RESUMEN
Pediatric knee deformities are common, and the classic treatment is corrective osteotomy. The aim of this study to assess the safety and efficacy of percutaneous low-energy osteotomy and casting with shanz screws fixation in treatment of Genu varum in children equal or younger than 7 years. This is a prospective nonrandomized case series study was conducted. A total of 38 patients (total of 60 limbs: 36 varus and 24 valgus) were treated by percutaneous low-energy osteotomy and casting with shanz screws fixation and observed over 2-5 years. Clinical and radiological outcomes were evaluated at the end of follow-up period by standing scanogram which enabled tibiofemoral angles and the mechanical axis to be measured and the rate of complications. There was a statistically significant improvement of the radiographic parameters in the form of tibiofemoral angle and MAD. Clinically, all the cases were completely corrected just one patient (two limbs) complicated by over-correction but statically non-significant and. pin tract infection in shanz screws fixation was noticed in one Patient. Percutaneous low-energy osteotomy and casting with shanz screws fixation is a simple, safe, and effective method in dealing with 7 years and younger children with pathological knee deformities. Level of evidence: Therapeutic level IV.
RESUMEN
BACKGROUND: The treatment of late stages of Legg-Calvé-Perthes disease (LCPD) is controversial. Although the concept of femoral head containment is a well-established technique of treatment, its use remains debatable in the late stages of the disease, as it does not improve symptoms in terms of limb length discrepancy and gait. AIM: To assess the results of subtrochanteric valgus osteotomy in symptomatic patients with late-stage Perthes disease. METHODS: From 2000 to 2007, 36 symptomatic patients with late stage of Perthes disease were surgically treated with subtrochanteric valgus osteotomy and followed-up for 8 to 11 years using the IOWA score and range of motion (ROM) variables. The Mose classification was also assessed at the last follow-up to reflect possible remodeling. The patients were 8 years old or older at the time of surgery, in the post-fragmentation stage, and complaining of pain, limited ROM, Trendelenburg gait, and/or abductor weakness. RESULTS: The preoperative IOWA score (average: 53.3) markedly improved at the 1-year post follow-up period (average: 85.41) and then slightly improved at the last follow-up (average: 89.4) (P value < 0.05). ROM improved, with internal rotation increased on average by 22° (from 10° preoperatively to 32° postoperatively) and abduction increased on average by 15.9° (from 25° preoperatively to 41° postoperatively). The mean Mose deviation of femoral heads was 4.1 mm at the end of the follow-up period. The tests used were the paired t-test and Pearson correlation test, where the level of significance was a P value less than 0.05. CONCLUSION: Subtrochanteric valgus osteotomy can be a good option for symptomatic relief in patients with late-stage of LCPD.
RESUMEN
Telemedicine was originally created as a way to treat patients who were located in remote places far away from local health facilities or in areas with shortages of medical professionals. Telemedicine is still used today to address those problems, and is increasingly becoming a tool for convenient medical care. With the emergence of pandemics, telemedicine became almost a mandatory and valuable option for continuing to provide medical care in various specialties. As the threat of pandemic progress has continued for months and may continue for years, it is essential to validate existing tools to maintain clinical assessment and patient treatment to avoid negative consequences of the lack of medical follow-up. Therefore, the establishment of a virtual assessment technique that can be conducted effectively is of outmost importance as a way of adapting to the current situation. This study evaluated the role of telemedicine in the assessment of various orthopedic pathologies by means of a systematic virtual evaluation.
RESUMEN
BACKGROUND: Diabetic ankle fractures were usually treated by open reduction and internal fixation (ORIF) which may lead to Charcot joint, or conservative which may lead to pressure sores. For better results, minimally invasive procedures have been developed, which decrease complications and enable early mobilization and rapid rehabilitation. MATERIALS AND METHODS: This is a retrospective study of a total of 26 uncontrolled diabetic patients: 8 males [30.8%] and 18 females [69.2%]. The mean age of the patients was 67.4 (range 60 to 75) years. We include only Weber A and B where 10 patients suffered from lateral malleolus only (38.5%), 11 patients with bi-malleolar ankle fracture (42.3%) and 5 patients with tri-malleolar fracture (19.2%). RESULTS: The mean time to union was 6.92 weeks (range of 6 to 12 weeks). Weight-bearing has begun from the first day in 19 patients (73.1%), while 7 patients began weight-bearing 4 weeks after the operation (26.9%). Mean follow-up ranged from 2 to 5 years. Mean AOFAS was 96.12 (range of 60 to 99). Only 3 patients suffered from complication: One patient suffered from Charcot joint, one suffered from fracture displacement and needed revision, and one suffered from mal-reduction. Thus, the complication rate was 11.5%. CONCLUSION: We believe that percutaneous cannulated screws technique is a simple and effective method that can be applied safely in uncontrolled DM patients with ankle fractures.
