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.

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.

The effect of prehabilitation on the range of motion and functional outcomes in patients following the total knee or hip arthroplasty: A pilot randomized trial.

OBJECTIVE: The study investigated the effect of prehabilitation on the quality of life and function in patients having total knee replacement (TKR)/total hip replacement (THR). METHODS: A pilot randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis was conducted. Sixty-four people undergoing elective lower-limb arthroplasty were included. Prehabilitation included one-hour twice-weekly sessions for at least three and a maximum of four weeks prior to surgery. Control participants did not complete any pre-surgical programs. Health utility and quality of life as measured by the EQ-5D-3L and the patient-specific functional scale were the primary outcomes measured before allocation and eight weeks post-operatively. RESULTS: No between-group differences were evident in health utility (main effect of the group -0.04 (95% Confidence Interval [CI] -0.16 to 0.08, p = 0.50) or patient-specific functional scale (main effect of the group -0.59 (95% CI -1.8 to 0.6, p = 0.73), but the group-by-joint interaction effects for the timed up and go (TUG) (7.6 (95% CI -0.9 to 16.1, p = 0.08)) and the EQ-5D VAS (-18.3 (95% CI -41.1 to 4.5), p = 0.11) were larger. Prehabilitation participants' knee flexion improved by 12.6 degrees (95% CI 5.2-20, p = 0.001). CONCLUSIONS: Prehabilitation improved knee flexion, but this did not translate into improved functional mobility or quality of life.

Prostatosymphyseal Fistula Treated by Robotic Assisted Radical Prostatectomy.

This case report documents a rare complication of prostate resection following a Greenlight laser procedure. The 75-year-old gentleman involved underwent photoselective vaporisation of the prostate (PVP) for clinically benign prostatic obstruction. Subsequent to PVP, the patient experienced recurrent macroscopic haematuria and pubic pain. Investigations confirmed the presence of a prostate-symphyseal fistula, a rare complication of PVP. We believe this to be the first reported case of successful treatment with robotic assisted radical prostatectomy.