Asunto(s)
Quistes Óseos Aneurismáticos/diagnóstico por imagen , Quistes Óseos Aneurismáticos/patología , Fracturas de Cadera/diagnóstico por imagen , Fracturas de Cadera/patología , Quistes Óseos Aneurismáticos/complicaciones , Preescolar , Fracturas de Cadera/complicaciones , Humanos , Masculino , RadiografíaAsunto(s)
Neoplasias Óseas/complicaciones , Neoplasias Óseas/patología , Fémur/diagnóstico por imagen , Fémur/patología , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/patología , Osteoma Osteoide/complicaciones , Osteoma Osteoide/patología , Neoplasias Óseas/diagnóstico por imagen , Niño , Trastornos Neurológicos de la Marcha/diagnóstico por imagen , Humanos , Masculino , Osteoma Osteoide/diagnóstico por imagen , RadiografíaRESUMEN
Half of the world's population lack access to adequate primary health care, and two thirds lack access to orthopaedic care. Globally, the need for health care outstrips the available resources. This problem is compounded in the developing world by a lack of trained medical personnel, a lack of medical facilities, and, in many regions, an inability to access existing facilities. There is little specific epidemiologic data about the exact burden of musculoskeletal disease in these countries, but most agree that it is reasonable to assume that it will increase. In the least developed and developing nations, problems with access are related to fundamental issues such as infrastructure, physical facilities, equipment, and trained personnel. There are a number of ways in which the orthopaedic community can become involved in ameliorating the burden. Education is the most effective method of providing a sustainable solution. The objective of educational organizations should be to train local health-care workers at all levels in their own environment to provide sustainable and appropriate care so that the programs become self-sufficient and ensure a continued supply of competent medical personnel.
Asunto(s)
Países en Desarrollo , Ortopedia , Accesibilidad a los Servicios de Salud , Humanos , Cooperación Internacional , Enfermedades Musculoesqueléticas/epidemiología , Enfermedades Musculoesqueléticas/terapiaRESUMEN
Although a detailed, comprehensive look at pediatric orthopedists' use of imaging is beyond the scope of this article, we offer an orthopedist's perspective of the role imaging plays in the care of children with tumors, scoliosis, and trauma. Given the growing, dynamic state of a child's skeleton, the long-term consequences of injury must always be considered.
Asunto(s)
Neoplasias Óseas/terapia , Sistema Musculoesquelético/lesiones , Escoliosis/terapia , Adolescente , Adulto , Niño , Preescolar , Humanos , Lactante , Recién NacidoAsunto(s)
Fibroma/patología , Fibromatosis Agresiva/patología , Quimioterapia Adyuvante , Niño , Preescolar , Ensayos Clínicos como Asunto , Terapia Combinada , Diagnóstico Diferencial , Femenino , Fibroma/etiología , Fibroma/cirugía , Fibromatosis Agresiva/etiología , Fibromatosis Agresiva/cirugía , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Morbilidad , Pronóstico , Radioterapia AdyuvanteAsunto(s)
Síndrome del Compartimento Anterior/diagnóstico , Síndrome del Compartimento Anterior/etiología , Traumatismos en Atletas/diagnóstico , Ejercicio Físico , Fútbol Americano/lesiones , Adolescente , Traumatismos del Tobillo/diagnóstico , Síndrome del Compartimento Anterior/rehabilitación , Síndrome del Compartimento Anterior/cirugía , Diagnóstico Diferencial , Humanos , Masculino , Esguinces y Distensiones/diagnóstico , Resultado del TratamientoRESUMEN
STUDY DESIGN: Description of an operative technique with an illustrative case report. OBJECTIVES: The technique is presented to provide an alternative to iliac crest graft procedures for achieving occipitocervical fusion in children. This technique is particularly useful in children with instability after extensive decompression or laminectomy and in children with a large protuberant occiput. SUMMARY OF BACKGROUND DATA: The majority of techniques previously described for occipitocervical fusion in children rely on corticocancellous iliac crest autograft. Results generally have been promising; however, it can be difficult to harvest enough graft to span large defects after extensive decompression or to contour an iliac crest graft to a protuberant occiput. Structural rib autograft is superior in terms of availability and its unique and modifiable contour. Theoretical benefits of rib graft include superior strength and lower donor site morbidity. METHODS: The surgical technique is described. A case of a 2-year-old boy with Down's syndrome and myelopathy secondary to cervical instability is reviewed. RESULTS: The patient underwent occipitocervical arthrodesis using the technique described. The child made a full neurologic recovery, and at the 2-years follow-up evaluation, the graft had incorporated and the spine was stable. CONCLUSION: A technique of occipitocervical arthrodesis in children is described using autologous rib graft. This procedure was designed to span large defects or to deal with a large protuberant occiput; however, it is also useful for less demanding cases and may offer several advantages compared with procedures relying on iliac crest graft.