Special article
A new, readily accessed and low-cost, device for treating depressed ping pong fractures non-surgically: Technical note
Un nuevo dispositivo, de fácil acceso y bajo costo para el tratamiento no quirúrgico de fracturas deprimidas en «ping pong»: Nota técnica
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The numerical value of the VAS is used. On the left is a patient with pain improvement during the test phase, and on the right is a patient not only without improvement but with worsening. The graphs show the dates and the type of programming that the patient is using at all times (from A to D).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nicolás Cordero Tous, Lucía Santos Martín, Carlos Sánchez Corral, Ana María Román Cutillas, Belén Núñez Alfonsel, Marta Román Moyano, Ángel Horcajadas Almansa" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Nicolás" "apellidos" => "Cordero Tous" ] 1 => array:2 [ "nombre" => "Lucía" "apellidos" => "Santos Martín" ] 2 => array:2 [ "nombre" => "Carlos" "apellidos" => "Sánchez Corral" ] 3 => array:2 [ "nombre" => "Ana María" "apellidos" => "Román Cutillas" ] 4 => array:2 [ "nombre" => "Belén" "apellidos" => "Núñez Alfonsel" ] 5 => array:2 [ "nombre" => "Marta" "apellidos" => "Román Moyano" ] 6 => array:2 [ "nombre" => "Ángel" "apellidos" => "Horcajadas Almansa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S113014732100110X" "doi" => "10.1016/j.neucir.2021.08.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S113014732100110X?idApp=UINPBA00004B" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849621000526?idApp=UINPBA00004B" "url" => "/25298496/0000003300000006/v3_202212060641/S2529849621000526/v3_202212060641/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "A new, readily accessed and low-cost, device for treating depressed ping pong fractures non-surgically: Technical note" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "328" "paginaFinal" => "333" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Federico E. Minghinelli, Rodolfo Recalde, Mariano Socolovsky, Alfredo Houssay" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Federico E." "apellidos" => "Minghinelli" "email" => array:1 [ 0 => "minghinelli.f@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Rodolfo" "apellidos" => "Recalde" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Mariano" "apellidos" => "Socolovsky" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Alfredo" "apellidos" => "Houssay" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "División Neurocirugía, Hospital de Clínicas José de San Martín, Facultad de medicina UBA, Buenos Aires, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "División Neurocirugía, Maternidad Santa Rosa, Vicente López, Buenos Aires, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "División Neurocirugía, Hospital Británico, Buenos Aires, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un nuevo dispositivo, de fácil acceso y bajo costo para el tratamiento no quirúrgico de fracturas deprimidas en «ping pong»: Nota técnica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1036 "Ancho" => 1250 "Tamanyo" => 88378 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The MARS consists of: a) a paediatric anaesthesia mask; b) macro-drip set; c) a portion of that set to be used in the system; d) a three-way stopcock; and e) two 60-ml syringes.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A depressed "ping pong" or "pond" fracture is a bone depression that occurs in neonates and infants due to incomplete bone mineralisation in the skull<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. In this type of fracture there is no break of the inner or outer table of the bone<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. They are classified as congenital or acquired. Congenital fractures occur in utero and are usually caused by pressure exerted on the skull when there are uterine tumours, compression against the promontory, compression between siblings in twin pregnancies, or compression exerted by the extremities of the foetus. Acquired ping pong fractures develop at the time of delivery (due to obstetric manoeuvres) or result from trauma in the first months of life<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The majority of authors state that ping pong fractures with a depth greater than 1 cm or those causing neurological symptoms and/or signs<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a>, should be treated surgically, even though surgery can lead to serious complications<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a>. When to carry out surgical treatment is still a matter of debate<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">There are other types of treatment described in the literature related to aspiration reduction systems. These treatments have lower complication rates than surgical treatment and are more accessible to the population as a whole<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,8</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study was to present a novel low-cost, easy-access manual aspiration reduction system (MARS) used in the treatment of a ping pong fracture in three patients.