Unilateral Abduction Dorsiflexion Mechanism Brace as an Attractive Alternative of Congenital Talipes Equino-Varus Treatment - a Preliminary Report.

Ponseti method of CTEV treatment includes use of a foot orthosis, compliance with this can be a challenge. A new brace- Abduction Dorsiflexion Mechanism brace (ADM, C-Prodirect) was introduced to address this. The aim of the study was to assess whether the new ADM brace improves compliance and prevents relapse in children with corrected clubfoot. Eight children with unilateral CTEV who did not tolerate the standard brace were included in the study. All children had been previously treated with Ponseti casting, Achilles tenotomy and Ponseti AFO Abduction Brace (C-Prodirect®). The mean age of children included was 27 months. Parents' satisfaction with the brace was assessed using Client Satisfaction with Device (CSD) questionnaire. Parents reported better tolerance of the brace by the child in six out of eight cases. ADM brace is viable alternative in maintaining correction of unilateral idiopathic CTEV when compliance to standard AFO abduction brace is poorly tolerated.

Surgical treatment of ankle instability in children with os subfibulare.

INTRODUCTION: Ankle instability in children due to soft tissue injury usually resolves after non-operative treatment. However, some children and adolescents with chronic instability require surgical treatment. A rarer cause of developing ankle instability is injury to the ligament complex in the presence of os subfibulare, an accessory bone inferior to the lateral malleolus. The aim of this study was to assess the results of operative management of chronic ankle instability in children with os subfibulare. MATERIALS AND METHODS: 16 children with os subfibulare and chronic ankle instability who failed non-operative treatment were enrolled prospectively into the study. One child was lost to follow-up and excluded from analysis. The mean age at the time of the surgery was 14 years and 2 months (range 9.5-17 years). The mean follow-up time was 43.2 months (range 28-48 months). Surgical treatment in all cases involved removal of os subfibulare and a modified Broström-Gould lateral complex reconstruction with anchors. Ankle status was assessed before and after surgery with The 100 mm Visual Analogue Scale and Foot and Ankle Outcome Score questionnaire. RESULTS: The mean Foot and Ankle Outcome Score improved from 66.8 to 92.3 (p < 0.001). Pain level improved from 67.1 preoperatively to 12.7 (p < 0.001). All children reported improvement in their ankle stability. There was one case of scar hypersensitivity that improved during observation and one superficial wound infection that resolved with oral antibiotics. One child reported intermittent pain without symptoms of instability following another injury. CONCLUSIONS: Ankle joint sprain with associated injury to os subfibulare complex can lead to chronic instability in children. If conservative management fails, then surgical treatment with modified Broström-Gould technique and excision of accessory bone is a safe and reliable method.

My child's leg is in a plaster. Can they fly?

Air travel in a cast with a fracture is associated with an increased risk of leg swelling in a tight compartment. We have hypothesised that there should be an accessible, universal policy for travel recommendations with the cast supported by high-quality literature. We have checked the 20 biggest airlines looking for their guidance on travel recommendation /restrictions in the presence of a broken leg in a cast, particularly in children. We have also carried out a literature review in the last 30 years to ascertain whether there is the best evidence relating to flying safely with a child in a cast. Nine airlines have an accessible policy on flying in a cast. Most airlines recommend to delay the flight 24-48 h after cast application. Four airlines require splitting the cast if applied 48 h before the flight. None of the airlines have specific recommendations related to children. A comprehensive review of the literature revealed 11 relevant articles. None of those studies were experimental studies on flying with a fracture, only one assessed flying in a cast. We did not find a research study focused specifically on children. The recommendation regarding flying restrictions varies among airlines and often there is no coherent policy available. The existing recommendations cannot be fully supported by experimental studies in the existing literature. Flying in a full cast should be delayed until 24-48 h after cast application. If the flight is an emergency, the cast should be bivalved.

Targeted Screening of Hip Dysplasia in Newborns: Experience at a District General Hospital in Scotland.

