Osteosarcoma extraesquelético. Presentación de un caso / Extraskeletal osteosarcoma. Case report

El osteosarcoma extraesquelético es un tumor maligno de alto grado que representa menos del 2% de los sarcomas de partes blandas y que afecta principalmente a personas entre la quinta y sexta década de la vida. Típicamente el diagnóstico es tardío, con un período síntomas-diagnóstico extenso, >6 meses en comparación con el del osteosarcoma convencional. Comunicamos el caso de un hombre de 43 años que acudió con una tumoración en la región glútea y el muslo izquierdo de un año de evolución. Luego de estudios complementarios y una biopsia no concluyentes, se procedió a la resección quirúrgica del tumor con márgenes amplios. El estudio histológico de la pieza indicó osteosarcoma extraesquelético. El paciente tuvo una evolución muy buena, sin elementos de recidiva local ni compromiso a distancia luego de 20 meses de seguimiento. Nivel de Evidencia: IV

Extraskeletal osteosarcoma (EOS) is a high-grade malignant tumor that accounts for less than 2% of soft tissue sarcomas and mainly engages people between the fifth and sixth decade of life. It is typically of late diagnosis, with an extensive symptom-diagnosis period greater than 6 months compared to conventional osteosarcoma. We report the case of a 43-year-old patient who presented in our service with a 1-year-old tumor localized in the gluteal and left thigh region. After inconclusive paraclinical studies and biopsy, the tumor was surgically resected with wide margins and diagnosed as EOS after the histological analysis of the piece. The patient showed a very good clinical and paraclinical progression without signs of local or distant recurrence after 20 months of follow-up. Level of Evidence: IV

Valgus slipped capital femoral epiphysis: presentation, treatment, and clinical outcomes using patient-reported measurements.

Valgus slipped capital femoral epiphysis (SCFE), is rare. This study describes the diagnosis, treatment and outcome of valgus SCFE in Uruguay. The medical records and radiographs were reviewed in eight consecutive children [mean age 11.9 years (range 9-13; six female)] with valgus SCFE between 1997-2017. In 2018-2019, all patients were reexamined clinically, new radiographs obtained, and patient-reported outcomes completed using the international tool of hip results (iHOT-12). The prevalence of clinical femoroacetabular impingement (FAI), avascular necrosis, and surgical complications were also studied. There were 11 valgus SCFEs in eight patients; two had primary bilateral SCFEs, and one child later developed a valgus SCFE in the contralateral hip. Seven out of eight patients were overweight. All were stable idiopathic SCFEs. The mean femoral head shaft angle on the anteroposterior radiographs for the 11 SCFEs was 145° (range 140-168) and 141° (range 139-145) for the six healthy contralateral hips. Slip severity measured on the Lauenstein projection was mild (<30°) in eight hips and moderate (30°-60°) in three hips. At a mean follow-up of 87 months (range 24-252), there were no cases of avascular necrosis. The mean iHOT12 was 74 (range 13-97). Significant remodeling was detected in both head shaft angle (8°) and alpha angle (10°) in the affected hips. Nine hips (81%) demonstrated clinical signs of FAI. Our study is the first to describe long-term results using both clinical and patient outcome measures (iHOT-12). A majority of patients have residual symptoms, likely associated with FAI.

Escoliosis idiopática del adolescente, análisis postoperatorio. Serie de casos / Idiopathic adolescent scoliosis, post-operative analysis. Case Series

