Dynamics of childhood obesity in Hong Kong throughout the COVID-19 pandemic before and after the school closures: a 3-year longitudinal study.

OBJECTIVE: This study is to evaluate if there is any difference in the balance between incidence of and remission from overweight/obesity in Hong Kong school-age children before and during the COVID-19 pandemic over three years. METHODS: This is a retrospective longitudinal study that involved children aged 6-16 years from a database of the School Physical Fitness Award Scheme. RESULTS: 2765 students were longitudinally followed up for two years. The prevalence of childhood overweight/obesity was increased between the 2019 and 2021 academic years (P < 0.001). During the COVID-19 pandemic, the rate of obesity remission significantly reduced by 7.9 % (P = 0.003), at a background of a plateau of obesity among children and adolescents. CONCLUSIONS: Our study provides evidence on the impact of school closure and home confinement as a standard infection control measure for the prevention of COVID-19, which are likely to break the balance between incidence of and remission from childhood obesity.

Effectiveness of inactivated COVID-19 vaccine CoronaVac in children aged less than 3 years old during Omicron wave in Hong Kong.

The COVID-19 pandemic has affected people of all ages worldwide. However, there is still no information on the vaccine effectiveness (VE) of inactivated COVID-19 vaccines in children aged less than 3 years old. This study highlighted that 2 doses of CoronaVac were effective in preventing COVID-19, with a VE of 83.1 %.

Mental health & maltreatment risk of children with special educational needs during COVID-19.

BACKGROUND: Children with special educational needs (SEN) are more vulnerable during the COVID-19 pandemic with risk of poor mental wellbeing and child maltreatment. OBJECTIVE: To examine the impact of COVID-19 on the mental health of children with SEN and their maltreatment risk. PARTICIPANTS AND SETTING: 417 children with SEN studying at special schools and 25,427 children with typical development (TD) studying at mainstream schools completed an online survey in April 2020 in Hong Kong during school closures due to COVID-19. METHOD: Emotional/behavioural difficulties, quality of life and parental stress of children with SEN were compared with typically developed children using mixed effect model. Linear regression analyses were performed to explore factors associated with child emotional/behavioural difficulties and parental stress during the pandemic. Chi-square test was performed to detect the differences in maltreatment risk before and during COVID-19. RESULTS: Children with SEN had significantly poorer overall quality of life (68.05 vs 80.65, p < 0.01). 23.5% of children had at least one episode of severe physical assault and 1.9% experienced very severe physical assault during COVID-19. Rates of physical assault increased significantly (59.8% vs. 71.2% p < 0.001) while children with mental disorders had increased risk of severe physical assault comparing to those without mental disorders (RR = 1.58, ꭓ2 = 5.19 p = 0.023). CONCLUSION: Children with SEN had poorer mental health than typically developed children during the COVID-19 pandemic. Maltreatment risk for children with SEN is higher in comparison to pre-COVID-19 era. Surveillance of child maltreatment, continuity of medical and rehabilitation care to support children with SEN are essential during a disease pandemic.

Extraosseous osteogenic sarcoma of the mediastinum occurring in a Chinese patient.

Osteogenic sarcoma can occur rarely in soft tissues, predominantly of the proximal lower limbs. The mediastinum is a less common site, with only five reports in the literature. We report a case occurring in a young Chinese man and review the literature.

Articular cartilage lesions of the knee following immobilisation or destabilisation for 6 or 12 weeks in rabbits.

Eighty mature female New Zealand White rabbits were sacrificed 6 or 12 weeks after either section of the medial collateral and the anterior cruciate ligaments with removal of the anterior third of the medial meniscus of one knee, or immobilisation of one knee, using the contralateral non-treated knee as the control. The area of degenerated joint surface of the distal femur, and water and proteoglycan content were measured, and the articular cartilage stained using haematoxylin and eosin and safranin O. Destabilisation resulted in a significantly larger time-dependent degenerated joint surface area. Water content significantly increased after 6 weeks with no significant differences between immobilisation and destabilisation. Destabilisation resulted in a significantly greater decrease in proteoglycan content. At 12 weeks, the control knees of the animals undergoing destabilisation showed significant degenerative changes. There were more extensive lesions in destabilisation, while 6 weeks of immobilisation produced moderate degenerative joint disease.

Palmar hyperhidrosis in children: treatment with video endoscopic laser sympathectomy.

