Arthroscopic Calcaneonavicular Coalition and Too-long Anterior Process of the Calcaneus Resection in Children.

Persistent symptomatic calcaneonavicular coalition (CNC) and too-long anterior process of the calcaneus (TLAP) are congenital disorders that can benefit from surgical treatment. The arthroscopic technique for CNC and TLAP resection has previously been described. The aim of this prospective study was to describe outcomes following arthroscopic resection of 12 (38.71%) CNC and 19 (61.29%) TLAP cases in 30 consecutive pediatric patients treated between July 2009 and March 2013. There mean age was 12.4 (range 10 to 15) years, and the mean follow-up was 55.2 (range 24 to 79) months. Radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores, AOFAS pain scores, and patient satisfaction were assessed. All final postoperative imaging scans revealed complete synostosis resection without recurrence. The mean overall AOFAS Ankle-Hindfoot Score increased from 78.87 (95% confidence interval [CI] 76.74 to 81.01) to 93.06 (95% CI 91.10 to 95.03) (p < .001). All patients showed pain reduction after surgery; even 1 patient (3.23%) who initially developed complex regional pain syndrome eventually had a successful outcome. The mean AOFAS pain score increased from 23.87 (95% CI 22.05 to 25.69) to 34.84 (95% CI 32.97 to 36.70) (p < .001). All patients were either satisfied (n = 9 [30%]) or very satisfied (n = 21 [70%]) with the intervention at the final follow-up. Although both arthroscopic CNC and TLAP resection are demanding techniques, they allow for precise coalition resection through a less invasive approach, which may ultimately lead to faster recovery and improved outcomes.

Passive range of glenohumeral motion in children with a Sprengel's deformity.

BACKGROUND: In Sprengel's deformity, loss of shoulder motion has been attributed exclusively to scapulothoracic stiffness. The purposes of this study were to evaluate passive glenohumeral (GH) joint motion in these children. METHODS: A prospective evaluation of 23 children was performed. Obtained data were demographics, Cavendish grade, bilateral active global shoulder elevation, and multidirectional passive GH range of motion, including: (a) GH internal rotation in abduction and GH cross-body adduction to assess for posterior GH contracture; (b) spinohumeral abduction angle (SHABD) to assess for inferior GH contracture; (c) spinohumeral adduction angle to assess for superior GH contracture; and (d) passive external rotation in shoulder adduction and abduction to assess for anterior GH contracture. Paired t tests and both Pearson's and Spearman's correlation analyses were performed. RESULTS: The mean patient age was 8.1 years (range, 1.4-16.7 years), with 13.4% of deformities Cavendish grade 1, 52.2% grade 2, 13.4% grade 3, and 21.7% grade 4. The involved shoulder showed a statistically significant decrease in mean active global shoulder elevation (117.4° vs. 176.1°), SHABD (14.6° vs. 41.5°), cross-body adduction (43° vs. 71.3°), and internal rotation in abduction (17.8° vs. 49.4°), all at P < .001. Strong inverse correlations were noted between Cavendish grade and both global shoulder elevation (r, -0.784) and SHABD (r, -0.669). Cavendish grade IV patients showed a mean decrease of 45° (range, 40°-60°) of SHABD. CONCLUSION: Shoulder elevation is also impaired by GH joint contractures.

Bone nonunion management in children with a vascularized tibial periosteal graft.

BACKGROUND: Vascularized periosteal graft have demonstrated a tremendous bone healing capacity in children. The objective is to report outcomes on the use of vascularized tibial periosteal graft (VTPG) during bone reconstruction in a series of children with complex bone healing problems. PATIENTS AND METHODS: Cases were collected retrospectively since May 2013 to May 2019, excluding cases of congenital pseudarthrosis of the tibia. Mean age at surgery was 12.8 (range 11-18) years. Indications included treatment of recalcitrant bone nonunion and the prevention of bone allograft-host junction nonunion in seven and three patients, respectively. The periosteal flap, based on the anterior tibial vessels, was harvested as a free flap in six instances and as a pedicled flap in four. RESULTS: Mean follow-up was 25.2 months (range 8-36). The flap showed a 13.6 cm (range 9-16) and mean width 3.4 cm (range 2.7-3.9). Early bone union was achieved, initially through periosteal callus, followed by cortical union at mean times of 2 and 4 months, respectively, in nine cases. The flap was not successful in a patient with severe comorbidities. No donor site complications were registered. CONCLUSIONS: VTPG was fast and high effective for the treatment complex bone nonunion or the prevention of allograft nonunion in children.

