Las coaliciones tarsianas como causa de dolor en el pie infantil: opciones terapéuticas / Tarsal coalitions as a cause of pain in the foot of children: Therapeutic options

Antecedentes y objetivo: La coalición tarsiana puede ser causa de dolor de medio-retropié en niños mayores. El objetivo es analizar los tipos de coalición tratados en nuestro centro hospitalario de 2010 a 2019 así como el tratamiento realizado. Material y método: Estudio observacional, descriptivo y retrospectivo de 18 pacientes con coalición tarsiana, 8 mujeres y 10 hombres, de 11,9±2,6 años de edad. Se recogieron datos epidemiológicos, hallazgos clínicos y de pruebas de imagen y tratamiento realizado. Resultados: Se revisaron 25 pies (38,8% bilaterales). El principal síntoma fue el dolor. Un 64% se asociaba a pie plano-valgo. El 52% se localizaba en la articulación calcáneo-escafoidea, y un 40% en la calcáneo-astragalina. El tratamiento fue conservador en un 44,4% de los casos y quirúrgico en el 56% (resección de la coalición). Se produjo un solo caso de recidiva. Los resultados fueron mayoritariamente excelentes o buenos (88%) tras un periodo medio de seguimiento de 4 años. Conclusiones: El tipo de coalición tarsiana diagnosticada con mayor frecuencia fue la localizada en la articulación calcáneo-escafoidea seguida de la calcáneo-astragalina, pero puede aparecer en cualquier articulación del pie. Casi la mitad respondieron bien al tratamiento conservador con resultados mayoritariamente buenos, pero el resto requirieron tratamiento quirúrgico por persistencia de la clínica, cuyos resultados fueron excelentes en todos los casos excepto en uno que sufrió una recidiva. En los casos de coaliciones calcáneo-astragalinas asociadas a valgo severo de retropié, la corrección de esta deformidad, asociada o no a la resección de la coalición, es recomendable.(AU)

Background and objective: The tarsal coalition can be a cause of mid-hindfoot pain in older children. The objective is to analyze the types of coalition treated in our hospital from 2010 to 2019 as well as the treatment carried out. Material and method: Observational, descriptive and retrospective study of 18 patients with tarsal coalition, 8 women and 10 men, aged 11.9±2.6 years. Epidemiological data, clinical findings and imaging tests, and treatment performed were collected. Results: Twenty-five feet (38.8% bilateral) were reviewed. The main symptom was pain. Sixty-four percent were associated with flat-valgus foot. Fifty-two percent were located in the calcaneal-scaphoid joint, and 40% in the calcaneal-talar joint. Treatment was conservative in 44.4% of cases and surgical in 56% (coalition resection). There was only one case of recurrence. The results were mostly excellent or good (88%) after a mean follow-up period of 4 years. Conclusions: The most frequently diagnosed type of tarsal coalition was that located in the calcaneal-scaphoid joint followed by the calcaneal-talar joint, but they can appear in any joint of the foot. Almost half responded well to conservative treatment with mostly good results, but the rest required surgical treatment due to persistence of the symptoms, the results of which were excellent in all cases except one who suffered a recurrence. In cases of calcaneal-talar coalitions associated with severe hindfoot valgus, correction of this deformity, associated or not with resection of the coalition, is recommended.(AU)

[Translated article] Tarsal coalitions as a cause of pain in the foot of children: Therapeutic options / Las coaliciones tarsianas como causa de dolor en el pie infantil: opciones terapéuticas

Antecedentes y objetivo: La coalición tarsiana puede ser causa de dolor de medio-retropié en niños mayores. El objetivo es analizar los tipos de coalición tratados en nuestro centro hospitalario de 2010 a 2019 así como el tratamiento realizado. Material y método: Estudio observacional, descriptivo y retrospectivo de 18 pacientes con coalición tarsiana, 8 mujeres y 10 hombres, de 11,9±2,6 años de edad. Se recogieron datos epidemiológicos, hallazgos clínicos y de pruebas de imagen y tratamiento realizado. Resultados: Se revisaron 25 pies (38,8% bilaterales). El principal síntoma fue el dolor. Un 64% se asociaba a pie plano-valgo. El 52% se localizaba en la articulación calcáneo-escafoidea, y un 40% en la calcáneo-astragalina. El tratamiento fue conservador en un 44,4% de los casos y quirúrgico en el 56% (resección de la coalición). Se produjo un solo caso de recidiva. Los resultados fueron mayoritariamente excelentes o buenos (88%) tras un periodo medio de seguimiento de 4 años. Conclusiones: El tipo de coalición tarsiana diagnosticada con mayor frecuencia fue la localizada en la articulación calcáneo-escafoidea seguida de la calcáneo-astragalina, pero puede aparecer en cualquier articulación del pie. Casi la mitad respondieron bien al tratamiento conservador con resultados mayoritariamente buenos, pero el resto requirieron tratamiento quirúrgico por persistencia de la clínica, cuyos resultados fueron excelentes en todos los casos excepto en uno que sufrió una recidiva. En los casos de coaliciones calcáneo-astragalinas asociadas a valgo severo de retropié, la corrección de esta deformidad, asociada o no a la resección de la coalición, es recomendable.(AU)

