Osteotomías desrotativas mediante fijación externa en la infancia

La mayoría de las alteraciones rotacionales de las extremidades durante la infancia, permiten por lo general el desarrollo de una función normal, y tienden a resolverse espontáneamente. Ocasionalmente, algunos pacientes pueden requerir corrección quirúrgica ante una alteración rotacional que persiste o progresa alterando la función de la extremidad, o bien que resulta estéticamente inaceptable para el paciente y su familia. Se presenta la experiencia de los autores en la realización de osteomías desrotadoras en la infancia utilizando la fijación externa.Most of rotational disorders of extremities during childhood are usually functional, and its natural history is spontaneous correction. Sometimes, surgery is indicated when a pathological persistent rotational disorder increase, or may induce disability, or is cosmetically unacceptable for patient and its family. The author’s experience in rotational osteotomies during childhood by using external fixation is presented

Utilización de factores de crecimiento plaquetarios asociados a fosfato pentacálcico en el tratamiento de lesiones óseas paratumorales en la infancia

El tratamiento de las lesiones óseas paratumorales (como el quiste óseo aneurismático y el quiste óseo simple) continúa siendo controvertido. Aunque existen diferentes posibilidades de tratamiento, el porcentaje de fallo en la curación debido a recidivas de estas lesiones no es desdeñable. Los autores presentan su experiencia retrospectiva en 5 casos en diferentes localizaciones anatómicas, tratados mediante curetaje y relleno de la lesión mediante un sustituto óseo (fosfato pentacálcico, fibrina y factores de crecimiento autólogos derivados de plaquetas) con resultados satisfactorios.Treatment of tumorlike lesions of bone (as aneurysmal bone cyst and simple bone cyst) remains controversial. Although there are different possibilities of treatment, the rate of failure to cure due to recurrences of both types of lesions is not negligible. The authors present their retrospective experience in 5 cases in different locations, where such lesions were treated by means of curettage and grafting using a bone substitute (pentacalcium phosphate, fibrine and autologous platelet derived growth factors) with satisfactory results

Soft Tissue Behavior During Limb Lengthening: An Experimental Study in Lambs

The effect of femoral elongation on skeletal muscle, nerves, and vessels was studied. Three groups of five lambs were used. After the intervention, the animals were killed at 2, 3, and 4 months. A left femoral elongation of 6 cm was practiced on all of them by means of callotasis, with a distraction rate of 0.5 mm every 12 hours. The femoral elongation process was evaluated by monthly x-ray films. The nucleic acid and protein levels in the muscular tissue were quantified at the level of the elongation focus and in the control extremity. The motor conduction velocity of the sciatic nerve was measured in both posterior limbs before the intervention and immediately before the lambs were killed. The arterial blood flow of both subsequent extremities was measured at the moment of death. A histological study of quadriceps muscle, sciatic nerves, artery, and subsequent femoral vein were examined histologically at the level of the elongation focus of both extremities. After elongation, no significant differences were observed in the muscle protein and nucleic acid levels with respect to the control extremity. No significant changes of the nerve conduction velocity were observed in any animal among the different groups. The arterial blood flow of the elongated extremity showed a progressive increase, reaching its maximum value 1 month after the distraction had terminated, with subsequent normalization. This increase of the blood flow was also observed in the control extremity, suggesting a possible systemic effect. The histological study revealed a comparative thickening of the endomysium and perimysium in the elongated muscle tissue, present at the end of the distraction and which was later normalized. No histological changes of the nerve stems undergoing distraction were observed either. During elongation, the arteries showed minimal histological changes. On the other hand, the veins showed areas of endothelial damage accompanied by thrombosis phenomena, especially at the end of the distraction period. The vascular morphology presented progressive normalization after the distraction phase

Estudio experimental en conejos de un nuevo vidrio bioactivo en la reconstrucción de defectos óseos