Primary Care Professionals' Acceptance of Medical Record-Based, Store and Forward Provider-to-Provider Telemedicine in Catalonia: Results of a Web-Based Survey.

While telemedicine services enjoy a high acceptance among the public, evidence regarding clinician's acceptance, a key factor for sustainable telemedicine services, is mixed. However, telemedicine is generally better accepted by both patients and professionals who live in rural areas, as it can save them significant time. The objective of this study is to assess the acceptance of medical record-based, store and forward provider-to-provider telemedicine among primary care professionals and to describe the factors which may determine their future use. This is an observational cross-sectional study using the Catalan version of the Health Optimum questionnaire; a technology acceptance model-based validated survey comprised of eight short questions. The online, voluntary response poll was sent to all 661 primary care professionals in 17 primary care teams that had potentially used the telemedicine services of the main primary care provider in Catalonia, in the Central Catalan Region. The majority of respondents rated the quality of telemedicine consultations as "Excellent" or "Good" (83%). However, nearly 60% stated that they sometimes had technical, organizational or other difficulties, which might affect the quality of care delivered. These negatively predicted their declared future use (p = 0.001). The quality of telemedicine services is perceived as good overall for all the parameters studied, especially among nurses. It is important that policymakers examine and provide solutions for the technical and organizational difficulties detected (e.g. by providing training), in order to ensure the use of these services in the future.

Transverse Anterior Approach to the Elbow for Pediatric Displaced Lateral Humeral Condyle Fractures.

BACKGROUND: The anterior approach to the elbow for pediatric lateral condyle fractures (LCF) would provide a better visualization of the articular fracture resulting in better functional results, less complications and a more cosmetically-appealing scar than usually seen with the lateral approach. METHODS: Retrospective study of children undergoing an open reduction and internal fixation of a displaced LCF via an anterior approach with a transverse incision. Bilateral elbow range of motion (ROM), upper limb alignment and complications were registered. A 4-point ordinal Likert-type scale was employed for parents to rate their level of satisfaction with the cosmetic appearance of the scar. RESULTS: Eighteen children of mean age 76 months (range 27 to 101 months) were included. Fractures were classified as Jackob's Type II in 14 cases and Milch's type II in all cases. Mean follow-up was 12 (range 4 to19) months.Successful condral fracture visualization and reduction was achieved in every case. No intra-operative or post-operative complications occurred. In all cases bone union was obtained 4 to 5 weeks after surgery and at final follow-up, active elbow ROM of at least 90%, was obtained. All parents claimed to be "very satisfied" with their child's scar. A lateral spur was identified in 66.7% o patients. CONCLUSION: The anterior approach to the elbow was both a feasible and safe allowing full anatomical cartilage reduction. Complications after this technique might decrease compared to the lateral approach but need future comparative studies. The rate of lateral spur did not decreased. Cosmetic scar results seem to be a clear advantage of this approach compared to the classical lateral approach.

Validation of a Short Questionnaire to Assess Healthcare Professionals' Perceptions of Asynchronous Telemedicine Services: The Catalan Version of the Health Optimum Telemedicine Acceptance Questionnaire.

