RESUMEN
A 14-year-old boy was admitted to the hospital after an episode of blunt trauma to the thorax, resulting in a Chance fracture of L1 and a compressive chylothorax 72h after admission. After initial drainage in the operating room, conservative management was successful. This case study documents one of the rare complications of spinal fractures in the context of high-energy blunt trauma. It is the first detailing a noniatrogenic post-traumatic compressive chylothorax in pediatrics responding positively to conservative management. Drainage should be considered the first-line procedure for both therapeutic and diagnostic purposes. Surgery is required if the leakage is still present after parenteral feeding and the implementation of a fat-free diet for 5-7 days.
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Quilotórax/etiología , Fracturas por Compresión/complicaciones , Fracturas de la Columna Vertebral/complicaciones , Traumatismos Torácicos/complicaciones , Heridas no Penetrantes/complicaciones , Accidentes por Caídas , Adolescente , Quilotórax/diagnóstico por imagen , Drenaje , Humanos , Vértebras Lumbares/lesiones , Masculino , Tomografía Computarizada por Rayos XRESUMEN
AIM: Published studies have suggested that two to five days of intravenous treatment could effectively treat paediatric bone and joint infections (PBJI), allowing a faster discharge. This study analysed the factors associated with PBJI hospital stays lasting longer than five days using the French National Hospital Discharge Database. METHODS: We selected children under 15 years hospitalised in 2013 with haematogenous PBJIs using a validated French algorithm based on specific diagnosis and surgical procedure codes. Risk factors for stays of more than five days were analysed using logistic regression. RESULTS: In 2013, 2717 children were hospitalised for PBJI, with 49% staying more than five days. The overall incidence of 22 per 100 000, was highest in males and toddlers. The main causes were septic arthritis (50%) and osteomyelitis (46%) and 50% of the pathogens were Staphylococci. The odd ratios for stays of five days or more were infancy, coded bacteria and sickle cell disease (7.0), having spondylodiscitis rather than septic arthritis (2.2) and being hospitalised in a general hospital rather than a teaching hospital (1.6). CONCLUSION: Half of the hospital stays exceeded five days, despite scientific evidence supporting a shorter intravenous antibiotherapy regimen. Greater knowledge and widespread use of short treatment regimens are needed.
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Antibacterianos/administración & dosificación , Artritis Infecciosa/epidemiología , Enfermedades Óseas Infecciosas/epidemiología , Tiempo de Internación , Administración Intravenosa , Adolescente , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/microbiología , Artritis Infecciosa/cirugía , Enfermedades Óseas Infecciosas/tratamiento farmacológico , Enfermedades Óseas Infecciosas/microbiología , Enfermedades Óseas Infecciosas/cirugía , Niño , Preescolar , Estudios Transversales , Femenino , Francia/epidemiología , Humanos , Lactante , MasculinoRESUMEN
BACKGROUND: Few published data are available on long-term outcomes of anterior spinal fusion for adolescent idiopathic scoliosis (AIS). The objective of this single-centre retrospective study was to assess clinical and radiological outcomes of one-stage anterior spinal fusion achieved using precontoured titanium anterior screw-plates. HYPOTHESIS: Our hypothesis was that anterior instrumentation produced both good functional outcomes and good correction in the coronal and sagittal planes. MATERIAL AND METHODS: This procedure was performed in 111 patients between 1975 and 1993. Among them, those who underwent a comprehensive evaluation at least 15 years later were included. The SRS-30 questionnaire and Oswestry Disability Index (ODI) were used to assess functional outcomes. Radiographic outcomes were evaluated on antero-posterior and lateral full-spine radiographs obtained pre-operatively, post-operatively, and at last follow-up. RESULTS: The study included 35 patients, who were re-evaluated after a mean of 21 years (15-31 years). Mean pre-operative Cobb's angle was 44°, mean age at surgery was 14.7 years, mean SRS-30 score was 3.65/5, and mean ODI was 14.9%. At last follow-up, mean Cobb's angle was 14.7° and 25 patients exhibited coronal misalignment with a mean deviation of 12mm. In the sagittal plane, the mean sagittal vertical axis (SVA) measured using the C7 plumb line was -28mm, with 8mm of anterior translation compared to the post-operative value (36mm). The functional outcome assessed using the SRS-30 score correlated significantly with pelvic tilt and anterior SVA translation. CONCLUSION: Anterior spinal fusion produces good long-term functional outcomes in AIS. Correction is both satisfactory and sustained. Anterior SVA translation over time may be associated with better functional outcomes. LEVEL OF EVIDENCE: IV (retrospective study).
