Ortopedia Pediátrica
Permanent URI for this community
Browse
Browsing Ortopedia Pediátrica by Title
Now showing 1 - 10 of 38
Results Per Page
Sort Options
- Acute Haematogenous Osteomyelitis in Lisbon: An Unexpectedly High Association with Myositis and ArthritisPublication . Gouveia, C; Branco, J; Norte, S; Arcangelo, J; Alves, P; Pinto, M; Tavares, DIntroduction: Despite the current trend toward less aggressive therapeutic approaches, acute haematogenous osteomyelitis (AHO) continues to be a challenge and is associated with significant morbidity worldwide. Our aim was to assess whether compliance with the current protocol was achieved in 80% of cases, to identify complications and the associated risk factors, and to analyse trends in the aetiology and management of AHO in the paediatric population. Methods: We conducted a longitudinal, observational, single-centre study in patients with AHO aged less than 18 years admitted to a paediatric hospital between 2008 and 2018 divided in 2 cohorts (before and after 2014). We analysed data concerning demographic and clinical characteristics and outcomes. Results: The study included 71 children with AHO, 56% male, with a median age of 3 years (interquartile range, 1-11). We found a 1.8-fold increase of cases in the last 5 years. The causative agent was identified in 37% of cases: MSSA (54%), MRSA (4%), S. pyogenes (19%), K. kingae (12%), S. pneumoniae (8%), and N. meningitidis (4%). Complications were identified in 45% of patients and sequelae in 3.6%. In recent years, there was an increase in myositis (30% vs 7%; P=.02), septic arthritis (68 vs 37.2%; p=0.012) and in the proportion of patients treated for less than 4 weeks (37 vs 3.5%; p=0.012), with a similar sequelae rates. The risk factors associated with complications were age 3 or more years, C-reactive protein levels of 20mg/L or higher, time elapsed between onset and admission of 5 or more days and positive culture, although the only factor that continued to be significantly associated in the multivariate analysis was positive culture. The presence of complications was a risk factor for sequelae at 6 months. Conclusions: Our study confirms that AHO can be aggressive. The identification of risk factors for complications is essential for management.
- Alterações Estruturais da Coluna e Exercício FísicoPublication . Mineiro, JOs efeitos do exercício físico na saúde e bem estar são de todos conhecidos. No entanto, na sociedade moderna em que vivemos, este tipo de actividade é por vezes levado aos limites da exaustão po desconhecimento da capacidade do nosso aparelho músculo esquelético nas várias etapas da vida e das mais diversas circunstâncias. Analisamos as alterações estruturais mais frequentes da coluna vertebral nos dois planos - cifoses, lordoses e escolioses - e o seu relacionamento com a actividade física e desportiva. Critérios de inaptidão para o desporto de contacto são outros dos assuntos discutidos neste artigo.
- An Analysis From a Tertiary Pediatric Hospital: Does Physical Activity Play a Role in the Management of Children and Young Adults With Osteogenesis Imperfecta?Publication . Galhardo Saraiva, F; Jonet, J; Roquette, M; Ovídio, J; Pires, MS; Campagnolo, JIntroduction: Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder characterized by reduced bone density and increased proneness to fractures. It manifests across a varied clinical spectrum of expressions in children and young adults. It is crucial for children with OI to have a multidisciplinary follow-up, including orthopedics, pediatrics, and physical medicine and rehabilitation. Although exercise may have no effect on the disease itself, it might improve the autonomy, self-esteem, and fitness of these children. Methods: Retrospective cohort analysis of children and young adults aged three or more years old followed-up in a Level III Pediatric Hospital between 1995 and 2020. Demographic and clinical data were obtained from the hospital records and from the caregivers via phone calls. To our knowledge, this is the first national case series published assessing exercise habits in children with this condition. Results: Among the 21 patients studied, the median age was 14 years, with no gender predominance. Eighteen (86%) practiced regular physical activity, while the remaining three (14%), all of whom were type III OI, were totally dependent. Of the aforementioned 18 children, 12 (67%) considered practicing the same level of physical activity compared to their healthy peers, although most of them needed adaptations. The most reported extracurricular activity was swimming, in 50% of the cases. About 39% engaged in physical activity two times or less per week, and 89% practiced for one hour or less per session. Discussion: Over the years, it has become clear that physical activity is an important part of OI management. While awareness of the importance of exercise already exists, proper planning, follow-up, and monitoring are essential.
- An Eleven-Year-Old Boy With Arthritis of the Hip Joint, and an 8-Year-Old Boy With SacroiliitisPublication . Mendo, T; Norte, S; Alves, P; Tavares, D; Pinto, M; Gouveia, C
- Artrite Séptica por Haemophilus Influenzae Serotipo A – Uma Etiologia RaraPublication . Valério, M; Moutinho, A; Marques, I; Carrusca, C; Tavares, D; Cassiano Neves, MDescreve-se um caso raro de artrite séptca por Haemophilus Influenzae (Hi) serotipo a (Hia)numa criança com o programa nacional de vacinação atualizado e antecendentes pessoais e familiares irrelevantes. A doente não apresentava fatores de risco e o estudo imunológico realizado não revelou alterações. Existem poucos casos relatados a nível mundial de infecção Hia e, de acordo com a revisão bibliográfica realizada. este é o primeiro caso de infecção osteoarticular por Hia descrito na Europa. No contexto deste caso, salienta-se a importância da determinação da estirpe na era pós-vacinal, bem como a exclusão de fatores predisponentes de doença invasiva por Hi não-b em idade pediátrica.