National Health Service Quality Improvement Scotland (NHS QIS) published a health technology scoping report in 2006 acknowledging that there are serious concerns within Scotland in relation to Developmental Dysplasia of Hip (DDH) as there is no formal screening program in place and there are significant variations between NHS boards leading to confusion for staff and parents. NHS QIS identified need for audit work to improve hip screening in Scotland. The aim of this study is review of current practice of selective screening for DDH. All newborns who had their first hip scan during one year period (2014) were included in this retrospective study and followed up until June 2015 to include any surgical intervention for dysplastic hip. Out of 428 babies (856 hip scans), abnormality was seen in 119 babies/147 hips (134 Graf 2a/2b, 10 hips were 2c and 3 hips were Graf grade 3). Average age when first scan was performed was 5 weeks (range 3 weeks to 22 weeks). Analysis of risk factors in 119 babies with abnormal scan was consistent with literature (83 breech, 12 family history, 12 HBW, 10 instability and 2 twins of breech). Twelve babies (16 hips) required treatment and were successfully treated in Pavlik harness. There was one case of missed/late dislocation, which lived in outside catchment area for 3 years since birth. During this study period there was no case of avascular necrosis or femoral nerve palsy as a result of treatment. In our experience, selective hip screening by ultrasound scan is useful in avoiding overtreatment and minimizing late presentations.

The results of the operative treatment of patellar instability in children with Down's syndrome.

Patellar instability can significantly influence the locomotor function in children with Down's syndrome. The aim of this study was to evaluate the mid-term results of the operative treatment of patellar instability in children with Down's syndrome. The study included eight children (10 operated knees) with Down's syndrome and associated patellar instability. The children's age ranged from 6 to 11 years (the mean age was 7 years 9 months). The operative treatment involved Green's quadricepsplasty in six cases (eight knees) and Green's quadricepsplasty augmented with a modified Galeazzi procedure - semitendinosus tenodesis - in two cases. The mean follow-up period was 3 years and 3 months. We achieved a stabilization of the patellofemoral joint and a correction of the position of the patella in seven knees (five of these were treated with Green's procedure and in two cases Green quadricepsplasty was combined with the Galeazzi procedure). We did not observe any recurrence of patellar dislocation in this group during the follow-up period. We noted two failures, defined as a recurrence of dislocation, during the mean of 9 months postoperatively. Green's quadricepsplasty provides satisfactory results in younger children with Down's syndrome. In older children, we recommend the modified Galeazzi procedure.

Treatment of solitary bone cysts with allogenic bone graft and platelet-rich plasma. A preliminary report.

The treatment of solitary bone cysts remains controversial. The high recurrence rate after operative treatment calls for the search of new effective treatment methods. The aim of this study was to evaluate the outcomes of treatment of solitary bone cysts with platelet-rich plasma (PRP) and allogenic bone grafts. The study group consisted of 9 patients (4 males and 5 females) with the diagnosis of solitary bone cyst. Their mean age was 12 years and 2 months (range: 6 to 17 years). All patients were symptomatic in routine daily activities. There was a coexisting fracture within the cyst wall in three patients. The operative procedure included removal of the cyst wall soft-tissue lining and filling of the cavity with deep frozen, gamma irradiated morselized allogenic bone grafts mixed with PRP. The PRP was prepared preoperatively with the GPS System (Gravitational Platelet Separation System, Biomet Merck). In six patients with an existing or impending fracture in particularly large cysts, fixation was used. For the cysts located close to the epiphysis (2 femurs, 1 humerus) we used an IM nail or DHS. For three cysts located in the diaphyseal region of the humerus we used an Ilizarov fixator. Three cysts with lower risk of impending fracture were left without fixation. The mean follow-up period was 19.5 months (range: 12 to 30). We noted no procedure-related complications and no refracture during the observation period. Bleeding from the wound was minimal, possibly as a result of PPP use. The wounds healed without swelling or excessive scar formation. After 12 months all the cysts were completely filled with new bone and were staged as Neer stage I. All the patients were asymptomatic. The use of PRP with allogenic bone grafts appears as a promising method for the treatment of solitary bone cysts. Further studies on larger patients series with longer follow-up will be necessary to answer the question whether this method will provide a lower recurrence rate compared to other forms of treatment.