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Placas Óseas , Tornillos Óseos , Escoliosis/cirugía , Fusión Vertebral/instrumentación , Adolescente , Adulto , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Escoliosis/diagnóstico por imagen , Fusión Vertebral/métodos , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Surgical treatment of early-onset scoliosis has greatly developed in recent years. Early-onset scoliosis covers a variety of etiologies (idiopathic, neurologic, dystrophic, malformative, etc.) with onset before the age of 5 years. Progression and severity threaten respiratory development and may result in respiratory failure in adulthood. Many surgical techniques have been developed in recent years, aiming to protect spinal and thoracic development. MATERIAL AND METHODS: Present techniques are based on one of two main principles. The first consists in posterior distraction of the spine in its concavity (single growing rod, or vertical expandable prosthetic titanium rib [VEPTR]), or on either side (dual rod); this requires iterative surgery, for lengthening, unless motorized using energy provided by a magnetic system. The second option is to use spinal growth force to lengthen the assembly; these techniques (Luque Trolley, Shilla), using a sliding assembly, are known as growth guidance. RESULTS: These techniques are effective in controlling early scoliotic deformity, and to some extent restore spinal growth. However, they show a high rate of complications: infection, rod breakage, spinal fixation pull out and, above all, progressive spinal stiffness, reducing long-term efficacy. Respiratory gain is harder to assess, as thoracic expansion does not systematically improve respiratory function, particularly due to impaired compliance of the thoracic cage.
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Escoliosis/cirugía , Fusión Vertebral/instrumentación , Edad de Inicio , Diseño de Equipo , HumanosRESUMEN
INTRODUCTION: In haemophiliacs, recurrent hemarthrosis and chronic synovitis lead to chronic arthropathy. Synovectomy is indicated when medical treatment fails. Few studies report the results of open synovectomy of the ankle in haemophiliacs with a small number of procedures and also a limited follow-up. AIM: The aim of this paper is to report the long-term results of open surgical synovectomy of the tibio-talar joint. METHODS: Thirty-two open synovectomies were performed in 21 young haemophiliacs in the same haemophilia center using an antero-lateral and postero-medial approaches. The median follow-up was 15.4 years. Clinical (Petrini scores) and radiological evaluations (Pettersson scores) were made preoperatively and at each multidisciplinary follow-up visit. Wilcoxon and Spearman's tests were used for the statistical analysis. RESULTS: Preoperative median Petrini score was 6 (range 3-12), and improved at 2 and 5 years follow-up (P = 0.0003 and P = 0.0001 respectively). At 10 and 15 years follow-ups, median score remained below preoperative score (median 3.5, range 0-11). Ten ankles had a follow-up of more than 20 years. Preoperative median Petterson score presented a slight but continuous worsening in the first 2 and 5 years of follow-ups (P = 0.02, P = 0.003), but not correlation between clinical and radiological results was observed. CONCLUSION: Our long-term results support that clinical scores are improved even if radiological scores progress. Open synovectomy retards the progression of the arthropathy, but not stops it. Bleeding and pain are controlled and even if recurrence of bleedings is frequent, it is less severe, less painful and requiring less factors replacement.