Introducción La escolisis es una deformidad tridimencional de la columna vertebral. El objetivo principal del tratamiento es evitar la progresión, lograr la máxima corrección y la artrodesis del menor numero de segmentos, con buen balance coronal y sagital que permita una fusión indolora. El objetivo del estudio es evaluar los resultados de los pacientes operados por escolisis idiopática del adoelscente en nuestro centro. Materiales y Métodos se realizó un estudio tipo serie de casos, se incluyeron pacientes operados entre 2011 y 2017; en ellos se estudiaron: los datos demografícos, el tipo de curva, la densidad de tornillos utilizados, el porcentaje de reducción lograda al año y las complicaciones. Resultados Se obtuvieron datos de 27 pacientes. Pedominaron las curva Lenke 1B. El ángulo de Cobb preoperatorio promedio fue de 66,5o con un postoperatorio de24,4o. La densidad de tornillo presentó un promedio de 1,4. Presentaron complicaciones el 25,6% de los pacientes, siendo la más frecuente la infección. En el cuestionario SRS-22 se obtuvieron buenas resultados. Discusión Se ha reportado una densidad de 0,8-1,69 tornillos por vértebra fusionada con un porcentaje de corrección de 64-70%. En nuestro resultados la densidad de tornillos por vertebra fusionado fue de 1,4 lográndose una reduccion de 64,1%. Aumentar el número de tornillos no aumentó el grado de corrección de las curvas. En concordancia con la literatura la complicación mas frecuente fue la infección, con baja incidencia de lesión neurológica. Concluimos que la técnica de artrodesis utilizada en nuestro centro, con tornillos pediculares de tercera generación, obtiene buenos resultados de reducción, con porcentaje de complicaciones similares a los reportados previamente.

Background Scoliosis is a three-dimensional deformity of the spine. The main objective of treatment is to avoid progression, achieve maximum correction and arthrodesis of the least number of segments, with good coronal and sagittal balance that allows a painless fusion. The aim of the study is to evaluate the results of patients who underwent to surgical fusion for adolescent idiopathic scoliosis. Material and Methods A case series study was conducted by analyzing medical records of patients who underwent to surgical fusion for adolescent idiopathic scoliosis. between 2011 through 2017.An analysis of demographic data, the type of curve, the density of screws used, the percentage of reduction achieved after one year, and complications was performed. Results Data of 27 patients was included. Lenke 1B curves were predominant. The mean preoperative Cobb angle was 66.5o with a postoperative 24.4o. Screw density presented an average of 1.4. Complications were presented in 25.6% of the patients, the most frequent being infection. Good results were obtained in the SRS-22 questionnaire. Discussion A density of 0.8-1.69 screws per fused vertebra has been reported with a correction percentage of 64-70%. In our results, the density of screws per fused vertebra was 1.4, achieving a reduction of 64.1%. Increasing the number of screws did not increase the degree of correction of the curves. In accordance with the literature, the most frequent complication was infection, with a low incidence of neurological injury. We conclude that the arthrodesis technique used in our center, with third-generation pedicle screws, obtains good reduction results, with a percentage of complications similar to those previously reported.

Analysis of orthopedic surgical procedures in children with cerebral palsy.

BACKGROUND: Orthopedic surgery in children with cerebral palsy (CP) aims to improve function and prevent deformities. Each child's condition in CP is unique and many co-variables influence surgical decision-making including a patient's age and their functional level. Little is known about the frequency of different types of orthopedic surgery in children with CP who have varied functional levels, particularly in countries from Latin America. AIM: To assess the type of orthopedic surgical procedures in relation to age and gross motor function in children with CP. METHODS: This retrospective study included all children with CP (n = 245) treated with elective orthopedic surgery at a Uruguayan university hospital between October 2010 and May 2016 identified from a surgical database. Eighteen children (7%) were lost to follow-up due to missing medical charts. Demographics, gross motor function classification (GMFCS), and orthopedic surgeries were obtained from the medical records of 227 children. Chi-squared tests and analysis of variance were used to assess the frequency of surgery, accounting for GMFCS levels. Mean age for soft tissue vs bone surgery was compared with the independent samples t-test. RESULTS: A total of 711 surgical procedures were performed between 1998 and 2016. On average, children had 3.1 surgical procedures and the mean age at first surgery was 8.0 years. There were no significant differences in age at first surgery among GMFCS levels (P = 0.47). The most common procedures were lower leg soft tissue surgery (n = 189, 27%), hip tenotomy (n = 135, 19%), and hamstring tenotomy (n = 104, 14%). For children with GMFCS level I, the mean number of surgeries per child [1.8 (range 1-9)] differed significantly at P < 0.05 in children with GMFCS levels II [3.2 (1-12)], III [3.2 (1-8)], IV [3.3 (1-13)], and V [3.6 (1-11)]. Within II, III, IV, and V, there was no significant difference in mean number of surgeries per child when comparing across the groups. The proportion of soft tissue surgery vs bone surgery was higher in GMFCS levels I-III (80%-85%) compared to levels IV (68%) and V (55%) (P < 0.05). CONCLUSION: The frequency of surgical procedures per child did not increase with higher GMFCS level after level I. However, the proportion of bone surgery was higher in GMFCS levels IV-V compared to I-III.

