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1.
J Surg Orthop Adv ; 30(1): 40-43, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33851913

RESUMO

We report using a spica cast created with cotton padding and Ace wrap without a rigid component for femur fracture in infants. Outcomes and complications of this soft spica cast were retrospectively compared with other treatments. There were 43 children younger than 6 months (43 diaphyseal fractures) included in the study. Treatment was a Pavlik harness (26 patients), a hard spica cast (8), or a soft spica cast (9) for an average of 3 weeks. All fractures demonstrated healing with similar final angulation and shortening. Hard spica casts caused the most complications. As for material costs, the soft spica is the least costly method ($2 per cast versus $87-$107 for Pavlik harness and $150 for hard spica). In conclusion, soft spica casts are as effective as other treatment options for femoral shaft fractures in young children. These casts are advantageous since they are easier to apply, easier to manage, and have a lower cost. (Journal of Surgical Orthopaedic Advances 30(1):040-043, 2021).


Assuntos
Moldes Cirúrgicos , Fraturas do Fêmur , Criança , Pré-Escolar , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/terapia , Fêmur , Humanos , Lactente , Radiografia , Estudos Retrospectivos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(11): e23576, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725923

RESUMO

ABSTRACT: Short-term immobilization leads to fatty muscular degeneration, which is associated with various negative health effects. Based on literature showing very high correlations between MRI Dixon fat fraction and Speed-of-Sound (SoS), we hypothesized that we can detect short-term-immobilization-induced differences in SoS.Both calves of 10 patients with a calf cast on one side for a mean duration of 41 ±â€Š26 days were examined in relaxed position using a standard ultrasound machine. Calf perimeters were measured for both sides. A flat Plexiglas-reflector, placed vertically on the opposite side of the probe with the calf in-between, was used as a timing reference for SoS. SoS was both manually annotated by two readers and assessed by an automatic annotation algorithm. The thickness values of the subcutaneous fat and muscle layers were manually read from the B-mode images. Differences between the cast and non-cast calves were calculated with a paired t test. Correlation analysis of SoS and calf perimeter was performed using Pearson's correlation coefficient.Paired t test showed significant differences between the cast and non-cast side for both SoS (P < .01) and leg perimeter (P < .001). SoS was reduced with the number of days after cast installment (r = -0.553, P = .097). No significant differences were found for muscle layer thickness, subcutaneous fat layer thickness, mean fat echo intensity, or mean muscle echo intensity.Short-term-immobilization led to a significant reduction in SoS in the cast calf compared to the healthy calf, indicating a potential role of SoS as a biomarker in detecting immobilization-induced fatty muscular degeneration not visible on B-mode ultrasound.


Assuntos
Traumatismos da Perna/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Atrofia Muscular/diagnóstico por imagem , Restrição Física/efeitos adversos , Ultrassonografia/métodos , Adulto , Idoso , Moldes Cirúrgicos/efeitos adversos , Feminino , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/fisiopatologia , Traumatismos da Perna/fisiopatologia , Traumatismos da Perna/terapia , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Atrofia Muscular/etiologia , Projetos Piloto , Estudos Prospectivos , Reprodutibilidade dos Testes , Som , Adulto Jovem
3.
Bone Joint J ; 103-B(5): 902-907, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33709769

RESUMO

AIMS: The management of completely displaced fractures of the distal radius in children remains controversial. This study evaluates the outcomes of surgical and non-surgical management of 'off-ended' fractures in children with at least two years of potential growth remaining. METHODS: A total of 34 boys and 22 girls aged 0 to ten years with a closed, completely displaced metaphyseal distal radial fracture presented between 1 November 2015 and 1 January 2020. After 2018, children aged ten or under were offered treatment in a straight plaster or manipulation under anaesthesia with Kirschner (K-)wire stabilization. Case notes and radiographs were reviewed to evaluate outcomes. In all, 16 underwent treatment in a straight cast and 40 had manipulation under anaesthesia, including 37 stabilized with K-wires. RESULTS: Of the children treated in a straight cast, all were discharged with good range of mo (ROM). Five children were discharged at six to 12 weeks with no functional limitations at six-month follow-up. A total of 11 children were discharged between 12 and 50 weeks with a normal ROM and radiological evidence of remodelling. One child had a subsequent diaphyseal fracture proximal to the original injury four years after the initial fracture. Re-displacement with angulation greater than 10° occurred for 17 children who had manipulation under anaesthesia. Four had a visible cosmetic deformity at discharge and nine had restriction of movement, with four requiring physiotherapy. One child developed over- granulation at the pin site and one wire became buried, resulting in a difficult retrieval in clinic. No children had pin site infections. CONCLUSION: Nonoperative management of completely displaced distal radial fractures in appropriately selected cases results in excellent outcomes without exposing the child to the risks of surgery. This study suggests that nonoperative management of these injuries is a viable and potentially underused strategy. Cite this article: Bone Joint J 2021;103-B(5):902-907.