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Articulación del Tobillo/cirugía , Hemartrosis/cirugía , Hemofilia A/complicaciones , Hemofilia B/complicaciones , Adolescente , Articulación del Tobillo/diagnóstico por imagen , Niño , Preescolar , Estudios de Seguimiento , Hemartrosis/complicaciones , Hemartrosis/patología , Humanos , Masculino , Radiografía , Estudios RetrospectivosRESUMEN
INTRODUCTION: Solid aneurysmal bone cyst (S-ABC) is a variant of aneurysmal bone cyst (ABC), an uncommon benign bone tumor. There are few cases described in the cervical spine in kids up today. We treated a recurrent case with neurological involvement that needed multiple surgical procedures and radiotherapy. CASE PRESENTATION: We report a case of C4 located S-ABC concerning a 2-year-old boy treated surgically by anterior and posterior approach. Three months after the initial procedure appearance of a tetraparesis led to diagnose a local recurrence treated by sclerotherapy and a second surgery. The patient had a full neurological recovery. Three months later, a follow-up CT scan showed a second recurrence requiring a new surgical revision by anterior approach and radiotherapy. OUTCOME: At 6-year follow-up after four surgical procedures, sclerotherapy and radiotherapy, the aneurysmal bone cyst has been healed. Patient had neurological impairment after a local recurrence but had full recovered after final revision surgery.
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Quistes Óseos Aneurismáticos/diagnóstico , Enfermedades de la Columna Vertebral/diagnóstico , Quistes Óseos Aneurismáticos/terapia , Vértebras Cervicales/cirugía , Preescolar , Diagnóstico Diferencial , Medicina Basada en la Evidencia/métodos , Humanos , Imagen por Resonancia Magnética , Masculino , Recurrencia , Enfermedades de la Columna Vertebral/terapia , Tomografía Computarizada por Rayos XAsunto(s)
Escoliosis/diagnóstico por imagen , Escoliosis/patología , Columna Vertebral/crecimiento & desarrollo , Columna Vertebral/patología , Tomografía Computarizada por Rayos X , Animales , Modelos Animales de Enfermedad , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/crecimiento & desarrollo , Vértebras Lumbares/patología , Columna Vertebral/diagnóstico por imagen , Sus scrofa , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/crecimiento & desarrollo , Vértebras Torácicas/patologíaAsunto(s)
Envejecimiento/fisiología , Fijación de Fractura , Tornillos Pediculares , Columna Vertebral/fisiopatología , Animales , Peso Corporal , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/fisiopatología , Radiografía , Columna Vertebral/diagnóstico por imagen , Sus scrofa , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/fisiopatologíaRESUMEN
Obturator muscles haematoma are rarely reported. The most often reported cases are primary pyomyositis or posttraumatic haematomas occurring during pelvic fractures. We firstly report herein two cases of spontaneous obturator internus haematoma (OIH) in two haemophiliacs with inhibitor. Clinical data and imaging of two patients treated in our clinic are reported here according to previously defined criteria of OIH in posttraumatic situation. Both patients were children suffering from severe and moderate haemophilia A, respectively, with an inhibitor at the time of the event. The clinical feature was marked by an iliopelvic pain letting discussing hip haemarthrosis, appendicitis or iliopsoas haematoma. For both patients ultrasonography (US) failed to provide the diagnosis. Careful and repeated clinical examinations eventually lead to suspect obturator haematoma which was confirmed by abdominopelvic computed tomography (CT) and magnetic resonance imaging (MRI). Respectively, high dose of FVIII or rFVIIa regimen allowed a rapid control of the muscular bleeding in the low and high responder inhibitor patients. Spontaneous OIH may be added to the differential diagnosis of iliopelvic pain in severe forms of haemophilia. US still often performed at first in such case remains unhelpful; abdominopelvic CT or MRI should be performed to discriminate among different diagnoses, including OIH which stays probably undiagnosed.
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Hematoma/etiología , Hemofilia A/complicaciones , Músculos Psoas , Adolescente , Niño , Humanos , MasculinoRESUMEN
The aim of this article is to provide an up-to-date overview on paediatric haemophilia care in the world, with emphasis on medical treatment, rehabilitation, and orthopaedic surgery. The reason these specific professions caregivers are included is that over 90% of bleeding episodes in people with haemophilia (PWH) occur within the musculoskeletal system; and of these 80% of bleedings occur in joints.