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The MARS consists of: 1) a paediatric anaesthesia face mask (Draeger or similar); 2) a portion of a macro-drip set (Euromix or similar); 3) a three-way stopcock (Safe-way or similar); and 4) two 60-ml syringes (Elite or similar) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The paediatric anaesthesia mask needs to be malleable to fit against the patient's skull and also transparent so it can be visualised during the procedure. To assemble the device you connect one end of the portion of macro-drip set to the ventilation hole of the paediatric anaesthesia mask and the other end to the three-way stopcock, connecting the two syringes to the other two stopcock ports (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In this way, negative pressure can be generated through the two syringes by applying the paediatric anaesthesia mask to the patient's head and reducing the fracture.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">We present three cases of depressed ping pong fractures documented from July 2020 to April 2021.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Case 1: a 14-day-old premature female patient delivered after a monitored pregnancy, with weight and head circumference appropriate for her age. She had a congenital depressed ping pong fracture. Skull X-ray revealed a right parietal depressed ping pong fracture measuring 2 × 1.5 cm. Transfontanellar ultrasound showed no associated abnormalities. The patient had no neurological signs or symptoms.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Case 2: an 8-month-old female patient, with weight and head circumference appropriate for her age. She presented with a 12 -h-old traumatic ping pong fracture. Brain tomography without contrast revealed a left parietal depressed ping pong fracture, with no other associated abnormalities. The patient had no neurological signs or symptoms.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Case 3: a 5-month-old female patient, with weight and head circumference appropriate for her age. She presented with an 18-h-old depressed ping pong fracture. Skull X-ray revealed a depressed ping pong fracture of the right parietal bone. Transfontanellar ultrasound showed no associated abnormalities. The patient had no neurological signs or symptoms.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The depression of the fracture was greater than 1 cm in all three cases. The decision was made to treat with the MARS. Before commencing, the device was tested on five healthy adult volunteers using its maximum force. None of the volunteers reported pain during the procedure or had any complications. The risks and benefits of the procedure were explained to the families, who then signed the informed consent form and the procedure was performed at the bedside of the patients without anaesthesia (sedation was used in case 2). The patients had venous access to treat any eventualities (hypotension and seizures, for example) and were monitored by the neonatology team throughout the procedure. All three patients were placed in supine position with their head slightly rotated towards the opposite side of the fracture. The paediatric anaesthesia mask was placed over the depressed ping pong fracture, achieving a hermetic seal. Aspiration was performed slowly, first with one syringe and then with the other. The procedure was repeated and the reduction of the fracture was clear (observed through the paediatric anaesthesia mask while the procedure was being performed). The entire procedure was completed in 20 min (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) and required a total of 240 cm<span class="elsevierStyleSup">3</span> of negative pressure in all three cases. We should clarify that the negative pressure needed to achieve satisfactory reduction of the fracture could vary from patient to patient.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">Satisfactory reduction of the depressed ping pong fracture was achieved in all three cases. Transfontanellar ultrasound showed no associated abnormalities. The neurological assessments were normal and the patients had good oral tolerance after the procedure. Skull X-rays performed the following day showed the satisfactory reduction of each of the fractures (<a class="elsevierStyleCrossRefs" href="#fig0020">Figs. 4 and 5</a>). The patients were discharged from the specialist area 24 h after the procedure, with outpatient follow-up.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Ping pong fractures with a depression of more than 1 cm, or which are causing signs or symptoms in the patient, are classically treated surgically. The surgery is performed in the operating theatre under general anaesthetic and consists of making a burr hole in the vicinity of the fracture, inserting a dissector below the depression and elevating the depression with the dissector<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5,9–11</span></a>. Zalatimo et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> propose an alternative treatment which involves introducing percutaneous microscrews to elevate the bone. However, this type of treatment can lead to complications inherent to both the general anaesthetic (e.g. cardiovascular, respiratory and internal environment alterations, air embolism and allergic reactions, among others) and the surgical procedure (e.g. epidural, subdural and intraparenchymal haematomas, traumatic subarachnoid haemorrhage and surgical wound infection), which can prolong the hospital stay<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a>.