Prevalence and clinical relevance of underlying pathological conditions in painful adolescent idiopathic scoliosis: a MRI-based study.

STUDY DESIGN: Cross-sectional comparative study. OBJECTIVES: Evaluate prevalence and clinical relevance of an underlying pathology in painful adolescent idiopathic scoliosis (AIS) patients after a non-diagnostic history, physical examination and spinal X-ray using Magnetic Resonance Image (MRI) as diagnostic tool. Discrepancies regarding indications of routine MRI screening in painful AIS patients are multifactorial. Few studies have investigated relationship and practical importance of painful AIS with an underlying pathology by MRI. METHOD: A total of 152-consecutive AIS patients complaining of back pain during a 36-month period were enrolled. All patients underwent whole-spine MRI after a non-diagnostic history, physical examination and spinal X-ray. Underlying pathologies were reported as neural and non-neural axis abnormalities based on MRI reports. Variables such as sex, age, constant or intermittent pain, night pain, back pain location (thoracic or lumbar pain), Cobb-angle and follow-up were evaluated as clinical markers to predict presence of underlying MRI pathologies. RESULTS: The presence of an underlying pathology was found by MRI in 54 painful AIS patients (35.5%). Isolated syringomyelia was the only neural axis abnormality found in 6 patients (3.9%). Non-neural axis abnormalities (31.6%) were composed by: 32 herniated nucleus pulposus, 5 vertebral disc desiccation, 4 ovarian cysts, 3 renal cysts, 2 sacral cysts, and 2 vertebral hemangiomas. There was no association with gender, age of presentation, initial coronal Cobb angle and follow up; with presence of an underlying pathology. Lumbar pain location was identified as an adequate clinical marker that correlated with presence of an underlying pathology (p = 0.01). CONCLUSIONS: Prevalence of underlying pathologies diagnosed by MRI in painful AIS was found high (35.5%), but it's clinical relevance and implication are debatable. The use of MRI did not affect orthopedic management of painful AIS patients who showed an underlying pathology. A thorough evaluation must be performed by clinicians; and discussed with patients and family prior to undergo further imaging management. LEVEL OF EVIDENCE: Level III.

Escoliosis desarrollo temprano. Curso de instrucción / Early onset scoliosis. Instructional course

Introducción Escoliosis de desarrollo temprano, es aquella escoliosis que se presenta antes de los 10 años de edad secundaria a anomalías estructurales congénitas de la columna, enfermedades neuromusculares, síndromes, o idiopáticamente. Materiales & Métodos Revisión literaria narrativa de todo lo publicado sobre escoliosis de desarrollo temprano durante 2003 al 2018. Resultados Esta deformidad de la columna a temprana edad limitara el crecimiento pulmonar e incapacitara la función respiratoria apropiada, provocando el síndrome de insuficiencia torácica. Históricamente, la historia natural de esta condición puede ser letal y el daño ocasionado por la escoliosis de desarrollo temprano suele ser permanente a pesar de su restauración. Actualmente, la escoliosis de desarrollo temprano se clasifica utilizando la combinación de las variables: edad, etiología, magnitud de la escoliosis y cifosis. Los métodos de tratamiento más utilizados son: enyesado en serie, implantes de distracción costal longitudinal en aleación de titanio, barras de crecimiento dobles, técnica de Shilla™, y barras de crecimiento electromagnéticas. Discusión Indudablemente, es imperativo conocer sus manifestaciones y peculiaridades para poder clasificar, monitorear la severidad, personalizar el tratamiento, detener el deterioro de la columna lo más pronto posible, y prevenir la insuficiencia respiratoria Nivel de evidencia IV