Telemedicine is both effective and able to provide efficient care at a lower cost. It also enjoys a high degree of acceptance among users. The Technology Acceptance Model proposed is based on the two main concepts of ease of use and perceived usefulness and is comprised of three dimensions: the individual context, the technological context and the implementation or organizational context. At present, no short, validated questionnaire exists in Catalonia to evaluate the acceptance of telemedicine services amongst healthcare professionals using a technology acceptance model. This article aims to statistically validate the Catalan version of the EU project Health Optimum telemedicine acceptance questionnaire. The study included the following phases: adaptation and translation of the questionnaire into Catalan and psychometric validation with construct (exploratory factor analysis), consistency (Cronbach's alpha) and stability (test-retest) analysis. After deleting incomplete responses, calculations were made using 33 participants. The internal consistency measured with the Cronbach's alpha coefficient was good with an alpha coefficient of 0.84 (95%, CI: 0.79-0.84). The intraclass correlation coefficient was 0.93 (95% CI: 0.852-0.964). The Kaiser-Meyer-Olkin test of sampling showed to be adequate (KMO = 0.818) and the Bartlett test of sphericity was significant (Chi-square 424.188; gl = 28; p < 0.001). The questionnaire had two dimensions which accounted for 61.2% of the total variance: quality and technical difficulties relating to telemedicine. The findings of this study suggest that the validated questionnaire has robust statistical features that make it a good predictive model of healthcare professional's satisfaction with telemedicine programs.

Disfunción del catéter de diálisis peritoneal por atrapamiento de la trompa de Falopio / Disfunction of peritoneal dialysis catheter caused by Fallopian tube entrapment

No disponible

Knee Arthritis in Children: When Can It Be Safely Treated With Needle Joint Aspiration? A Large Children's Tertiary Hospital Study.

BACKGROUND: Early joint decompression associated to antibiotic therapy is the most important procedure to reduce joint damage in septic knee arthritis in children. Several joint decompression methods have been described such as arthrotomy with open debriding, arthroscopic drainage or needle joint aspiration. The aim of the present study was to determinate which patients with acute septic knee arthritis could be safely treated with needle joint aspiration. METHODS: Patients with an acute knee arthritis diagnosed between September 2003 and December 2013 in our children's tertiary hospital were retrospective review. All cases were initially treated with needle joint aspiration. Primary end-point was failure of joint aspiration. RESULTS: A total of 74 patients were included in the study. Forty-two (56.8%) were male and median age was 1.49 years. Mean delay between onset of symptoms and diagnosis was 3.6 days and in 25 (33.8%) cases patients needed more than 1 visit to the emergency room. Median C-reactive protein (CRP) value was 36.3 mg/L and was >20 mg/L in 59 (79.7%) cases. A total of 11 (14.9%) patients showed failure of the joint aspiration treatment between 3 and 21 days after initial joint aspiration. The stepwise forward logistic regression model only identified as independent predictor of joint aspiration failure an age older than 3 years old (odds ratio, 5.64; 95% confidence interval, 1.38-29.61; P=0.018). Joint aspiration did not fail in any patient younger than 12 months and neither in any patient younger than 3 years old with CRP value <20 mg/L. Otherwise, treatment failed in 38% of patients older than 3 years and in 16% of patients between 1 and 3 years with a CRP>20 mg/L. CONCLUSIONS: Septic knee arthritis treated with needle joint aspiration succeed in all patients younger than 1 year and in all patients between 1 and 3 years with a CRP<20 mg/L. Alternative treatment such as arthroscopy debridement should be early considered in patients older than 3 years and patients between 1 and 3 years with CRP>20 mg/L. LEVEL OF EVIDENCE: Level III.

A cost savings analysis of asynchronous teledermatology compared to face-to-face dermatology in Catalonia.