</p><p id="par0065" class="elsevierStylePara elsevierViewall">There are other treatments described in the literature involving fracture reduction systems using aspiration<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,8,11–13</span></a>. This would avoid the above anaesthesia- and surgery-related complications, reducing both hospital stay and costs. Suction reduction systems are numerous and include the obstetric suction cup<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,11,13</span></a> and the breast milk extractor<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,12,14</span></a>, which are connected to an automatic vacuum pump. There are also reports that show complications associated with these aspiration reduction systems. Govaert et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> reported subgaleal bleeding in neonates with vacuum-assisted delivery. Prevedel et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> reported subdural haematomas with the use of the same device, while Musahl et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> presented a case of rupture of the superior sagittal sinus, which required surgical repair, after a delivery assisted with an obstetric vacuum cup. However, there are reduction systems with manual suction, like ours, which are not connected to an automatic vacuum pump<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,18</span></a>. No complications beyond scalp bruising have been found with manual reduction devices. Our working team therefore decided against postoperative follow-up brain computed tomography scans on our three cases, their decision also taking into account the risk of radiation exposure and the fact that the post-procedure neurological physical examination showed no changes. Reduction devices with manual suction make it possible to see the patient's head while the procedure is being performed, and also to control the negative pressure exerted on the fracture in real time<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,18</span></a>. Perhaps the main advantage of the MARS is that, unlike other reduction devices that use manual suction, the MARS has a three-way stopcock, allowing two 60-ml syringes to be connected in series, thereby enabling higher negative pressure to be exerted on the fracture than when using only one syringe.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The ideal timing for treating a ping pong fracture after trauma is subject to debate. Compression of the brain due to the fracture could compromise brain function<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>. There may also be migration of osteocytes to the fracture site, which could make it difficult to reverse the fracture or achieve complete elevation of the fracture as the days go by<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>. These fractures should therefore be treated as soon as possible after the trauma. In their series of nine cases treated with a manual aspiration reduction device, Ramiro Lopez Elizalde et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> describe the successful treatment of eight cases, in which the trauma was less than 74 h old. In the case with an unsuccessful outcome, the fracture was six days old. In terms of age, the younger the patient, the better the result, as there is a direct relationship between age and bone density; the younger the patient, the softer and more flexible their bones will be. De Paul Djientcheu et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> reported the successful use of an obstetric vacuum extractor to treat a depressed fracture in a 17-year-old patient.</p><p id="par0075" class="elsevierStylePara elsevierViewall">More patients need to be successfully treated with the MARS to accurately delineate the appropriate time range for treatment after trauma, and the appropriate age range of patients who can be treated in this way. Ideally these literature reports should come from others and not only from our working group.</p><p id="par0080" class="elsevierStylePara elsevierViewall">MARS is an effective, safe and easily reproducible system, and any health centre has the materials to make one. This would make the treatment of depressed ping pong fractures that require treatment available to the entire population. It would also allow the patient to be treated quickly at the bedside, without the need for general anaesthesia or surgery, avoiding the complications inherent to these procedures and reducing parents' anguish, length of hospital stay and all the associated costs. This procedure should ideally be performed by neurosurgeons.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0085" class="elsevierStylePara elsevierViewall">With its low-cost, easily accessible and easy-to-assemble components, MARS is a novel system that can be copied in any hospital in the world.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In this article we have described the successful and unproblematic use of this system to reduce depressed ping pong fractures in three patients. We hope our report will stimulate others to adopt, test and ultimately report on this technique, in order to provide further support for its use and make it more accessible to all those who may benefit from it.