review of the literature

Introducción: Las fracturas de cóndilo humeral lateral (FCHL) representan del 12 al 17% de las fracturas de codo pediátrico. La asociación de esta fractura con luxación de codo es poco común, siendo escasa la bibliografía y generalmente limitada a reportes de casos. Nuestro objetivo fue revisar sistemáticamente la literatura sobre las fracturas del cóndilo lateral del húmero asociadas a luxación de codo en niños. Métodos: Se realizó una revisión sistemática mediante una búsqueda exhaustiva en las bases de datos PubMed y Embase de literatura revisada por pares entre 1960 y 2020. Dos revisores filtraron los resultados y buscaron artículos en inglés o español que reportan pacientes esqueléticamente inmaduros con fracturas del cóndilo lateral del húmero asociadas a luxación de codo. Los resultados analizados incluyeron características del paciente y de la lesión, estrategias de tratamiento, complicaciones y resultados finales. Resultados: La búsqueda inicial arrojó un total de 851 estudios. Después de la revisión, se incluyeron 16 estudios, con 67 pacientes disponibles para revisión. Las edades reportadas al momento de la lesión variaron entre 2 y 12 años. La lesión se presentó más comúnmente en varones con fracturas tipo Milch II, Jakob tipo 3. La dirección de la luxación fue posteromedial en la mayoría de los casos. La reducción abierta por abordaje lateral y la colocación de clavijas Kirschner fue el tratamiento más comúnmente realizado. El seguimiento reportado se presentó en un rango 3 a 156 meses. Catorce estudios informaron complicaciones en un tercio de los pacientes, que incluyen: limitación del rango de movimiento, cúbito varo, inestabilidad, prominencia del implante, retraso de la consolidación, seudoartrosis, consolidación viciosa, osificación heterotópica, lesión neurológica y fallo del implante. Trece estudios informaron resultados clínicos, que se calificaron como regulares o pobres en 2de cada 10pacientes.(AU)

Background: Lateral humeral condyle fractures are the second most common fracture around the elbow in children. However, the association of an elbow dislocation is a rare entity. Therefore, literature on young patients with this uncommon combination is sparse. We aimed to perform a systematic review of the literature searching for pediatric lateral condyle humerus fractures associated to elbow dislocation. Methods: A systematic review of the PubMed and Embase databases was conducted for peer-reviewed literature between 1960 and 2020. Two reviewers filtered the results, looking for articles in English and Spanish that reported fractures of the lateral condyle of the humerus associated to elbow dislocation in skeletally immature patients. Outcomes included patient and injury characteristics, treatment strategies, complications, and final outcomes including range of motion. Results: The initial search yielded a total of 851 studies. After initial screening, 16 studies were included, with 67 patients available for review. Age reported at the time of injury ranged from 2 to 12 years. The lesion occurred more commonly in males (60%) with Milch II, and Jakob type 3 fractures. The direction of the dislocation was posteromedial in most cases. Open reduction by lateral approach and Kirschner pin placement was the most performed treatment. The reported follow-up ranged from 3 to 156 months. Fourteen studies reported complications in 1/3 of the patients including: limited range of motion, cubitus varus, instability, hardware prominence, delayed union, nonunion, malunion, heterotopic ossification, neurological injury, and hardware failure. Thirteen studies reported clinical outcomes, which were rated as fair or poor in 2out of 10patients.(AU)

Fractures of the lateral condyle of the humerus associated with elbow dislocation in children. A systematic review of the literature / Fracturas del cóndilo lateral del húmero asociadas a luxación de codo en niños. Una revisión sistemática de la literatura

Background: Lateral humeral condyle fractures are the second most common fracture around the elbow in children. However, the association of an elbow dislocation is a rare entity. Therefore, literature on young patients with this uncommon combination is sparse. We aimed to perform a systematic review of the literature searching for pediatric lateral condyle humerus fractures associated to elbow dislocation. Methods: A systematic review of the PubMed and Embase databases was conducted for peer-reviewed literature between 1960 and 2020. Two reviewers filtered the results, looking for articles in English and Spanish that reported fractures of the lateral condyle of the humerus associated to elbow dislocation in skeletally immature patients. Outcomes included patient and injury characteristics, treatment strategies, complications, and final outcomes including range of motion. Results: The initial search yielded a total of 851 studies. After initial screening, 16 studies were included, with 67 patients available for review. Age reported at the time of injury ranged from 2 to 12 years. The lesion occurred more commonly in males (60%) with Milch II, and Jakob type 3 fractures. The direction of the dislocation was posteromedial in most cases. Open reduction by lateral approach and Kirschner pin placement was the most performed treatment. The reported follow-up ranged from 3 to 156 months. Fourteen studies reported complications in 1/3 of the patients including: limited range of motion, cubitus varus, instability, hardware prominence, delayed union, nonunion, malunion, heterotopic ossification, neurological injury, and hardware failure. Thirteen studies reported clinical outcomes, which were rated as fair or poor in 2out of 10patients.(AU)

