Buried intramedullary implants for paediatric forearm fractures. Does the refracture rate improve? / Implantes intramedulares enterrados para fracturas de antebrazo pediátricas. ¿Mejora la tasa de refracturas?

INTRODUCTION: Unstable forearm fractures may require surgical management by reduction and osteosynthesis with intramedullary needles. This fixation should be removed early if it has been left exposed, but this could increase the risk of refracture in a bone in the period of remodelling. As an alternative we can keep the needles, buried subcutaneously, for a longer time, to protect the bone callus. OBJECTIVE: To assess whether there are differences between using exposed needles with respect to burying them in paediatric patients with forearm fractures. Our hypothesis is that by burying the needles we keep them longer by reducing forearm refractures. MATERIAL AND METHODS: We present a cohort of 75 paediatric patients with a forearm fracture between 2010 and 2016. Demographic data, surgical technique, complications and patient follow-up were collected. RESULTS: The implants were left exposed in 50 patients and 25 buried. The average time of removal of the exposed implants was 6.8weeks and 17.6weeks in the buried ones. No significant differences were found in terms of consolidation (P=.19) or immobilization time (P=.22). Regarding refractures, a greater number was observed in the exposed osteosynthesis group (4patients) compared to only one case with buried osteosynthesis, but there were no significant differences (P=.49). No postsurgical complications were detected and the functionality was excellent at the end of the follow-up in both groups. CONCLUSION: Leaving implants buried in relation to skin exposed does not cause a decrease in the number of refractures or other complications, with adequate patient functionality in both cases.

[Double bilateral talocalcaneal and calcaneonavicular coalition in a 15 year-old patient: treatment and results]. / Doble coalición astragalocalcánea y calcaneoescafoidea bilateral en un paciente de 15 años: tratamiento y resultados.

BACKGROUND: We report the case of a male, 15 year-old patient without any remarkable pathologic history, with double talocalcaneal and calcaneonavicular coalition in both feet. He underwent surgery of the left foot due to onset of refractory symptoms after conservative treatment. RESULTS: Both coalitions were resected and pedal muscle was interposed at the level of the calcaneonavicular joint as well as an endorthesis in the tarsal sinus. The patient became totally asymptomatic after surgery. CONCLUSIONS: Multiple bilateral tarsal coalitions, i.e., present in both feet, are very infrequent, except when they are associated with syndromic pictures or conditions such as fibular hemimelus, Alpert syndrome, Nievergelt-Pearlman syndrome, multiple synostosis or hereditary symphalangism. Treatment should be individualized based on the location of the synostosis.

Implantes intramedulares enterrados para fracturas de antebrazo pediátricas. ¿Mejora la tasa de refracturas? / Buried intramedullary implants for paediatric forearm fractures. Does the refracture rate improve?

INTRODUCCIÓN: Las fracturas inestables de antebrazo pueden requerir un manejo quirúrgico mediante reducción y osteosíntesis con agujas intramedulares. Esta fijación debe retirarse precozmente si se ha dejado expuesta, pero esto podría aumentar el riesgo de refracturas sobre un hueso en periodo de remodelado. Como alternativa podemos mantener durante más tiempo las agujas, enterradas a nivel subcutáneo, para proteger el callo óseo. OBJETIVO: Valorar si hay diferencias entre utilizar agujas expuestas respecto a enterrarlas en pacientes pediátricos con fracturas de antebrazo. Nuestra hipótesis es que al enterrar las agujas las mantenemos más tiempo reduciendo las refracturas de antebrazo. MATERIAL Y MÉTODOS: Presentamos una cohorte de 75 pacientes pediátricos con fractura de antebrazo entre 2010 y 2016. Se recogieron datos demográficos, técnica quirúrgica, complicaciones y seguimiento del paciente. RESULTADOS: Los implantes se dejaron expuestos en 50 pacientes y 25 de forma enterrada. El tiempo medio de retirada de los implantes expuestos fue de 6,8 semanas, y de 17,6semanas en los enterrados. No se hallaron diferencias significativas en cuanto a consolidación (p = 0,19) ni en tiempo de inmovilización (p = 0,22). Respecto a las refracturas, se observa un mayor número en el grupo de la osteosíntesis expuesta (4pacientes) respecto a solo un caso con osteosíntesis enterrada, pero sin llegar a presentar diferencias significativas (p = 0,49). No se detectaron complicaciones posquirúrgicas y la funcionalidad fue excelente al final del seguimiento en ambos grupos. CONCLUSIÓN: Dejar los implantes enterrados respecto a expuestos a piel no condiciona una disminución en el número de refracturas ni otras complicaciones, con una adecuada funcionalidad del paciente en ambos casos

INTRODUCTION: Unstable forearm fractures may require surgical management by reduction and osteosynthesis with intramedullary needles. This fixation should be removed early if it has been left exposed, but this could increase the risk of refracture in a bone in the period of remodelling. As an alternative we can keep the needles, buried subcutaneously, for a longer time, to protect the bone callus. OBJECTIVE: To assess whether there are differences between using exposed needles with respect to burying them in paediatric patients with forearm fractures. Our hypothesis is that by burying the needles we keep them longer by reducing forearm refractures. MATERIAL AND METHODS: We present a cohort of 75 paediatric patients with a forearm fracture between 2010 and 2016. Demographic data, surgical technique, complications and patient follow-up were collected. RESULTS: The implants were left exposed in 50 patients and 25 buried. The average time of removal of the exposed implants was 6.8 weeks and 17.6weeks in the buried ones. No significant differences were found in terms of consolidation (P=.19) or immobilization time (P=.22). Regarding refractures, a greater number was observed in the exposed osteosynthesis group (4patients) compared to only one case with buried osteosynthesis, but there were no significant differences (P=.49). No postsurgical complications were detected and the functionality was excellent at the end of the follow-up in both groups. CONCLUSION: Leaving implants buried in relation to skin exposed does not cause a decrease in the number of refractures or other complications, with adequate patient functionality in both cases

Resultados del tratamiento quirúrgico de la deformidad de Sprengel mediante la técnica de Woodward / Results of surgical treatment of Sprengel deformity using the Woodward technique

Se realiza un estudio retrospectivo de los resultados clínicos y radiológicos de 6 pacientes afectos de escápula elevada congénita (deformidad de Sprengel) tras el tratamiento quirúrgico de los mismos empleando la técnica de Woodward. El nivel medio de elevación prequirúrgica del borde inferior de la escápula respecto a la contralateral fue de 3,3 cm, mientras que el déficit medio de abducción fue de 45°. Con un seguimiento medio de 6 años la elevación del borde inferior escapular había pasado a 1,4 cm y la ganancia media de abducción había mejorado 30° respecto a los valores prequirúrgicos. En 2 casos se realizó una osteotomía clavicular para evitar una posible lesión del plexo braquial al descender la escápula. Debido a la hipoplasia escapular asociada, con una disminución en la longitud vertical, no se debe intentar durante la cirugía llevar el ángulo inferior escapular al mismo nivel del contralateral (AU)