RESUMO
We report the results of the treatment of nine children with an aneurysmal bone cyst of the distal fibula (seven cysts were juxtaphyseal, and two metaphyseal). The mean age of the children was 10 years and 3 months (7 years and 4 months to 12 years and 9 months). All had open physes. All cysts were active and in seven cases substituted and expanded the entire width of the bone (type-2 lesions). The mean longitudinal extension was 5.7 cm (3 to 10). The presenting symptoms were pain, swelling and pathological fracture. Moderate fibular shortening was evident in one patient. In six patients curettage was performed, using phenol as adjuvant in three. Three with juxtaphyseal lesions underwent resection. A graft from the contralateral fibula (one case) and allografts (two cases) were positioned at the edge of the physis for reconstruction. The mean follow-up was 11.6 years (3.1 to 27.5). There was no recurrence. At the final follow-up there was no significant difference in the American Orthopaedic Foot and Ankle Society scores (excellent/good in all cases) and in growth disturbance, alignment, stability and bone reconstitution, but in the resection group the number of operations, including removal of hardware, complications (two minor) and time of immobilisation/orthosis, were increased. Movement of the ankle was restricted in one patient. The potential risks in the management of these lesions include recurrence, physeal injury, instability of the ankle and hardware and graft complications. Although resection is effective it should be reserved for aggressive or recurrent juxtaphyseal lesions.
Assuntos
Cistos Ósseos Aneurismáticos/cirurgia , Curetagem , Fíbula/cirurgia , Cistos Ósseos Aneurismáticos/diagnóstico por imagem , Criança , Feminino , Fíbula/diagnóstico por imagem , Humanos , Masculino , Radiografia , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
The authors present the case of a sister and a brother who came to our observation at different times and both affected with Pyle's disease with marked valgus of the knee. The clinical cases reported demonstrate how in Pyle's disease with significant valgus of the knee temporary asymmetrical tibial epiphysiodesis was able to correct the deformity, not only by provoking the momentary arrest of growth in the growth cartilage on the internal tibial aspect, but also by allowing for bone remodeling in the tibial metaphysis.
Assuntos
Doenças do Desenvolvimento Ósseo , Adolescente , Doenças do Desenvolvimento Ósseo/diagnóstico , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Doenças do Desenvolvimento Ósseo/cirurgia , Remodelação Óssea , Criança , Epífises/diagnóstico por imagem , Epífises/cirurgia , Feminino , Fêmur/diagnóstico por imagem , Seguimentos , Humanos , Articulação do Joelho/anormalidades , Articulação do Joelho/diagnóstico por imagem , Masculino , Radiografia , Tíbia/cirurgia , Fatores de Tempo , Resultado do TratamentoRESUMO
It is the purpose of this paper to present the case of a patient who came to our observation because of the occurrence of non-elastic hardening of the skin (stone hard skin) and of the subcutaneous tissue that began during early childhood. The parents reported having observed the gradual functional limitation of numerous joints with asymmetrical distribution, more evident in the elbow and the right scapulohumeral joint. There were no signs of involvement of the internal organs; hematologic testing was normal. Described for the first time in 1971 by Esterly nd McKusik and called stiff skin syndrome (SSS), this is a rare genetic alteration characterized by hardening of the skin and subcutaneous tissue associated with gradual joint stiffness and, at times, hirsutism. Generally, there are no modifications in the internal organs or in the musculoskeletal structures; anomalies of the immune system are not described. Modifications are manifested during early childhood causing gradual functional limitation of the hips and knees, with consequent difficulty related to posture and walking. Deficit in the upper limbs is less important. The literature describes about 25 cases with little incidence of familiarity; etiopathogenesis is unknown.
Assuntos
Escleroderma Sistêmico/diagnóstico , Pele/patologia , Adolescente , Biópsia , Humanos , Masculino , Escleroderma Sistêmico/genética , Escleroderma Sistêmico/patologia , Escleroderma Sistêmico/terapia , SíndromeRESUMO
The authors report the case of a patient aged 10 years with late diagnosis of osteoid osteoma localized in the right pedicle of L1 due to a paucisymptomatic and aspecific clinical onset, characterized only by the occurrence of left-convex wide-range scoliosis that was completely solved after surgical excision of the neoformation.
Assuntos
Vértebras Lombares , Osteoma Osteoide , Neoplasias da Coluna Vertebral , Criança , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Osteoma Osteoide/diagnóstico , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/cirurgia , Modalidades de Fisioterapia , Cuidados Pós-Operatórios , Cintilografia , Escoliose/diagnóstico , Escoliose/etiologia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
The authors describe a case of lumbar vertebral osteoid osteoma localized in the body of L5 characterized by a very subtle clinical onset (limping as a result of poor positioning of the hip), and by a clinical course where pain was totally absent.
Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Osteoma Osteoide/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Criança , Humanos , Locomoção , Vértebras Lombares/cirurgia , Masculino , Osteoma Osteoide/cirurgia , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The authors successfully used an external fixator in 10 children affected by one of the following pathologies: fracture of the femur with poor consolidation and marked shortening of the limb; fracture in a hypoplastic segment; severe multiple trauma; delay in consolidation of pathologic bone; fracture in bone regeneration. On the basis of the results obtained, it is affirmed that the external fixator is the ideal means of osteosynthesis for use in any of the above-described situations.
Assuntos
Fixadores Externos , Fraturas do Fêmur/cirurgia , Fraturas Fechadas/cirurgia , Adolescente , Fatores Etários , Alongamento Ósseo , Regeneração Óssea , Criança , Pré-Escolar , Feminino , Fraturas do Fêmur/complicações , Seguimentos , Fraturas Fechadas/complicações , Humanos , Desigualdade de Membros Inferiores/etiologia , Desigualdade de Membros Inferiores/cirurgia , Masculino , Fatores de TempoRESUMO
Isolated fracture or detachment of the lesser trochanter is an infrequent occurrence. In most cases the event is part of a complex of fractures involving the femoral neck and the greater trochanter. Isolated fracture caused by direct trauma is rare because of the anatomical location of the lesser trochanter which is protected anteriorly and posteriorly by large muscular masses, superiorly by the head and the neck of the femur, laterally by the femur itself, and medially by the ilio- and ischio-public branches of the pelvis. Trauma is usually indirect, caused by sudden traction by the iliopsoas muscle on the femoral tendinous insertion. The highest frequency is observed in young patients who are still growing where there is an imbalance between muscular strength and resistance of the osteochondral plate of the tendinous insertion. Particularly affected are adolescent athletes of male sex aged from 13 to 17 years. Similar overloading of traction in an adult would probably produce only muscular stretching. Diagnosis is based on radiographic ascertainment, obtained with the thigh in extra-rotation, supported by rather typical clinical findings such as acute pain in the inguinal region and in Scarpa's triangle, limping, passive movement of the hip in all directions with pain in maximum extension and relief when seated. Nonsurgical treatment with the limb resting in flexion, further confirmed by the case presented in this study, still remains the treatment of choice in most cases, obtaining excellent functional results. The authors believe that it was of interest to report this clinical case because of the rareness of the pathology observed and because of the specific features of its etiology.
Assuntos
Ciclismo/lesões , Fraturas do Quadril/etiologia , Adolescente , Moldes Cirúrgicos , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/terapia , Humanos , MasculinoRESUMO
Ollier's disease is a chondromatosis of the long bones that occurs rarely but that is highly disabling because it causes severe dysmetria and deformity of the lower limbs. Surgical correction of these skeletal changes is obstructed by poor mechanical resistance of the bone tissue affected and by the amount of lengthening required to even the lower limbs. It is the purpose of this study to indicate the surgery of choice for the treatment of this disease, comparing the two most recent methods used: Wagner's technique and the Ilizarov method. The latter is more reliable in terms of mechanical hold and the possibility of correcting severe deformities, producing bone regenerate of excellent quality even in major lengthening procedures. These results were obtained by adapting the Ilizarov method to the features of the chondromatous bone, thanks to the extreme malleability of the circular external fixator.
Assuntos
Alongamento Ósseo/métodos , Encondromatose/cirurgia , Técnica de Ilizarov , Desigualdade de Membros Inferiores/cirurgia , Alongamento Ósseo/instrumentação , Regeneração Óssea , Encondromatose/diagnóstico por imagem , Estudos de Avaliação como Assunto , Seguimentos , Humanos , Desigualdade de Membros Inferiores/diagnóstico por imagem , Radiografia , Fatores de TempoRESUMO
The authors take into consideration the different phases of the treatment of congenital hip dysplasia (CHD) as it is related to age and natural development. Within the first year of age three objectives must be aimed at: reduction of the epiphysis, its retention and immobilization, maturation of the hip. After three years of age, once the epiphysis has been reduced, reconstructive and stabilizing surgery must be performed (acetabuloplasty and femoral osteotomy) in order to correct the modified joint parameters. After ten years of age and until the end of growth the degree of dysplasia influences treatment, as intervention is justified (preferably with biological reconstruction of the acetabulum) in forms of severe dysplasia caused by the definite occurrence of pain at an early age. We emphasize the importance of adapting treatment to the specific phase of evolution of the hip understood to be dynamic reality.