BACKGROUND: A teledermatology pilot scheme was first conducted in the town of Manresa (Barcelona) in the summer of 2010. The clinical success of the scheme prompted its expansion to the whole county of Bages in 2011 and to the adjacent county of Berguedà in 2012. In the teledermatology service, primary care physicians take a photograph of the lesion and attach it to the electronic medical records of the patient together with a brief clinical account. In the referral hospital, the consultant dermatologists access the electronic medical records, review the images and suggest a treatment or action plan. Next, the primary care physicians review these recommendations and call the patient to report the results. This whole process is usually completed in less than 5 working days. METHODS: A cost saving analysis comparing teledermatology with dermatology face-to-face visits was performed in the county of Bages measuring the cost difference attributable to visits saved. RESULTS: The estimated added costs of the teledermatology service during 2016 amounted to 61,870 €. For the same period, the estimated costs of traditional outpatient dermatology services were of 113,034 €. This represents savings of 51,164 € per year. After subtraction of societal costs, the savings equal 10,350 € per year. CONCLUSIONS: Using a teledermatology service instead of face-to-face dermatology consultations could save 51,164 € per year (11.4 € per patient visited) in the county of Bages. Societal savings are the most significant.

On-Top-Plasty for Atypical Thumb Duplication: A Case Report With 10 Year Follow-up.

BACKGROUND: A very uncommon pattern of thumb duplication consists of an ulnar-side floating thumb and a radial-side distally hypoplastic thumb. METHODS: We report the case of a 15-month-old child with this type of thumb duplication on his right hand treated with an on-top-plasty technique. The ulnar-side segment was pedicled and transferred to the lateral thumb, which was distally resected. RESULTS: A well-aligned and widely mobile thumb with a wide first web and an excellent cosmetic appearance was exhibited 10 years after surgery. CONCLUSIONS: On-top-plasty technique might be amenable to reconstruct certain atypical thumb duplications.

Water Quality Assessment of the Pardo River Basin, Brazil: A Multivariate Approach Using Limnological Parameters, Metal Concentrations and Indicator Bacteria.

Located in the southeast of Brazil, the Pardo River Basin has a large population and an economy focused on agriculture, with a strong predominance of the sugarcane agro-industry. The purpose of the study was to assess the water quality of the Pardo River Basin under a multivariate approach using limnological parameters, metal concentrations, and indicator bacteria. Nine sampling campaigns were performed during both the dry and rainy seasons. Element concentrations were determined by inductively coupled plasma spectrometry (ICP-MS, Perkin Elmer Elan 6000). A battery of test to determine limnological parameters was performed (in situ). Total coliforms and Escherichia coli were detected and quantified using Defined Substrate Technology Colilert® and multiple tube dilutions. Principal component analysis and hierarchical cluster analysis were used as multivariate exploratory analysis. In general, the results suggest the influence of rain, possible sewage discharges into the watercourse, and the input of organic matter in some sampling points in both seasons, besides the absence of riparian vegetation in much of the Pardo River. The likely influence of industrial activities that do not have great prominence in the region was supported by temporal/spatial assessment of Cr and V. The water quality monitoring of Pardo River is an important tool for environmental management, and its continuity is indicated to obtain a consistent series of systematic data and thereby support concretely the actions of planning and controlling the use of water from the Pardo River and soil around them.

Vascularized ulnar periosteal pedicled flap for forearm reconstruction: Anatomical study and a case report.

PURPOSE: Through an anatomical review, the aim of this study is to define the ulnar periosteal branches of the posterior interosseous vessels (PIV). In addition, we report the clinical utility of a vascularized ulnar periosteal pedicled flap (VUPPF), supplied by the investigated PIV, in a complex case of radial nonunion. METHODS: Ten upper limbs latex colored from fresh human cadavers were used. Branches of the PIV were dissected under 2.5× loupe magnification, noting the periosteal, muscular, and cutaneous branches arising distal to the interosseous recurrent artery. The VUPPF was measured in length (cm) and width (cm). RESULTS: The PIV provided a mean 12.8 periosteal branches to the ulna distributed along the most distal 15 cm, with a mean distance between branches of 1 cm, allowing for the design of a VUPPF which measured a mean 12 cm in length and 1.7 cm in width. We used a VUPPF of 7.8 cm in length and 2 cm in width to treat extensive nonvascularized bone graft nonunion with a defect of 2 cm of the left radius in a 6-year-old girl, secondary to previous Ewing's Sarcoma reconstruction. Successfully consolidation was achieved 6-months after surgery. The patient did not present postoperative complications. At 2-years of follow-up after surgery, active supination was 80° and pronation 0° (due an incomplete interosseous ossification); grip strength was 80% that of the opposite hand. The patient had resumed all her daily activities. CONCLUSIONS: VUPPF may be considered a valuable and reliable surgical option for forearm reconstruction in complex clinical scenarios.