Assuntos
Anestesia/métodos , Moldes Cirúrgicos , Fixação de Fratura/métodos , Manipulação Ortopédica , Fraturas do Rádio/terapia , Fios Ortopédicos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Fraturas do Rádio/diagnóstico por imagem
4.
Medicine (Baltimore) ; 100(10): e24988, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725871

RESUMO

INTRODUCTION: Contractures frequently occur in the finger joints after immobilization. This report describes the effect of acupotomy treatment in patients with joint contracture due to immobilization of the finger joints. PATIENT CONCERNS AND CLINICAL FINDINGS: Case 1 was of a 39-year-old male patient who had flexion limitation of the left thumb and difficulty in grasping. Case 2 was of a 41-year-old female patient who had flexion limitation of the right index finger and difficulty in typing. Stiffness occurred after tendon repair surgery and cast immobilization in both cases. In Case 1, the patient had limited flexion movement of the first metacarpophalangeal and interphalangeal joints after 5 weeks of immobilization of the left thumb in a cast. In Case 2, the patient had limited flexion movement after 3 weeks of immobilization of the second proximal interphalangeal joint of the left hand in a cast. DIAGNOSIS, INTERVENTIONS, AND OUTCOMES: We diagnosed both patients with finger joint contracture due to immobilization. Conservative treatment for approximately 4 weeks did not lead to improvement in either patient. Acupotomy is the key treatment for improving movement in Korean Medicine. Therefore, acupotomy was performed, and joint stiffness markedly improved without adverse events. Both patients reported that the daily use of the damaged fingers became comfortable. CONCLUSION: We found that acupotomy may be effective for finger joint contracture due to improper immobilization. We suggest it as a simple and safe treatment for joint contracture.


Assuntos
Terapia por Acupuntura , Moldes Cirúrgicos/efeitos adversos , Contratura/terapia , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/fisiopatologia , Complicações Pós-Operatórias/terapia , Adulto , Contratura/etiologia , Contratura/fisiopatologia , Feminino , Humanos , Cápsula Articular/fisiopatologia , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular , Traumatismos dos Tendões/cirurgia , Resultado do Tratamento
5.
Bone Joint J ; 103-B(2): 247-255, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517725

RESUMO

AIMS: To compare operative and nonoperative treatment for displaced distal radius fractures in patients aged over 65 years. METHODS: A total of 100 patients were randomized in this non-inferiority trial, comparing cast immobilization with operation with a volar locking plate. Patients with displaced AO/OTA A and C fractures were eligible if one of the following were found after initial closed reduction: 1) dorsal angulation > 10°; 2) ulnar variance > 3 mm; or 3) intra-articular step-off > 2 mm. Primary outcome measure was the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) after 12 months. Secondary outcome measures were the Patient-Rated Wrist and Hand Evaluation (PRWHE), EuroQol-5 dimensions 5-level questionnaire (EQ-5D-5L), range of motion (ROM), grip strength, "satisfaction with wrist function" (score 0 to 10), and complications. RESULTS: In all, 89 women and 11 men were included. Mean age was 74 years (65 to 91). Nonoperative treatment was non-inferior to operation with a five-point difference in median QuickDASH after 12 months (p = 0.206). After three and six months QuickDASH favoured the operative group (p = 0.010 and 0.030). Median values for PRWHE were 19 (interquartile range (IRQ) 10 to 32) in the operative group versus ten (IQR 1 to 31) in the nonoperative group at three months (p = 0.064), nine (IQR 2 to 20) versus five (IQR 0 to 13) (p = 0.020) at six months, and two (IQR 0 to 12) versus zero (IQR 0 to 8) (p = 0.019) after 12 months. Range of motion was similar between the groups. The EQ-5D-5L index score was better (mean difference 0.07) in the operative group at three and 12 months (p = 0.008 and 0.020). The complication rate was similar (p = 0.220). The operated patients were more satisfied with wrist function (median 8 (IQR 6 to 9) vs 6 (IQR 5 to 7) at three months, p = 0.002; 9 (IQR 7 to 9) vs 8 (IQR 6 to 8) at six months, p = 0.002; and 10 (IQR 8 to 10) vs 8 (IQR 7 to 9) at 12 months, p < 0.001). CONCLUSION: Nonoperative treatment was non-inferior to operative treatment based on QuickDASH after one year. Patients in the operative group had a faster recovery and were more satisfied with wrist function. Results from previous trials comparing operative and nonoperative treatment for displaced distal radius fractures in the elderly vary between favouring the operative group and showing similar results between the treatments. This randomized trial suggests that most elderly patients may be treated nonoperatively. Cite this article: Bone Joint J 2021;103-B(2):247-255.