Assuntos
Luxação Congênita de Quadril/cirurgia , Fatores Etários , Criança , Pré-Escolar , Feminino , Luxação Congênita de Quadril/diagnóstico por imagem , Humanos , Lactente , Osteotomia , RadiografiaRESUMO
A total of 8 cases affected with injection-induced contractures of the quadriceps occurring in 7 patients were followed-up at the Division of Pediatric Orthopaedics at the Rizzoli Orthopaedic Institute. Mean age was 8 years (minimum 5, maximum 9). Surgery involved arthromyolysis according to Judet whether or not associated with distal reconstruction of the quadriceps. Mean follow-up was 9 years (3-17). Mean increase in passive flexion of the knee was 70 degrees, while deficit in active extension was observed in 50% of cases. The clinical aspects indispensable for diagnosis, the therapeutic choices, the surgical method reported in the literature and the results obtained using this method are all discussed.
Assuntos
Contratura/cirurgia , Injeções/efeitos adversos , Criança , Pré-Escolar , Contratura/etiologia , Feminino , Seguimentos , Humanos , Masculino , Coxa da PernaRESUMO
The authors describe a rare form of pseudotumor of the muscle tissue of an inflammatory nature with an unknown etiology that occurred in a boy aged 13 years, characterized by the occurrence of rapidly-developing swelling, no pain symptoms, with degeneration of the myofibers, evident eosinophilia and lymphomonoplasmacellular infiltrate. Surgical excision of the lesion is the treatment of choice.
Assuntos
Miosite , Adolescente , Humanos , Masculino , Miosite/diagnóstico , Miosite/cirurgiaRESUMO
The authors describe a clinical case of a patient affected with Lowe syndrome. Ocular modifications, as well as those involving the nervous system, renal function, and the locomotor apparatus, typical of the syndrome, are taken into consideration. The problem of axial deformity of the knee, secondary to spontaneous fracture of the femur, a frequent occurrence in these patients, is dealt with.
Assuntos
Síndrome Oculocerebrorrenal , Criança , Feminino , HumanosRESUMO
A total of 69 cases (73 hips) of the sequelae of septic osteoarthritis of the hip are studied. The sequelae are classified based on whether or not the femoral epiphysis is present, and on stability of the joint according to Hunka (1982). Three of the hips were treated non-surgically. All of the others were submitted to from a minimum of 2 to maximum of 5 operations with the purpose of re-establishing joint relationships. The results were: good: 50 hips (72.5%); fair 12 (17.4%); poor: 11 (16%). The most significant sequelae were hip instability, joint function limitation, and shortening of the limb.
Assuntos
Artrite Infecciosa/cirurgia , Osteoartrite do Quadril/cirurgia , Artrite Infecciosa/classificação , Artrite Infecciosa/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Seguimentos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Osteoartrite do Quadril/classificação , Osteoartrite do Quadril/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Radiografia , Reoperação/estatística & dados numéricosRESUMO
The authors describe 17 patients submitted to trochanteric arthroplasty between 1979 and 1999 at the Division of Pediatric Orthopaedics and Traumatology of the Rizzoli Orthopaedic Institute. There were 9 females and 8 males aged from 1 to 8 years (mean of 4) affected with the sequelae of septic arthritis of the hip with complete destruction of the epiphysis and of the femoral neck (types IVB and V according to the Hunka classification system). Mean follow-up was 9 years (minimum 1, maximum 23). Surgery is described and indications are discussed: this is the only type of treatment that may be offered in place of conservative treatment.
Assuntos
Osteoartrite do Quadril/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Osteoartrite do Quadril/microbiologiaRESUMO
A knowledge of the morphology of the cruciate ligaments in congenital hypoplasias of the lower limb, susceptible to treatment to even the length discrepancy, is of practical importance in the prevention of subdislocation and dislocation of the knee during the distraction phase of femoral and/or tibial lengthening. The authors report their experience with 20 arthroscopies diagnosed in 20 children affected with congenital hypoplasia of the lower limb (shoft congenital femur, longitudinal peroneal hemimelia) performed prior to assembling the Ilizarov external fixator for femoral and/or tibial lengthening. None of the patients had congenital dislocation of the knee or knee with recurvation. In the patients in our study, it is possible to demonstrate that the anatomical cause of instability of the knee in congenital hypoplasias of the lower limb may be constituted by aplasia of one or both cruciate ligaments.
