[Radial Head and Neck Fractures in Children].

[Radial head and neck fractures in children].

Rev Esp Cir Ortop Traumatol. 2012 Jul-Aug; 56(4): 300-5
Fuentes-Salguero L, Downey-Carmona FJ, Tatay-Díaz A, Moreno-Domínguez R, Farrington-Rueda DM, Macías-Moreno ME, Quintana-Del Olmo JJ

To analyse cases of radial head and neck fractures in children and compare them with the literature.Retrospective and descriptive study of 21 children with radial head and neck fractures. The following parameters were collected: demographics, comorbidity, classification, treatment, need for rehabilitation, lack of range of motion (ROM), time for recovery and complications.The series included 11 males, and the mean age was 8.3 years. The right side was affected in 14 patients. Twelve cases had an associated ipsilateral elbow injury. According to the Chambers classification, 15 cases belonged to group A, while in the Steele-Graham classification, 12 cases were in group I. Eleven patients were treated with immobilization only, 4 percutaneously, and 6 by open reduction and internal fixation (ORIF). Eleven of them needed rehabilitation and despite this, 8 did not achieve full mobility. The mean time to obtain the greatest ROM was 4.71 months. Eight patients had complications, with the most common being neuroapraxia and valgus deformity of the elbow.Treatment of paediatric radius head and neck fractures must be step-wise, from immobilization only, manual and/or percutaneous reduction, to ORIF, whichever is less indicated. In this respect, both the transcapital needle and/or removal the radius head should be avoided. The most common complication is lack of supination, especially in cases treated by ORIF. The posterior interosseous neuroapraxia was the most common of the rest of complications. HubMed – rehab

[Epidural posterior migration of disc fragment].

Rev Esp Cir Ortop Traumatol. 2012 May-Jun; 56(3): 224-6
Jové Talavera R, Altemir Martínez V, Chárlez Marco A, Mas Atance J, Curiá Jové E, Aguas Valiente J

The posterior epidural migration of a fragment of lumbar disc herniation is a rare clinical presentation.We report the case of a 76-year-old with back pain and progressive paraparesis in the lower limbs, with the emergence of a cauda equina syndrome 4 days after admission. MRI showed lumbar spondylosis and a well-defined intra-spinal mass in the posterior epidural space. Surgical resection of the epidural mass was performed. The pathological study revealed an intervertebral disc fragment; thus it was a complete migration of a herniated lumbar disc. The patient was healed after surgery and specific rehabilitation treatment.Patients with posterior migration of disc fragment may present with severe neurological deficits, such as cauda equina syndrome. Because the radiological images of disc fragments are similar to those of other lesions, such as metastasis, synovial cyst, dural abscess or haematoma, definitive diagnosis is made by excision and pathological study. Emergency surgery is required to prevent severe neurological deficits. HubMed – rehab

[Measurement of the results of functional treatment of metatarsal fractures using the AOFAS scale and the duration of work incapacity].

Rev Esp Cir Ortop Traumatol. 2012 Mar-Apr; 56(2): 132-9
Ubeda Pérez de Heredia I, Martínez de Renobales JI, García Díaz J, Otaño Aranguren FJ, Sánchez Zapirain I

To demonstrate the effectiveness of functional treatment for the fractures of the metatarsal, which consisted of immediate or early weight bearing without immobilisation.We prospectively studied 276 patients with simple or complex fractures of the metatarsal, treated with a functional method which consisted of immediate (before the 3(rd) day since the fracture) or early (between 3(rd) and 21(st) day) effective weight bearing. Inclusion criteria were patients aged 16-65, both sexes, diagnosed with isolated or multiple, closed or opened type I metatarsal fractures who did weight bearing exercises during the first 21 days. We analysed the effects of the steroid injection proposed for this treatment in the focus of the fracture, the days of weight bearing, rehabilitation and number of metatarsal fractures. Results were evaluated using AOFAS (American Orthopaedic Foot and Ankle Society) scores, days of work incapacity and complications of the treatment.The AOFAS score for patients treated functionally was excellent and we found few complications with it.The functional method is based on the function of ligaments and muscles of the forefoot and the aid of a rigid-soled shoe which allows early weight-bearing to avoid secondary displacement of the fractures. The results show that immediate weight bearing provides better results than delayed bearing. Injection of steroid does not appear to have any benefit.We propose the functional method for all closed displaced or non-displaced metatarsal fractures, except for the displaced fractures on the base of the fifth metatarsal. HubMed – rehab