Chondrosarcoma of the Hand Bones: A Report of 6 Cases and Review of the Literature.

BACKGROUND: Primary malignant tumours of the hand are extremely rare, with chondrosarcoma being the most common. We describe six consecutive cases of chondrosarcoma (CS) of the hand, with a follow-up of 12 months to 10 years after surgical intervention. METHODS: Five cases were primary tumors and one was secondary to Ollier's disease. Mean age at diagnosis was 67.5 years (range 46 to 85 years) and three patients were males. The bone most commonly affected was the proximal phalanx (in 4 patients), followed by the metacarpal bone (3 cases in the other 2 patients). The first symptom was an increase in volume in five cases and a pathological fracture in one. The x-ray study showed signs of malignancy in two cases only. In the other four cases, CT and MRI studies were necessary to complete the diagnosis. RESULTS: Primary amputation was performed in two cases and intralesional curettage and cancellous bone autograft in four. Primary amputation was performed in two cases and intralesional curettage and cancellous bone autograft in four. We found three grade I/III CS and three grade II/III CS in the histological study. Local recurrences occurred in three patients, two being grade II/III CS. One of the three had undergone an initial amputation and underwent re-amputation, another had had curettage of the lesion and was amputated, and the third patient decided not to undergo the procedure due to her age. A pulmonary nodule was suspected at the most recent follow up in a fourth patient, who had been diagnosed with a grade II/III CS. CONCLUSIONS: Although CS of the hand bones behaves as a locally aggressive lesion, it rarely metastasizes. Intralesional curettage with a cancellous bone autograft appears to be a good option in low-grade CS to preserve the function, keeping in mind the high rate of recurrence. Wide excision or amputation is recommended when severe joint deformity or soft tissue involvement interferes with hand function.

Luxación traumática de cadera en un niño / Luxation traumatique de hanche chez l'enfant / Traumatic hip dislocation in a child

Introducción: la luxación traumática de cadera en un paciente pediátrico es una lesión muy infrecuente. No existe consenso sobre su manejo óptimo en urgencias y el seguimiento posterior. Reporte de caso: se reporta el caso de un niño de 4 años que sufrió una luxación traumática de cadera derecha mientras esquiaba. Recibió tratamiento conservador que consistió en reducción cerrada y sin inmovilización posterior. Se realizó una revisión de la literatura sobre esta lesión traumática, su tratamiento y seguimiento. Se mencionan las características diferenciales de la entidad en la población adulta. Resultados: en el presente caso, los resultados fueron muy satisfactorios, pues el paciente tuvo una recuperación funcional completa con un nivel de vida equiparable al que tenía antes de la luxación. Conclusión: la luxación traumática de cadera en la población pediátrica es infrecuente. Sin embargo, dada la importancia de su reducción a la mayor brevedad posible con el objetivo de evitar complicaciones posteriores como la osteonecrosis avascular, es preciso diagnosticarla y tratarla lo más precozmente posible. No existe consenso, sin embargo, en cuanto al tratamiento y seguimiento óptimo de esta afección una vez resuelto el episodio agudo(AU)

Introduction: traumatic hip dislocation in a pediatric patient is a rare injury. There is no consensus on the optimal management in its emergency and follow-up. Case report: the case of a 4 year-old boy who suffered a traumatic dislocation of the right hip while skiing is reported. He received conservative treatment consisting of closed reduction and with no further immobilization. A review of the literature on this traumatic injury, treatment and follow-up was performed. The differential characteristics of the above entity in the adult population are mentioned. Results: in the present case, the results were very satisfactory, since the patient had complete functional recovery with same level of life that he had before the dislocation. Conclusion: traumatic hip dislocation in pediatric population is rare. However, given the importance of its reduction as soon as possible in order to avoid further complications such as avascular osteonecrosis, diagnosis and treatment is necessary as early as possible. There is no consensus, however, as to the optimal treatment and monitoring of the condition after an acute episode is solved(AU)

Introduction: la luxation traumatique de hanche est une lésion peu fréquente chez l'enfant. Il n'existe pas de consensus sur sa prise en charge en urgences et son suivi subséquent. Rapport de cas: le cas d'un enfant âgé de 4 ans ayant souffert une luxation traumatique de la hanche droite lors du ski est rapporté. Il a eu un traitement conservateur consistant en réduction fermée sans immobilisation ultérieur. On a fait une revue de la littérature de cette lésion traumatique, son traitement et son suivi. Les caractéristiques de différentiation de cette affection dans une population adulte sont mentionnées. Résultats: dans ce cas, les résultats ont été satisfaisants, car le patient a eu une complète récupération fonctionnelle lui permettant un niveau de vie comparable à celui qu'il menait avant la luxation. Conclusions: la luxation traumatique de hanche est peu fréquente chez l'enfant. Il est pourtant nécessaire de la diagnostiquer et la traiter précocement pour éviter des complications telles que l'ostéonécrose avasculaire. Mais, il n'existe pas encore de consensus sur un traitement et un suivi appropriés(AU)

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