Topographic and morphometric features of the nutrient foramina of the fibula in the South African mixed-ancestry population group and their surgical relevance

Nutrient foramina are canals that convey nutrient arteries and nerves into the diaphysis of long bones to supply the medullary cavity. The aim of the present study was to investigate the direction, number, location and position of nutrient foramina on the shafts of the fibulae. 201 dry fibulae of adult 20th-century mixed-ancestry South Africans were macroscopically examined for direction, number, location and position of the nutrient foramina. For each bone, a Foraminal Index was calculated giving the position of the nutrient foramina in relation to the bone length. Most of the fibulae (87.1%) had their nutrient foramina directed towards the ankle joint, while few (5.5%) had their nutrient foramina directed towards the knee joint. A single nutrient foramen (90.0%) was most frequent, and also the posterior surfaces of the shafts of the fibulae harbored the majority (50.6%) of the nutrient foramina. A rare location of the nutrient foramina was identified on the interosseous borders (22.2%) of the fibulae in this population. Nutrient foramina were positioned mainly on the middle third (1/3) of the shafts of the fibulae with the Foraminal Index ranging between 33.02-75.57% and a mean of 42.46±14.42%. In conclusion, the middle segment of the shafts of the fibulae of the mixed-ancestry South African population was the most common site for nutrient foramina, and thus makes it ideal for harvesting long portions of free vascularised cortical bone grafts for treatment of massive bone loss and fractures

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Morphometric studies of the nutrient foramen in lower limb long bones of adult black and white South Africans

The present study analyzed the direction, number, location and position of the nutrient foramina in 1080 lower limb long bones of 20th century adult black and white South Africans. In each population 90 complete skeletons were used resulting in 360 femora, 360 tibiae and 360 fibulae being analyzed. The majority of the nutrient foramina pointed away from the growing end of the diaphysis in the lower limb bones with a few pointing in the opposite direction in both black and white populations. A single nutrient foramen was common on the shafts of the tibia and fibula in both populations, while, in the femur, double nutrient foramina were most frequent in the white population as opposed to one in the black counterparts. Nutrient foramina were located most frequently on the linea aspera of the femur and the posterior surface of both the tibia and the fibula in both black and white populations. The mean foraminal indices were as follows: in the black population, 41.87% for the femur, 31.66% for the tibia and 43.33% for the fibula, and in the white population, 44.58% for the femur, 33.15% for the tibia and 46.86% for the fibula. These foraminal indices represent the relative positions of the nutrient foramina on the shaft of the bone. The information about direction, number, location and position of the nutrient foramina is important clinically during free vascularized bone grafting to preserve the blood supply of the graft, during fracture repair, joint replacement surgeries, and also in medico-legal cases

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¿Son realmente infrecuentes las fracturas de hueso largo en menores de 2 años? / Are long bone fractures really rare in children younger than 2 years?

Introducción. Las fracturas son habituales entre las lesiones no intencionadas en la infancia, pero se cree que son poco frecuentes en lactantes. Objetivo. Determinar la frecuencia diagnóstica y las características de las fracturas producidas en niños menores de 2 años. Método. Estudio retrospectivo de las consultas de niños menores de 2 años diagnosticados de fractura de hueso largo en urgencias. Resultados. Se incluyen 258 consultas (prevalencia 0,2%), el 25,2% de niños menores de 1 año. Se diagnosticaron 293 fracturas (35 niños presentaban dos). El hueso más fracturado fue el radio (en menores de 1 año, el fémur), siendo en rodete el tipo más habitual. En 196 consultas (76%) se especifica la causa; las más frecuentes, caídas y golpes. El 15,1% de pacientes precisaron ingreso. Conclusiones. Las fracturas de hueso largo, aunque poco frecuentes en lactantes, presentan una morbilidad elevada. Es importante una anamnesis exhaustiva para esclarecer la causa y poder aplicar medidas preventivas (AU)

Introduction. Fractures are frequent events among the unintentional injuries of childhood; however, it is also believed that they are rare in preschool children. Objective. To determine the diagnostic frequency and the characteristics of fractures in children under two years of age. Method. Retrospective study of all children younger than two years diagnosed with a long bone fracture in the emergency department of a tertiary center during a 3-year period. Results. A total of 258 encounters (prevalence 0.2%) where a fracture was documented in a young child were included for the study; 25.2% of the children were younger than one year. 293 fractures were diagnosed (with 35 patients having two). The most frequent fractured bone was the radius (in less than one year olds was the femur), with the buckle fracture being the most common type. In 196 of the visits (76%) the cause was documented; the most common were falls and trauma. An admission was required in 15.1% of the patients. Comments. Long bone fractures, although uncommon in young children, have high morbidity rates. A thorough clinical history is important to establish the cause of the injury and to apply preventive measures (AU)