Objetivo: Se evaluó "in vivo" un vidrio bioactivo en la reparación de defectos óseos en animales esqueléticamente maduros e inmaduros. Material y Método: Se intervinieron 32 conejos machos de Nueva Zelanda divididos aleatoriamente en dos Grupos de 16: esqueléticamente maduros e inmaduros respectivamente. En todos ellos, se labró un defecto óseo en la cara lateral del cóndilo femoral. En la mitad de cada Grupo se relleno el defecto óseo con un implante de biovidrio. El resto sirvió como control. En los animales inmaduros, el defecto óseo resultó equivalente a una lesión fisaria tipo VI de Rang. El seguimiento fue de 4 meses. Se realizó un estudio radiográfico mensual, así como un estudio necrópsico, histológico e histomorfométrico de los especimenes. Resultados: Todos los animales finalizaron el estudio. No se observaron desviaciones axiales de las extremidades intervenidas en los animales inmaduros. El vidrio presentó una excelente osteointegración tanto en animales maduros como inmaduros, con evidencia de osteoconducción sobre su superficie, de forma simultánea a a su degradación y reabsorción, sin deformidades o ruturas. Las formación ósea inducida y reabsorción, sin deformidades o roturas. La formació ósea inducida por el vídrio fue la mayor en los niveles inmaduros respecto a los maduros. Los animales control presentaron una reparación del defecto óseo de menor calidad, con variaciones entre individuos. Conclusiones: El comportamiento "in vivo" el vidrio testado permite considerarlo como un material adecuado para la sustitución o reparación ósea, en el relleno de cavidades, la cobertura de superficie de implantes, y la vehiculización de sustancias. En cirugía del cartílago de crecimiento podría utilizarse como material de interposición tras la resección de puentes óseos fisarios.Objective: to evaluate the usefulness of a new bioactive glass in bone defect healing in rabbits. Material & Methods: 32 New Zeland rabbits were randomly distributed in two groups of 16: mature and immature respectively . In all of them, a bone defect was performed in the lateral surface of femoral distal epiphysis. A glass bioactive implant was placed in the bone defect of 8 animals in each group. The others served as control. In the immature rabbits, bone defect results as a Type VI physeal injury of Rang. Follow-up was 4 months. A standardised radiographic study was monthly performed, and after sacrifice, a histological and morphometric study on the femora was done. Results: All the animals survived the follow-up. No axial deviations of distal femoral growth were observed in immature rabbits. The tested glass showed an excellent osteointegration in all the animals, with osteoconduction evidence over its surface, accompanying degradation and resorption phenomena, but without deformities of break. Bone healing over the tested bioactive glass was higher in immature rabbitr than in mature animals. The control animals showed a poor bone defect healing, with variations among individuals. Conclusion: The in vivo behaviour of tested bioactive glasas suggests its use as possible bone substitute for cavities filling, implant surfaces, and as drugs vehicle. In growth plate surgery, it should be use as interposition material afeter physeal bone bridges resection

Enclavijado de Ender en las fracturas del macizo trocantéreo: análisis retrospectivo de la ocupación del canal medular

Se revisaron las historias clínicas de 226 pacientes afectos de fracturas del macizo trocantérico, tratadas mediante enclavijado de Ender en un periodo de 9 años en el Hospital del Insalud de Barbastro. La estabilidad de las fracturas se determinó mediante la clasificación de Ramadier. Se valoró el porcentaje de ocupación de la cavidad medular femoral por los clavos de Ender y la posible relación de este parámetro con la migración del material de osteosíntesis. Se evaluó también la utilidad del bloqueo distal de los clavos de Ender con agujas de Kirschner, en la prevención de su migración distal. Se comprobó una relación significativa entre el porcentaje de ocupación del canal medular y la migración distal del material en las fracturas inestables. El bloqueo distal con aguja de Kirschner no se acompañó de una menor incidencia en la migración distal de los clavos.A retrospective study was done on 226 trochanteric fractures managed with Ender nails during a 9 years period at the Insalud Hospital of Barbastro. Stability of these fractures was classified following Ramadier's criteria. Filling of the medular cavity by Ender nails and its relation with osteosyntehsis migration was analysed. Distal locking of Ender nails by Kirschner pins was evaluated to prevent its distal mobilization. A significative relationship was observed between a high filling rate of the medular cavity and lower distal migration rate in unestable trochanteric fractures. Distal locking of Ender nails was not accompanied of lower rate of distal osteosynthesis migratio

Fractura de estrés en la infancia: consideraciones diagnósticas sobre 9 casos

Las fracturas de estrés son lesiones que suelen estar en relación con ciclos repetidos de carga sobre un hueso normal sometido a un exceso de solicitaciones mecánicas o bien sobre un hueso con menor resistencia. Se presenta una revisión de 9 casos de fractura de estrés tratadas en el Hospital Infantil Miguel Servet de Zaragoza, en los últimos 10 años, con resultado de 5 niños y 4 niñas, con una edad media de 10,11 años (rango: 5-14). El tiempo de diagnóstico medio fue 17,6 días (rango: 1-92), y las localizaciones más frecuentes fueron los metatarsianos, la tibia y el cuello femoral. Solo dos de los casos estaban relacionados con la práctica deportiva. Todos presentaron clínica de dolor y alteración de la marcha. En uno de ellos se realizó un diagnóstico inicial de sospecha de sarcoma de Ewing. Todos fueron tratados de forma conservadora. El tiempo de seguimiento medio fue 23,92 meses (rango: 2-96).Stress fractures are injuries that are often related to repeated cycles of loading on a normal bone subjected to excessive mechanical stress, as well on a bone of less resistance. We present a review of 9 cases of stress fracture treated at Children's Hospital Miguel Servet in Zaragoza, in the last 10 years, resulting in 5 boys and 4 girls, mean age 10,11 years (3-14). Mean time for diagnosis was 17,6 days (1-92), and the most frequent location was metatarsals, tibia and femoral neck. Only two of the cases were related to sports. All of them presented clinical pain and abnormal gait. One patient received a suspect initial diagnosis of Ewing sarcoma. All were treated conservatively. The mean follow up was 23.92 months (2-96)

Delayed distraction in bone lengthening improved healing in lambs.