Introducción: Las fracturas de cóndilo humeral lateral (FCHL) representan del 12 al 17% de las fracturas de codo pediátrico. La asociación de esta fractura con luxación de codo es poco común, siendo escasa la bibliografía y generalmente limitada a reportes de casos. Nuestro objetivo fue revisar sistemáticamente la literatura sobre las fracturas del cóndilo lateral del húmero asociadas a luxación de codo en niños. Métodos: Se realizó una revisión sistemática mediante una búsqueda exhaustiva en las bases de datos PubMed y Embase de literatura revisada por pares entre 1960 y 2020. Dos revisores filtraron los resultados y buscaron artículos en inglés o español que reportan pacientes esqueléticamente inmaduros con fracturas del cóndilo lateral del húmero asociadas a luxación de codo. Los resultados analizados incluyeron características del paciente y de la lesión, estrategias de tratamiento, complicaciones y resultados finales. Resultados: La búsqueda inicial arrojó un total de 851 estudios. Después de la revisión, se incluyeron 16 estudios, con 67 pacientes disponibles para revisión. Las edades reportadas al momento de la lesión variaron entre 2 y 12 años. La lesión se presentó más comúnmente en varones con fracturas tipo Milch II, Jakob tipo 3. La dirección de la luxación fue posteromedial en la mayoría de los casos. La reducción abierta por abordaje lateral y la colocación de clavijas Kirschner fue el tratamiento más comúnmente realizado. El seguimiento reportado se presentó en un rango 3 a 156 meses. Catorce estudios informaron complicaciones en un tercio de los pacientes, que incluyen: limitación del rango de movimiento, cúbito varo, inestabilidad, prominencia del implante, retraso de la consolidación, seudoartrosis, consolidación viciosa, osificación heterotópica, lesión neurológica y fallo del implante. Trece estudios informaron resultados clínicos, que se calificaron como regulares o pobres en 2de cada 10pacientes.(AU)

Prevalence of hypovitaminosis D in patients with juvenile osteochondritis dissecans. / Prevalencia de hipovitaminosis D en pacientes con osteocondritis disecante juvenil.

BACKGROUND: Juvenile osteochondritis dissecans (JOCD) is an acquired joint disease of unknown etiology that affects skeletally immature patients and has the potential to progress to osteoarthritis. Recent studies have reported a high prevalence of vitaminD deficiency in patients with osteochondral lesions. The aim of our study was to determine serum vitaminD levels in patients diagnosed with JOCD. METHODS: Serum 25(OH)D levels of 31 patients (22 males) presenting 40 lesions (29 JOCD of the knee, and 11 of the ankle) were evaluated. The average age was 11.9±2.9years. HypovitaminosisD was defined as a value less than 30ng/mL and was divided into vitaminD insufficiency (20 to 30ng/mL) and vitaminD deficiency (<20ng/mL). RESULTS: HypovitaminosisD was present in 45.2% of the evaluated patients (32.2% insufficiency and 13% deficiency). No significant differences were found in the mean values and incidence of hypovitaminosis between those patients in which the sample was taken in warm or cold season (P=.267 and P=.875, respectively). Patients who required surgery had a higher incidence of hypovitaminosis than those treated conservatively (60% versus 31%, P=.054). There was no correlation in the incidence of hypovitaminosis with sex, location, stability of the lesion, or if the lesion was uni- or bilateral. CONCLUSION: In our series, almost half of the patients diagnosed with JOCD presented abnormal serum levels of vitaminD. A two-fold incidence of hypovitaminosis was observed in patients requiring surgical treatment compared to patients managed conservatively. The association found in this study does not imply causation, but it should be considered within the set of actions for the treatment of these injuries.

Immunomodulatory effect of pigeon serum in an acute and chronic murine model of bird fanciers lung.

INTRODUCTION: Since the immunopathological mechanisms of bird fancier's lung (BFL) are not well known, we created two models of the disease (acute and chronic BFL) to study and compare the pathways involved in its immunopathogenesis. MATERIALS AND METHODS: C57BL/6 mice were used. Two intraperitoneal injections of 100 µL of commercial pigeon serum (PS) or saline (SAL) were administered with an interval of 48 h in between. Subsequently, intranasal instillations of 40 µL of PS or SAL were performed three days a week, for three weeks in the acute model (AC/PS) and for twelve weeks in the chronic model (CR/PS). Total lung capacity (TLC) was assessed. Pulmonary inflammation was evaluated in bronchoalveolar lavage (BAL), and total serum immunoglobulin (Ig) G was measured in serum samples 24 h, 7 days and 14 days after the last exposure. Histological studies of lungs were assessed. RESULTS: A drop in TLC was observed in treated mice. This decrease was more marked in the CR/PS group (p < 0.001). Neutrophil and lymphocyte counts increased in both AC/PS and CR/PS groups (p < 0.01). The extent of airway inflammation was also examined in the histological analysis of the lungs, which showed predominant perivascular and peribronchiolar inflammation, with centrilobular oedema and subpleural inflammation in the AC/PS group. In the CR/PS group, the changes were greater, with increased levels of IL-5, IL-17F, IL-13 and IL-10 and decreased levels of IL-2. CONCLUSIONS: Bronchial inflammation is present in acute and chronic models of HP following exposure to PS. Our results support the role of neutrophils and IL-17 in the development of the disease and an evolution towards a Th-2 immune response in chronic HP. These models may serve as a tool for future studies of the pathogenesis of HP.