Background and objective: The tarsal coalition can be a cause of mid-hindfoot pain in older children. The objective is to analyze the types of coalition treated in our hospital from 2010 to 2019 as well as the treatment carried out. Material and method: Observational, descriptive and retrospective study of 18 patients with tarsal coalition, 8 women and 10 men, aged 11.9±2.6 years. Epidemiological data, clinical findings and imaging tests, and treatment performed were collected. Results: Twenty-five feet (38.8% bilateral) were reviewed. The main symptom was pain. Sixty-four percent were associated with flat-valgus foot. Fifty-two percent were located in the calcaneal-scaphoid joint, and 40% in the calcaneal-talar joint. Treatment was conservative in 44.4% of cases and surgical in 56% (coalition resection). There was only one case of recurrence. The results were mostly excellent or good (88%) after a mean follow-up period of 4 years. Conclusions: The most frequently diagnosed type of tarsal coalition was that located in the calcaneal-scaphoid joint followed by the calcaneal-talar joint, but they can appear in any joint of the foot. Almost half responded well to conservative treatment with mostly good results, but the rest required surgical treatment due to persistence of the symptoms, the results of which were excellent in all cases except one who suffered a recurrence. In cases of calcaneal-talar coalitions associated with severe hindfoot valgus, correction of this deformity, associated or not with resection of the coalition, is recommended.(AU)

[Translated article] Tarsal coalitions as a cause of pain in the foot of children: Therapeutic options.

BACKGROUND AND OBJECTIVE: The tarsal coalition can be a cause of mid-hindfoot pain in older children. The objective is to analyse the types of coalition treated in our hospital from 2010 to 2019 as well as the treatment carried out. MATERIAL AND METHOD: Observational, descriptive and retrospective study of 18 patients with tarsal coalition, 8 women and 10 men, aged 11.9±2.6 years. Epidemiological data, clinical findings and imaging tests, and treatment performed were collected. RESULTS: Twenty-five feet (38.8% bilateral) were reviewed. The main symptom was pain. Sixty-four percent were associated with flat-valgus foot. Fifty-two percent were located in the calcaneal-scaphoid joint, and 40% in the calcaneal-talar joint. Treatment was conservative in 44.4% of cases and surgical in 56% (coalition resection). There was only one case of recurrence. The results were mostly excellent or good (88%) after a mean follow-up period of 4 years. CONCLUSIONS: The most frequently diagnosed type of tarsal coalition was that located in the calcaneal-scaphoid joint followed by the calcaneal-talar joint, but they can appear in any joint of the foot. Almost half responded well to conservative treatment with mostly good results, but the rest required surgical treatment due to persistence of the symptoms, the results of which were excellent in all cases except one who suffered a recurrence. In cases of calcaneal-talar coalitions associated with severe hindfoot valgus, correction of this deformity, associated or not with resection of the coalition, is recommended.

Tarsal coalitions as a cause of pain in the foot of children: Therapeutic options. / Las coaliciones tarsianas como causa de dolor en el pie infantil: opciones terapéuticas.

BACKGROUND AND OBJECTIVE: The tarsal coalition can be a cause of mid-hindfoot pain in older children. The objective is to analyze the types of coalition treated in our hospital from 2010 to 2019 as well as the treatment carried out. MATERIAL AND METHOD: Observational, descriptive and retrospective study of 18 patients with tarsal coalition, 8 women and 10 men, aged 11.9±2.6 years. Epidemiological data, clinical findings and imaging tests, and treatment performed were collected. RESULTS: Twenty-five feet (38.8% bilateral) were reviewed. The main symptom was pain. Sixty-four percent were associated with flat-valgus foot. Fifty-two percent were located in the calcaneal-scaphoid joint, and 40% in the calcaneal-talar joint. Treatment was conservative in 44.4% of cases and surgical in 56% (coalition resection). There was only one case of recurrence. The results were mostly excellent or good (88%) after a mean follow-up period of 4 years. CONCLUSIONS: The most frequently diagnosed type of tarsal coalition was that located in the calcaneal-scaphoid joint followed by the calcaneal-talar joint, but they can appear in any joint of the foot. Almost half responded well to conservative treatment with mostly good results, but the rest required surgical treatment due to persistence of the symptoms, the results of which were excellent in all cases except one who suffered a recurrence. In cases of calcaneal-talar coalitions associated with severe hindfoot valgus, correction of this deformity, associated or not with resection of the coalition, is recommended.