Assuntos
Placas Ósseas , Moldes Cirúrgicos , Fixação de Fratura/métodos , Fraturas do Rádio/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Redução Fechada , Feminino , Seguimentos , Fixação de Fratura/instrumentação , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Resultado do Tratamento
6.
J Rehabil Med ; 53(3): jrm00168, 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33443290

RESUMO

OBJECTIVE: To compare the effects of two postoperative regimens following carpal tunnel release; plaster casting and elastic bandaging. DESIGN: A randomized controlled study. PATIENTS: Patients with carpal tunnel syndrome and planned surgical carpal tunnel release were invited to participate. METHODS: A total of 94 patients were randomized to either plaster casting or elastic bandaging to be used 2 weeks postoperatively. Muscle strength, pain rated on a visual analogue scale, range of movement, sensibility, oedema, and different scores regarding symptoms and function were measured before and 2, 4, 6, 8 and 26 weeks after surgery. RESULTS: No differences were found between the 2 groups for any measurement, except for the DASH (Disability of the Arm, Shoulder and Hand) Health Score and daily function, rated 2 weeks postoperatively, in which the bandage group scored better. Both groups improved significantly over time for all measurements, sensibility was improved after 2 weeks, while strength was not fully recovered until week 26. CONCLUSION: Following carpal tunnel release no benefits were found in using plaster casting, compared with elastic bandaging. Among these patients there was more discomfort during plaster casting compared with elastic bandaging; therefore plaster casting is not recommended following this type of surgery.


Assuntos
Síndrome do Túnel Carpal/terapia , Moldes Cirúrgicos/normas , Bandagens Compressivas/normas , Feminino , Humanos , Masculino , Resultado do Tratamento
7.
Artigo em Inglês | MEDLINE | ID: mdl-33498625

RESUMO

Introduction: Drop-out before treatment completion is a vexing problem for all clubfoot clinics. We and others have previously identified better engagement with parents as a crucial method of ameliorating incomplete clubfoot treatment, which increases deformity relapse. Materials and methods: The novel use of community facilitators enabled an audit of over 300 families who had dropped-out from a child's clubfoot treatment. A questionnaire standardized the parent interviews. Parents were encouraged to present for clinical review of their child's clubfeet. Results: When treatment was discontinued for six months, 309 families were audited. A social profile of families was developed, showing that most lived in tin houses with one working family member, indicating low affluence. Family issues, brace difficulty, travel distances, and insufficient understanding of ongoing bracing and follow-up were the main reasons for discontinuing treatment. Overt deformity relapse was found in 9% of children, while half of the children recommenced brace use after review. Conclusions: Identifying families at risk of dropping out from clubfoot care enables support to be instigated. Our findings encourage clinicians to empathize with parents of children with clubfoot deformity. The parent load indicator, in parallel with the initial clubfoot severity assessment, may help clinicians to better appreciate the demand that treatment will place on parents, the associated risk of drop-out, and the opportunity to enlist support.