Changes in PH in exhaled breath condensate after specific bronchial challenge test in patients with chronic hypersensitivity pneumonitis: a prospective study.

BACKGROUND: The aim of this study was to investigate the influence of the specific inhalation challenge (SIC) on changes of pH values in exhaled breath condensate (EBC) in patients with hypersensitivity pneumonitis (HP). METHODS: A prospective study of 85 patients with suspected HP, of whom 63 were diagnosed with HP due to exposure to avian or fungal antigens. In all cases, EBC samples were collected before and after completion of the SIC and pH values were determined. RESULTS: Taken as a whole, patients with HP did not present changes in EBC pH after SIC. However, considering only patients with exposure to molds, those diagnosed with HP had a significantly more acid pH post-SIC than those with another diagnosis (p = 0.011). This fact is not observed in patients exposed to bird's antigens. A ROC curve showed that a reduction in EBC pH of 0.3 units or more after SIC in patients diagnosed with HP due to exposure to molds had a sensitivity of 30 % (CI: 12.8 to 54.3 %) and a specificity of 100 % (CI: 65.5 to 100 %). CONCLUSION: EBC pH may be useful in interpreting SIC results in patients with HP, especially in those patients exposed to molds. Further studies are now required to test the validity of these proposals.

Evaluación de Dolor Cervical en pacientes tratados mediante Ejercicios de Rehabilitación / Evaluation of cervical pain in patients treated by rehabilitation exercises

Objetivo. Cuantifi car la mejoría del dolor cervical tras una pauta de ejercicios de rehabilitación y evaluarsu repercusión en la capacidad para realizar actividades cotidianas de la vida diaria.Diseño. Estudio observacional de carácter longitudinal.Participantes. Pacientes adultos con edades comprendidas entre 20-65 años que acudieron a consulta con dolor cervical (n = 56) entre Enero-Marzo de 2006 y fueron tratados mediante ejercicios de rehabilitación. Selección mediante muestreo no probabilístico en dos consultas de atención primaria.Emplazamiento. Centro de salud urbano.Mediciones. Características del dolor e intensidad mediante escala visual analógica (EVA), consumode analgésicos, estado psíquico (Escala de Ansiedad/Depresión de Goldberg), repercusión del dolorcervical mediante The Northwick Park Neck Questionnaire (NPQ) al inicio y tras la realización durantedos semanas de ejercicios de rehabilitación isotónicos e isométricos y variables sociodemográficas.Resultados. La puntuación media en la EVA (rango 0 a 10) descendió de 4,5±1,9 DE a 3,9±2,4 DE (p=0,02). La puntuación inicial media NPQ fue de 32,7±17,5 DE y tras 2 semanas de 25,1±15,4 DE (p<0,001). La repercusión de los ejercicios de rehabilitación en las actividades diarias (dormir, leer, coger peso, trabajar, actividades sociales, conducir, etc.) se evaluó mediante la reducción en la puntuación NPQ, la cual se produjo en el 69,6% de los pacientes, siendo ≥20% en el 14,3% y ≥10% enel 39,3%. Dicha reducción fue signifi cativamente superior (p<0,05) en pacientes con menor tiempo deevolución del cuadro doloroso y de carácter continuo, mayor intensidad en la EVA y consumo previo de analgésicos.Conclusiones. Moderada repercusión de los ejercicios de rehabilitación en la intensidad del dolor cervicaly en la capacidad para realizar actividades diarias. La mejoría es superior en los pacientes que presentan dolor cervical más intenso, de carácter continuo y menor tiempo de evolución

Objective. To quantify cervical pain improvement after rehabilitation exercises and to evaluate its impactfor to develop daily life activities.Design. Observational and longitudinal study.Subjects. Patients with age range 20-65 who have consulted by pain to doctor.Setting. Urban health centre .Principal measurement. Pain profile and intensity by visual analogical score (VAS), analgesic consumption,physic state by Goldberg depression and anxiety score, cervical pain impact by Northwick Park Neck Questionnaire (NPQ) before and after two week following rehabilitation isometrics and isotonic exercises and social-demographic variables.Results. The average level in VAS (0-10 rang) has decreased from 4.5 ± 1.9 SD to 3.9 ± 2.4 SD(p=0.02). The beginning average level NPQ was 32.7 ± 17.5 SD and after 2 weeks, 25.1 ± 15.4 SD(p<0.001). The impact of rehabilitation exercises in daily activities (to sleep, to read, to fatten, to work,social relations, to drive, etc ) has been tested by reduction of NPQ level in 69.6 % of patients, ≥ 20 %in 14.3 % and ≥ 10 % in 39.3 %. The reduction was signifi cantly higher (p<0.005) in patients with lesspain evolution and continuous profi le, higher intensity of VAS and analgesic consumption.Conclusions. It has been showed a moderate impact in pain intensity and capability for to developdaily activities by rehabilitation exercises. There is a higher improvement in patients who suffer a moreintense, continue and with less evolution cervical pain