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1814915" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1584558" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1814914" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1584557" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-05-20" "fechaAceptado" => "2021-07-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1584558" "palabras" => array:5 [ 0 => "Fracture" 1 => "Ping-pong" 2 => "Aspiration" 3 => "Treatment" 4 => "Reduction" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1584557" "palabras" => array:5 [ 0 => "Fractura" 1 => "Ping-pong" 2 => "Aspiración" 3 => "Tratamiento" 4 => "Reducción" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The aim of this paper is to describe a low-cost and readily accessed Manual Aspiration Reduction System (MARS) for use treating ping-pong fractures in three patients.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The MARS is composed of a pediatric anesthesia mask, part of a macro dripper, a 3-way stopcock, and two 60-ml syringes. Prior to its use in our patient, the system was tested on five adult volunteers to maximum negative pressure, and none reported pain during the procedure or experienced any other complication.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We present three clinical cases of patients with depressed ping-pong fracture who were treated with the MARS at the bedside without anesthesia. The patients were monitored by the neonatology team throughout the procedure.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Skull radiography revealed reduction of the fracture after the procedure performed with the MARS in all patients. The transfontanellar ultrasound and follow-up neurological examination were normal. The patient progressed favorably and was discharged from our service after 24 h.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Due to its components, the MARS is a low-cost and readily accessed system. In this case, it permitted satisfactory reduction of a ping-pong fracture in all patients. This system should greatly simplify the treatment of such fractures.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">El objetivo del trabajo es describir un sistema de reducción con aspiración manual de bajo costo y fácil acceso (SiRAMa) utilizado para tratar fracturas deprimidas en «ping pong» en 3 pacientes.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Método</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">El SiRAMa está compuesto por una máscara de anestesia pediátrica, parte de un macrogotero, una llave de 3 vías y 2 jeringas de 60 ml. Previamente a su utilización en los pacientes el sistema se testó en 5 voluntarios adultos utilizando su máxima potencia, los cuales no refirieron dolor durante el procedimiento ni presentaron otra complicación.</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Presentamos 3 casos clínicos de pacientes con fractura deprimida en «ping pong», los cuales fueron tratados con el SiRAMa al lado de la cama sin anestesia. Los pacientes fueron monitorizados por el equipo de neonatología durante todo el procedimiento.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La radiografía de cráneo evidenció la reducción de la fractura tras el procedimiento realizado con el SiRAMa en todos los pacientes. La ecografía transfontanelar y el examen neurológico de control fueron normales. Los pacientes evolucionaron favorablemente y fueron dados de alta a las 24 horas.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Debido a sus componentes el SiRAMa es un sistema de bajo costo y fácil acceso. En este caso permitió la reducción satisfactoria de la fractura en «ping pong» en todos los pacientes. Este sistema permitiría simplificar el tratamiento de las fracturas de este tipo que así lo requieran.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Minghinelli FE, Recalde R, Socolovsky M, Houssay A. Un nuevo dispositivo, de fácil acceso y bajo costo para el tratamiento no quirúrgico de fracturas deprimidas en «ping pong»: Nota técnica. Neurocirugia. 2022;33:328–333.</p>" ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1036 "Ancho" => 1250 "Tamanyo" => 88378 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The MARS consists of: a) a paediatric anaesthesia mask; b) macro-drip set; c) a portion of that set to be used in the system; d) a three-way stopcock; and e) two 60-ml syringes.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 597 "Ancho" => 900 "Tamanyo" => 34487 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Manual aspiration reduction system fully assembled.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 588 "Ancho" => 900 "Tamanyo" => 67864 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Performing the ping pong fracture reduction procedure with the MARS at the patient's bedside without sedation or anaesthesia.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1499 "Ancho" => 1500 "Tamanyo" => 361851 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">a, b and c: Comparison images pre-procedure (below, red arrow: depressed ping pong fracture) and post-procedure (above, red arrow: satisfactory reduction of the fracture) in the 14-day-old, 8-month-old and 5-month-old patients, respectively.</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1080 "Ancho" => 1000 "Tamanyo" => 110537 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">a, b and c: Pre- and post-procedure X-rays and 3D tomography in the 14-day-old, 8-month-old and 5-month-old patients, respectively.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Falls in young children with minor head injury: A prospective analysis of injury mechanisms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. 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