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Atención a la Salud/normas , Países Desarrollados , Países en Desarrollo , Hemofilia A/terapia , Enfermedades Musculoesqueléticas/terapia , Accesibilidad a los Servicios de Salud , Hemofilia A/complicaciones , Humanos , Enfermedades Musculoesqueléticas/etiología , Procedimientos Ortopédicos , PediatríaRESUMEN
In the last years, much progress has been achieved in the treatment of lysosomal storage disorders. Until recently only symptomatic treatment was available for the affected patients. Progressively enzyme replacement treatments have been developed for several diseases, namely Gaucher disease, Fabry disease, mucopolysaccharidoses type I, II and VI and Pompe disease. In this review we will summarize the efficacy and safety of these treatments and describe new therapeutic trials for other lysosomal storage disorders or perspectives in the use of currently available treatments.
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Terapia de Reemplazo Enzimático , Enfermedades por Almacenamiento Lisosomal/tratamiento farmacológico , Ensayos Clínicos como Asunto , Terapia de Reemplazo Enzimático/métodos , Terapia Enzimática , Enzimas/genética , Enfermedad de Fabry/tratamiento farmacológico , Enfermedad de Gaucher/tratamiento farmacológico , Enfermedad del Almacenamiento de Glucógeno Tipo II/tratamiento farmacológico , Humanos , Enfermedades por Almacenamiento Lisosomal/diagnóstico , Enfermedades por Almacenamiento Lisosomal/enzimología , Mucopolisacaridosis/tratamiento farmacológico , Resultado del TratamientoRESUMEN
BACKGROUND/AIMS: Prader-Willi syndrome (PWS) is a complex genetic disorder whose many manifestations include obesity and short stature. Diabetes, osteoporosis, and scoliosis are common. We evaluated the effects of human growth hormone (hGH). METHODS: A prospective cohort study of 36 children (1-15 years of age) with genetically confirmed PWS who were given hGH (mean dose 0.033 ± 0.006 mg/kg/day) for 36 months. At baseline and once yearly, we evaluated growth, insulin-like growth factor-1 (IGF-1), body composition, bone mineral density (BMD), glucose tolerance, serum lipids, and spinal radiographs. RESULTS: Height gain over the 3-year period was 1.2 SD score. Lean body mass increased significantly during each treatment year. Total body fat decreased by 5.42 and 1.17% in the 1st and 2nd years, respectively. BMD remained unchanged during therapy. IGF-1 and homeostasis model assessment index of insulin resistance increased, and glucose intolerance was found in 22.7% of patients at baseline and 0% at 3 years. None of the patients had diabetes. Their lipid profile improved. Scoliosis was present in 27.8% of the patients at baseline and 47.2% at 3 years. CONCLUSION: GH treatment in children with PWS has multiple beneficial effects on growth and body composition. Tolerance is good, with an improvement in glucose metabolism, although IGF-1 levels and insulin resistance parameters should be monitored closely. The high rate of scoliosis warrants monitoring by a pediatric orthopedic surgeon.
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Hormona de Crecimiento Humana/uso terapéutico , Síndrome de Prader-Willi/tratamiento farmacológico , Síndrome de Prader-Willi/metabolismo , Composición Corporal/efectos de los fármacos , Densidad Ósea/efectos de los fármacos , Metabolismo de los Hidratos de Carbono/efectos de los fármacos , Niño , Estudios de Cohortes , Femenino , Humanos , Resistencia a la Insulina/fisiología , Factor I del Crecimiento Similar a la Insulina/metabolismo , Metabolismo de los Lípidos/efectos de los fármacos , Masculino , Estudios Prospectivos , Escoliosis/etiologíaRESUMEN
An achondroplastic patient with a thoracolumbar kyphosis was first seen at the age of 16 at our institution. His only concern at that time was the aesthetic implication of his deformity. His physical examination was normal except for loss of the neurologic reflexes in the lower limbs. The radiographs showed a fixed 180° thoracolumbar kyphosis with correct frontal and sagittal balances. No spinal cord anomaly was found on MRI. Two years later, he developed a progressive neurogenic claudication of the lower limbs. He was still neurologically intact at rest. The MRI showed an abnormal central spinal cord signal in front of the apex of the kyphosis associated with the narrow congenital spinal canal. In regards to this progressive neurological worsening, a surgical treatment was decided. We decided to perform a front and back arthrodesis combined with a spinal cord decompression without reduction of the deformity. A five-level hemilaminotomy was performed with a posterior approach at the kyphosis deformity. The spinal cord was individualised onto 10 cm and the left nerve roots were isolated. A decancellation osteotomy of the three apex vertebrae and a disc excision were performed. The posterior aspect of the vertebral body was then translated forward 2 cm and in association with the spinal cord. Two nerve roots were severed laterally to approach the anterior part of the kyphosis and a peroneal strut graft was inlayed anterolaterally. A complementary anterior and a right posterolateral fusion was made with cancellous bone. The patient was immobilised in a cast for 3 months relayed by a thoracolumbosacral orthosis for 6 months. At 3 years follow-up, the neurogenic claudication had disappeared. No worsening of the kyphosis was observed. His only complaint is violent electric shock in the lower limbs with any external sudden pressure on the spinal cord in the area uncovered by bone.