Syndromic clubfoot beyond arthrogryposis and myelomeningocele: orthopedic treatment with Ponseti method. / Pie zambo sindrómico más allá de la artrogriposis y el mielomeningocele: tratamiento ortopédico con el método de Ponseti.

INTRODUCTION: Talipes equinovarus or clubfoot is a congenital deformity of the foot with bone, muscle, and tendon involvement. It's one of the most frequent foot malformations in pediatric orthopedics. Although generally idiopathic, it may have a syndromic cause and be associated with musculoskeletal, neurological, or connective tissue conditions. The treatment of choice in idiopathic clubfoot is the Ponseti method based on manipulation and fixation with serial casts that seek progressive correction of the deformity. The Ponseti method effectiveness has been demonstrated in arthrogryposis and myelomeningocele clubfoot. There are few clinical studies demonstrating the efficacy of this therapeutic option in patients with syndromic clubfoot. MATERIAL AND METHODS: Retrospective study with 6 patients (9 feet) with syndromic clubfoot treated in a tertiary center with the Ponseti method with a minimum follow up of two years (2-18). The results were evaluated with the Pirani classification, assessing clubfoot severity before and after treatment. RESULTS: Of the six patients treated were used an average of 6.5 casts. The Pirani scale obtained a mean score of 5.2 before treatment, with a decrease to 1.27 after treatment, with a mean improvement of 3.93 points. In more than half of the cases it was necessary to lengthen the Achilles tendon to correct the equine deformity. In addition, an ankle-foot orthosis was used to reduce recurrences in patients with dysmetria or psychomotor retardation. The most frequently observed residual deformity was the adduct. A patient relapsed twice. CONCLUSIONS: The Ponseti method obtains effective results in the correction of syndromic clubfoot, although it requires a greater number of corrective casts than other pediatric foot pathologies.

Epidemiological study on supracondylar fractures of distal humerus in pediatric patients. / Estudio epidemiológico sobre fracturas supracondíleas de húmero distal en pacientes pediátricos.

OBJECTIVE: The purpose of this work is to study the epidemiology of patients with distal humerus supracondylar fractures in pediatric age treated in a tertiary hospital. METHOD: A descriptive study was conducted on the epidemiological characteristics of distal humerus supracondylar fractures in pediatric patients treated in a tertiary hospital from January 1, 2014 to June 30, 2018. The following variables were analyzed: age, side of lesion, sex, type of Gartland's classification, date of injury, mechanism, place and moment of trauma, therapeutic attitude, complications and associated fractures. RESULTS: A total of 140 patients were included in the study, with an average age of 5 years and 3 months. According to Gartland's classification, 40% of patients with type I fractures were found, 20.7% with type II and 39.3% with type III. Of the total sample, 76 patients (54.3%) were treated surgically and 9 (6.4%) had neurological complications. Likewise, in 135 cases the place of the fall could be identified, most of them (52.1%) in the park with a significantly higher incidence from May to August (45.8%) and the weekends (70.71%). CONCLUSIONS: The incidence of supracondylar humerus fractures seems to be greater associated with the activity in the parks and, above all, it would be greater during the summer period, in the afternoon and the weekends.

[Quantification of changes in the external morphology of the back by means of surface topography based on structured light in idiopathic scoliosis in adolescents after a year of treatment with orthopedic corse]. / Cuantificación de cambios en la morfología externa de la espalda mediante topografía de superficie basada en luz estructurada en la escoliosis idiopática del adolescente tras un año de tratamiento con corsé ortopédico.