Assuntos
Pé Torto Equinovaro , Bangladesh , Moldes Cirúrgicos , Criança , Pé Torto Equinovaro/terapia , Humanos , Lactente , Tenotomia , Resultado do Tratamento
8.
J Pediatr Orthop ; 41(3): e259-e265, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33417388

RESUMO

BACKGROUND: Long-leg casts (LLCs) are an established treatment for pediatric tibial shaft fractures including fractures involving the distal third. There is a paucity of literature assessing the use of short-leg cast (SLC) for tibial shaft fractures. The purpose of this study was to determine if SLC were as effective as LLC for the treatment of pediatric distal third tibial shaft fractures. METHODS: A retrospective review was conducted on consecutive distal third tibial shaft fractures treated at a tertiary pediatric hospital from 2013 to 2018. Exclusion criteria included midshaft and proximal fractures of the tibia, distal fractures that violated the tibial physis or plafond, and pathologic fractures. We compared primary outcomes of time to weight-bearing, time to union, and final angulation between LLC and SLC groups. RESULTS: Eighty-five patients aged 5 to 17 years (mean age: 9.2±3.2 y) met inclusion criteria, including 50 LLC and 35 SLC patients. Time to weight-bearing for SLC (3.3±0.6 wk) was shorter compared with LLC (6.4±0.7 wk, P<0.0001). Overall, fractures treated with SLC had a shorter time to the union (7.4±0.9 wk) compared with LLC (9.0±0.9 wk, P=0.026) without statistical differences in final angulation at the time of union. There was a higher percentage of cast complications in the LLC treatment group (12%) compared with SLC (6%). CONCLUSIONS: SLC demonstrated earlier time to weight-bearing and shorter time to fracture union when compared with LLC. Surgeons should consider SLC and early weight-bearing for the treatment of distal third tibial shaft fractures in children. LEVEL OF EVIDENCE: Level III-retrospective comparative study.


Assuntos
Moldes Cirúrgicos/estatística & dados numéricos , Fraturas da Tíbia/terapia , Adolescente , Criança , Pré-Escolar , Diáfises , Feminino , Humanos , Perna (Membro) , Masculino , Nova Orleans/epidemiologia , Estudos Retrospectivos , Contenções , Tíbia , Fraturas da Tíbia/epidemiologia , Resultado do Tratamento , Suporte de Carga
9.
J Pediatr Orthop ; 41(3): e252-e258, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33417391

RESUMO

BACKGROUND: As there is a current increasing tendency to treat displaced tibial shaft fractures in adolescents surgically, it has become more important to predict failure of cast treatment for these patients. In the past, redisplacement of pediatric tibial shaft fractures has been reported at rates of 20% to 40%. Although the efficacy of the three-point index (TPI), gap index, and cast index has been demonstrated for upper extremity fractures in children, to date no index has been shown to accurately predict redisplacement for pediatric tibial shaft fractures. The aim of this study was to determine the predictive factors for redisplacement in pediatric tibial shaft fractures. METHODS: In all, 157 displaced pediatric tibial shaft fractures were evaluated retrospectively. Patient age, initial and postreduction fracture angulation, shortening and translation, quality of reduction, obliquity of fracture, associated fibular fractures, and 3 indices (TPI, cast index, and gap index) were analyzed. Receiver operating characteristic analysis was performed to determine the cutoff points and logistic regression was used to show the risk factors of redisplacement. RESULTS: There were 53 female and 104 male patients with a mean age of 9.1 (5 to 15 y) and 45 patients developed redisplacement during the follow-up. Mean TPI and gap index and initial and postreduction fracture translation were higher in patients with redisplacement, while TPI>0.855 and postreduction translation >18% were the only independent risk factors for fracture redisplacement. No differences were observed regarding associated fibular fracture, quality of reduction, initial/postreduction angulation, and shortening. CONCLUSIONS: The TPI>0.855 and postreduction translation >18% are independent risk factors for redisplacement of tibial shaft fractures in children. Although the gap index can be useful, the cast index is not an appropriate tool for these fractures.


Assuntos
Redução Fechada/estatística & dados numéricos , Fraturas da Tíbia/epidemiologia , Fraturas da Tíbia/terapia , Adolescente , Moldes Cirúrgicos , Criança , Pré-Escolar , Diáfises , Feminino , Humanos , Modelos Logísticos , Masculino , Curva ROC , Radiografia , Estudos Retrospectivos , Fatores de Risco , Fraturas da Tíbia/diagnóstico por imagem , Falha de Tratamento , Turquia/epidemiologia
10.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33408102

RESUMO

A pisiform dislocation is an uncommon injury which can lead to significant morbidity if missed. The literature regarding pisiform dislocation is limited and largely from case reports. In this case, we present a 51-year-old right-hand dominant male who sustained the injury after a fall. He attended the emergency department on the same day and a closed reduction was able to be performed under a haematoma block. On review in follow-up clinic the patient's symptoms had completely resolved.