Background Early onset scoliosis presents before the age of 10 years old due to congenital structural anomalies of the thorax, neuromuscular diseases, and syndromes, or is idiopathic. Methods A review of the literature from 2003 to 2018 on the early onset scoliosis. Result A deformity of the spine at an early age limits lung development and proper respiratory function, thereby provoking the onset of a thoracic insufficiency syndrome. Historically, the natural path of this condition can be lethal, and the damage caused by the early onset scoliosis tends to be permanent, regardless of its restoration after the age of 10. The early onset scoliosis classification is currently based on the age, aetiology, and the extent of the deformity. The treatment modalities most often used are: serial casts, vertical expandable prosthetic titanium ribs, double traditional growing rods, Shilla™ growing rods, and magnetically controlled growing rods. Discussion Undoubtedly, it is imperative to know its manifestations and peculiarities in order to classify the disease, as well as to monitor the disease. Treatment should be personalised, and the deterioration of the spine halted as soon as possible, as well as to prevent respiratory insufficiency Level of evidence IV

Funcionalidad y calidad de vida luego de la cirugía de escoliosis neuromuscular / Functionality and quality of life after neuromuscular scoliosis surgery

Introducción: El objetivo de este trabajo fue estudiar las complicaciones de la cirugía en pacientes con escoliosis neuromusculares operados en nuestro Centro, así como la funcionalidad y la calidad de vida luego del tratamiento quirúrgico. Materiales y Métodos: Se realizó un estudio retrospectivo, de tipo serie de casos. Se revisó la historia clínica, y se entrevistó al paciente y al cuidador principal. Luego de la cirugía, se evaluaron las complicaciones, la funcionalidad, la calidad de vida y el grado de satisfacción de los cuidadores. Resultados: La tasa de complicaciones fue del 26,7%, por infección y alteraciones hemodinámicas. Se obtuvieron resultados positivos en la funcionalidad y la calidad de vida de los pacientes, y fueron más significativos en cuanto a la capacidad de estar sentado y las actividades de la vida diaria. Conclusiones: La cirugía de los pacientes con escoliosis neuromuscular mejora la capacidad y el equilibrio de estar sentado, lo que favorece la capacidad digestiva, respiratoria y de vida social del paciente. Si bien se trata de cirugías con altas tasas de complicaciones, las tasas de satisfacción por parte de los cuidadores son altas. Nivel de Evidencia: IV

Introduction: The objective of this study was to evaluate surgical complications in patients with scoliosis operated on in our Center, as well as their functionality and quality of life after surgical treatment. Methods: A retrospective case series study was carried out. Medical history was reviewed and the patient and primary caregiver were interviewed. Results after surgery were assessed for complications, function, quality of life and caregivers´ degree of satisfaction. Results: Complication rate was 26.7%, due to infection and hemodynamic alterations. Positive results were obtained regarding function and quality of life of these patients, being more significant in terms of the ability to be seated and activities of daily living. Conclusions: Surgery of patients with neuromuscular scoliosis improves the capacity and balance of sitting, favoring digestive, respiratory and social life capacity. Although rate of complications is high, satisfaction rates on the part of the caregivers are elevated. Level of Evidence: IV

Fracturas desplazadas de epicóndilo medial. Revisión bibliográfica sistematizada / Displaced fractures of medial epicondyle. A systematized bibliographic review / Fraturas com Deslocamento de Epicôndilo Medial. Revisão Bibliográfica Sistematizada