Influence of the treatment of developmental dysplasia of the hip by the abduction brace on locomotor development in children.

PURPOSE: To assess the influence of treating developmental dysplasia of the hip (DDH) with the abduction brace on locomotor development in children. METHODS: One hundred children treated for DDH served as the study group. There were 80 girls and 20 boys. The children's average age at the beginning of the treatment was 8 weeks. The control group consisted of 100 healthy children with normal hips and without any locomotor system disorders. We have evaluated factors such as the age at which the treatment started, the duration of the treatment, the birth weight of the child and the time when the children started sitting and walking independently. RESULTS: On average, treatment with the abduction brace lasted 13 weeks (ranging from 6 to 26 weeks). The mean age at which the patients began to sit was 7 months, which was one week later compared to children from the control group (P = 0.28). The age at which they started walking was 12 months and 2 weeks, which was 3 weeks later than in the control group (P = 0.002). CONCLUSION: For children with DDH, the abduction brace is a safe and effective method of treatment and, although the infants begin to walk about 3 weeks later compared to healthy children, this practice does not seriously affect the child's locomotor development.

[Carbon external fixator--CARBOELASTOFIX in treatment of tibia diaphysis fractures]. / Stabilizator weglowy CARBOELASTOFIX w leczeniu zlamaii trzonów kosci piszczelowych.

The authors presents the results of healing status of tibia diaphysis fractures treated with carbon-plate fixator on a group of 12 patients (9 men and 3 women with age between 27 and 89 years). Long-term mechanical investigations and studies at animals, performed at our Department have shown advantages of bone fixation performed with a new device for osteosynthesis, called by authors CARBOELASTOFIX. General principle of the method is the use of external fixation device, made of carbon-epoxide resin composite plates with variable flexibility, enabling hastened fracture healing. The research allowed also to work out the guidelines of indications for surgery, surgical technique and method of modifying flexibility of fixation consistently with fracture healing course. The mean time of observation (from the operation to the healing) was 23 weeks, having 10 good and 2 bad results.

The evaluation of social awareness of osteoporosis, based on the aimed questionnaire.

BACKGROUND: Osteoporosis is the most common osteopathy. Osteoporosis is recognized by World Health Organization as a civilization disease. Still, the awareness of osteoporosis in polish society is unknown. The aim of the study is demographic evaluation of people who are interested in diagnosis and treatment of osteoporosis. Another aim is to analyze data such as age, sex, fracture occurrence, style of life of people who have phoned to Osteoporosis Information Telephone (OIT). MATERIAL AND METHODS: The analysis was based on 501 individuals (446 women, 55 men). The evaluated parameters were age, sex, place of living, education, risk factor awareness, fracture occurrence and the source of knowledge about OIT. The auxiliary questions concerned previous diagnosis and treatment. RESULTS: In 83,3 % of analyzed group the general information about osteoporosis was acquired from newspapers, 13,11% from books and folders, 3 % from radio programmes, 0,4 % from TV, and 0,19% from internet. 23,5% of people acquired information about OIT from magazines including weekly TV programme. 148 people (29,5%) were examined by densitometry. 57 people (11,3%) had a previous history of bone fractures. CONCLUSIONS: Our study helps to evaluate the social awareness of osteoporosis in people interested in this problem. We hope that our results will help to rise social awareness of osteoporosis thanks to new medial advertising companies in the future and will become the base for others analyzes of osteoporosis.

[Comparison of the Ender's nailing and Dynamic Hip Screw (DHS) fixation in the treatment of trochanteric fractures in elderly patients]. / Porównanie rozleglosci zabiegu przy zastosowaniu pretów Endera i sruboplytki DHS w leczeniu zlamaan przezkretarzowych kosci udowej u osób w wieku podeszlym.

