Osteoma osteoide: causa poco frecuente de dolor crónico en la muñeca en una niña / Osteoid osteoma: unusual cause of chronic pain in the wrist in a child

El osteoma osteoide es una lesión ósea benigna que, habitualmente, se acompaña de clínica típica caracterizada por dolor nocturno que mejora con antiinflamatorios no esteroideos. Aunque la presentación clínica es típica, con frecuencia, es común la demora diagnóstica, en especial, en los casos con localización atípica.Se presenta el caso de una paciente de 10 años con dolor en la muñeca izquierda de dos años de evolución con diagnóstico de osteoma osteoide localizado en el hueso grande del carpo. La localización atípica de la lesión conllevó un retraso diagnóstico importante

Osteoid osteoma is a benign bone lesion that is usually accompanied by a typical clinical condition characterized by night pain that improves with non-steroidal anti-inflammatory drugs. Although the clinical presentation is frequently typical, diagnostic delay is common, especially in cases with an atypical location.We report the case of a 10-year-old patient with left wrist pain of two years of evolution with diagnosis of osteoid osteoma located in capitate bone. The atypical location of the lesion led to a significant diagnostic delay.

[Osteoid osteoma: unusual cause of chronic pain in the wrist in a child]. / Osteoma osteoide: causa poco frecuente de dolor crónico en la muñeca en una niña.

Osteoid osteoma is a benign bone lesion that is usually accompanied by a typical clinical condition characterized by night pain that improves with non-steroidal anti-inflammatory drugs. Although the clinical presentation is frequently typical, diagnostic delay is common, especially in cases with an atypical location. We report the case of a 10-year-old patient with left wrist pain of two years of evolution with diagnosis of osteoid osteoma located in capitate bone. The atypical location of the lesion led to a significant diagnostic delay.

El osteoma osteoide es una lesión ósea benigna que, habitualmente, se acompaña de clínica típica caracterizada por dolor nocturno que mejora con antiinflamatorios no esteroideos. Aunque la presentación clínica es típica, con frecuencia, es común la demora diagnóstica, en especial, en los casos con localización atípica. Se presenta el caso de una paciente de 10 años con dolor en la muñeca izquierda de dos años de evolución con diagnóstico de osteoma osteoide localizado en el hueso grande del carpo. La localización atípica.

Displasia del desarrollo de la cadera en niños con trastorno psicomotor. ¿Factor de riesgo para un mal resultado? / Developmental dysplasia of the hip in children with a psychomotor disorder. A risk factor for a poor outcome?

INTRODUCCIÓN: El tratamiento ortopédico de la displasia del desarrollo de la cadera (DDC) presenta un alto porcentaje de éxito en casos diagnosticados precozmente o en los primeros meses de vida. Sin embargo, se desconoce qué resultados presentan estos pacientes cuando posteriormente son diagnosticados de un trastorno psicomotor. MATERIAL Y MÉTODOS: Se realiza un estudio observacional retrospectivo de los casos de DDC con mala evolución tras tratamiento ortopédico, desconociéndose si presentaban algún tipo de trastorno psicomotor. Los pacientes fueron valorados clínica y radiológicamente, y por la Unidad de Neurología Infantil. RESULTADOS: De los 325 casos de DDC diagnosticados en 293 pacientes, 10 pacientes (3%) con 16 caderas con DDC fueron diagnosticados de algún tipo de trastorno psicomotor. Todos los casos inicialmente fueron tratados ortopédicamente. La evolución tanto clínica como radiológica en estos casos fue favorable sOlo en 4 (25%). En los 12 restantes se indicó quirúrgica para su resolución (75%). Hubo mejoría tras tratamiento quirúrgico en el índice acetabular (p = 0,005) y en el índice de extrusión de Reimers (p = 0,042). El ángulo cÉrvico-diafisario y el ángulo CE de Wiberg también mejoraron, pero su diferencia no fue estadísticamente significativa. El diagnóstico del trastorno psicomotor se realizó a los 2,5 años de edad. El inicio de la deambulación de estos pacientes estaba retrasado, iniciándose a los 2,4 años. CONCLUSIONES: El trastorno psicomotor puede condicionar una tórpida evolución en el tratamiento conservador de la DDC; el riesgo relativo de presentar un mal resultado es 7.2 veces mayor en estos pacientes. Ante una mala respuesta al tratamiento convencional de una DDC, debe sospecharse la existencia de un posible trastorno neurológico de base, especialmente si hay un retraso en la deambulación

INTRODUCTION: Orthopaedic treatment of developmental dysplasia of the hip (DDH) has a high success rate in cases that are diagnosed early. However, the outcomes of these patients are not really known when they are subsequently diagnosed with some type of cerebral impairment. MATERIALS AND METHODS: A retrospective observational study was conducted on cases of DDH with a poor outcome after orthopaedic treatment, being unknown if they had any type of psychomotor disorder. The patients were clinically and radiologically assessed, and afterwards received neurological valuation by the Child Neurology Unit. RESULTS: Of the 325 cases of DDH diagnosed in 293 patients, 10 patients (3%) with 16 hips with DDH were diagnosed of any cerebral impairment. All them were initially treated orthopedically. Clinical and radiologically evolution was succesful only in 4 cases (25%) being necessary any surgical procedure in the remaining 12 cases. After surgical treatment we got an improvement in the Acetabular Index (p = 0.005) and Reimers Extrusion Index (p = 0.042). Neck-shaft angle and Wiberg CE angle also improved but this difference was not statically significant. Cerebral impairment was diagnosed at 2,5 years of age and the begining of walking was delayed at 2.4 years of age. CONCLUSIONS: Cerebral impairment can lead to an unfavourable outcome in the treatment of DDH, with the relative risk of a poor outcome being 7.2 times higher in these patients. An unfavourable outcome with conventional treatment of DDH must make us suspect the presence of some type of neurological disorder, particularly if there is a delay in walking

[Developmental dysplasia of the hip in children with a psychomotor disorder. A risk factor for a poor outcome?]. / Displasia del desarrollo de la cadera en niños con trastorno psicomotor. ¿Factor de riesgo para un mal resultado?

INTRODUCTION: Orthopaedic treatment of developmental dysplasia of the hip (DDH) has a high success rate in cases that are diagnosed early. However, the outcomes of these patients are not really known when they are subsequently diagnosed with some type of cerebral impairment. MATERIALS AND METHODS: A retrospective observational study was conducted on cases of DDH with a poor outcome after orthopaedic treatment, being unknown if they had any type of psychomotor disorder. The patients were clinically and radiologically assessed, and afterwards received neurological valuation by the Child Neurology Unit. RESULTS: Of the 325 cases of DDH diagnosed in 293 patients, 10 patients (3%) with 16 hips with DDH were diagnosed of any cerebral impairment. All them were initially treated orthopedically. Clinical and radiologically evolution was succesful only in 4 cases (25%) being necessary any surgical procedure in the remaining 12 cases. After surgical treatment we got an improvement in the Acetabular Index (p=0.005) and Reimers Extrusion Index (p=0.042). Neck-shaft angle and Wiberg CE angle also improved but this difference was not statically significant. Cerebral impairment was diagnosed at 2,5 years of age and the begining of walking was delayed at 2.4 years of age. CONCLUSIONS: Cerebral impairment can lead to an unfavourable outcome in the treatment of DDH, with the relative risk of a poor outcome being 7.2 times higher in these patients. An unfavourable outcome with conventional treatment of DDH must make us suspect the presence of some type of neurological disorder, particularly if there is a delay in walking.