[Radial head and neck fractures in children]. / Fracturas pediátricas de cabeza y cuello de radio.

OBJECTIVE: To analyse cases of radial head and neck fractures in children and compare them with the literature. METHOD: Retrospective and descriptive study of 21 children with radial head and neck fractures. The following parameters were collected: demographics, comorbidity, classification, treatment, need for rehabilitation, lack of range of motion (ROM), time for recovery and complications. RESULTS: The series included 11 males, and the mean age was 8.3 years. The right side was affected in 14 patients. Twelve cases had an associated ipsilateral elbow injury. According to the Chambers classification, 15 cases belonged to group A, while in the Steele-Graham classification, 12 cases were in group I. Eleven patients were treated with immobilization only, 4 percutaneously, and 6 by open reduction and internal fixation (ORIF). Eleven of them needed rehabilitation and despite this, 8 did not achieve full mobility. The mean time to obtain the greatest ROM was 4.71 months. Eight patients had complications, with the most common being neuroapraxia and valgus deformity of the elbow. DISCUSSION AND CONCLUSIONS: Treatment of paediatric radius head and neck fractures must be step-wise, from immobilization only, manual and/or percutaneous reduction, to ORIF, whichever is less indicated. In this respect, both the transcapital needle and/or removal the radius head should be avoided. The most common complication is lack of supination, especially in cases treated by ORIF. The posterior interosseous neuroapraxia was the most common of the rest of complications.

[Bone mineral density in a population with severe infantile cerebral palsy]. / Densidad mineral ósea en la población con afectación severa por parálisis cerebral infantil.

OBJECTIVE: To determine the bone mineral density (BMD) values in children and adolescents with moderate and severe infantile cerebral palsy (ICP) in our catchment area, and compare these values with a healthy population. MATERIAL AND METHOD: A prognostic study of cases and controls for the assessment of BMD in patients from 2 to 18 years old with infantile cerebral palsy belonging to the Gross Motor Function Classification System (GMFCS) Groups IV and V. The BMD measurements were performed at distal femur level, dividing this region into 3 areas following the forearm protocol. RESULTS: The BMD for each of the three areas studied results in the final sample of 69 patients were much lower than the reference levels. There was a statistically significant difference (P<.05) between the BMD values in the two sub-groups studied. DISCUSSION: The greater the involvement, from a neurological point of view, in patients classified as Group V shows a very low BMD compared to patients of similar sex and age. The acquisition of bone capital in patients with ICP does not follow the normal pattern of the healthy population.

Pulgar en resorte en niños. Comparación de resultados entre la liberación percutánea y la cirugía abierta / Trigger thumb in children: comparison of results between percutaneous release and open surgery

Objetivo. Evaluar las diferencias entre la liberación abierta y percutánea del pulgar en resorte en niños. Material y métodos. Hemos realizado un estudio descriptivo retrospectivo de los niños intervenidos desde enero de 2000 hasta febrero de 2009 en nuestro centro. Se excluyeron aquellos pacientes con afectación de dedos largos (no pulgares), intervenidos simultáneamente de otras patologías o ingresados por otros motivos, así como aquellos que rechazaron el tratamiento propuesto. Se realizó una u otra técnica quirúrgica, así como las revisiones posteriores, según las preferencias del facultativo que atendía al paciente. Resultados. Encontramos 176 pulgares en resorte (159 niños), con una edad media de 2,58 años, siendo la mayoría unilaterales (n=142). Hemos encontrado diferencias estadísticamente significativas entre ambos tratamientos con respecto al tiempo quirúrgico (p<0,01), siendo menor en la polectomía percutánea (14,56min) respecto a la cirugía abierta (33,49min). Conclusión. La polectomía percutánea en niños es una buena alternativa, sencilla, económica y rápida pero, requiere la colaboración familiar para evitar las recurrencias y obtener el éxito completo (AU)