Introducción: la fractura de epicóndilo medial representa 12% a 20% de las fracturas del codo pediátrico. Existe controversia en la indicación del tratamiento para las fracturas con un desplazamiento mayor de 2 mm. El objetivo de este trabajo es revisar la indicación y los resultados de los diferentes tratamientos realizados en las fracturas de epicóndilo medial desplazadas más allá de 2 mm. Material y método: se utilizaron las bases de datos electrónicas PubMed y Bireme. La búsqueda arrojó un total de 313 artículos de los cuales nueve cumplían con los criterios de inclusión propuestos al iniciar la búsqueda. Discusión: se analizaron y compararon los métodos de diagnóstico por imagen utilizados y su rendimiento, los diferentes tipos de tratamiento y las complicaciones. Conclusión: no debe ser el desplazamiento de la fractura lo que guíe el tratamiento sino la energía traumática y la estabilidad en valgo del codo. Se han reportado excelentes resultados tanto con tratamiento conservador como quirúrgico de las fracturas desplazadas de epicóndilo medial. Faltan estudios comparativos con seguimiento a largo plazo de buen nivel de evidencia para recomendar uno u otro tratamiento en las fracturas desplazadas de epicóndilo medial.

Introduction: fractures of medial epicondyle represent 12 to 20% of pediatric elbow fractures. Treating fractures with greater than 2 mm of displacement is a matter of debate. The study aims to review indications and results of the different treatments indicated for fractures of medial epicondyle with greater than 2 mm of displacement. Method: the PubMed and Bireme electronic data bases were used. Search revealed 313 articles, 9 of which met the inclusion criteria set upon initiation of the study. Discussion: imaging techniques used and their diagnostic yield were compared, as well as the different of treatments and complications. Conclusion: treatment should not be defined based on the fracture's displacement, but rather on the trauma energy and the valgus stability of the elbow. Excellent results were reported both with a conservative treatment and with a surgical approach to displaced fractures of medial epicondyle. Comparative studies need to be done with long term follow-up that is well recorded to recommend the right treatment for displaced fractures of medial epicondyle.

Introdução: a fratura de epicôndilo medial representa 12 a 20 % das fraturas do cotovelo em crianças. Existe controvérsia na indicação do tratamento para fraturas com deslocamento superior a 2 mm. O objetivo deste trabalho é revisar a indicação e os resultados dos diferentes tratamentos realizados nos casos de fraturas de epicôndilo medial com deslocamento de mais de 2 mm. Materiais e métodos: foram utilizadas as bases de dados electrónicas PubMed e de Bireme. A pesquisa bibliográfica recuperou 313 artículos sendo que 9 cumpriam com os critérios de inclusão propostos no inicio do trabalho. Discussão: foram analisados e comparados os métodos de diagnóstico por imagem utilizada e seu rendimento, os diferentes tipos de tratamento e as complicações. Conclusão: o deslocamento da fratura não deve ser o determinante do tratamento, mas sim a energia traumática e a estabilidade em valgo do cotovelo. Foram informados resultados excelentes tanto com tratamento conservador como cirúrgico das fraturas com deslocamento de epicôndilo medial. Faltam estudos comparativos com seguimento em longo prazo com evidencias de alta qualidade para recomendar o tipo de tratamento nos casos de fraturas com deslocamento de epicôndilo medial.

Acetabular osteoid osteoma excision by controlled hip dislocation: a case report.

Osteoid osteoma of the acetabulum is rare and its treatment represents a challenge for the orthopedic surgeon. We report a case of a 12-year-old boy with osteoid osteoma in the acetabulum who was treated with a controlled hip dislocation and a gamma probe guide to facilitate excision. The diagnosis was confirmed by pathology. The patient was asymptomatic immediately after surgery and remained so at long-term follow-up.

Resultados de una encuesta sobre tratamiento de la cifosis torácica causada por enfermedad de Scheuermann / Resultados de uma pesquisa sobre o tratamento da cifose torácica de Scheuermann / Results of a survey on the treatment of thoracic Scheuermann´s kyphosis

