Could trochanteric pelvic stabilization be removed from the adolescent idiopathic scoliosis brace? A prospective pilot study.

BACKGROUND: Idiopathic scoliosis is the most common musculoskeletal deformity in children. There is a dose-response relationship between compliance and improvement in scoliosis. The literature revealed that esthetic considerations have negative consequences on the quality of life (QOL) of patients and consequently on wearing time of the brace. To minimize esthetic problems and then increase QOL and wearing time, we proposed a new relay brace named "corset Collerette" without a pelvic-trochanteric base. METHODS: A prospective cohort study was conducted in the rehabilitation department of Bordeaux University Hospital. Patients consulting for adolescent idiopathic scoliosis were registered in a prospective hospital database. The patients expressing unwillingness to wear the usual brace or who had decreased compliance were offered the corset Collerette and were included in a 3-month follow-up. Outcome measures assessed at baseline and at 3 months were Scoliosis Research Society Outcomes Questionnaire (SRS-22) and Brace Questionnaire scales and wearing time. Cobb's angle evolution since the start of bracing was also collected. The primary end point was the QOL assed by the SRS-22 scale at 3 months of follow-up. RESULTS: The first 38 patients agreeing to wear the corset Collerette were included in the study. The QOL assessed by the SRS-22 was significantly improved with the corset Collerette ( p < 0.05). There was no significant increase in wearing time and thoracic Cobb's angles between baseline and follow-up ( p > 0.05). CONCLUSION: The switch to the corset Collerette allowed an improvement in the QOL of the patients and avoid a decrease in compliance with wearing the brace and maintain the same in-brace Cobb's angles.

Clinical features of 27 shark attack cases on La Réunion Island.

BACKGROUND: Between January 2000 and September 2016, there have been 27 documented shark attacks on La Réunion Island. The insular nature of La Réunion has allowed us to perform an extensive survey of these attacks. The objective was to describe the clinical features of these shark attacks, as only case reports have been published up to now. METHODS: This was a retrospective observational study of the 27 cases of nonprovoked shark attacks that have occurred between January 2000 and September 2016. Post-humate predation, provoked attacks, and isolated attack on devices were excluded. All bone and vascular injuries were documented in the 21 remaining cases. Prehospital tourniquet use was specifically recorded. RESULTS: Among the 21 victims, eight died (38%) despite rapid use of resuscitation techniques in five cases when it was feasible; these techniques were not needed in the survivors. Thirteen patients were immediately treated in the operating room. Amputation or disarticulation occurred 13 times in 10 victims, five of whom died. Twelve injuries to major vascular structures were found in 11 victims, six of which died. A prehospital tourniquet was applied in four of the five surviving victims who had injuries to major vascular structures (including one victim with major humeral and femoral artery damage) and in one victim who died (the very proximal wound was not controlled). CONCLUSION: Our study found that quickly applying a tourniquet to the injured limb(s) contributes to the victim's survival. Disarticulation is a particular feature of shark attacks. The number and severity of shark attacks at La Réunion Island are worse than in the rest of the world. LEVEL OF EVIDENCE: Epidemiological, level V.