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Acondroplasia/complicaciones , Cifosis/etiología , Cifosis/cirugía , Médula Espinal/cirugía , Fusión Vertebral/métodos , Adolescente , Descompresión Quirúrgica/métodos , Humanos , Cifosis/diagnóstico por imagen , Laminectomía/métodos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Masculino , Radiografía , Estenosis Espinal/cirugía , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/cirugía , Resultado del TratamientoAsunto(s)
Artritis Infecciosa/diagnóstico , Artritis Infecciosa/microbiología , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/microbiología , Conducta Cooperativa , Comunicación Interdisciplinaria , Osteomielitis/diagnóstico , Osteomielitis/microbiología , Grupo de Atención al Paciente , Técnicas Bacteriológicas , Niño , Humanos , Reacción en Cadena de la Polimerasa , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: In haemophiliacs, synovectomy is indicated for recurrent joint bleedings, despite medical treatment. METHOD: We report a series of 23 surgical synovectomies of the knee with a median follow-up of 8.8 years. The median age of patients at surgery was 13.5 years. Clinical and radiological evaluations were made according to the Petrini and the Pettersson scores, at 1 and 5 years after surgery, and at the last follow-up. Wilcoxon and Spearman's tests were used for the statistical analysis. RESULT: The Petrini score improved at 1 and 5 years (P < 0.001). Nine patients have 20 years of follow-up and a stable result. In more than half of the knees, no episode of recurrent bleeding occurred. The effect of surgery on the range of motion (ROM) was moderate and mobilisation under anaesthesia did not improve it significantly. There was a progressive worsening of the radiological score, but no correlation between clinical and radiological score was noticed (ρ = 0.08, P = 0.77). CONCLUSION: Complete synovectomy gives good long-term results in term of bleeding recurrence and overall function.
RESUMEN
PURPOSE OF THE STUDY: Pigmented villonodular synovitis is an exceptional condition in children. The clinical, biological and imaging presentation is not specific and a histology sample is required for certain diagnosis. Because of this lack of specificity, together with the rare occurrence of the disease, late diagnosis is not uncommon, making correct management an even greater challenge in the growing child. MATERIAL AND METHOD: Between 1995 and 2001, six children were treated for pigmentary villonodular synovitis, four girls and two boys, mean age 11.5 years. The knee was involved in five cases (three diffuse forms and two localized forms). One diffuse form involved the ankle. The diagnosis was suggested by the MRI findings in all patients and confirmed at the histological examination of a biopsy sample. Surgery was used in five cases and medical treatment in one patient with a diffuse form affecting the knee. A synoviorthesis (Hexatrione) was used systematically in three diffuse forms affecting the knee joint. RESULTS: Mean follow-up was 58 months. Recurrence was noted in two diffuse forms, one involving the knee at 10 months from arthroscopic synovectomy and one involving the ankle 24 months after surgical synovectomy. Systematic use of the synoviorthesis did not prevent recurrence in one case. The synoviorthesis was also used in the two cases of recurrence as a complement to surgical treatment but with no effect. Growth was not affected in any of the children. DISCUSSION: The etiopathogenic mechanism underpinning pigmented villonodular synovitis remains unclear. Genetic factors are suspected in childhood cases. MRI is the complementary examination of choice for diagnosis and follow-up. In children, treatment of pigmented villonodular synovitis depends on marginal excision of the lesion for localized forms and total synovectomy for the diffuse forms. The efficacy of the triamcinolone hexacetonide synoviorthesis remains open to debate and would require a larger series with longer follow-up for evaluation.
