Long-term Follow-up of Dorsal Wedge Osteotomy for Pediatric Freiberg Disease.

BACKGROUND: Treatment for Freiberg disease has been largely conservative despite availability of various operative options for severe or refractory cases. The aim of this study was to evaluate the long-term results of pediatric patients with symptomatic Freiberg disease treated with intra-articular dorsal wedge osteotomy. METHODS: Pediatric patients treated for Freiberg disease with surgery between January 1982 and 1999 were identified and selected for long-term clinical evaluation. Patients were evaluated regarding operative satisfaction and clinical outcome, performed according to the American Orthopaedic Foot & Ankle Society (AOFAS) lesser toe metatarsophalangeal-interphalangeal scale and range of motion (ROM) of metatarsophalangeal (MTP) joint. Patients had radiographic assessment of degenerative joint status with anteroposterior and oblique foot x-ray. Twenty patients (18 female, 2 male; mean age 15.2 years; range 12-17 years) were identified. The mean follow-up period was 23.4 (range 15-32) years. RESULTS: The clinical outcomes of our patients were classified as excellent in 16 (80%) and good in 4 (20%). The AOFAS mean score was 96.8 (range 91-100) points at the last clinical appointment. A negative correlation between AOFAS score and time of follow-up (r's = -0.61, P < .001) was found. Also, a strong negative correlation was found between Smillie classification and AOFAS final score (r's = -0.88, P < .001). CONCLUSION: The patients were very satisfied with pain and quality of life at a mean follow-up time of 23.4 years. To our knowledge, this is the first long-term follow-up report supporting the procedure described by Gauthier and Elbaz as a good option for operative treatment of Freiberg disease. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Eagle syndrome.

Eagle syndrome, also known as elongated styloid process, is a condition first described by Watt Eagle in 1937. It occurs when an elongated styloid process or calcified stylohyoid ligament causes recurrent throat pain or foreign body sensation, dysphagia, or facial pain. Additional symptoms may include neck or throat pain with radiation to the ipsilateral ear. It is usually hard to diagnose because the symptoms related to this condition can be confused with those attributed to a wide variety of facial neuralgias. In this article, a case of Eagle syndrome exhibiting unilateral symptoms with bilateral elongation of styloid process is reported.

[Jefferson scale of physician lifelong learning: translation and adaptation for the portuguese medical population]. / Aprendizagem ao longo da vida do médico: tradução e adaptação da escala de Jefferson.

The competence and professionalism of doctors depend on the process of Lifelong Learning (LLL). In the Portuguese settings, in which the re-certification of physicians' skills or knowledge is currently not required, the exercise of LLL is left to personal motivation and initiative. The importance of LLL has been highlighted in numerous international recommendations and has already led, in the United States, to the development and validation of a scale for measuring physician LLL - the Jefferson Scale of Physician Life Long Learning (JSPLL). The lack of valid instruments to measure LLL adapted to the Portuguese contexts was the basis for this work, which presents the translation and adaptation of JSPLL, and the subsequent validation of the translated version to the Portuguese medical community. The translation and validation of the English version of JSPLL (JSPLL-VP) was conducted with physicians of Health Care institutions in the District of Braga, Portugal, in 2007. Methods of both qualitative (translation, assessment of the translation, retro translation) and quantitative nature (internal consistency analysis, factor analysis and analysis of response frequencies) resulted in a factor analysis that replicated, with the exception of three items, the distribution of the original scale by four factors: professional learning beliefs and motivation, scholarly activities, attention to learning opportunities and technical skills in seeking information. The results show that the JSPLL-VP is a valid Scale fit for purpose. Cronbach's alpha coefficients for the whole scale (.89) and for each factor, confirmed the internal consistency of the Scale. Additionally, differences were found between mean and standard deviations for different Scale factors. In summary, this work provides a new validated tool to monitor physician's LLL in Portugal. The transversal characterization of LLL of specific medical professionals - by specialty or by type of institution - or longitudinal studies in relation with profiles of medical training can contribute to the quality of Medical Education at the pre- or post-graduate levels.