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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: [email protected] * 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