Clinical examination and imaging resources in children and adolescent back pain.

Back pain is a relatively common complaint in children and adolescents. The pediatric patient presenting with back pain can often be challenging, and there are many well-known organic diagnoses that should not be missed. In younger children, an organic cause of back pain can often be found. However, back pain in older children and adolescents is often "non-specific." The differential diagnosis of back pain in children includes neoplasms, developmental, and inflammatory conditions. Basic steps should include an in-depth anamnesis, a systematic physical examination, and standard spine radiographs (anteroposterior and lateral). Nevertheless, advanced diagnostic imaging and laboratory studies should be included when indicated to avoid missing or delaying a serious diagnosis. If other types of imaging tests are necessary (magnetic resonance imaging, computed tomography, bone scan, or single photon emission computed tomography), they should be guided by diagnostic suspicion.

Reliability and Validity of the Adapted Spanish Version of the Early-onset Scoliosis-24 Questionnaire.

STUDY DESIGN: Translation and validation of the Early Onset Scoliosis-24 Questionnaire (EOSQ-24). OBJECTIVE: To cross-culturally adapt the American English version of the EOSQ-24 into Spanish language, and to assess its reliability and discriminative validity. SUMMARY OF BACKGROUND DATA: Treatment of early-onset scoliosis (EOS) seeks to improve natural history and health-related quality of life in children, but radiographic parameters are insufficient to evaluate the severity and efficacy of treatment in these patients. EOSQ-24 was developed to assess the health-related quality of life of EOS children; however, it has not been transculturally adapted and validated for Spanish subjects. METHODS: Translation and cross-cultural adaptation of the original EOSQ-24 was performed according to published guidelines by an expert committee. The Spanish version of the EOSQ-24 was applied to 44 EOS patients. Reliability was assessed by internal consistency using Cronbach α, item-total correlations, and inter-item correlations. Data quality was assessed by mean, median, percentage of missing data, and ceiling and floor effects. For discriminative validity, comparisons between categorical variables were made by using non-parametric (Kruskal-Wallis and/or Mann Whitney U) tests, and Spearman correlation coefficients were used for continuous variables. RESULTS: In our study, all items and domains showed very good global internal consistencies (Cronbach α 0.897 and 0.836, respectively). Corrected item-total correlations were good for all domains (>0.3). Two of 24 items showed low corrected item-total correlations (r = 0.179 and r = 0.254), but Cronbach α did not increase when these items were removed. Inter-item correlations were acceptable (>0.2). EOSQ-24 was found capable to discriminate patients with different curves severity (P = 0.001), diagnosis (P = 0.006), and ambulatory status (P = 0.053). CONCLUSION: The Spanish version of the EOSQ-24 is reliable and a valid tool for the psychometric assessment of children with EOS, and can be applied in routine clinical practice and for research purposes. LEVEL OF EVIDENCE: 2.

Luxación inveterada de Monteggia. Técnica de Bell-Tawse modificada / Monteggia dislocation inveterate

La lesión de Monteggia consiste en la fractura del tercio proximal del cúbito asociada a la luxación anterior de la articulación radiocubital proximal. Es muy poco frecuente en niños (el 2% de las fracturas de la región del codo) y los casos inveterados son más inusuales. Se han descrito muchas estrategias terapéuticas para su tratamiento, sin que esté clara la necesidad de reconstrucción del ligamento anular. A continuación, describimos la técnica de Bell Tawse modifi cada a propósito de un caso de una paciente de 5+6 años con una lesión de Monteggia inveterada

Monteggia’s injury is a fracture of the proximal ulna which is associated with anterior dislocation of the proximal radioulnar joint. It is not a common injury in children (it only represents 2% of fractures of the elbow) and inveterate cases are even more unusual. Many surgical treatments have been proposed for this injury. Nevertheless, there is not a general agreement regarding the necessity of the annular ligament reconstruction. Here we describe the modifi ed technique of Bell-Tawse in a 5 and a half years patient with inveterate Monteggia injury

Physeal fracture of the distal femur in a newborn: role of arthrography.

Making the diagnosis of a physeal separation of the distal end of the femur in a newborn is a true challenge. The radiological diagnosis is not always simple and a high index of suspicion is needed. Also, knowing the age of appearance of the ossific nuclei helps in reaching a diagnosis. However, it is imperative to perform a differential diagnosis with other causes that may compromise the life of the newborn. An early diagnosis and adequate treatment are fundamental in avoiding permanent deformity of the affected limb. We present a case report, along with a review of the literature, to describe the clinical and radiological findings that aid in reaching a diagnosis and giving the proper treatment. We also point out the importance of the role of the arthrography and closed reduction as an alternative to simple open reduction.