Palmar hyperhidrosis (PH) often starts in childhood and can be a disabling condition for a significant number of young children at the age they begin primary school. There are few reports regarding the surgical treatment of PH in children. The authors report on 40 PH patients under 16 years of age treated with video thoracoscopic laser sympathectomy; there has been substantial experience with this procedure for the treatment of adults with PH. A satisfactory result, with very low morbidity, was achieved for all 40 children. The surgical technique is described briefly. With the technique, the proper sympathetic segment is visualized in almost all cases and then definitely ablated with a fiberoptic low-power laser while under the aid of sympathetic monitoring. Consequently, an adequate sympathectomy warranting a long-lasting therapeutic effect can be achieved without the need of tissue diagnosis. No case required conversion to open sympathectomy. Neither injury to the lung nor bleeding was encountered. Horner's syndrome did not occur in any case. Bilateral sympathectomy was accomplished generally within 30 minutes. All patients were discharged after an overnight stay and are doing well with normal activities. The most frequent complication was compensatory hyperhidrosis, which was tolerable after reassurance. Based on the accumulated experience, it is justified to recommend early surgery, with this refined technique, in cases of severe PH in children.

Treatment of deformed tibial intramedullary nail: report of two cases.

Fixation of long-bone fractures using high-tensile-strength intramedullary nails is now a well-established form of treatment. A high-energy injury may deform and angulate such nails. Such incidents are rare-only two cases have previously been reported in the literature. We report the cases of two patients with deformed intramedullary tibial nails as the result of second injury to the same leg. The bent nails were removed in the conventional manner despite the straight intramedullary canal.

Reconstruction of extensor mechanism after trauma and infection by transposition of the Achilles tendon: report of technique and four cases.

High-energy injuries to the knee often involve extensive soft tissue loss as well as fractures. In certain situations, the patellar tendon may be lost due to initial injury or post-injury complications such as infection. Use of the gastrocnemius flap is a popular method of covering the defect as well as controlling infection and promoting healing by increasing local vascularity. We present a method of reconstructing the patellar tendon by extending the use of the gastrocnemius flaps using its Achilles tendon and calcaneal insertion. The distal insertion of the Achilles tendon is fixed to the tibial tuberosity with a cancellous screw, and the proximal end is sutured to the quadriceps muscles. The knee is immobilized for 1 week, after which the knee is mobilized in a hinged brace. Three of the four cases had good results, one a moderate result (the initial injury was extensive, with dislocation of the knee).

Surgical management of patients with osteogenesis imperfecta: 10 years' experience.

The orthopedic problems of osteogenesis imperfecta (OI) are multiple and formidable, if not untreatable. Controversy surrounds the timing and method of its management and to date, no reports have been published on the orthopedic treatment of these patients in Taiwan. This paper reports the surgical treatment of eight OI patients (average age, 3 yr 5 mo) who were unable to walk before surgery. Preoperatively, the incidence of long bone fracture ranged from once per month to twice per year. The average degree of femoral and tibial bowing as measured from leg radiographs at the first visit were 42 degrees and 32 degrees, respectively. Four patients underwent intramedullary nailing of both the femur and tibia while another four patients underwent intramedullary nailing of the femur only in the primary operation. The implants used were mostly Steinmann pins or Rush nails, and a femoral Kuntscher nail was used in one case. At the mean postoperative follow-up period of 5 years 4 months, five patients could walk independently without support. Two walked with wheel-carts and one could rise and stand with minimal support. We conclude that patients with OI can benefit from early surgical correction and stabilization and experience improvement in their ambulatory status despite the multiple procedures required.

Treatment of congenital pseudarthrosis of the tibia with the Ilizarov method.

Congenital pseudarthrosis of the tibia (CPT) is a difficult orthopedic problem. Many modalities of treatment have been used but none provide comprehensive treatment with highly satisfactory results. We reviewed the surgical management and results of eight consecutive patients with CPT treated with the Ilizarov technique for nonunion, angulation, leg length discrepancy and valgus ankle between 1988 and 1992. The median age at the time of Ilizarov treatment was 1.8 years (range, 0.4-20.1 yr). Primary union at the pseudarthrosis site was achieved in five of the eight patients. After a median follow-up period of 5.2 years (range, 3.0-6.2 yr), final union at the pseudarthrosis site was achieved in seven of the eight patients (union rate, 87.5%). However, nonunion persisted at the distraction site in one patient. In the six patients who achieved union and functional recovery, the median number of total surgeries was four; there were two residual deformities. Leg length discrepancy was corrected in these six patients to less than 1.7 cm. Six out of the eight patients were satisfied with the results. In general, the treatment course was lengthy with numerous complications, especially in young children. The Ilizarov technique, with its ring design, simultaneously addresses several problems associated with CPT, and may provide a comprehensive treatment for CPT with promising results. Combination treatment with other methods is necessary.

