NATIONAL HEALTH FUND Esteban Arze O-456 * Box 524 * Phone:425 1142 * Fax: 425 1186 REGIONAL OFFICE COCHABAMBA – BOLIVIA Distribution: DEPARTMENT OF PEDIATRICS Cite N............... MEDICAL REPORT NAME: Gutiérrez Chávez Ana Berenice AGE: 13 years REGISTRATION: 82-0608-MGR CODE: 52 COMPANY: Bolivian Police DATE: 09-12-2020 The patient is undergoing specialized orthopedic trauma treatment at the Clínica del Sur in La Paz since March 2011 with the following diagnoses. - Pseudo arthrosis congenital tibia Perone distal third of right leg (lax). - Tibial varus, antecurvatum, and internal rotation (right leg) - Right leg shortening The initial clinical treatment (March 29, 2011) consisted of Open resection of pseudo-tumor fibrous tissue, surgical cleaning, edge regularization, stabilization with baby Ilizarov fixator and Kirschner needle in the form of a virgula, placement of cortico-spongy graft of iliac crest, aspiration of stem cells from the same region, corticotomy in the proximal metaphysis and bone lengthening. There was a good immediate and mediate postoperative evolution, 5 months after the beginning of the treatment, lysis started to appear in the pathological focus, and there was a good bone regeneration in the elongation focus. A new surgical intervention was performed (August 22, 2011), which consisted of the revision of the Ilizarov fixator, and the edges of the pathological focus, called aggressiveness of the base pathology, were revived. A new surgical intervention was performed (January 28, 2014) for presenting recurrence of the congenital pathology that consisted of open resection of the pseudo-tumoral fibrous tissue, surgical cleaning, edge regularization, drilling of the sclerotic bone channel in both bone extremities, placement of cortical-sponge graft of the iliac crest, stabilization with Ilizarov fixator for children and Kirschner needle in the form of a virgula. It is as much as I can inform for purposes that suit the person concerned. Dr. Romulo Rodriguez Vides TRAUMATOLOGY - ORTHOPEDICS Mat Prof. R-303 Col. R-54 CNS MEDICAL CERTIFICATE Bs. Bs 25. 2078740 Place and Date: La Paz February 07, 2014 Names and Surnames (of the Doctor) Dr. Sergio Iriarte Vincenti M.S. and P.S. Register, I-71 C.M.B. Register, I-45 _____________________________________________________________________________ The Underwriting Physician Certifies: Patient ANA BERENICE GUTIERREZ CHAVEZ, 6 years old, is undergoing specialized treatment in Orthopedics and Traumatology at the Clínica de Sur in this city since March 2011, with the following diagnosis: - PSEUDOARTHOSIS CONGENITAL TIBIA AND PERONEUS DISTAL THIRD RIGHT LEG (LAX) - ANTECURVATOY TIBIAL VARUS AND INTERNAL ROTATION - (RIGHT LEG) - SHORTENING RIGHT LEG The Initial surgical treatment (March 29, 2011) consisted of: - OPEN RESECTION OF PSEUDOTUMORAL FIBROUS TISSUE, SURGICAL CLEANING, EDGE REGULARIZATION, STABILIZATION WITH BABY ILIZAROV FIXATOR AND VIRGIN KIRSCHNER WIRE. - PLACEMENT OF ILIAC CREST CORTICO-SPONGY GRAFT - ASPIRATION OF MOTHER CELLS FROM THE SAME REGION - CORTICOTOMY IN PROXIMAL METAPHYSIS AND BONE LENGTHENING. There was good immediate and mediate postoperative evolution, 5 months after the beginning of the treatment, lysis started to appear in the pathological focus, and good bone regeneration was present in the elongation focus. It was carried out a new surgical intervention (22-08-11) which consisted of - REVISION OF THE ILIZAROV PYJAMAS, EDGES WERE REVIVED IN THE PATHOLOGICAL FOCUS, DENOTING AGGRESSIVENESS OF THE BASE PATHOLOGY. She used a circular device for some time and it was removed, then used a protective brace A new surgical intervention was performed on January 28th of this year, for presenting recurrence of the congenital background pathology, which consisted of - OPEN RESECTION OF PSEUDOTUMORAL FIBROUS TISSUE, SURGICAL CLEANING - HEDGE TRIMMING - MILLING OF THE SCLEROTIC BONE CHANNEL AT BOTH BONE ENDS - PLACEMENT OF CORTICO-SPONGY GRAFT OF ILIAC GRESTA - STABILIZATION WITH ILIZAROV FIXATOR FOR CHILDREN AND KIRSCHNER WIRE IN THE SHAPE OF A VIRGULA “It should be noted that the world's Children's Orthopedic literature refers to Congenital Pseudoarthrosis as a pathology with malignant behavior (recurrence of the disease) in a high percentage of cases, above 50%, in most cases with poor prognosis”. This is how much I certify in honor of the truth and for consequential purposes ******************************************************************************** Dr. Sergio Iriarte V. MEDICO CIRUJANO Ortopedia y traumatología MSP I – 71 CMB I - 45 SEAL Doctor's signature Radiology Center Imaging Health Digital Radiology. Panoramic, Dental, Mammography, Ultrasound, and X-Ray at home Cbba 19 November 2018 Name: Ana Berenice Gutierrez Age: 11 a. Physician: A.Q.C. RADIOGRAPHY: RIGHT LEG Description. - A.P/LAT, - Tumescent soft tissue in the inner leg segment, with localized external and posterior segmental radiolucency - Bone structures of a very diminished radius in the lower epiphyses, as well as in the posterior tarsus, with long bone fractures observed in the lower 1/3 with angulation and finishing of the upper bone ends over the lower ones, presenting also a slight periosteal reaction - Right tibia - talus - calcaneal joint aligned with verticalization of posterior tarsal structures CL. -INFLAMMATORY CHANGES IN SOFT TISSUE -ANGLED TIBIA PERONEAL DIAPHYSEAL FRACTURE -VERTICALIZATION OF THE POSTERIOR TARSUS AND MARKED LOCAL OSTEOPENIA Dr. Juan Miguel Osuna G MEDICAL RADIOLOGIST Mat. Prof. 0-408 ADDRESS: Aniceto Arce #422 (In front of German Urquidi Maternity Hospital) * PHONES: 4534900 - 4378663 CEL 70358639 60381015 E-mail: imagen-salud@hotmail.com * Cochabamba – Bolivia MEDICAL CERTIFICATE Bs. Bs 25. 2079539 Place and Date: …………………………………………………………………………………… Names and Surnames (of the Doctor) ……………………………………………......................... M.S. and P.S. …………………………………. C.M.B. Register, I-45…………………………. SEAL Doctor's Signature