OBJETIVO: Conocer que parámetros se deben considerar para encarar el tratamiento de la cifosis torácica causada por la enfermedad de Scheuermann. MÉTODO: Se realizó una recolección de informaciones consistente en aplicar un cuestionario a 25 informantes calificados, colegas de diferentes países de Íbero/Latinoamérica miembros de SILACO (Sociedad Íbero/Latinoamericana de Columna) y se analizaron los resultados de las mismas. RESULTADOS: Como tratamiento ortopédico, la mayoría se inclinó por el uso del corsé de Milwaukee, indicado en pacientes prepúberes y pospúberes con curvas mayores de 60º y en curvas de menos de 60º si tienen dolor. El tiempo de uso: 22 hrs por día, su mantenimiento hasta llegar a Risser 4 o 5. Se observó una tasa de abandono de 48% al plan terapéutico. En lo referente a tratamiento quirúrgico, las indicaciones surgen: por localización de la deformidad, el valor angular, dolor, edad y estética. La extensión del área a fusionar fue determinada con los espinogramas y radiografías dinámicas. Se eligió la vía posterior como vía de abordaje con barras y tornillos, y en algunos casos la combinación con ganchos. Se evaluaron los resultados del tratamiento quirúrgico (de acuerdo a la opinión del médico), que fueron catalogados como buenos en un 64%. CONCLUSIONES: Se realizó una encuesta de opinión sobre el tratamiento de la cifosis torácica causada por enfermedad de Scheuermann .y se analizaron 25 formularios de respuestas de calificados cirujanos de columna, de diferentes países de Ibero/Latinoamérica miembros de SILACO. La encuesta ha permitido establecer normas de conducta terapéuticas (ortopédicas y quirúrgicas) para el tratamiento de esta afección.

OBJETIVO: Obter os parâmetros a serem considerados para realizar o tratamento da cifose torácica de Scheuermann. MÉTODOS: Os dados foram obtidos por meio de um questionário que foi respondido por 25 membros da SILACO (Sociedad Ibero-Latino-americana de Columna) e análise dos resultados das respostas. RESULTADOS: Como tratamento ortopédico, a maioria optou pelo uso do colete de Milwaukee indicado para pacientes pré-púberes e pós-púberes com curvas maiores que 60° e curvas de menos de 60° acompanhadas de dor. O tempo de uso diário do colete foi de 22 horas até atingir Risser 4 ou 5. A taxa de abandono do plano terapêutico foi de 48%. Em relação ao tratamento cirúrgico, a maioria afirmou que as indicações estão relacionadas com localização da deformidade, valor angular, dor, idade e a estética. A extensão da área da artrodese foi determinada por meio de radiografias totais de coluna e dinâmicas. A abordagem posterior foi escolhida como a via de acesso preferida, utilizando-se hastes, parafusos e associação com ganchos. CONCLUSÃO: Realizamos uma pesquisa sobre o tratamento da cifose torácica decorrente de doença Scheuermann. Analisamos 25 formulários de resposta de cirurgiões de coluna qualificados de diferentes países membros da SILACO. A pesquisa permitiu estabelecer normas de conduta terapêutica (ortopédicas e cirúrgicas) para tratamento dessa afecção.

OBJECTIVE: To determine which parameters should be considered to address the treatment of thoracic Scheuermann kyphosis. METHOD: A survey information with a questionnaire applied to 25 informants, colleagues from different countries of Ibero-Latin American members of SILACO (Sociedad Ibero-Latinoamericana de Columna) and to analyze the results. RESULTS: Regarding to the orthopedic treatment the majority tended towards the use of Milwaukee brace for pre-pubertal and post-pubertal patients with curves greater than 60º and in curves of less than 60º if they had pain. Time of use: Twenty two hours per day until reaching Risser of 4 or 5. The rejection rate of the therapeutic plan was 48%. Regarding surgical treatment, the majority established that the indications are related to the location of the deformity, the angular value, pain, age and aesthetics. The extension of the area to be fused was determined by the total column and dynamic X-rays. Posterior approach was chosen to access; rod and screws, and in some cases the combination with hooks. CONCLUSION: We conducted a survey about the treatment of thoracic kyphosis due to Scheuermann disease and analyzed 25 response forms of qualified spine surgeons from different countries that are SILACO members. The survey has allowed to establish standards of management (orthopedic and surgical) for the treatment of this condition.

