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Las infecciones osteoarticulares son más frecuentes en niños que en adultos y causan morbilidad y secuelas a largo plazo importantes. Hemos realizado un estudio retrospectivo de los casos de infección ósteo-articular (IOA) (artritis séptica, osteomielitis aguda o ambas) diagnosticados en nuestro hospital entre 1997 y 2007. Se diagnosticaron 16 niños con IOA, 7 (43%) en los últimos 2 años. Feuron artritis séptica (AS) 9 (56%), uno con afectación ósea asociada, y 7 (44%) osteomielitis aguda (OA). Entre los niños con AS la edad osciló entre 13 y 150 meses (mediana, 33). Las articulaciones más afectadas fueron la rodilla y el tobillo. Se documentaron microbiológicamente 3 casos (33%), (S. aureus, S. pneumoniae y P. aeruginosa). Los días totales de antibioterapia oscilaron entre 18 y 40 (media, 30). Entre los niños con OA, la edad varió entre 16 y 168 meses (mediana, 92). La localización más frecuente fue la tibia. Se documentaron microbiológicamente 4 casos (57%). Todos fueron S. aureus. La duración de la antibioterapia varió entre 24 y 53 días (media, 35). Las infecciones osteoartículares siguen siendo frecuentes, con una aumento progresivo en la incidencia. La principal etiología sigue siendo el S. aureus, por lo que la cobertura antibiótica empírica debe dirigirse contra este microorganismo (AU)

Bone and joint infections are more frequent in children tan in adults and cause orbidity and important long-term sequels. A retrospective analysis of all the diagnosed cases of bone and/or joint between 1997 and 2007 was performed. 16 children were diagnosed of bone and/or infection, 7 (43%) in the last 2 years. Septic arthritis (SA) was found in 9 patients (56%), one of them with bone extension, and acute osteomyelitis (AO) in 7 (44%). Children with SA had ages between 13 and 150 months (median 33). The most frequently affected joints were the knee and the ankle. We documented microbiologically 3 cases (33%), (s. aureus, s. pneumonia and P. aeruginosa). The days of antibiotic therapy ranged between 18 and 40 (mean 30), and those of intravenous therapy between 8 and 24 (mean 13). The age of children diagnosed of AO ranged between 16 and 168 months (median 92). The most frequent location was the tibia. In 2 occasions, surgical drainage was performed. The microbiologic diagnosis was made in 4 cases (57%). All of them were S. aureus. The day of antibiotic therapy ranged between 24 and 53 days (mean 35), our of which between 7 and 46 days (mean 14) was made intravenous. Bone and joint infections are still frequent. The incidence seems to increase in the last years. S. aureus in the main responsible agent, so the empirical antibiotic treatment should be directed against this microorganism (AU)

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Las fracturas del codo en la infancia son lesiones frecuentes, difíciles de diagnosticar por la inmadurez del esqueleto, y que en ocasiones asocian lesiones neurovasculares; su tratamiento y seguimiento es complejo. Realizamos una revisión retrospectiva de todos los pacientes menores de 16 años que fueron ingresados para tratamiento de fracturas en el codo, realizando un estudio epidemiológico de estas fracturas en nuestra población. Estudiamos las complicaciones asociadas, incluidas las neurovasculares, y valoramos las secuelas. Nuestro objetivo es orientar en el diagnóstico, tratamiento y seguimiento ante un niño con un traumatismo en el codo. En 414 casos de fracturas del codo, la lesión más frecuente es la fractura supracondílea, seguida de la fractura arrancamiento de la epitróclea. La fractura supracondílea es también la que más complicaciones asocia, incluidas las neurovasculares. El nervio cubital es el que más veces está afectado, y la fractura supracondílea es la causa más frecuente. Las lesiones vasculares son menos frecuentes. Sólo se presentaron 4 casos de síndrome compartimental, y ningún caso de síndrome de Volkmann. La incidencia de secuelas, 1 por ciento en nuestra serie, es baja. Concluimos que la fractura supracondílea es la más frecuente y también la más grave, por asociar más complicaciones. A pesar de la gravedad de las complicaciones, las secuelas finales son poco frecuentes. Es necesaria una exploración neurológica al ingreso para el diagnóstico precoz de lesiones neurológicas (AU)

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The cases of 35 patients in whom a triplane fracture had been treated at the Ramón y Cajal Hospital were reviewed. The diagnosis of biplane and triplane fracture can now be made by standard radiograph. However, plain radiographs alone did not accurately demonstrate the configuration of the fracture, and computed tomography must be performed. Closed reduction should be attempted first. Failure to obtain or maintain (or both) an adequate closed reduction is an indication for operative treatment. Prognosis is surprisingly good. Only when adequate reduction (< 2 mm displacement) has not been achieved can degenerative changes be seen at long-term follow-up (> 5 years).

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The authors present 15 cases of discrepancy of the lower limbs > 5 cm, in children in whom the histological diagnosis was Ewing's sarcoma or osteosarcoma, who were treated using polychemotherapy or radiotherapy or both in some cases and limb-salvage surgery. Ten of these patients required compensation for discrepancy by limb lengthening. In three patients, a second lengthening had to be carried out. A shortening of the contralateral femur was performed in two cases, and in another two, a femur-tibia epiphysiodesis was done. The average lengthening achieved was 8.1 cm with a healing index of 41 days/cm. Leg-length discrepancy in the treatment of sarcomas of the musculoskeletal system is an important sequela, especially when treating children. Compensation for this can be obtained by lengthening healthy bone, with a complication rate similar to that of other etiologies. The difference compensated depends on the biological capacity of bone regeneration of the individual and, therefore, is a definitive solution.

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We have studied the medium- and long-term effects of femoral intramedullary nailing in 34 children. There was a high incidence of abnormality at the proximal end of the femur, including coxa valga, arrest of growth of the greater trochanter and thinning of the neck of the femur, because of damage to the trochanterocervical growth plate. These disorders affected 30% of the patients, mostly under the age of 13 years (p < 0.05), and were seen more frequently when the nail had been introduced through the piriform fossa. Other factors, such as the side, gender, aetiology, proximal or retrograde insertion, the size of nail and removal of the implant did not influence the result. We recommend that in patients under the age of 13 years other methods of management should be used to avoid damage to the growth plate.

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Twenty-two patients with marked displacement of a fracture of the proximal humeral epiphysis have been treated with closed or open reduction and fixation by Kirschner wires. At an average follow-up of 6.8 years there have been good functional results in almost all patients (91.1), with better results in patients under 13 years of age particularly with less residual displacement or angulation. Since there is a greater occurrence of residual deformity and symmetria and limitation of motion in older patients, a more aggressive approach to correct the initial displacement and angulation is warranted in those over the age of 13 years.

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Fly larvae are responsible for animal disease well known by veterinarians. However, their finding in humans in nontropical countries is a rarity. Recently, we have found several larvae of Lucilia sericata in an achondroplastic child during the phase of lengthening of both tibiae with osteotax. We think that the myasis diagnosed in our patient is the first such case reported in the literature. For the time being, it should be considered a fortuitous finding and not as a complication of surgery.

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