The aim of this study was an evaluation which operative method of treatment: stabilisation with the Dynamic Hip Screw or with Ender's nails is less invasive procedure in elderly patients with trochanteric fractures. 100 consecutive patients with trochanteric fracture were enrolled into the study, of which 53 patients (49 women, 4 men; mean age 89 years) were stabilised intramedullarily with the use of Ender's nails and 47 patients (26 women, 21 men; mean age 76 years) were treated operatively with the use of Dynamic Hip Screw. The factors compared the mean length of hospital stay, the mean duration of the surgery, post-operative blood loss, early local and general complication rate and mortality in both groups. We took into account their general health and coexisting illnesses according to the American Society of Anesthesiologists (ASA) classification, type of fracture according to AO and Evan's classifications and the surgeon's experience. The mean duration of the surgery was 27 minutes longer in the case of DHS stabilisation. The complication rate was higher and the mean length of postoperative hospital stay was longer after Ender nailing. The mean blood loss: the drop in Red Blood Cells (RBC), Haematocrit (Ht) and the Mean Haemoglobin Concentration (Hb) was also higher in patients treated with the use of Ender nails. The mean rate of blood units that had to be transfused postoperatively was also higher in "Ender" group. The difference was statistically significant, especially in the group of patients treated as emergency procedure at the day of admission (p < 0.05). The operative treatment of trochanteric fractures in elderly patients with the use of DHS device showed to be a less invasive procedure in comparison to Ender nailing. In conclusion, the indications for this method of trochanteric fractures' treatment should be expanded, especially in the case of unstable fractures.

[Correlation between the content of transforming growth factor-beta 1, interleukin-1 beta and collagenase activity in proximal femur bone samples obtained from patients with femoral neck fracture]. / Wzajemne relacje pomiedzy zawartoscia transformujacego czynnika wzrostu-beta 1, interleukiny-1 beta i aktywnoscia kolagenazy w bioptatach kostnych blizszego konca kosci udowej u chorych po zlamaniu szyjki kosci udowej.

The aim of this study was to determine correlations between the content of TGF-beta1, IL-1beta and collagenase activity in bone samples of the femoral neck obtained from patients with femoral neck fracture. The material consisted of 42 samples of cancellous bone of femoral neck collected during hemiarthroplasty or total hip replacement procedure. 24 samples of cancellous bone from patients with osteoarthritis of the hip harvested during total hip replacement served as a control group. The content of TGF-beta1, IL-1beta was measured using ELISA and collagenase activity was measured with spectrofluorometry. In patients with fracture there was found a distinct inversely proportional correlation between the content of TGF-beta1 and IL-1beta. This correlation was not observed in the control group. In addition, a directly proportional relation between the content of TGF-beta1 and IL-1beta was discovered. These results confirm mutual correlations between examined cytokines in bone.

[Evaluation of femoral neck fracture treatment with hemiarthroplasty in elderly patients]. / Ocena wyników leczenia zlaman szyjki kosci udowej endoprotezoplastyka polowicza u chorych w wieku podeszlym.

The authors reviewed the medical records of 457 patients who underwent a hemiarthroplasty procedure for the treatment of displaced femoral neck fracture. The age of the patients ranged from 60 to 103 years (mean age: 83 years). Follow-up evaluation of 331 patients was done 4-114 months post-op (mean follow-up time 52 months). 19 patients (4.2%) died in hospital, 67 patients (14.6%) developed systemic conditions during hospitalisation. 12 months post-op the mortality rate was 15.7%. Mean survival was 36.5 months. According to the Merle d'Aubigne-Postel evaluation system there were 154 satisfactory results (75.9%). Cemented or uncemented implantation techniques had no influence on long term results. 94 patients (4.2%) achieved pre-injury mobility. The reoperation rate was 8.1%. Poor general conditions at admission that postponed surgery and impaired mobility were strong negative prognostic factors.