Subscapularis Z-lengthening in children with brachial plexus birth palsy loses efficiency at mid-term follow-up: a retrospective cohort study.

PURPOSE: The aim of this study was to evaluate early and mid-term clinical outcomes after isolated subscapularis Z-lengthening in children with shoulder internal rotation contractures resulting from brachial plexus birth palsy. METHODS: Children with brachial plexus birth palsy treated with subscapularis tendon Z-lengthening from 2001 to 2011 were retrospectively reviewed. Over this period, 31 patients were identified. Primary outcome was improvement in Mallet score after surgery, and secondary outcome measures were active range of motion and Mallet sub-scores. Clinical outcomes were collected at three time intervals: pre-operatively, one-year post-operative and at latest follow-up. RESULTS: After exclusion, 21 patients remained for further analysis. Mean age at surgery was 3.7 years (range, 1.2-8.7), and mean follow-up length was 6.5 years (2.9-9.7). Moderate improvements were found for mean Mallet score, active external rotation, active abduction and hand-to-mouth movement at one year and latest follow-up. However, improvements in active external rotation and Mallet score were not fully maintained at final follow up. CONCLUSION: Isolated subscapularis Z-lengthening is effective at early follow-up, but results are not maintained at mid-term follow-up.

To cool or not to cool: evolution of the treatment of burns in the 18th century.

The 18th century represents a transitional period in evolution of surgery and burn treatment, a time just before major advances such as asepsis, burn excision and skin grafting, were to revolutionise surgical practice. The medical minds of this era first began to question the centuries of dogma and speculation that were at the heart of medicine. The evolution of the treatment of burns in this crucial time is reviewed from the perspective of two of the exceptional medical minds of that era John Hunter and James Earle. Many of their observations are still valid today and their influence would prove inspirational in ushering in modern era of burn management.

Predicting survival in thermal injury: a systematic review of methodology of composite prediction models.

BACKGROUND: The widespread use of mathematical models to predict mortality as an outcome in burn injury is limited by concerns regarding the accuracy of the predictions. This discrepancy in reported and actual model accuracy can be the result of lack of adherence to appropriate methodological standards for the construction of prediction models. AIM: We undertook a systematic review of the methodology of published mortality prediction models against methodological standards. The aim was to identify methodologically superior models for further evaluation and research into outcome prediction. METHODS: Electronic searches were performed on MEDLINE, CINHAL, EMBASE, Web of Science(®), the Cochrane collection and a general web search was performed using Google(®). The searches were complemented by a manual search of the contents of leading burns journals. Methodology of the studies included in the review was evaluated against published standards for composite prediction models. RESULTS: 45 studies reporting composite models specifically for predicting mortality in patients sustaining thermal injury between 1949 and 2010 were included in the review. Only 8 models fulfilled the published methodological standards for composite model construction and validation. These include Modified Baux Score, Abbreviated Burn Severity Index, Total Burn Surface Index and prediction models described by Coste et al., Ryan et al., McGwin et al., Galeiras et al. and Belgian Outcome of Burn Injury (BOBI) study group. CONCLUSION: This review has demonstrated that although a variety of complex models for predicting mortality in thermal injury have been devised, only 8 models have been constructed using appropriate methodological standards. These models warrant further evaluation in independent patient populations and data sets to identify the ones best suited for outcome prediction and performance monitoring.