BACKGROUND: To quantify the morphological changes in the surface of the back of adolescents with idiopathic scoliosis as a result of treatment with braces and to correlate them with radiographic changes. MATERIAL AND METHODS: An analytical, cohort, prospective study on a sample of 31 adolescents with idiopathic scoliosis. We divided them into two groups: eleven treated with braces and twenty without them. Quantification of the deformity was performed on two separate occasions with an interval of one year using three systems: 1) angle of trunk rotation (scoliometer); 2) surface topography; 3) full spine X-rays. RESULTS: No statistically significant differences were detected between the initial and final assessment of the topographic and radiographic variables in the group with braces. In the untreated group, only in measures with the scoliometer significant differences were registered. A positive correlation was found between the Cobb angle difference of the main curve with two topographic variables that quantify the asymmetry in the axial and coronal plane, respectively. DISCUSSION: In following patients with scoliosis treated with braces, we should consider and evaluate not only radiographic parameters such as the Cobb angle, but also clinical and topographic parameters that quantify the external deformity of the back, as there is a clinical-radiographic discrepancy amply demonstrated in the literature. The improvement of the external shape of the back is a very important factor for the patient, and can influence a better completion of the orthopedic treatment. In our study, the scoliotic curve and external deformity of the back remained stable during the follow-up period in both treated and untreated patients.

ANTECEDENTES: Cuantificar los cambios morfológicos producidos en la superficie de la espalda de adolescentes con escoliosis idiopática como resultado del tratamiento mediante corsé y correlacionarlos con las variaciones radiográficas. MATERIAL Y MÉTODOS: Estudio analítico, de cohortes, prospectivo, sobre una muestra de 31 adolescentes con escoliosis idiopática divididos en dos grupos: 11 con tratamiento mediante corsé y 20 sin corsé. Se realizó una cuantificación de la deformidad en dos ocasiones separadas entre sí por un intervalo de un año mediante tres sistemas: 1) ángulo de rotación del tronco (escoliómetro); 2) topografía de superficie; 3) radiografía simple de raquis completo. RESULTADOS: No se detectaron diferencias estadísticamente significativas entre la valoración inicial y final de las variables topográficas y radiográficas en el grupo con corsé. En el grupo no tratado, sólo hubo diferencias significativas para las medidas del escoliómetro. Se encontró una correlación positiva entre la diferencia del ángulo de Cobb de la curva principal con la de dos variables topográficas que cuantifican la asimetría en el plano axial y en el coronal, respectivamente. DISCUSIÓN: En el seguimiento de pacientes con escoliosis tratados con corsé, se deben tener en cuenta y valorar no sólo parámetros radiográficos como el ángulo de Cobb, sino también parámetros clínicos y topográficos que cuantifiquen la deformidad externa de la espalda, ya que existe una discrepancia clínico-radiográfica demostrada de manera amplia en la literatura. La mejoría de la forma externa de la espalda es un factor muy importante para el paciente y es lo que va a percibir fundamentalmente, lo que puede influir en una mejor cumplimentación del tratamiento ortopédico. En nuestro estudio, la curva escoliótica, así como la deformidad externa de la espalda, se mantuvo estable en el período de seguimiento tanto en los pacientes tratados con corsé como en los no tratados.

Background acetabular aneurysmal bone cyst in a 7 year-old: Presentation of a case. / Quiste óseo aneurismático localizado en trasfondo acetabular en un niño de 7 años: a propósito de un caso.

The bone cyst is a rare benign tumor that usually develops in childhood. There are several treatment options, however when it is located within the pelvis treatment is complex. A 7 year-old patient who presented with 3 months of right hip pain and limping. The initial radiograph showed a discrete periostic reaction and acetabulum effacement. The MRI and CT scans suggested the diagnosis of aneurysmal bone cyst and was confirmed by open biopsy. Two serial embolizations were performed with good results, the patient was asymptomatic one year after.

[Dome shaped osteotomy combined with transposition of the ulnar nerve as a treatment for post-traumatic ulnar valgus in a pediatric patient]. / Osteotomía cupuliforme combinada con transposición del nervio cubital como tratamiento del cúbito valgo postraumático en una paciente pediátrica.

A sequel of supracondylar fractures of distal humerus in children is the angular deformity. It is usually more frequent cubitus varus, but there are reported cases of cubitus valgus. The latter may be the cause of the occurrence of a late ulnar nerve neuropathy, which will require treatment. There is controversy as to whether it is possible to successfully treat both problems at the same surgical procedure. This article describes the case of a girl of 11 years old, who has a cubitus valgus deformity secondary to supracondylar fracture of distal humerus of right elbow at the age of seven years, associated with progressive symptoms of ulnar nerve neuropathy. This patient was treated successfully by a single procedure for corrective dome-shaped supracondilar osteotomy associated with subcutaneous anterior transposition of the ulnar nerve through a posterior approach.

