Compresión medular por hipercifosis toracolumbar en un cuadro de displasia espondiloepifisaria congénita

En algunos casos de displasia espondiloepifisaria puede resultar difícil el diagnóstico diferencial de las alteraciones de la marcha por coexistir una cifosis angular severa con posible compromiso medular y una coxopatía importante. Cuando existe una compresión medular, el pronóstico generalmente es sombrío y es excepcional encontrar en la literatura una indicación quirúrgica favorable en este tipo de displasias. Presentamos 2 casos afectos de Displasia Espondiloepifisaria en los que se planteó el diagnóstico diferencial y se realizaron tratamientos quirúrgicos diferentes, obteniendo buenos resultados.The clinical findings in DEEC are: Disproportionate dwarfisms (with short spine, kyphoscoliosis, pectus carinatus), genu valgum, etc. The epiphyses are poorly ossified and deformed. Progressive motor weakness may be the first clinical symptom of spinal cord compression caused by a kyphoscoliosis. In these cases we must make a differential diagnosis with a premature osteoarthritis of the hips. We report two cases. One of them was treated with spinal fusion for correction of her kyphoscoliosis, and the other one with a total hip arthroplasty

Evolución de las curvas sagitales en pacientes afectos de escoliosis tratados con corsé de milwaukee

En una serie de 41 pacientes con escoliosis idiopática tratados ortopédicamente con corsé de Milwaukee, se analizó retrospectivamente el efecto del corsé en la evolución de la curva sagital torácica. El corsé no tuvo efecto lordosante en el 66% de los casos. El efecto lordosante se desarrolló con mayor frecuencia en pacientes menores de 12 años o con más de tres años de tratamiento; sin embargo, hubo pacientes que lo llevaron 5 años o más sin modificación alguna en la curva sagital. En conclusión, el corsé de Milwaukee tiene un efecto lordosante en tan sólo un tercio de los casos tratados. Los factores que favorecen la rectificación del raquis torácico parecen ser la larga duración del tratamiento y una colocación en edades tempranas, por debajo de los 12 años.A retrospective analysis was carried out in a group of 41 patients affected by idiopathic scoliosis treated by Milwaukee brace. The aim of the study was to asses the effect of the brace in the evolution of the thoracic sagital curve. We observed a higher frecuency of cases with thoracic lordosis in patients with less than 12 years of age, or in those treated for more than 3 years. There were cases who wore the brace for more than 5 years with no modification in the sagital curve. In conclusion, the Milwaukee brace induced a lordotic effect in just one third of patients treated for idiopathic scoliosis. The onset of treatment in patients under 12 years and long a periods of treatment should be considered as the predisponing factors for thoracic lordosis

Fractures of allografts used in limb preserving operations

One hundred and thirty-seven allografts used since 1986 in limb preserving operations for malignant bone tumours were reviewed. The follow up was longer than two years. There were fourteen fractures (10.2%) in twelve patients at a mean time of 22 months from the operation. Most of them were in the metaphyseal area and were related to perforations of the allograft made for stabilisation with plates, for tendon and ligament reattachment, or any other hole in the allograft. Fractures occurred always after the allograft-host junction was united. Healing was achieved in 7 cases by internal fixation with autologous bone grafting in a mean of 5 months. In cases of multiple fractures of the allograft, the graft was exchanged. We recommend using intramedullary fixation in order to reduce the incidence of allograft fracture, and the use of internal fixation, with intramedullary whenever possible, and autologous bone grafting to achieve consolidation of the fractures

Trasplante óseo

We describe the methodology of the Bone and Soft Tissue Bank, from extraction and storage until use. Since the year 1986, with the creation of the Bone Bank in the University Clinic of Navarra, more than 3,000 grafts have been used for very different types of surgery. Bone grafts can be classified into cortical and spongy; the former are principally used in surgery to save tumour patients, in large post-traumatic reconstructions and in replacement surgery where there are massive bone defects and a structural support is required. The spongy grafts are the most used due to their numerous indications; they are especially useful in filling cavities that require a significant quantity of graft when the autograft is insufficient, or as a complement. They are also of special help in treating fractures when there is bone loss and in the treatment of delays in consolidation and pseudoarthrosis in little vascularized and atrophic zones. They are also used in prosthetic surgery against the presence of cavity type defects. Allografts of soft tissues are specially recognised in multiple ligament injuries that require reconstructions. Nowadays, the most utilised are those employed in surgery of the anterior cruciate ligament although they can be used for filling any ligament or tendon defect. The principal difficulties of the cortical allografts are in the consolidation of the ends with the bone itself and in tumour surgery, given that these are patients immunodepressed by the treatment, the incidence of infection is increased with respect to spongy grafts and soft tissues, which is irrelevant. In short, the increasingly widespread use of allografts is an essential therapeutic weapon in orthopaedic surgery and traumatology. It must be used by expert hands

Influencia de la hipotiroxinemia materna durante la gestación sobre el desarrollo psicomotor