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Sinovitis Pigmentada Vellonodular/diagnóstico , Adolescente , Niño , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
PURPOSE OF THE STUDY: Tillaux fractures in adolescents correspond to Salter and Harris type III fractures involving the anterolateral portion of the tibial epiphysis. These are intra-articular fractures. The objective was to determine the circumstances of these fractures, the radiological signs, and the therapeutic modalities as well as the long-term clinical and radiological outcome. MATERIAL AND METHODS: We reviewed 19 Tillaux fractures. Ten patients underwent surgical treatment and nine orthopedic treatment following importance of displacement. RESULTS: At mean follow-up of 33.8 months, results were rated good in 17 on 19 cases. DISCUSSION: This fracture is often observed in teenagers victims of trauma with external rotation of the foot. Closure of distal growth cartilage of the tibia occurs medially to laterally, the anterolateral portion remaining open longer. Forced external rotation of the anterior tibiofibular ligament pulls off an anterolateral fragment of the distal tibial epiphysis. Surgical treatment is indicated for fractures with a displacement of more than 2 mm or a vertical displacement to achieve open reduction and screw fixation. Orthopedic treatment is used for non-displaced fractures. CONCLUSION: The prognosis of Tillaux fractures is good as was observed in our series and in series reported in the literature.
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Traumatismos del Tobillo/cirugía , Epífisis/lesiones , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/cirugía , Adolescente , Traumatismos del Tobillo/clasificación , Traumatismos del Tobillo/diagnóstico por imagen , Traumatismos del Tobillo/terapia , Niño , Epífisis/diagnóstico por imagen , Femenino , Fijación de Fractura/métodos , Humanos , Masculino , Pronóstico , Radiografía , Estudios Retrospectivos , Fracturas de la Tibia/clasificación , Fracturas de la Tibia/terapiaRESUMEN
PURPOSE OF THE STUDY: Fracture of the anterior tibial tubercle is exceptional in adolescents. The purpose of this work was to better understand the circumstances of such fractures, identify potential complications, and assess outcome of different therapeutic options. MATERIAL AND METHOD: This was a retrospective analysis of a consecutive series of 22 children with avulsion fracture of the anterior tibial tubercle. The circumstances of the fracture were noted. The Ogden classification was used to establish the radiological type. Associated lesions were also noted as were any complications. Two types of treatment were given: orthopedic or surgical (several types). The functional outcome was assessed at last follow-up. RESULTS: Mean age at fracture of the anterior tibial tubercle was 13 years (range 12-16) in 14 boys and 7 girls. It occurred after a jump or reception after a jump in 22 of the children. Five patients presented symptomatic homo- or contralateral anterior tibial apophysitis before the accident. The fracture was not displaced (type IA) in ten patients and was treated orthopedically. In twelve patients, the fracture was displaced (type IB, II, or III) and required osteosynthesis. Immobilization was maintained for four weeks on average (range 3-7). Associated lesions were observed in half of the twelve displaced fractures, with five cases of patellar ligament avulsion and three cases of meniscal injury. There were no complications with type IA fractures. For the twelve displaced fractures, complications were observed in seven children: hematoma (n = 2), infrapatellar hypoesthesia (n = 2), complete rupture of the patellar ligament 38 months after surgery (n = 1), recurvatum with leg length discrepancy (n = 1), and stiff knee (n = 1). Mean follow-up was two years (range 9 months-8 years). The functional outcome was excellent in all patients with a non-displaced fracture and in seven of the twelve patients who underwent surgical treatment. DISCUSSION: Non-displaced fracture of the anterior tibial tubercle I children (type IA) should be considered as a separate entity responding very well to orthopedic treatment. The other cases of displaced fracture generally require surgery which enables an assessment of often associated lesions. The prognosis of displaced fractures of the anterior tibial tubercle is more sever due to the associated lesions and potential complications. We describe the second case of recurvatum and leg length discrepancy following fracture of the anterior tibial tubercle. CONCLUSION: Displaced fracture of the anterior tibial tubercle in adolescents is often associated with soft tissue injury (patellar ligament, menisci). Surgery is indispensable and provides good functional results.
