Usefulness of digital measurements for functional evaluation of paediatric elbow range of motion.

BACKGROUND: Elbow immobilization due to fractures of the upper limb is frequent in paediatric patients. Proper follow-up is critical to assess elbow functional recovery. Telemedicine can be an option for remote monitoring of these patients. The purpose of this study was to compare personal and virtual evaluation of elbow range of motion after long arm cast withdrawal in paediatric patients. METHODS: An observational cross-sectional study was carried out which included all paediatric patients with elbow immobilization in long arm casts treated at our centre. After cast withdrawal, elbow range of motion was evaluated by telemedicine and in office consultation in all four movements (flexion, extension, pronation and supination). RESULTS: Ninety-three patients met the selection criteria. Median age at time of immobilization was 8 years. Mean elbow immobilization time was 23 days (range 18-56 days). When comparing office and remote measurements, no statistical differences were found for any of the four elbow movements measured in our study. CONCLUSIONS: Remote evaluation of elbow range of motion by telemedicine is technically feasible. We evaluated elbow range of motion in paediatric patients after immobilization and we did not find differences between digital and in office measurements. The results were similar to those obtained through assessment in the office. We believe that this is a useful tool to facilitate remote patient follow-up.

Craniocervical spinal instability after type 1 Arnold Chiari decompression: a case report.

To present and describe an unusual case of spinal instability after craniocervical spinal decompression for a type-1 Chiari malformation. Type-1 Chiari malformation is a craniocervical disorder characterized by tonsillar displacement greater than 5 mm into the vertebral canal; posterior fossa decompression is the most common surgical treatment for this condition. Postoperative complications have been described: cerebrospinal fluid leak, pseudomeningocele, aseptic meningitis, wound infection, and neurological deficit. However, instability after decompression is unusual. A 9-year-old female presented with symptomatic torticollis after cervical decompression for a type-1 Chiari malformation. Spinal instability was diagnosed; craniocervical stabilization was performed. After a 12-month follow-up, spinal stability was achieved, with a satisfactory clinical neck alignment. We present a craniocervical instability secondary to surgical decompression; clinical and radiological symptoms, and definitive treatment were described.

Proximal femoral resection and articulated hip distraction with an external fixator for the treatment of painful spastic hip dislocations in pediatric patients with spastic quadriplegia.

We describe the results obtained with an alternative method of treatment for spastic painful hip dislocations in nonambulatory patients, which consists of a proximal femoral resection with capsular interposition arthroplasty, and the addition of a hinged external fixator for postoperative articulated hip distraction to allow for an immediate upright position and the ability to sit in a wheelchair. We performed this technique in three patients (four hips) with a mean age at the time of surgery of 15 years. Postoperatively, clinical improvement was observed in all four hips, with respect to pain relief, sitting tolerance, perineal care and functional range of motion.