Una secuela de las fracturas supracondíleas de húmero distal en la infancia es la deformidad angular. Generalmente es más frecuente el cúbito varo, pero también existen casos descritos de cúbito valgo. Esta última puede ser la causa de la aparición de una neuropatía tardía del nervio cubital, que requerirá de tratamiento. Existe controversia en cuanto si es posible tratar con éxito ambos problemas en un mismo procedimiento quirúrgico. En este artículo se presenta el caso de una niña de 11 años, que presenta una deformidad en cúbito valgo secundaria a una fractura supracondílea de húmero distal de codo derecho a la edad de siete años, asociada con una clínica progresiva de neuropatía del nervio cubital. Esta paciente se trató de forma satisfactoria mediante un procedimiento único de osteotomía correctora cupuliforme supracondilar asociada con una transposición anterior subcutánea del nervio cubital a través de un abordaje posterior.

Quiste óseo aneurismático subperióstico localizado en el quinto metatarsiano en una niña de 13 años: a propósito de un caso / Subperiosteal aneurysmal bone cyst located in the fifth metatarsal shaft in a 13 year-old girl

Objetivo. Se presenta un caso poco frecuente de quiste óseo aneurismático por su localización y por su forma de presentación clínica y radiográfica inicial. Caso clínico. Mujer de 13 años que consultó por dolor atraumático en el borde externo del pie derecho con radiografía inicial normal y presentación al cabo de un mes de una lesión tumoral subperióstica en la diáfisis del quinto metatarsiano, cuyo diagnóstico definitivo fue de quiste óseo aneurismático tipo iv de Campanacci. Conclusiones. Existen pocos casos en la literatura médica de quiste óseo aneurismático que presenten estas características. Por su localización poco frecuente, este tipo de lesiones pueden plantear dificultades diagnósticas con otro tipo de enfermedades, como tumores, fracturas de estrés o infecciones (AU)

Objective. We present s a case of aneurysmal bone cyst, unusual and rare, both for its location and its initial clinical and radiographic presentation. Case report. A girl of 13 years consulting for atraumatic pain in the outer edge of right foot, with a normal initial X-ray and then one month later presented with a subperiosteal tumour lesion in the fifth metatarsal shaft, which was definitively diagnosed as an aneurysmal bone cyst, Campanacci type IV. Conclusions. There are few cases in the literature of aneurysmal bone cyst with these characteristics. Such lesions may pose significant diagnostic difficulties with other pathologies, such as tumours, stress fractures or infections, due to its unusual presentation (AU)

Osificación heterotópica periarticular secundaria a disfunción neurogénica central / Periarticular heterotopic ossification secondary to central neurogenic dysfunction

Presentamos el caso clínico de una paciente de 48 años de edad con antecedentes de tetraparesia secundaria a lobectomía derecha y desarrollo de una osificación heterotópica periarticular que incluía ambas articulaciones de las rodillas. La valoración del metabolismo de las lesiones óseas motivó la realización de una gammagrafía ósea. El patrón gammagráfico demostró un predominio de afectación del compartimento medial y lateral de la rodilla izquierda y medial de la rodilla derecha, siendo atribuido inicialmente a una osteoartritis degenerativa. Creemos interesante la presentación de este caso clínico por dos circunstancias: 1) la rareza de afectación de las rodillas en la osificación heterotópica periarticular secundaria a disfunción cerebral y 2) por la posibilidad de realizar un diagnóstico falso positivo: afectación osteoartrítica idiopática versus osificación yuxtaarticular.Se pretende realizar una pequeña revisión de: la utilidad de los métodos diagnósticos por la imagen en la valoración de la osificación heterotópica periarticular y del diagnóstico gammagráfico diferencial respecto a enfermedades osteoarticulares más frecuentes entre la población general (AU)

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[Periarticular heterotopic ossification secondary to central neurogenic dysfunction]. / Osificación heterotópica periarticular secundaria a disfunción neurogénica central.

A case of a 48 year old woman with a medical background of tetraparesis related to a right lobectomy and periarticular ossification development (that included both knee joints) is presented. Bone scintigraphy was performed to evaluate the metabolism of the bone lesions. The scintigraphic pattern showed an important involvement of the medial and lateral left knee and medial right knee compartments, initially attributed to degenerative osteoarthritis. We believe that the presentation of this case report is interesting for two reasons: 1) the rareness of knee involvement in periarticular heterotopic ossification related to cerebral dysfunction, and 2) the possibility of a false positive diagnosis: osteoarthritic involvement versus juxta-articular ossification. This paper reviews the role of diagnostic imaging methods in the assessment of periarticular heterotopic ossification and the differential scintigraphic diagnosis regarding to osteoarticular disorders (more frequent among the general population).