Endoscopic Woodward procedure for Sprengel deformity: case report.

Sprengel deformity (SD) results in a limitation of movement of the shoulder girdle and produces an esthetic defect. Our aim is to assess the feasibility and advantages of a minimally invasive endoscopic approach for SD correction. A 4-year-old boy with a Cavendish grade III right SD. The patient underwent an endoscopic Woodward procedure with access through two small incisions at the level of the upper and lower angles of the scapula. Near-symmetrical shoulder elevation was achieved, with an excellent cosmetic result. The endoscopic Woodward procedure is a feasible, effective, and minimally invasive technique in the treatment of SD. LEVEL OF EVIDENCE: V.

Vascularized fibular grafts extended with vascularized periosteum in children.

PURPOSE: The purpose of this report is to evaluate the results of extending vascularized fibular grafts (VFG) with vascularized periosteum (VPG) in bone defect reconstruction in children. METHODS: Retrospective study of 10 children, mean age at surgery was 9.8 years (range, 4-16 years). Origin of one defect was oncological (n = 5), septical (n = 2), traumatic (n = 2), or congenital (n = 1). In five cases the flap consisted of a VFG and a vascularized epiphyseal transfer (VFET) in five. Mean bone defect was 8.5 cm .Mean length of the vascularized periosteal extension was 5.5 cm (range 3.5-8) for VFET, 4.8 cm for VFG (range 3-8). Bone union was assessed with monthly radiographs. RESULTS: Radiographs showed a periosteal callus at 4 weeks in all cases. Bone union was achieved at a mean of 8.4 weeks (range 4-12). Donor site complications included two cases of flexor hallucis longus contracture, and one case of surgical wound marginal necrosis following FVG. One transient tibialis anterior weakness and one tibialis anterior contracture occurred following VFET harvest. None required surgical treatment. Mean follow-up was 28.7 months (range 7-72). CONCLUSIONS: The association of a vascularized periosteal extension with fibular flaps seems to accelerate flap to recipient bone union. © 2016 Wiley Periodicals, Inc. Microsurgery 37:410-415, 2017.

Reduced patellofemoral and walking pain with mobile-bearing vs. fixed-bearing total knee replacements: a mid-term prospective analytic study.

OBJECTIVE: Total knee replacement (TKR) is the standard treatment for advanced stage knee osteoarthritis. The introduction of the mobile-bearing (MB) design has given rise to a series of theoretical advantages compared to fixed-bearing (FB) implants, although current literature does not reveal significant differences between the designs. The aim of this study was to estimate the clinical results of 2 cemented total knee prosthetic designs: an MB and an FB design. METHODS: A series of patients with similar clinical and radiographic characteristics were treated consecutively with 100 FB followed by 94 MB implants. Patients were evaluated radiographically and clinically. RESULTS: Statistically significant differences were found in terms of pain at 5 years in favor of MB prostheses (p=0.006). The "pain on ascending/descending stairs" category on the KSS score showed improvement at 5 years for the MB design (p=0.003). MB implants showed better results in terms of ability to ascend/descend stairs at five years (p=0.002). With regards to the patients' ability to walk, there were differences at 1 year (p=0.020) and at 5 years (p=0.021) in favor of MB implants. CONCLUSION: At a mean follow-up of 5 years, significant differences were observed in the MB prosthesis in terms of postoperative pain, ability to ascend/descend stairs, and patellofemoral pain.

Have We Improved Pain Control in Cancer Patients? A Multicenter Study of Ambulatory and Hospitalized Cancer Patients.