Patellar thickness in total knee replacement.

The question of patellar thickness after total knee replacement (TKR) is an important issue. From November 1989 to June 1993, a total of 294 TKR were performed on 219 patients (34 males, 185 females) with an average age of 67 years. Tricon-M prostheses were used in TKRs performed before October 1992, and PCA prostheses were used after that date. In each TKR, all polyethylene patellar components used on patellar resurfacing were cemented in place. The average preoperative patellar thickness was 21.2 +/- 1.8 mm. The thickness was preserved in 106 knees, while for 53 knees, a slight increase in thickness (mean, 1.5 +/- 0.9 mm) was recorded, and for 120 knees, a slight decrease in thickness (mean, 1.5 +/- 0.8 mm) was recorded. Lateral retinacular release was performed in 96 knees (40%) of the 238 TKR with a Tricon-M prosthesis, but in only seven knees (17%) among the 41 TKR using the PCA prosthesis. Patellar subluxation and dislocation after TKR occurred in 13 knees of 11 patients (10 females, one male, mean body weight 63.5 kg) with the Tricon-M prosthesis. The mean time from arthroplasty to occurrence of patellar instability was eight months. Six knees were treated by proximal realignment procedure while seven knees were given conservative treatment, with good results and no recurrence reported. The use of a patellar cutting jig allows better control of patellar thickness when performing patellar resurfacing for small patella. No complications such as patellar fracture, infection or patellar component-loosening were encountered in the 294 TKRs performed.

Posterior slope angle of the medial tibial plateau.

The overall average of the posterior slope of the medial plateau of the tibia as determined from the lateral radiography of the knee was 10 degrees +/- 4 degrees, with a range from 0 degrees to 20 degrees. This value was independent of age and gender and was unaffected by arthrosis as long as the arcuate contours of the medial socket were not eroded and could be identified by lateral radiography. While the average value of this posterior slope was similar to that of a cadaveric study, the range was much greater. The current practice of neglecting the preoperative posterior tibial slope and arbitrarily setting the tibial component at a predetermined posterior tilt angle failed to take into account the wide variation in posterior tibial slope.

Rapid airway access by modified retrograde intubation.

Rapid access to the airway is important to ensure successful resuscitation. However, the establishment of a patent airway by orotracheal intubation is not always easy. This is especially true in patients with upper airway pathology or anatomic variations. A modified retrograde intubation technique was developed using the plastic sheath of the spring guidewire of a central venous pressure (CVP) kit as an introducer. This is considered to be a simple and safe method to provide a secure airway where intubation is difficult or in an emergency. This report presents our clinical experience using this method in 10 patients.

Regional nerve block for total knee arthroplasty.

Femoral and sciatic nerve blocks have been used occasionally for unilateral total knee arthroplasty (TKA). In order to evaluate the effectiveness of this technique, combined femoral 3-in-1 and sciatic nerve blocks were performed in 20 cases of TKA, by the same surgeon. This surgeon also performed unilateral TKA under spinal anesthesia in another 20 cases. The anesthetic effectiveness of the two types of anesthesia was compared in terms of the time needed to complete the surgery, amount of intraoperative blood loss, and time interval until the first dose of analgesic. The results showed that the two types of anesthesia had comparable anesthetic effects. Ten of the 20 patients who had spinal anesthesia complained of postoperative urinary retention, while none of those who had nerve block had this complaint. Neither group experienced postpunctural headache, neurovascular damage, or drug-over-dose toxicity. We conclude that combined femoral 3-in-1 and sciatic nerve block is an effective anesthetic alternative for unilateral TKA.

Vibration arthrometry of the knee with torn meniscus: a preliminary report.

Although projects using vibration signals generated by the joint to detect joint disorders are still experimental, vibration arthrometry has been shown to be useful in assessing meniscal pathology. A prospective study using vibration arthrometry to diagnose meniscal tears was carried out in 25 consecutive patients with knee injuries. They comprised 20 males and five females with an average age of 34 years. An arthroscopic examination of the injured knee was given to every patient. Six cases of medial meniscal tear, 12 lateral meniscal tear, and two torn discoid menisci were found. The remaining five cases had normal menisci. By correlating the vibration arthrography of the patients to their corresponding arthroscopic findings, 15 were found to be true-positive, five true-negative and five false-negative. There were no false-positive readings. The accuracy, sensitivity and specificity of the vibration arthrometry in diagnosing meniscal tear was 80%, 75% and 100%, respectively. Vibration arthrometry was shown to be a reliable, non-invasive diagnostic tool in diagnosing meniscal tear of the knee.