Assuntos
Artroscopia , Fêmur , Articulação do Joelho/anormalidades , Articulação do Joelho/patologia , Tíbia , Doenças Ósseas/complicações , Doenças Ósseas/congênito , Criança , Pré-Escolar , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Dislocation of the elbow in children is considered to be a benign injury in most cases. The aim of this paper is to evaluate whether this condition has late sequelae in the adult age. The study consisted of a retrospective evaluation of patients under 15 years old at the time of injury. METHODS: 40 patients were selected for the follow-up evaluation. The mean age of the children at the time of injury was 10.9 years old (range 5-14 years). Four patients were lost to follow-up, so they were not considered for final clinical evaluation. For the other 36 patients, the follow-up examination was undertaken after an average of 15 years (range 7-22 years). The average age of the patients at the follow-up was 26 (range 18-34 years). RESULTS: At the end of follow-up period, there were few subjective complications. No redislocations occurred. None of the patients had been influenced by their elbow injury in their choice of occupation. X-rays were available for 27 patients. These were graded using Linscheid and Wheeler criteria and were excellent in 14 patients, good in 10 and fair in 3. CONCLUSIONS: Dislocation of the elbow in children is a benign injury in the majority of cases and has a good prognosis in the adult age too in spite of extensive damage to the periarticular structures. Ectopic ossifications are a common finding, but only large periarticular ectopic ossifications were associated with a decrease in range on motion. Extension loss is the most common sequelae. Level of evidence IV.
Assuntos
Lesões no Cotovelo , Luxações Articulares/complicações , Adolescente , Criança , Pré-Escolar , Cotovelo , Seguimentos , Humanos , Prognóstico , Estudos Retrospectivos , Fatores de TempoRESUMO
The outcome of 56 children (61 shoulders) treated surgically at the Rizzoli Institute between April 1975 and June 2010 for congenital elevation of the scapula is reported. There were 31 girls and 25 boys with a mean age at surgery of 6.4 years (2 to 15). The deformity involved the right shoulder in 20 cases, the left in 31 and was bilateral in five. The degree of the deformity was graded clinically and radiologically according to the classifications of Cavendish and Rigault, respectively. All patients underwent a modified Green procedure combined, in selected cases, with resection of the superomedial portion of the scapula and excision of any omovertebral connection. After a mean follow-up of 10.9 years (1 to 29.3), there was cosmetic improvement by at least one Cavendish grade in 54 shoulders (88.5%). The mean abduction of the shoulder improved from 92° (50° to 155°) to 112° (90° to 170°) and the mean flexion improved from 121° (80° to 160°) to 155° (120° to 175°). The unsatisfactory cosmetic result in seven shoulders was due to coexistent scoliosis in two cases and insufficient reduction of the scapular elevation in the other five. An incomplete upper brachial plexus palsy occurred post-operatively in three patients but resolved within seven months. We suggest that a modified Green procedure combined with resection of the superomedial portion of the scapula provides good cosmetic and functional results in patients with Sprengel's shoulder.
Assuntos
Escápula/anormalidades , Articulação do Ombro/anormalidades , Anormalidades Múltiplas/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Radiografia , Amplitude de Movimento Articular/fisiologia , Escápula/diagnóstico por imagem , Escápula/cirurgia , Índice de Gravidade de Doença , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Resultado do TratamentoRESUMO
A total of 38 relapsed congenital clubfeet (16 stiff, 22 partially correctable) underwent revision of soft-tissue surgery, with or without a bony procedure, and transfer of the tendon of tibialis anterior at a mean age of 4.8 years (2.0 to 10.1). The tendon was transferred to the third cuneiform in five cases, to the base of the third metatarsal in ten and to the base of the fourth in 23. The patients were reviewed at a mean follow-up of 24.8 years (10.8 to 35.6). A total of 11 feet were regarded as failures (one a tendon failure, five with a subtalar fusion due to over-correction, and five with a triple arthrodesis due to under-correction or relapse). In the remaining feet the clinical outcome was excellent or good in 20 and fair or poor in seven. The mean Laaveg-Ponseti score was 81.6 of 100 points (52 to 92). Stiffness was mild in four feet and moderate or severe in 23. Comparison between the post-operative and follow-up radiographs showed statistically significant variations of the talo-first metatarsal angle towards abduction. Variations of the talocalcaneal angles and of the overlap ratio were not significant. Extensive surgery for relapsed clubfoot has a high rate of poor long-term results. The addition of transfer of the tendon of tibialis anterior can restore balance and may provide some improvement of forefoot adduction. However, it has a considerable complication rate, including failure of transfer, over-correction, and weakening of dorsiflexion. The procedure should be reserved for those limited cases in which muscle imbalance is a causative or contributing factor.