Assuntos
Acidentes por Quedas , Redução Fechada , Luxações Articulares/diagnóstico , Pisciforme/lesões , Traumatismos do Punho/diagnóstico , Moldes Cirúrgicos , Humanos , Luxações Articulares/etiologia , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Pisciforme/diagnóstico por imagem , Resultado do Tratamento , Traumatismos do Punho/etiologia , Traumatismos do Punho/cirurgia
11.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495194

RESUMO

Congenital knee dislocation is a rare condition of unknown aetiology. It could be associated with syndromes or may occur as an isolated entity. The severity of the deformity determines the method of treatment. Treatment options range from conservative casting to surgical correction. The case presented is of a newborn with an isolated grade II dislocation treated with serial casting. On follow-up at 2 years, the patient had a good outcome, with full range of motion and independent mobility.


Assuntos
Moldes Cirúrgicos , Luxação do Joelho/congênito , Feminino , Humanos , Recém-Nascido , Luxação do Joelho/diagnóstico por imagem , Luxação do Joelho/terapia
12.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504525

RESUMO

Upside-down reversal of vision (UDRV) is a rare form of metamorphopsia, or visual illusions that can distort the size, shape or inclination of objects. This phenomenon is paroxysmal and transient in nature, with patients reporting a sudden inversion of vision in the coronal plane, which typically remains for seconds or minutes, though occasionally persists for hours or days, before returning to normal. Distorted egocentric orientation (ie, the patient perceives the body to be tilted away from the vertical plane) is even more rare as a co-occurring phenomenon. To the best of our knowledge, this is the first reported case of a veteran who presented with UDRV and distorted egocentric orientation during hospitalisation on an inpatient physical medicine and rehabilitation setting following an elective hip surgery. This case serves not only to document the presence of rare visual illusions, but also illustrates the importance and value of an interdisciplinary team approach.


Assuntos
Doença de Graves/diagnóstico , Ilusões , Transtornos da Percepção/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Veteranos , Transtornos da Visão/diagnóstico , Idoso , Antitireóideos/uso terapêutico , Artroplastia de Quadril , Moldes Cirúrgicos , Endocrinologia , Doença de Graves/tratamento farmacológico , Luxação do Quadril/cirurgia , Hospitais de Veteranos , Humanos , Masculino , Metimazol/uso terapêutico , Neuropsicologia , Equipe de Assistência ao Paciente , Transtornos da Percepção/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Psiquiatria , Reoperação , Transtornos da Visão/fisiopatologia
13.
J Pediatr Orthop ; 41(1): e30-e35, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32991491

RESUMO

BACKGROUND: Phalangeal neck fractures account for 13% of pediatric finger fractures. Al Qattan type I (undisplaced) fractures are treated nonoperatively. There is increasing evidence that Type 2 (displaced) fractures achieve remarkable fracture remodeling with nonoperative treatment and patients frequently make a full functional recovery. The options available for nonoperative management of these fractures are either a plaster cast or a removable splint. We hypothesized that there would be no significant difference in radiologic outcome in pediatric phalangeal neck fractures (Types I and II) treated with splint or cast immobilization. METHODS: This is a retrospective study of patients aged 18 and below with phalangeal neck fractures treated nonoperatively from 2008 to 2017. Radiographs were compared at <1 week and >3 weeks after injury. Translation and angulation in coronal and sagittal planes were measured and compared using Student t tests. Baseline variables were compared using χ or Fisher exact tests. RESULTS: There were 47 patients with phalangeal neck fractures treated nonoperatively during the study period. There were 9 type I and 38 type II fractures. The mean age was 10 years with 40 males and 7 females. Fractures occurred in 33 dominant and 14 nondominant hands and involved 29 proximal and 18 middle phalanges. Nineteen children were treated in casts and 28 with removable splints. The mean duration of follow-up was similar between the 2 groups. The most affected phalanx was the proximal phalanx of the small finger and the most common fracture pattern was type IIA. There was no significant difference in clinical and radiologic outcomes between children who were treated in casts and those treated in removable splints. CONCLUSION: There was no difference in the clinical and radiologic outcomes in pediatric phalangeal neck fractures treated with cast or splint immobilization. Splinting has the added benefits of increased comfort and hygiene and we routinely offer splinting as a viable alternative in the nonoperative treatment of Al Qattan type I and type II phalangeal fractures. TYPE OF STUDY/LEVEL OF EVIDENCE: Level III-therapeutic studies.