- Bilateral Hip Heterotopic Ossification with Sciatic Nerve Compression on a Paediatric Patient–An Individualized Surgical Approach: A Case ReportPublication . Nóbrega, JP; Jordão, P; Arcângelo, JBackground: Neurogenic heterotopic ossification is an acquired serious complication described in patients with central nervous system disorders and defined by bone formation in non-osseous tissue. Case summary: We present an unusual case of a 13-yr-old boy presenting with hip pain and severe gait impairment 5 mo after the diagnosis of hemiplegia following a spontaneous intracerebral haemorrhage. Computed tomography revealed bilateral heterotopic ossification of both the paretic and the non-paretic limbs, with entrapment of the sciatic nerve. The choice of surgical or nonsurgical management of such patients depends on the timing of diagnosis, the symptoms, and the extent of maturation of the ossified lesions. Surgical resection remains the only treatment with proven, evidence-based effectiveness. The choice of surgical approach largely depends on the location of the ossified lesions. Conclusion: We believe the plane of dissection presented is a satisfactory option for resection of a posteromedial mass and sciatic nerve release.
- Carpal Synovitis with Capitate Bone Tuberculosis in a ChildPublication . Grenho, A; Arcângelo, J; Jordão, P; Gouveia, CWe present a 10-year-old boy with 2-month duration non-traumatic wrist pain and inflammatory signs. Due to elevated inflammatory markers on blood tests, with an increase in radiocarpal and intercarpal joints synovial fluid and no bony lesions, the patient was submitted to wrist arthrocentesis for the suspicion of septic arthritis. The patient did not improve on conventional treatment, however. An MRI showed synovitis around the carpus and a lytic lesion of the capitate bone due to osteomyelitis. A biopsy was able to identify the causative agent as Mycobacterium tuberculosis, and the patient was treated with antibiotics. He improved significantly, with no pain and signs of normal capitate bone remodelling on the last radiograph.
- Claudicação da Marcha - Três Casos, Três Diagnósticos...Publication . Duarte, M; Ramos, S; Conde, M; Gouveia, CIntrodução: A claudicação da marcha na criança é frequente tendo múltiplas etiologias (infeciosa, traumática, inflamatória, mecânica ou neoplásica). Apresentam-se três casos de gonalgia com diagnósticos distintos. Caso clínico:Caso clínico 1: Rapaz de 2 anos, com gonalgia com 4 dias de evolução, sinais inflamatórios e limitação funcional. Sem leucocitose, PCR 87mg/L, VS 68mm/h e ecografia com derrame articular. Realizou artrocentese com identificação de Kingellakingae no líquido articular, confirmando o diagnóstico de artrite séptica. Medicado com cefuroxime (30 dias) com ótima evolução. Caso clínico 2: Rapaz de 2 anos, com gonalgia há 15 dias, limitação da extensão do joelho e calor local. Análises com PCR 6.9mg/L, VS 30mm/h, ANAs positivos 1/160 e ecografia com derrame articular e sinovite. Submetido a artrocentese com HC e LA estéreis, não tendo apresentado resposta à antibioterapia (AB). Às 7 semanas por manter quadro com ritmo inflamatório foi feito o diagnóstico de artrite idiopática juvenil oligoarticular, medicado com anti-inflamatório e sinovectomia química com melhoria. Caso clínico 3: Rapaz de 3 anos, com gonalgia persistente com 3 semanas de evolução e sinais inflamatórios. Analiticamente sem parâmetros inflamatórios e sem resposta à AB. Radiografia com reação periosteal e alteração da densidade do fémur. Ressonância magnética evidenciou lesão ocupando espaço femoral distal sólida e heterogénea. A biópsia confirmou osteossarcoma de alto grau. Realizou quimioterapia e aguarda cirurgia. Conclusões: Estes casos ilustram a heterogeneidade e amplo espectro de gravidade etiológica dos quadros de claudicação da marcha. Apesar de frequentemente associados a quadros benignos, também podem ser resultado de patologias graves e crónicas.
- Complicated Kingella kingaeosteoarthritisPublication . Alcafache, M; Nobre, S; Tavares, D; Gouveia, C
- Deformidades do Pé - Conceitos Básicos e Orientações para Médico de FamíliaPublication . Sant'Anna, F; Cassiano Neves, MO pé da criança constitui uma das principais preocupações dos pais em relação ao futuro da criança. Os autores abordam, de forma resumida, as principais deformidades do pé da criança, bem como as suas indicações terapêuticas e fornecem indicações sobre as atitudes a tomar pelo médico de família ou pediatra.