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Fracturas de la Tibia , Adolescente , Niño , Femenino , Humanos , Masculino , Estudios Retrospectivos , Fracturas de la Tibia/clasificación , Fracturas de la Tibia/terapiaRESUMEN
PURPOSE OF THE STUDY: Septic hip arthritis is a recognized complication of sickle-cell disease. The incidence is difficult to assess but is significant since certain authors estimate that 11% of children with sickle-cell disease develop orthopedic complications. We report our experience with hip joint infection in adults with sickle-cell disease. MATERIAL AND METHODS: We diagnosed ten cases of hip joint infection in seven adults with sickle-cell disease. The characteristic feature of the septic arthritis was the development of a septic focus in a zone of osteonecrosis of the femoral head. Diagnosis was difficult due to the presence of prior hip disease and also the circumstances of development: other infectious foci, septicemia, distant osteomyelitis. The diagnosis was confirmed by joint puncture and isolation of the causal germ. Despite adapted antibiotics and immobilization with traction-suspension, hip joint destruction could not be prevented and all patients became bedridden. Surgery was therefore undertaken to remove the head and neck and institute local antibiotic treatment. A total hip prosthesis was implanted in all patients. RESULTS: At 2 to 12 years follow-up, all seven patients had nearly normal hip function (all 10 hips). Recurrent infection nevertheless developed in 2 hips, demonstrating the limitations of this technique.
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Anemia de Células Falciformes/complicaciones , Artritis Infecciosa/complicaciones , Artritis Infecciosa/cirugía , Artroplastia de Reemplazo de Cadera , Articulación de la Cadera , Adulto , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
PURPOSE OF THE STUDY: Aneurysmal cyst is an uncommon benign primitive bone tumor generally observed in young subjects, in a spinal localization in 10% of the cases. We report the clinical, radiological, and therapeutic aspects of seven cases of aneurysmal cyst of the spine. MATERIAL AND METHODS: This series included seven children, mean age 11.7 years (range 8-14) who were followed for 9 years on the average (range 2-24 years). Findings were compared with reports in the literature. RESULTS: Four cysts were located in the cervical spine (C1, C3, C4, C7), two in the thoracic spine (T4, T7) and one in the sacrum. Biopsy-resection was performed in six patients. The sacral cyst was treated by selective arterial embolization. Two complications were observed after surgical treatment. Bony filling of the lesion, evaluated by CT scan six months after surgery, was achieved in five cases, incomplete in two without recurrence of cystic cavities. DISCUSSION AND CONCLUSION: Aneurysmal bone cysts account for 15% of all primitive tumors of the spine. They are more frequent in the cervical and thoracic spine than in a lumbar or sacral localization. One vertebra is involved in most cases, generally the vertebral body and the posterior arch with an asymmetrical extension to one pedicle in some cases. Neurological complications of variable severity are frequent and can be improved by surgical removal of the tumor. CT scan and MRI are the best exams to analyze the spinal cyst, to show bony walls and liquid-liquid levels suggestive of aneurysmal bone cyst, to evaluate the tumor extension and to search for cord compression. When the CT scan and MRI show characteristic signs of aneurysmal bone cyst of the spine, we do not perform a biopsy systematically if complete removal of the tumor appears possible. Surgical removal with biopsy is the treatment of choice. Reconstruction and stabilization of the spine must be complete using bone graft with or without instrumentation. In case of medullary involvement, decompression must be performed rapidly with the most complete tumor removal as possible. Selective arterial embolization can be used in some localizations or as preparation to surgery. Radiotherapy is contraindicated in children because of the risk of radio-induced tumors.