Assuntos
Moldes Cirúrgicos , Traumatismos dos Dedos/terapia , Falanges dos Dedos da Mão/lesões , Fraturas Ósseas/terapia , Contenções , Adolescente , Criança , Feminino , Mãos , Humanos , Masculino , Radiografia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento
14.
Int J Clin Pract ; 75(5): e13957, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33345360

RESUMO

OBJECTIVES: Malnutrition is a crucial health problem predominantly in the developing countries. Malnutrition in children is one of the main risk factors for diseases and mortality. Club foot or congenital talipes equinovarus (CTEV) is the most common form of congenital orthopaedic abnormality. Over the past 20 years, the Ponseti method is considered the gold standard for the treatment of clubfoot. Our objective is to determine the prevalence of malnutrition in clubfoot patients, and its effects on the outcome of Ponseti technique in patients presenting to the Orthopaedic Clinic of tertiary care Hospital in Karachi, Pakistan. METHOD: The cross-sectional study was conducted from January to December 2018. Total 153 clubfoot patients were treated and the World Health Organization (WHO) classification of weight-for-age index was used to assess the nutritional status of patients, and its impact on outcome of Ponseti technique was recorded and analysed with a P value ≤ .05 as significant. RESULTS: Of the 153 patients, 112 (79.7%) were found in good nutritional status and 42 (20.6%) were malnourished. The average number of casts per patient and patients requiring 6+ casts in the undernutrition group was higher compared with good nutrition group (45.5% vs 21.42%, respectively). The number of Achilles tenotomy performed in the undernutrition group was also higher (76.4% vs 51.8%). CONCLUSION: A significant correlation between patients' nutritional status and outcome of the Ponseti technique is found as it influences the number of casts, possible relapse and failure of treatment.


Assuntos
Pé Torto Equinovaro , Desnutrição , Moldes Cirúrgicos , Criança , Pé Torto Equinovaro/epidemiologia , Pé Torto Equinovaro/terapia , Estudos Transversais , Humanos , Lactente , Desnutrição/epidemiologia , Paquistão/epidemiologia , Resultado do Tratamento
15.
J Orthop Surg Res ; 15(1): 604, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33308269

RESUMO

BACKGROUND: The treatment for femoral shaft fracture (FSF) depends on the age of the patient. While the Pavlik harness is the first choice for patients under 6 months of age, spica casting is preferred for patients over 6 months and under preschool age. Minimally-invasive surgery using elastic stable intramedullary nails is also used in some cases. Skin traction is another treatment choice for some patients who are not candidates for the above methods. This study aimed to evaluate the feasibility of surveillance ultrasonography (US) for the conservative treatment of FSFs in young children. MATERIALS AND METHODS: This retrospective study included 92 children who were diagnosed with FSF in our hospital from April 2017 to May 2019. After applying the inclusion and exclusion criteria, they were divided into US surveillance (A) and control (B) groups. All patients received conservative treatment by skin traction. For group A, US was used to assess the femur fractures and adjust its reduction on days 1, 3, 5, 7, 10, and 14 until the fracture stabilized. For group B, the fractures were checked by radiographs on days 1, 3, 5, 7, 10, and 14 until the callus appeared. The FSF angle was measured using anteroposterior and lateral radiographs. RESULTS: All patients were followed up for 18 months. The radiographic evaluation of both groups at the final follow-up showed a significant difference in the FSF angle. The radiograph times and accumulated radiation also showed significant differences between the two groups. However, there was no significant difference in the incidence of complications. CONCLUSIONS: For FSF closed reduction, surveillance US is a better option compared to radiographs in children treated by skin traction. This approach can significantly decrease exposure to X-ray radiation and improve the reduction. LEVEL OF EVIDENCE: III.