Etiología y presentación clínica de las infecciones osteoarticulares en niños hospitalizados en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell 2003-2005 / Etiology and clinical presentation of osteoarticular infections in children hospitalized in the Pediatric Hospital of the Pereira Rossell Hospital Center 2003-2005

Introducción: en el año 2001, en Uruguay, se comenzó a observar en niños un aumento en la frecuencia de aislamientos de S. aureus meticilino resistente en niños con infecciones adquiridas en la comunidad (SAMR-AC). Resulta necesario conocer la epidemiología y las manifestaciones clínicas de las infecciones osteoarticulares para adecuar las recomendaciones terapéuticas. Objetivo: describir la etiología, presentación y evolución clínica de los niños hospitalizados con infecciones osteoarticulares en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell. Material y método: se incluyeron los niños hospitalizados entre el 1º de enero de 2003 y el 31 de diciembre de 2005, con diagnóstico al egreso de osteomielitis, osteoartritis y artritis séptica. Para la definición de caso se consideraron: manifestaciones clínicas, hallazgos en el centellograma óseo, germen aislado de hemocultivo o cultivo óseo, o ambos, o articular. Se analizó etiología, presentación clínica, evolución y tratamiento. Resultados: se incluyeron 106 niños; edad media 7 años. Se aisló germen en 56 (52%): S. aureus meticilino sensible 41% (n=23), SAMR-AC 27% (n=15), S. pneumoniae 14% (n=8), S. pyogenes 5,5% (n=3), otros 12,5% (n=7). Comparados con otras etiologías los niños con infecciones por SAMR-AC tuvieron presentación clínica más grave: pandiafisitis (n=7), focos múltiples (n=1), trombosis venosa profunda y tromboembolismo pulmonar (n=2). Estos 15 niños requirieron drenaje quirúrgico; presentaron estadía más prolongada (promedio 31 versus 13 días) y más secuelas (6 versus 1). Los dos fallecimientos ocurrieron en niños con esta etiología. Conclusiones: SAMR-AC constituye un nuevo agente de las infecciones osteoarticulares en niños en nuestro medio. Frente a la sospecha clínica de esta infección es necesario insistir en la punción ósea diagnóstica e iniciar una antibioticoterapia empírica apropiada para este agente.

Summary Introduction: in the year 2001 an increase in isolation frequencies of methicillin-resistant Staphylococcus aureus (CA-MRSA) was observed in children with communityacquired infections. We need to know the epidemiology and clinical presentation of osteoarticular infections in order to adapt therapeutic recommendations. Objective: to describe etiology, clinical features and evolution of children hospitalized with osteoarticular infections at the Pediatric Hospital of the Pereira Rossell Health Care Center. Method: the study included children hospitalized from January 1, 2003 through December 31, 2005, with a discharge diagnosis of osteomyelitis, osteoarthritis or septic arthritis. The following were considered for case definition: clinical features, bone centellogram findings, blood or bone culture isolated germ, or both cultures or articular isolated germ. Etiology, clinical features, evolution and treatment were analyzed. Results: 106 children were included, average age was 7 years old. The germ was isolated in 56 (52%):41% methicillin-sensitive Staphylococcus aureus (n=23), community 27% acquired methicillin-resistant Staphylococcus aureus (n=15), S. pneumoniae 14% (n=8), S. pyogenes 5.5% (n=3), others 12.5% (n=7). When compared with other etiologies, children with community acquired methicillin-resistant Staphylococcus aureus showed the most serious clinical presentation: pandiaphysis (n=7), multiple foci (n=1), deep venous thrombosis and pulmonarthromboembolism (n=2). 15 children required surgical drainage; and hospitalization time was longer ( average 31 versus 13 days) and more sequels (6 versus 1). Two deaths corresponded to children with this etiology. Conclusions: community acquired methicillin-resistant Staphylococcus aureus constitutes a new agent in osteoarticular infections in children in our country. Upon clinical suspicion of this infection, it is necessary to insist on performing bone puncture as a diagnostic procedure, and to initiate empirical administration of antibiotics that are appropriate for this agent.

