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ObjectiveThis study evaluated the epidemiological profile of patients with suspected physical abuse, especially regarding the occurrence of fractures, treated in a referral hospital.MethodsThe authors reviewed all reports of suspected abuse against children and adolescents (AACA) in this hospital from January 2005 to December 2015. They were assessed and separated by month and year. The characteristics of the victims of physical abuse with occurrence of fractures were studied. The features of the fractures were evaluated in those patients with available radiographs.ResultsOf the 3125 notifications, 500 were classified as physical injuries; of these, 63 had fractures. An annual progressive increase in notifications was observed. As for age group, 50 patients (80.6%) were up to three years old and 36 (58%) up to one year. Most were male (60%) and the likely aggressors were mother alone and both parents (27.5% each). In 30 patients with available images, fractures of long bones (femur, tibia, and humerus) predominated (71%), as well as a single fracture line (74%), diaphyseal location (73%), and a transverse line (57%). There were two deaths in fracture cases (3%).ConclusionAll orthopedists should be alert to suspected AACA in children with trauma below the age of three, even without classic signs of abuse.

The supracondylar humerus fracture is the most common elbow fracture in children, corresponding to 58% of these cases. The objective of this study is to report a rare postoperative complication, the pseudoaneurysm of the brachial artery. A 9-year-old girl with was admitted with a Gartland III supracondylar fracture of the right humerus, presenting normal neurological and vascular exams. The patient underwent a surgical treatment with percutaneous fixation and immobilization and was re-evaluated after 2 and 4 weeks. In the last evaluation the immobilization and fixation were removed. She returned after 3 months, presenting a progressive palpable, painless mass in the 1/3 distal right arm. The arterial ultrasound showed a mass in the cubital fossa, which presented internal flow and some wall thrombi, compatible with pseudoaneurysm of the brachial artery. After diagnosis, the treatment was a vascular surgery for dissection and reconstruction of the artery. The incidence of vascular involvement in Gartland III fractures ranges from 2% to 38%. False aneurysms originate from arterial hematomas caused by trauma to the arterial lumen, and their developing time can vary. There are few reports of this complication, so there is no consensus about the treatment.

ResumoOsteomielites fúngicas, principalmente associadas à artrite séptica, são incomuns no Brasil, e por isso às vezes de difícil diagnóstico e tratamento. Relatamos um caso de uma paciente jovem, sem fator de risco imunossupressor, com o desenvolvimento de uma osteomielite e evolução para artrite séptica do quadril. O diagnóstico foi realizado após a sua drenagem cirúrgica e visualização do Cryptococcus Neoformans à anatomia patológica. Foi instaurado o tratamento antifúngico, com remissão total dos sintomas. Como não há consenso em relação ao tratamento de osteomielites fúngicas, descrevemos este relato de caso para atentar ortopedistas sobre a importância do diagnóstico diferencial nas artrites de quadril e a boa evolução do tratamento clínico após a drenagem e isolamento do patógeno.