Serious infectious complications related to extremity cast/splint placement in children.

BACKGROUND: Extremity injuries necessitating splinting or casting are commonly seen in the emergency department (ED) setting. Subsequently, it is not uncommon for patients to present to the ED with complaints related to an extremity cast or splint. OBJECTIVE: To present a literature-based approach to the identification and initial management of patients with possible infectious cast/splint complications in the ED setting. CASE REPORTS: We present two cases of serious infectious complications arising from extremity cast/splint placement seen in a single pediatric ED: a case of toxic shock syndrome in an 8-year-old child, and a case of necrotizing fasciitis resulting in upper extremity amputation in a 3-year-old child. CONCLUSIONS/SUMMARY: A wide spectrum of potential extremity cast/splint infectious complications may be seen, which include limb- or life-threatening infections such as toxic shock syndrome and necrotizing fasciitis. Simply considering these diagnoses, and removing the cast or splint to carefully inspect the affected extremity, are potential keys to early identification and optimal outcome of cast/splint complications. It is also prudent to maintain particular vigilance when treating a patient with a water-exposed cast, which may lead to moist padding, skin breakdown, and potential infection. In patients with suspected serious infections, aggressive fluid management and antibiotic therapy should be initiated and appropriate surgical consultation obtained without delay.

Sífilis congenita presentación de un caso clínico radiológico / Congenital syphilis radiological presentation of a clinical case

La sífilis congénita tiene origen en la infección materna y se debe a la transmisión que sufre el feto por vía transplacentaria durante el embarazo. En paises subdesarrollados se puede mencionar como factor de riesgo la ausencia de un diagnóstico precoz en los controles prenatales y la poca información sobre todo en las madres adolescentes hacia esta enfermedad, la misma que avanza hacia la muerte in útero del feto, o al nacimiento con múltiples alteraciones del recien nacido. Se presenta el caso de un neonato cuya madre infectada no recibio tratamiento y posterior al nacimiento el neonato presentó clínica significativa por lo que se le realizaron una serie de exámenes, dentro de los que destacan los radiológicos en huesos largos, donde se advierten alteraciones típicas de esta enfermedad.

Congenital syphilis originates by maternal infection and is due to the transplacental transmission which the fetus suffers during pregnancy. In underdeveloped countries, the absence of an early diagnostic test during prenatal care has to be mentioned as a risk factor as well as the poor information on this disease that exists among mothers, especially teenage mothers. Due to these facts the progression of the disease frequently leads to death in uterus of the fetus or to multiple birth defects when the baby is born.We present the case of a newborn baby whose infected mother was not treated, and who after birth presented important clinical signs due to which a series of tests were carried out among which the radiology of the long bones stands out where the typical alterations of the disease are seen.