Flexible intramedullary nails with traction versus plaster cast for treating femoral shaft fractures in children: comparative retrospective study.

CONTEXT AND OBJECTIVE Femoral fractures are common in children between 2 and 12 years of age, and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. However, in some situations, a surgical approach is recommended. The objective here was to compare treatments for femoral shaft fractures using intramedullary nails (titanium elastic nails, TEN) versus traction and plaster casts in children. The hypothesis was that TEN might provide better treatment, with good clinical results in comparison with plaster casts. DESIGN AND SETTING This retrospective comparative study was conducted in a public university hospital. METHODS Sixty children with femoral fractures were evaluated; 30 of them underwent surgical treatment with TEN and 30 were treated conservatively using plaster casts. The patients' ages ranged from 5 to 13 years (mean of 9 years). RESULTS The mean duration of hospitalization was nine days for the surgical group and 20 days for the conservative group. The incidence of overgrowth in the patients treated with TEN was 60.0% and, for those treated conservatively, 13.3%. Partial weight-bearing was allowed after 3.5 weeks in the surgical group and after 9.6 weeks in the conservative group. New hospitalization was required for 90.0% in the surgical group and 16.7% in the conservative group. Patients treated with plaster casts presented higher incidence of complications, such as loss of reduction. CONCLUSIONS The surgical method presented better results for children.

Flexible intramedullary nails with traction versus plaster cast for treating femoral shaft fractures in children: comparative retrospective study / Hastes intramedulares flexíveis com tração versus aparelho gessado para o tratamento de fraturas diafisárias do fêmur em crianças: estudo comparativo retrospectivo

Femoral fractures are common in children between 2 and 12 years of age, and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. However, in some situations, a surgical approach is recommended. The objective here was to compare treatments for femoral shaft fractures using intramedullary nails (titanium elastic nails, TEN) versus traction and plaster casts in children. The hypothesis was that TEN might provide better treatment, with good clinical results in comparison with plaster casts.

This retrospective comparative study was conducted in a public university hospital.

Sixty children with femoral fractures were evaluated; 30 of them underwent surgical treatment with TEN and 30 were treated conservatively using plaster casts. The patients' ages ranged from 5 to 13 years (mean of 9 years).

The mean duration of hospitalization was nine days for the surgical group and 20 days for the conservative group. The incidence of overgrowth in the patients treated with TEN was 60.0% and, for those treated conservatively, 13.3%. Partial weight-bearing was allowed after 3.5 weeks in the surgical group and after 9.6 weeks in the conservative group. New hospitalization was required for 90.0% in the surgical group and 16.7% in the conservative group. Patients treated with plaster casts presented higher incidence of complications, such as loss of reduction.

The surgical method presented better results for children. .

Fraturas femorais são comuns em crianças entre 2 e 12 anos de idade, e 75% das lesões acometem a diáfise. Tração seguida de aparelho gessado (“gesso”) é universalmente aceita como tratamento conservador. Entretanto, em algumas situações o tratamento cirúrgico é recomendado. O objetivo foi comparar o tratamento de fraturas diafisárias do fêmur com hastes intramedulares (titanium elastic nails, TEN) com tração e gesso em crianças. A hipótese era de que TEN pode ser melhor tratamento, com bons resultados clínicos em comparação com o gesso.

Este estudo retrospectivo e comparativo foi conduzido num hospital público universitário.

Sessenta crianças com fraturas de fêmur foram avaliadas, 30 delas foram submetidas a tratamento cirúrgico com TEN e 30 foram tratadas de forma conservadora usando gesso. A idade dos pacientes variou de 5 a 13 anos (média de 9 anos).

O tempo médio de internação foi de 9 dias para o grupo cirúrgico e 20 dias para o grupo conservador. A incidência de crescimento excessivo nos pacientes tratados com TEN foi de 60,0% e, para aqueles tratados de forma conservadora, 13,3%. Sustentação parcial de peso foi permitida após 3,5 semanas no grupo cirúrgico e após 9,6 semanas no grupo conservador. Houve 90,0% de novas internações no grupo cirúrgico e 16,7% no grupo conservador. Pacientes tratados com gesso apresentaram maior incidência de complicações, tais como perda de redução.

Diagnóstico precoce e o tratamento cirúrgico do polegar em gatilho congênito na criança utilizando o sistema de internação hospital-dia / Early diagnosis and surgical treatment of congenital trigger thumb in children using the day hospital admission system