The maternal thyroid function during early pregnancy plays a fundamental role in foetal brain development as synthesis of thyroid hormone does not begin until the 20th week of gestation. Material and methods Throughout the year 2002, 147 women in their 37th week of pregnancy were enrolled for the study. To evaluate their thyroid function, the serum concentrations of free T4 and of TSH were determined. After birth, the psychomotor development of their children was evaluated with the Mc- Carthy scales. Results The median value of free T4 was 9.37 pmol/l, being the data obtained from more than half of the sampled women below the hypothyroxinaemia threshold. Children born from mothers with T4 levels below percentile 10 showed a significantly lower score on the general cognitive index than those whose mothers had normal free T4 serum concentrations. A positive correlation was found between the values of maternal free T4 and the general cognitive index (r 0.43; p < 0.01). Conclusions The concentrations of maternal free T4 are important, not only during the first months of pregnancy, but all along the process to ensure adequate development of the foetal brain

Consolidation of massive bone allografts in limb-preserving operations for bone tumours

This study analysed the influence of several factors affecting the consolidation time of 83 massive bone allografts in 79 patients with malignant bone tumours: osteosarcoma 57; Ewing's sarcoma 8; malignant fibrous histiocytoma 3; chondrosarcoma 4; fibrosarcoma 5; and giant cell tumours 2. The mean age of the patients was 19 years and the mean length of the allografts was 18 cm. The minimum follow up was for 12 months. The mean consolidation time for metaphyseal and diaphyseal osteotomies was 6.5 and 16 months respectively. Fifteen diaphyseal osteotomies required autologous cancellous grafting. There were 8 allograft fractures after consolidation. The following factors which might influence consolidation were analysed: age of the host and donor; allograft length and site; type of osteotomy and osteosynthesis; intra-arterial and systemic chemotherapy; intraoperative and external radio-therapy. In diaphyseal osteotomies there were statistically significant differences in consolidation time with the use of systemic chemotherapy, external radiotherapy and the recipient's age

Use of brachytherapy in children with cancer: the search for an uncomplicated cure

Brachytherapy is a sophisticated radiation method in which radioisotopes are placed inside or at a short distance from the tumour. The volume of tissue that receives the prescribed dose of radiotherapy is therefore fairly small compared with that used in standard radiotherapy techniques. In paediatric oncology, this method of radiation delivery can have a favourable effect on several undesirable long-term side-effects that sometimes develop in children who receive radiotherapy, such as growth retardation and development of second primary tumours. Here, we describe the rationale for use of brachytherapy in children with cancer, the methods of the different brachytherapy techniques available, and the results obtained with several brachytherapy regimens in expert institutions throughout the world

External fixation in tumour pathology

An appraisal of the clinical records of patients with malignant bone tumours enabled us to identify 61 whom we have treated by external fixation. There were 38 males and 23 females with ages ranging from 4 to 58 years, the mean being 14 years. The average period of follow-up was 6 years (1-12 years). For the purpose of our analysis the patients were divided into three groups according to whether the fixator was fitted before, during or after tumour resection

Tratamiento de los tumores metafiso-epifisarios malignos de extremidad inferior con prótesis

Desde Abril de 1977 hasta Junio de 1992, han sido tratados 110 paciente s mediant e cirugía conservadora por presentar un tumor óseo primitivo maligno en región metafiso-epifisaria de fémur y tibia. El seguimiento medio ha sido de 6.4 años (1- 15 años). El diagnóstico histológico ha sido: osteosarcoma (48 casos), tumore s metastá- sicos (25) y Sarcoma de Ewing (8 casos) entre otros. La localización del tumor fue: extremidad proximal de fémur (42 casos) y distal de fémur y proximal de tibia (56 casos). Todos los pacientes han sido tratados siguiendo los protocolos del Cáncer de la Clínica Universitaria de Navarra. La supervivencia actual se sitúa en el 72%. 5 casos (8%) presentaron recurrencia local y 5 (8%) enfermedad metastásica. La funcionalidad, siguiendo los criterios de Mankin ha sido: en la cadera un 64.6% de excelente s y buenos resultados y en la rodilla un 62.4%. Las principales complicaciones han sido infección (6 casos ) y ruptura del implant e (PTR GSB) (6 casos). Creemos que el desarrollo médicoquirúrgico ha permitido que e l tratamient o conservado r de la extremidad se a e l de elección, frente a la amputación en este tipo de patologíaFrom April 1977 to June 1992, 110 case s of malignant bone tumors have been treated in the Department of Orthopaedic s of the Navarra University Clinic by limb salvage surgery located al he femur and tibia epiphysis. The mean follow-up period was 6.4 year s (1 to 15 years). The histologic diagnosis was osteosarcoma in 48 cases, metastasis in 25 cases, Ewing's sarcoma in 8 case s and others. The anatomi c sites included proximal femur in 42 cases and distal femur or proximal tibia in 56 cases. All the patients wer e treated following the Cance r Protocols of the Navarra Universit y Clinic. At review, the global survival rate wa s 72%. 5 case s (8%) developed local recurrences and 5% metastatic disease. The most significant complications wer e infection 6 cases, and failure of the material of osteosynthesis (Knee endoprosthesis) 6 cases. We think that the medical, surgical and rehabilitative advance s have allowed limb saving surger y t o becom e th e primar y metho d o f treatmen t o f bon e malignan t tumor s i n young children, being a successful alternative to amputation