RESUMEN
Complete separation of an epiphysis is a rare complication of neonatal osteomyelitis and septic arthritis. We report two cases of pathologic epiphyseal separation after neonatal osteomyelitis, involving the distal and proximal femoral epiphyses with a follow-up of 2 and 7.5 years, respectively. Birth trauma, scurvy, and nonaccidental injury should be considered in the differential diagnosis of pathologic epiphyseal slip. The pitfalls in diagnosis are many, and plain radiograms of unossified epiphyses are often misleading. A high index of suspicion and the use of imaging modalities are useful in making an early diagnosis of epiphyseal slip. The optimal treatment is controversial, and the long-term prognosis is uncertain. The potential for recovery appears to be excellent, provided an early diagnosis is made and prompt treatment by anatomic reduction of the displaced epiphysis is instituted.
Asunto(s)
Artritis Infecciosa/complicaciones , Epífisis Desprendida/etiología , Osteomielitis/complicaciones , Epífisis Desprendida/diagnóstico por imagen , Epífisis Desprendida/terapia , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/microbiología , Humanos , Lactante , Recién Nacido , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/microbiología , Pronóstico , RadiografíaRESUMEN
A prospective study of 42 children with forearm fractures, treated by closed reduction and plaster, was conducted to assess the remodeling capacity of the radial epiphyseal plate after union of fracture with angulation. The children's ages ranged from 3 to 15 years. The effect of residual angulation of the healed fracture on the distal radial epiphyseal plate was examined radiographically over a median follow-up time of 3 years and 2 months, to observe the behavior of the distal radial epiphyseal plate during remodeling and to identify the factors that influenced this process. On the basis of these findings, guidelines are proposed for the treatment of forearm fractures that have healed with residual angulation. The inclinations of the distal radial epiphyseal plate on the fractured and normal forearms were compared on anteroposterior and lateral radiographs, at union and at final follow-up, in both the radioulnar and the dorsovolar planes. An alteration of inclination was seen in all patients with dorsovolar angulation of the radial growth plate, which always tended toward a correction of the abnormal inclination. In diaphyseal fractures, the distal radial epiphyseal plate realigned well only in children aged < or = 10 years, whereas with distal radial fractures, realignment of the epiphyseal plate and restoration of function was uniformly good up to age 15. Diaphyseal fractures, with radioulnar angulation in the growth plate, did not seem to remodel completely and were associated with loss of motion, whereas in distal fractures, irrespective of the final inclination of the epiphyseal plate, the range of motion returned completely at the end of follow-up. Abnormal angulation in the radioulnar plane was poorly corrected in all patients. These results could be helpful in the treatment of forearm fractures that are positioned or have healed in residual angulation.