BACKGROUND: Pain in cancer patients is recognized as a major health problem, yet few studies of both inpatient and outpatient populations have been carried out. OBJECTIVE: The study objective was to assess the frequency, type, and characteristics of pain in adult cancer patients, including both inpatients and outpatients. METHODS: This cross-sectional study involved 1064 adult cancer patients (437 outpatients and 627 inpatients) from 44 hospitals and/or long-term-care centers in Catalonia, Spain. Cancer patients suffering from pain of any etiology for ≥2 weeks and/or under analgesic treatment ≥2 weeks were enrolled. Demographic and pain data were collected. The Spanish version of the Brief Pain Inventory was used to assess pain. RESULTS: Pain frequency was 55.3%. Pain was less frequent in outpatients than inpatients (41.6% versus 64.7%; p<0.001), although median pain duration was longer in outpatients (20 versus 6 weeks; p<0.001). Pain was assessable in 333 patients, and intensity was similar in both out- and inpatients; however, outpatients reported less improvement, less pain interference with daily life, and less pain related to the cancer per se. In both groups, patients with multiple myeloma (73%), breast (65%), and lung cancer (61%) were most likely to report pain. CONCLUSIONS: Pain in cancer patients, both ambulatory and hospitalized, remains a challenge for health care professionals, health administrators, and stakeholders. Our study reveals the high level of pain and distress that cancer patients continue to suffer, a problem that is particularly notable in outpatients due to the intensity and duration of the pain.

Comparison of cannulated screws versus compression staples for subtalar arthrodesis fixation.

BACKGROUND: Different fixation techniques have been described in the literature for isolated subtalar arthrodesis (ISA). The purpose of this study was to compare the fusion rate and clinical outcome of ISA using cannulated compression screws or compression staples. METHODS: Thirty-three patients (33 feet) underwent ISA using screw (17 feet) or staples (16 feet) fixation. Patients were followed for 42.7 ± 16.4 months (range, 24.5-84.3 months). The subtalar fusion was assessed radiographically and clinically. Clinical outcome measures included the visual analog scale (VAS) for pain and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. RESULTS: The average pain score decreased significantly from 6.4 ± 1.1 (range, 5-9) to 0.8 ± 1.3 (range, 0-4) (P < .001). In the screws group, the average AOFAS hindfoot score increased significantly from 54.6 ± 8.8 (range, 37-67) preoperatively to 86.1 ± 7.1 (range, 71-91) postoperatively (P < .001). In the staples group, the average AOFAS hindfoot score increased significantly from 53.4 ± 11.1 (range, 33-69) preoperatively to 83.4 ± 6.9 (range, 71-91) postoperatively (P < .001). The AOFAS hindfoot score was comparable in both groups (P = .149). Only the AOFAS hindfoot score function subgroup in the screw fixation was significantly higher than in the staples fixation group (P = .005). There were 4 cases of nonunion at the site of subtalar arthrodesis (2 from screws group, 2 from staples group). The complication rate was comparable in both groups. CONCLUSION: The fusion rate was comparable in both groups, while the postoperative functional outcome was significantly better in the screw fixation group. LEVEL OF EVIDENCE: Level III, retrospective comparative cohort study.

Osteochondromas around the ankle: Report of a case and literature review.

INTRODUCTION: An osteochondroma or exostosis is a benign bone tumour consisting of a bony outgrowth covered by a cartilage cap that occurs commonly in the metaphysis of long bones, mainly the distal femur, proximal tibia and proximal humerus. PRESENTATION OF CASE: We describe an unusual case of a distal tibia osteochondroma affecting the lateral malleolus of a young girl. DISCUSSION: Most osteochondromas are asymptomatic and seen incidentally during radiographic examination. Osteochondromas are rarely localized in the foot and ankle. CONCLUSION: Although most of the osteochondromas in children should be treated conservatively until skeletal maturity, those affecting the distal tibia or fibula should be treated with surgical excision in order to prevent ankle deformity, syndesmotic lesions or even fracture due to the expanding nature of this benign tumour.