Objective. Assess the differences between open and percutaneous release of trigger thumb in children. Material and methods. We performed a retrospective study of all the patients operated on at our institution between January 2000 and February 2009. Our exclusion criteria were: patients with trigger fingers other than the thumb, that were being operated on simultaneously of another condition, admitted for other reasons or refused treatment. The surgical technique was left to the preference of the attending physician. Results. We found 176 trigger thumbs (159 children), with a mean age of 2.58 years, the majority being unilateral (n=142). Statistically significant differences between the two treatments were only found regarding surgical time (p<0.01); percutaneous release (14,56min) was less time-consuming than the open technique (33,49min). Conclusion. Percutaneous release in children is a good, simple, cheap and fast alternative but it requires compliance of the parents in order to avoid recurrence and to obtain complete success (AU)

Fractura abierta del antebrazo con pérdida de sustancia ósea por airbag en un niño de 12 años / Airbag-induced open forearm fracture with bone loss in a 12-year-old child

Objetivo: Se presenta una lesión poco frecuente en un pasajero de edad pediátrica y su mecanismo de acción. Caso clínico: Varón de 12 años que viajaba en el asiento delantero derecho en un vehículo todoterreno que se vio involucrado en un accidente de circulación, y por el que sufrió una fractura abierta grado IIIB del cúbito y el radio derechos con pérdida de sustancia ósea de éste último. Discusión: No se conoce otro caso similar que se haya publicado en la bibliografía médica. La lesión que se presenta es infrecuente en un pasajero de un vehículo y excepcional en pacientes de edad pediátrica. Conclusiones: El despliegue del airbag puede salvar una vida, pero es un acontecimiento violento que pone en riesgo la vida de los niños. La posibilidad de tener lesiones por airbag no se debe infravalorar; deben adoptarse las medidas oportunas, además de investigar más profundamente el tema para evitar estas lesions (AU)

Purpose: To report on an unusual type of injury for a pediatric patient and describe its probable mechanism. Clinical case: A 12-year old male traveling in the right front seat of a 4-wheel drive vehicle that was involved in a road accident and sustained an open grade IIb right ulna and radius fracture with bone loss in the latter. Discussion: We do not know of any other case like this in the literature. The injury we present is not only unusual for a passenger in a vehicle, but is – in our view – also exceptional in pediatric patients. Conclusions: Life-saving as it can be, airbag deployment is a violent occurrence that can threaten a child's life. The possibility of sustaining airbag-induced injuries must not be underestimated. Such injuries should be prevented by taking appropriate prevention measures and by conducting further research into the subject (AU)

Lesión de Monteggia inveterada. Resultados con la técnica de Bell-Tawse modificada en tres casos / Inveterate Monteggia Injury. Results with the modified Bell-Tawse procedure in three cases

Objetivo: La lesión de Monteggia es poco frecuente (el 2% de las fracturas de la región del codo) y los casos inveterados son muy raros. A continuación se presentan 3 casos tratados mediante reducción abierta y reconstrucción del ligamento anular con fascia tricipital. Casos clínicos: La edad media de los 3 sujetos era de 7 años (rango de 5 a 9), 2 de ellos eran varones y todos presentaban lesiones tipo i de Bado en el lado derecho. Los 3 recibieron tratamiento mediante técnica de Bell-Tawse modificada por Lloyd-Roberts y Bucknill; en un enfermo se asoció osteotomía cubital. Resultados: No se presentaron complicaciones. Tras un seguimiento medio de 35 meses (rango de 9 a 84) todos los sujetos consiguieron un arco de flexoextensión funcional con una pérdida leve de pronosupinación, pero no se detectaron restricciones en las actividades de la vida diaria ni déficit funcional. Conclusiones: La técnica de Bell-Tawse modificada es un método efectivo, aun cuando produce una pérdida leve de movilidad, especialmente de pronosupinación. Los resultados a largo plazo de esta técnica son mejores que los que se consiguen con la escisión tardía de la cabeza radial luxada (AU)