We compared delayed distraction (DD) with immediate distraction (ID) in bone-lengthening. Open femoral diaphyseal osteotomy was performed on 24 three-month-old lambs, and extemal distractor fixators were applied. In the ID group (n 12 ), distraction commenced on the first postoperative day; in the DD group (n 12 ), distraction was delayed until the tenth day alter surgery. In all the animals, the femur was lengthened by 2 cm at the rate of 1 mm/day. The animals were killed 1, 2, and 3 months postoperatively. Radiography and densitometry of the lengthened callus showed that DD, compared with ID, improved the quality of the callus with quicker, denser, and more homogeneous bone formation

Lengthening of the first metatarsal bone. A case of congenital shortening

A 14-year-old boy had a congenital shortening of the first right metatarsal bone, with overloading of the central metatarsals and medial deviation of the second toe. A percutaneous osteotomy and slow distraction by an external fixator for 10 weeks lengthened the bone from 32 mm to 60 mm. After the distraction, a bone graft was performed, and tenotomies and a capsulotomy corrected a threatening subluxation. Consolidation of the lengthening focus required 16 weeks

Factores del retardo de consolidación en fracturas de antebrazo pediátricas

El objetivo de este estudio es determinar factores para el retardo de curación en fracturas pediátricas diafisarias de antebrazo. Presentamos un estudio caso-control de todas las fracturas pediáticas de antebrazo tratadas en el Hospital Universitario Miguel Servet, desde 2003 hasta 2009, y que presentaron retardo de consolidación, con un seguimiento mínimo de 12 meses. Los criterios de exclusión fueron fractura-luxación, infección, osteosíntesis insuficiente, fractura en tallo verde, abierta, patológica y asociada a fractura de cabeza radial, así como pacientes sin el seguimiento mínimo establecido. El cálculo estadístico incluyó análisis de regresión lineal bivariante y multivariante. Resultados: Durante este periodo se trataron 441 fracturas de antebrazo completas, de ambos huesos: 14 de ellas (3.2%) sufrieron retardo de consolidación; y 63 controles cumplieron los criterios de inclusión y fueron seleccionados aleatoriamente. El análisis bivariante mostró diferencias significativas entre los grupos "retardo de consolidación" y "control" en edad, necesidad de tratamiento quirúrgico, reducción abierta frente a cerrada y tiempo hasta retirada del material. Si embargo, la reducción abierta de la fractura, más frecuente en el grupo "retardo de consolidación", fue la única variable que permaneció asociada en el análisis multivariante. Conclusiones: El factor predictivo más importante para el retardo de consolidación en fracturas pediátricas de antebrazo es la reducción abierta.The aim of this study was to assess predictive factors for delayed healing in forearm paediatric fractures. This is a case-control study of all paediatric shaft fractures of forearm presenting delayed union in follow-up period of 12 months or more, from 2003 through 2009, treated in Miguel Servet University Hospital. Exclusion criteria were fracture-dislocations, infection, suboptimal osteosynthesis, greenstick, open, pathologic and associated radial head fractures, as well as patients without stablished period of follow up. Statistical assessment included bivariant and multivariant linear regression analysis. Results: During the study period 441 complete both-bone forearm fractures were treated: 14 of them (3.2%) were identified as suffering delayed union; and 63 controls fulfilling inclusion criteria were randomly selected. Bivariant analysis showed significant differences between "delayed union" and "control" groups in age, need of surgical treatment, open versus closed reduction and mean time to hardware removal. However, open reduction of the fracture, more frequent in the "delayed union" group, was the only variable which remained associated in the multivariant analysis. Conclusions: The strongest predictor of union delay in paediatric forearm fractures is open reduction

Soft Tissue Behavior During Limb Lengthening: An Experimental Study in Lambs

The effect of femoral elongation on skeletal muscle, nerves, and vessels was studied. Three groups of five lambs were used. After the intervention, the animals were killed at 2, 3, and 4 months. A left femoral elongation of 6 cm was practiced on all of them by means of callotasis, with a distraction rate of 0.5 mm every 12 hours. The femoral elongation process was evaluated by monthly x-ray films. The nucleic acid and protein levels in the muscular tissue were quantified at the level of the elongation focus and in the control extremity. The motor conduction velocity of the sciatic nerve was measured in both posterior limbs before the intervention and immediately before the lambs were killed. The arterial blood flow of both subsequent extremities was measured at the moment of death. A histological study of quadriceps muscle, sciatic nerves, artery, and subsequent femoral vein were examined histologically at the level of the elongation focus of both extremities. After elongation, no significant differences were observed in the muscle protein and nucleic acid levels with respect to the control extremity. No significant changes of the nerve conduction velocity were observed in any animal among the different groups. The arterial blood flow of the elongated extremity showed a progressive increase, reaching its maximum value 1 month after the distraction had terminated, with subsequent normalization. This increase of the blood flow was also observed in the control extremity, suggesting a possible systemic effect. The histological study revealed a comparative thickening of the endomysium and perimysium in the elongated muscle tissue, present at the end of the distraction and which was later normalized. No histological changes of the nerve stems undergoing distraction were observed either. During elongation, the arteries showed minimal histological changes. On the other hand, the veins showed areas of endothelial damage accompanied by thrombosis phenomena, especially at the end of the distraction period. The vascular morphology presented progressive normalization after the distraction phase