Subungual squamous cell carcinoma: report of 2 cases.

Subungual squamous cell carcinoma (SCC) is a rare malignant tumor with an indolent course. Its etiology is unknown. It often involves the distal phalanx of the thumb or the index finger, and often presents as a chronic ulcer that is commonly misdiagnosed as chronic paronychia, pyogenic granuloma or verruca vulgaris. Approximately 150 cases of subungual SCC, including one in a Taiwanese patient, have been reported. Here, we report two cases of subungual SCC presenting as a chronic ulcer of the nail bed refractory to antibiotic treatment. One case involved the right thumb, while the other involved the right index finger. Radiographs of both cases showed an osteolytic bone lesion involving the distal phalanx. Excision biopsy revealed SCC in both cases. Both patients received amputation of the involved distal phalanx and showed no signs of reoccurrence during 5 years of follow-up. These findings suggest that all recalcitrant ulcers of the nail bed should be biopsied to facilitate early diagnosis and treatment of subungual SCC.

The second case of Paget's disease (osteitis deformans) in a Chinese lady.

Paget's disease of the bone is extremely rare in the Chinese population. We report a case of a 91-year-old female patient who presented with a leg ulcer after an injury. On examination, she was incidentally noted to have bowing of the tibia and facial features suggestive of Paget's disease which was later confirmed with plain radiograph. An extensive search of the international literature over the last thirty years, including the use of Medline, has revealed only one other case report of Paget's disease in a Chinese patient in Thailand.

Limb salvage surgery with microsurgical reconstruction for the treatment of musculoskeletal tumours involving the upper extremity.

Microsurgical reconstructive techniques have been applied in the management of 14 patients with malignant bone and soft tissue tumours as well as for 30 patients with benign but aggressive bone lesions affecting the upper extremity. Vascularised bone grafts were used in 6 patients with malignant bone tumours and 30 patients with aggressive bone lesions. Reconstruction with soft tissue free flap transfer was required in 6 patients with soft tissue defects, primarily following excision of soft tissue tumours in 2 and after excision of recurrent tumours in 4 patients. Microneural dissection and vascular reconstruction were performed in 2 patients with tumours around the major neurovascular bundles. The patients were followed up for varying periods, ranging from 1 to 12 years and assessment of the limb function was performed using Enneking's system of evaluation. There were no local recurrences. In the malignant tumour group, 3 patients died of systemic disease, 7 were alive but with disease and 4 were disease free. Extremity function was excellent in 3 patients, good in 6 patients, fair in 4 patients and poor in 1 patient. In the benign bone tumour group, extremity function was graded as excellent in 12 patients, good in 14 patients, fair in 3 patients and poor in 1 patient. The vascular bone grafts united in all but 3 patients at 4 months following surgery. Minimal donor site complications had been recorded and there had been no failures. Useful limb salvage may thus be achieved with the application of microsurgical techniques for a variety of indications in limb salvage surgery after tumour excision.

The use of customized long stem hemiarthroplasty in ipsilateral femoral neck and pending shaft fracture: case report.

Most orthopaedic units do not have long stem femoral hemiarthroplasty prosthesis in their inventory. Situations that require replacement of the femoral head and internal fixation of the ipsilateral femoral shaft include femoral neck and shaft fracture as a result of either trauma or metastasis. The author reports on one technique of solving this problem by the use of an Austin-Moore hemiarthroplasty in combination with a half sawed Gross-Kempf (GK) intramedullary nail. The length of the GK nail was tailored according to the measured femoral length. The two implants were then impacted with a 4 cm overlap. Additional security was provided by the tension band wire placed between one of the distal locking holes in the nail and the hole in the Austin-Moore' implant and tunneled through the intramedullary nail.

Brachial plexus injury in association with fracture-dislocation of the shoulder.

Anterior dislocation of the shoulder is generally not associated with neurological compromise. We report three patients in whom a brachial plexus injury was caused by an anterior dislocation of the shoulder. One patient was further complicated by vascular involvement. The forces producing the injury are usually small, and the neurological trauma is likely to be neuropraxia. Conservative management is usually successful, and, in our patients, recovery took place after an average of six months.