Introdução: o polegar em gatilho congênito ou tenossinovite estenosante do polegar é a dificuldade de extensão do polegar, identificada nos primeiros meses de vida. Objetivo: a proposta deste estudo foi discutir o tratamento cirúrgico com os resultados, as complicações e as vantagens na utilização da internação hospital-dia. Método: no período de fevereiro de 2001 até janeiro de 2008, verificaram-se 25 crianças entre 3 meses e 6 anos, portadoras de polegar em gatilho congênito. Foram operadas 35 mãos, e 10 casos eram bilaterais. Observamos que a manifestação clínica quanto à dificuldade de extensão do polegar estava presente em todas as mãos operadas e nenhuma criança queixava-se de dor. As crianças foram submetidas à mesma técnica cirúrgica, anestesia geral inalatória, com incisão transversa na prega volar metacarpofalangeana do polegar acometido e abertura longitudinal da polia flexora A1. Não foi utilizado antibiótico e as crianças foram internadas pelo sistema hospital-dia. Resultados: Quinze crianças eram do sexo masculino e dez do sexo feminino. Dos pacientes com lesão bilateral, sete eram do sexo masculino e três do feminino. Quanto ao lado acometido, obtivemos sete polegares direitos, oito esquerdos e dez bilaterais. Como complicações, não houve nenhuma recidiva; um polegar evoluiu com infecção cutânea superficial e dois polegares apresentaram deiscência parcial da sutura após a retirada dos pontos. Conclusões: o polegar em gatilho congênito ou tenossinovite estenosante do polegar na criança pode ser tratado com segurança através da abertura simples da polia flexora A1, utilizando-se a internação hospital-dia.

The congenital trigger disorder or stenosing tenosynovitis of the thumb is the difficulty of extending the thumb, identified in early months of life. Objective: The purpose this study was to discuss the operative results, complications and advantages of the day hospital system. Method: This study was carried out from February 2001 to January 2008, with 25 children aging from 3 months to 6 years old with congenital trigger finger thumb. Thirty-five hands were submitted to surgery, and ten children had both hands attacked. The limited extension of the thumb was the clinical characteristic observed in all operated hands and no child had pain complaint. All children were submitted to the same surgical technique, by the use of inhalational general anesthetics, with transversal incision in the metacarpophalangeal volar pleat of the thumb and longitudinal resection of the flexor pulley A1. Antibiotic therapy was not used and all children were admitted by the day hospital system. Results: fifteen were boys and ten were girls. Seven boys and three girls had the pathology in both hands. Comparing the incidence of each side, we have found seven right congenital trigger thumbs, eight left and ten occurring in both sides. The complications found were: one thumb had superficial cutaneous infection and two thumbs presented dehiscence of the incision after the removal of the suture. There were no cases of recurrence of the disease after surgery. Conclusion: we concluded that congenital trigger disorder or stenosing tenosynovitis in children can be safely treated with simple incision of flexor pulley A1 and with day hospital system.

Complicações osteoarticulares da analgesia congênita / Osteoarticular complications of congenital analgesia

Os autores apresentam dois irmãos com diagnóstico de analgesia congênita, com suas características clínicas e evolução. Essa doença é rara, apresenta alta morbidade e gera complicações osteoarticulares de difícil solução. O objetivo dos autores foi ressaltar a importância do diagnóstico tanto para o tratamento de suas afecções secundárias, quanto para seu aspecto jurídico.

The authors present two brothers with congenital pain insensitivity, with their clinical characteristics and evolution. This disease is rare, has high morbidity and originates complex osteoarticular complications. The aim of the authors was to emphasize the value of the diagnosis for a better treatment and to avoid legal problems to the parents.

Short hospitalization period with elastic stable intramedullary nails in the treatment of femoral shaft fractures in school children.

PURPOSE: To evaluate the safety and period of hospitalization of the treatment of femoral shaft fractures with titanium elastic nails (TEN) in the age range 5 to 14 years. The hypothesis was that TEN might be a low-cost treatment, with good clinical results and short length of hospitalization. METHODS: Thirty children with femur fractures were surgically treated with TEN. RESULTS: The patients spent an average of 9.4 days in hospital. The average period for the healing process was 7.7 weeks. Partial weight bearing was permitted 3.3 weeks after surgery. The incidence of overgrowth was 60%, with an average of 0.40 cm. CONCLUSIONS: The surgical method brings few complications and results in good limb alignment, with a short period of hospitalization and early return to daily activities and school.

Piomiosite tropical / Tropical Pyomiositis

Os autores apresentam dois casos de pacientes com diagnóstico de Piomisite Tropical, relatando seu quadro clínico, exames complementares bem como sua evolução. Esta doença caracteriza-se pelo aparecimento de abscessos isolados ou múltiplos em diversos grupos musculares, sendo comum em regiões de clima tropical, mas podendo também, embora com menor freqüência, ser encontrada em lugares de clima temperado. O objetivo destes relatos é descrever as características da Piomisite Tropical, os meios de diagnóstico e suas possíveis complicações. Os autores concluem que o sucesso do tratamento depende do diagnóstico precoce.

Tíbia vara de Blount em gêmeos monozigóticos / Blount's disease in monozygotic twins

Os autores relatam dois casos raros de gêmeas monozigóticas, de famílias distintas, apresentando tíbia vara de Blount do tipo infantil. Num caso a doença é unilateral nas irmãs e afeta assimetricamente membros opostos; no outro, uma paciente é afetada unilateralmente e a outra em ambas as pernas. Discutem a variabilidade de apresentação clínica da doença; na evolução do primeiro caso houve regressão da angulação inicial da deformidade. O relato tem o objetivo de acrescentar dois novos casos aos dois previamente descritos na literatura, além de discutir a etiologia da doença, questionando o possível caráter de transmissão genética.