Purpose To evaluate the safety and period of hospitalization of the treatment of femoral shaft fractures with titanium elastic nails (TEN) in the age range 5 to 14 years. The hypothesis was that TEN might be a low-cost treatment, with good clinical results and short length of hospitalization. Methods Thirty children with femur fractures were surgically treated with TEN. Results The patients spent an average of 9.4 days in hospital. The average period for the healing process was 7.7 weeks. Partial weight bearing was permitted 3.3 weeks after surgery. The incidence of overgrowth was 60%, with an average of 0.40 cm. Conclusions The surgical method brings few complications and results in good limb alignment, with a short period of hospitalization and early return to daily activities and school.

CONTEXT AND OBJECTIVE: Femoral fractures are common in children between 2 and 12 years of age, and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. However, in some situations, a surgical approach is recommended. The objective here was to compare treatments for femoral shaft fractures using intramedullary nails (titanium elastic nails, TEN) versus traction and plaster casts in children. The hypothesis was that TEN might provide better treatment, with good clinical results in comparison with plaster casts. DESIGN AND SETTING: This retrospective comparative study was conducted in a public university hospital. METHODS: Sixty children with femoral fractures were evaluated; 30 of them underwent surgical treatment with TEN and 30 were treated conservatively using plaster casts. The patients' ages ranged from 5 to 13 years (mean of 9 years). RESULTS:The mean duration of hospitalization was nine days for the surgical group and 20 days for the conservative group. The incidence of overgrowth in the patients treated with TEN was 60.0% and, for those treated conservatively, 13.3%. Partial weight-bearing was allowed after 3.5 weeks in the surgical group and after 9.6 weeks in the conservative group. New hospitalization was required for 90.0% in the surgical group and 16.7% in the conservative group. Patients treated with plaster casts presented higher incidence of complications, such as loss of reduction. CONCLUSIONS: The surgical method presented better results for children. RESUMO CONTEXTO E OBJETIVO:Fraturas femorais são comuns em crianças entre 2 e 12 anos de idade, e 75% das lesões acometem a diáfise. Tração seguida de aparelho gessado ("gesso") é universalmente aceita como tratamento conservador. Entretanto, em algumas situações o tratamento cirúrgico é recomendado. O objetivo foi comparar o tratamento de fraturas diafisárias do fêmur com hastes intramedulares (titanium elastic nails, TEN) com tração e gesso em crianças. A hipótese era de que TEN pode ser melhor tratamento, com bons resultados clínicos em comparação com o gesso. TIPO DE ESTUDO E LOCAL: Este estudo retrospectivo e comparativo foi conduzido num hospital público universitário. MÉTODOS: Sessenta crianças com fraturas de fêmur foram avaliadas, 30 delas foram submetidas a tratamento cirúrgico com TEN e 30 foram tratadas de forma conservadora usando gesso. A idade dos pacientes variou de 5 a 13 anos (média de 9 anos). RESULTADOS: O tempo médio de internação foi de 9 dias para o grupo cirúrgico e 20 dias para o grupo conservador. A incidência de crescimento excessivo nos pacientes tratados com TEN foi de 60,0% e, para aqueles tratados de forma conservadora, 13,3%. Sustentação parcial de peso foi permitida após 3,5 semanas no grupo cirúrgico e após 9,6 semanas no grupo conservador. Houve 90,0% de novas internações no grupo cirúrgico e 16,7% no grupo conservador. Pacientes tratados com gesso apresentaram maior incidência de complicações, tais como perda de redução. CONCLUS...

Calcinosis universalis is characterized by the deposit of calcium salts in skin, subcutaneous tissue, tendons and muscles. Most cases become apparent during the first decade of life. Clinical aspects may vary from arthralgia to movement limitation, with calcification of soft tissues. Differential diagnosis should exclude fibrodysplasia ossificans progressive, progressive osseous heterodysplasia, myositis ossificans and dermatopolymyositis. There is no specific treatment, but the use of calcium chelates (EDTA), biphosphonates (disodium etidronate) and steroids are mentioned. This paper presents a review of the literature and adds a new case of calcinosis universalis and its evolution in 28 months, describing laboratory and radiograph findings and suggesting the differential diagnosis among processes of soft tissue calcification.

Tibial diaphyseal fractures in children and adolescents are relatively common injuries and often evolve with good results when treated through traditional methods of conservative treatment. Their elevated frequency is due to the high degree of exposure of children in physical activities and also to the topographic location, exposing them to direct or indirect trauma. The approach used should consider and respect some features regarding age, place of affection (whether proximal or distal), type of fracture and therapy. The anatomical advantage of a thicker periosteum and flexibility when submitted to angular impacts can provide younger children with greater stability and, consequently, increases their chances of a better prognosis than older children and adolescents. In the latter, the degree of exposure to highenergy trauma and the greater complexity and severity of injuries have caused the recent trend towards stabilization surgery to become more common. Frequent complications in the evolution of fractures in adults such as infection, delayed union and nonunion are much less common in children, although the risk of occurrence of compartment syndrome is an event that requires attention, especially with plaster.

RESUMOA claudicação na criança é uma queixa frequente nos consultó-rios dos pediatras, dos ortopedistas pediátricos e nos pronto-socorros. Diversas são as causas para essa condição e identificá-las torna-se um desafio. Quanto maior a idade do paciente, melhor é a coleta da anamnese e mais completo se torna o exame físico, facilitando o raciocínio médico na busca da origem do distúrbio. Para facilitar a abordagem, três grupos etários podem e devem ser considerados. No grupo etário infantil, de um aos três anos de idade, os diagnósticos mais prováveis incluem: sinovite transitória, artrite séptica, desordens neurológicas (paralisia cerebral (PC) branda e distrofia muscular), displasia do desenvolvimento do quadril (DDQ), coxa vara, artrite reumatoide juvenil (ARJ) e neoplasias (osteoma osteoide, leucemia); no grupo etário escolar, dos quatro aos 10 anos de idade, além dos diagnósticos acima, doença de Legg-Calvé-Perthes, menisco discoide, discrepâncias de comprimento dos membros inferiores e "dor do crescimento"; nos adolescentes, dos 11 aos 15 anos de idade: epifisiólise, DDQ, condrólise, síndromes de overuse, osteocondrite dissecante e coalizão tarsal. A proposta deste trabalho é atualizar o leitor em relação à abordagem do paciente pediátrico que apresenta claudicação e discutir as suas prováveis causas. Descritores