Síndrome de embolia grasa tras fractura ósea / Fat embolism syndrome after bone fractures

Objetivos. Revisar la incidencia, las características clínicas, diagnósticas y terapéuticas, así como la mortalidad del síndrome de embolia grasa (SEG) en la última década. Pacientes y métodos. Estudio retrospectivo y descriptivo de los pacientes diagnosticados de SEG postraumático entre enero de 2001 y diciembre de 2011 en un solo centro. Resultados. Se evalúan 19 pacientes, 16 varones y 3 mujeres, con edad media de 27 años. Todos presentaban fracturas de huesos largos como consecuencia de un politraumatismo, múltiple en el 78,9%. La clínica respiratoria fue la más frecuente (89,5%), seguida de la neurológica (68,4%) y del exantema petequial (63,2%). El tiempo medio de presentación desde el ingreso fue de 42h. En todos se realizó estabilización precoz de la fractura previa al episodio embólico. En ningún caso se utilizaron corticoides profilácticos. El tratamiento quirúrgico definitivo tuvo una demora media de 7 días y la estancia media hospitalaria fue de 34 días. La incidencia de SEG fue de 0,14% y la mortalidad del 10,5%. Conclusiones. El SEG postraumático afectó fundamentalmente a pacientes jóvenes, politraumatizados, con fracturas de huesos largos. Presentaron manifestaciones de la tríada clínica clásica (respiratorias, neurológicas, exantema), tras un periodo asintomático inicial de menos de 2 días. Su incidencia global fue baja(AU)

Objectives. To review the incidence, clinical features, diagnosis, therapy and mortality rates of fat embolism syndrome (FES) in a tertiary referral hospital in the last decade. Patients and methods. Retrospective and descriptive study of patients diagnosed with post-traumatic FES between january 2001 and december 2011. Results. A total of 19 patients, 16 men and 3 women, with an average age of 27 years were evaluated. All had long bone fractures, multiple in 78.9%, as a result of multiple injuries. Respiratory symptoms were the most frequent (89.5%), followed by neurological symptoms (68.4%) and petechial rash (63.2%). The average time of presentation of the syndrome after admission was 42 hours. All patients underwent early stabilisation of the fracture prior to the embolic event. Steroids prophylaxis was not used in any of the cases. Definitive surgical treatment had mean delay of 7 days. The mean hospital stay was 34 days. The overall incidence of FES was 0.14%, and mortality was 10.5%. Conclusions. Post-traumatic FES mainly affected young patients with multiple injuries and long bone fractures. They all had symptoms of the classic clinical triad (respiratory, neurological, rash) after an initial asymptomatic period of less than 2 days. The overall incidence was low(AU)

Reconstrucción vascular durante cirugía conservadora de la extremidad en el tratamiento de sarcomas del miembro inferior / Vascular reconstruction during limb preserving surgery in the treatment of lower limb sarcoma: A report on four cases

Objetivo: Exposición de la experiencia de este centro en reparación quirúrgica de vasos mayores durante la cirugía de resección de tumores en la extremidad inferior y la pelvis. Material y método: Se presentan 4 casos consecutivos de cirugías de resección tumoral del miembro inferior asociadas a reconstrucción vascular de vasos mayores en el mismo acto quirúrgico en tumores del aparato locomotor realizadas en el hospital entre 1990 y 2009. Se analizan el tipo tumoral, la reconstrucción vascular y las complicaciones inmediatas y a largo plazo que presentaron. Resultados: Se estudió un sarcoma de Ewing de pelvis, un condrosarcoma de pelvis, un sarcoma parostal de fémur distal y un schwannoma atípico de muslo. En 2 casos la reparación se realizó por lesión vascular intraoperatoria. En los otros 2 casos se realizó una resección vascular por no haber plano de disección entre el tumor y los vasos. Se logró conservar la extremidad en 3 de los 4 casos (AU)

Purpose: To report on the experience acquired by our center in the field of surgical repair of the great vessels during tumor resection surgery in the lower limb and the pelvis. Materials and Methods: We present 4 consecutive cases of lower limb musculoskeletal tumor resection surgery associated to great vessel reconstruction performed in the same surgical procedure. The procedures were performed in our hospital between 1990 and 2009. We analyzed tumor type, technique for vascular reconstruction and immediate and long-term complications. Results: We studied a Ewing sarcoma of the pelvis; a pelvic chondrosarcoma, a parosteal distal femur sarcoma and an atypical thigh schwannoma. In two cases, repair was achieved through an intraoperative vascular lesion. In the other two cases, a vascular resection was carried out owing to the inexistence of a dissection plane between the tumor and the vessels. Limb preservation was achieves in three of the four cases (AU)