Résumé Introduction: en 2001, en Uruguay, on commence à observer (chez des enfants) une augmentation à la fréquence d’isolement de S. aureus méticilline résistant chez des enfants avec infections acquises dans la communauté (SAMR-AC). Il s’avère nécessaire de connaître l’épidémiologie et les manifestations cliniques des infections ostéo-articulaires afin d’y adapter le traitement. Objectif: décrire l’étiologie, la présentation et l’évolution clinique des enfants hospitalisés avec des infections ostéo-articulaires à l’Hôpital Pédiatrique du Centre Hospitalier Pereira Rossell. Matériel et méthode: on inclut les enfants hospitalisés entre le 1er janvier 2003 et le 31 décembre 2005, à diagnostic d’ostéomyélite, ostéoarthrite et arthrite sceptique au moment de la sortie. On tient compte de: manifestations cliniques, données de scintigraphie osseuse, germe isolé d’hémoculture ou culture osseuse, ou les deux, ou articulaire. On analyse l’étiologie, la présentation clinique, l’évolution et le traitement. Résultats: on inclut 106 enfants; moyenne d’âge 7 ans. Prélèvement de germe chez 56 (52%): S.aureus métycilino sensible 41% (n=23), SAMR-AC 27% (n=15), S. pneumoniae 14% (n=8), S. pyogenes 5,5% (n=3), d’autres 12,5% (n=7). Si on compare à d’autres étiologies, les enfants avec infections par SAMR-AC ont eu une présentation clinique plus grave: pandiaphysite (n=7), localisations multiples (n=1), thrombose veineuse profonde et thrombœmbolisme pulmonaire (n=2). Ces 15 enfants ont requis drainage chirurgical; leur séjour fut plus long (moyenne 31 versus 13 jours) et il eurent plus de séquelles (6 versus 1). Les deux décès chez des enfants ayant cette étiologie. Conclusions: SAMR-AC constitue un nouvel agent des infections ostéo-articulaires chez nos enfants. S’il existe un soupçon clinique de cette infection, il faut faire une ponction osseuse diagnostique et commencer une antibioticothérapie empirique appropriée.

Resumo Introdução: em 2001, observou-se no Uruguai, um aumento na freqüência de S.aureus meticilina-resistente isolados em crianças com infecções adquiridas na comunidade (SAMR-AC). Faz-se necessário conhecer a epidemiologia e as manifestações clínicas das infecções osteoarticulares para adequar as recomendações terapêuticas. Objetivo: descrever a etiologia, apresentação e evolução clínica das crianças com infecções osteoarticulares internadas no Hospital Pediátrico do Centro Hospitalar Pereira Rossell. Material e método: foram incluídas todas as crianças internadas entre o dia 1º de janeiro de 2003 e o dia 31 de dezembro de 2005, cujo diagnóstico na alta era osteomielite, osteoartrite ou artrite séptica. A definição como caso foi feita considerando as manifestações clínicas, os resultados da cintilografia óssea, o microrganimo isolado de hemocultura ou de cultura óssea, ou ambas, ou articular. Foram analisadas a etiologia, a apresentação clínica, a evolução e o tratamento. Resultados: cento e seis crianças com idade média de 7 anos foram incluídas no estudo. Em 56 (52%) delas foi feito o isolamento de gérmen: S. aureus meticilina-sensível 41% (n=23), SAMR-AC 27% (n=15), S. pneumoniae 14% (n=8), S. pyogenes 5,5% (n=3), outros 12,5% (n=7). Comparados com outras etiologias, as crianças com infecções por SAMR-AC tiveram quadros clínicos mais graves: pandiafisite (n=7), focos múltiples (n=1), trombose venosa profunda e tromboembolismo pulmonar (n=2). Nestas 15 crianças foi necessário realizar drenagem cirúrgica, o período de internação foi mais prolongado (média 31 versus 13 dias) e foram registradas mais seqüelas (6 versus 1). Os dois óbitos registrados corresponderam a crianças com esta etiologia. Conclusões: o SAMR-AC é um novo agente de infecções osteoarticulares em crianças no nosso meio. Quando houver suspeita clínica desta infecção deve-se insistir na realização de uma punção óssea diagnóstica e iniciar antibioticoterapia empírica apropriada para este agente.