Purpose: Monteggia injuries are a rare occurrence (2% of all elbow fractures), and inveterate cases are extremely unusual. We present 3 cases treated by means of open reduction and reconstruction of the annular ligament with a strip of triceps fascia. Case reports: The mean age of the 3 patients was 7 years (range: 5–9). Two of them were male and all presented with type 1 Bado injuries on the right side. All 3 were treated by means of the Bell-Tawse technique as modified by Lloyd-Roberts and Bucknill; one of the patients was also subjected to ulnar osteotomy. Results: There were no complications. After a mean follow-up of 35 months (range: 9–84) all patients achieve a functional flexion-extension range. They experienced a slight loss of pronosupination but they reported no restrictions to their activities of daily living or any functional impairment. Conclusions: The modified Bell-Tawse technique is an effective method, even if it leads to a slight loss of mobility, especially in terms of pronosupination. The long-term results of this technique are better than those achieved with a late excision of the dislocated radial head (AU)

Piomiositis de los obturadores de la cadera / Pyomyositis of hip obturator muscles

El absceso (piomiositis) del músculo obturador interno es extremadamente raro en zonas de clima templado, aunque recientemente se ha visto un aumento en su prevalencia. Habitualmente existe un retraso en el diagnóstico y tratamiento del mismo. Además de nuestro caso, y tras realizar una búsqueda en la bibliografía médica, revisamos todos los casos de piomiositis de los músculos de la cadera publicados recientemente (AU)

Obturator internus muscle abscess (pyomyositis) is extremely rare in temperate environments, although there has been a recent reported increase in prevalence. There usually is a delay in diagnosis and onset of treatment. In addition to our case, we reviewed all cases of pyomyositis of hip muscles found in a review of the recent medical literature (AU)

Síndrome compartimental agudo no traumático del pie en el niño / Non-traumatic acute compartmental syndrome in a child's foot

Introducción. La causa más frecuente de síndrome compartimental agudo (SCA) es la traumática. A pesar de ser frecuente en adultos, pocos autores han descrito este cuadro en pacientes en edad pediátrica. La causa más frecuente de SCA del pie en niños son los aplastamientos con o sin fractura asociada. Caso clínico. Presentamos el caso de una niña de 8 años de edad que presentaba dolor y edema persistente en el pie derecho. Entre sus antecedentes, destaca la existencia de un hemangioma congénito en el segundo dedo del pie derecho. A la exploración, el miembro estaba frío, con los pulsos distales débiles. Se ingresó con el diagnóstico inicial de hemangioma cavernoso con un hematoma que afectaba el retorno venoso del pie. Tras medir las presiones compartimentales, diagnosticamos un síndrome compartimental agudo del pie derecho y realizamos una fasciotomía. Conclusiones. Revisamos la bibliografía actual buscando casos de SCA sin traumatismo causado por un hemangioma. Concluimos que podríamos estar ante una complicación no descrita de los hemangiomas localizados en miembros que, si no se diagnostica precozmente, puede tener consecuencias graves

Introduction. The most common cause for the acute compartmental syndrome (ACS) is trauma. Being a common condition in adults, very few authors have described it for pediatric patients. The most frequent cause for foot ACS in children is a crushing, which may or may not have an associated fracture. Case report. This is the case of an 8 year-old girl who presented with pain and persistent edema in her right foot. An outstanding feature in her clinical history was a congenital hemangioma on the second toe of her right foot. On examination, the limb was cold with weak distal pulses. The case was initially recorded as a cavernous hemangioma with a hematoma affecting the venous return from the foot. After measuring the patient's compartmental pressure levels we diagnosed an acute compartmental syndrome in her left foot and performed a fasciotomy. Conclusions. We reviewed the current literature in order to look for instances of ACS without concomitant hemangioma-caused trauma. We concluded that our case might be an as yet undescribed complication of hemangiomas present in limbs. If it is not diagnosed soon enough, this complication might lead to serious consequences

[Pyomyositis of hip obturator muscles]. / Piomiositis de los obturadores de la cadera.

Obturator internus muscle abscess (pyomyositis) is extremely rare in temperate environments, although there has been a recent reported increase in prevalence. There usually is a delay in diagnosis and onset of treatment. In addition to our case, we reviewed all cases of pyomyositis of hip muscles found in a review of the recent medical literature.