Assuntos
Tratamento Conservador/métodos , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Ultrassonografia Doppler/métodos , Fatores Etários , Moldes Cirúrgicos , Criança , Pré-Escolar , Redução Fechada/métodos , Estudos de Viabilidade , Feminino , Fixação de Fratura/métodos , Humanos , Lactente , Masculino , Exposição à Radiação/prevenção & controle , Radiografia , Tração/métodos
16.
Acta Ortop Mex ; 34(1): 43-46, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-33230999

RESUMO

The clubfoot is one of the most common conditions in Pediatric Orthopedics, may affect each part of the foot and ankle, equinus, varus, and internal rotation of the calcaneum, and true equinus of the ankle are common. The Ponseti method is an universally accepted treatment, consisting of three phases: manipulation and plaster, Achilles tendon tenotomy and maintenance phase. The highest percentage of relapses occurs in the maintenance phase and the deficient family member is associated in most cases. We present a clinical case of a patient with typical clubfoot treated with the Ponseti method on four occasions without the need of surgical treatment.


Assuntos
Tendão do Calcâneo , Pé Torto Equinovaro , Tenotomia , Tendão do Calcâneo/cirurgia , Articulação do Tornozelo , Moldes Cirúrgicos , Criança , Pé Torto Equinovaro/cirurgia , Humanos , Lactente , Resultado do Tratamento
17.
Medicine (Baltimore) ; 99(42): e22800, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080753

RESUMO

BACKGROUND: At present, the treatment of base fractures of the fifth metatarsal, especially the area I fractures, is still a controversial topic. The objective of our work was to assess the radiological and clinical outcomes of displaced avulsion fractures of the fifth metatarsal base after treated with conservative treatment or intramedullary screw. METHODS: All of the fifth metatarsal fractures patients underwent surgery by the senior authors in our hospital from January 2017 to December 2019 were reviewed. Institutional Review Board in the Subsidiary Hospital of Guizhou Medical University approved this study. Patients with the following conditions can be included:Patients with the following conditions will be excluded: follow-up less than 6 months; open fracture; pathological fracture; osteoporotic fracture; patients have the history of ankle or foot surgery. Radiographs were taken at 1, 3, 6 and 12 months in outpatient follow-up. The following outcomes were assessed in the follow-up: functional outcomes, the score of patient satisfaction, as well as the motion range, and complications. All the statistical analyses were implemented via applying the software of SPSS Version 12 (SPSS Inc, Chicago, IL). RESULTS: We hypothesized that there was no remarkable difference between two groups in the outcomes after operation. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6024).


Assuntos
Tratamento Conservador , Fixação Interna de Fraturas , Fratura Avulsão/terapia , Ossos do Metatarso/lesões , Moldes Cirúrgicos , Fratura Avulsão/diagnóstico por imagem , Humanos , Imobilização , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Medidas de Resultados Relatados pelo Paciente , Projetos de Pesquisa , Estudos Retrospectivos , Escala Visual Analógica
18.
Rev. bras. ortop ; 55(5): 637-641, Sept.-Oct. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1144205

RESUMO

Abstract Objective Congenital clubfoot (PTC) is a congenital orthopedic condition often requiring intensive treatment; little is known about the impact of such treatment on motor development. The present study assessed whether gait development is later in patients with PTC treated with the Ponseti method in comparison to a control group and analyzed possible related factors. Methods Patients born at term, < 6 months old, not submitted to previous treatment and with a minimum follow-up period of 24 months were included. The control group consisted of patients with no musculoskeletal disorders seen during the present study. Results The study group consisted of 97 patients, whereas the control group had 100 subjects. The mean age at gait start was 14.7 ± 3.2 months in the study group and 12.6 ± 1.5 months in the control group (p< 0.05). Factors related to late gait included age at beginning of treatment > 3 weeks, number of plaster cast changes > 7, recurrence and nonperformance of Achilles tenotomy. Age at beginning of treatment > 3 weeks was related to a greater number of plaster cast changes. Gender and laterality were not related to late gait development. Conclusion Congenital clubfoot patients treated with the Ponseti method show independent walking approximately 2 months later than the control group. Delayed treatment, higher number of plaster cast changes, recurrence and nonperformance of Achilles tenotomy were related to late gait.


Resumo Objetivo O pé torto congênito (PTC) é uma das alterações ortopédicas congênitas que mais frequentemente necessita tratamento intensivo, e pouco se sabe o impacto desse tratamento no desenvolvimento motor. O presente estudo buscou avaliar se pacientes portadores de PTC tratados pelo método de Ponseti desenvolvem a marcha mais tardiamente comparado a um grupo controle e analisar possíveis fatores relacionados. Métodos Incluídos pacientes nascidos a termo, com < 6 meses de idade, sem tratamento prévio e com seguimento mínimo de 24 meses. O grupo controle foi de pacientes sem alterações musculoesqueléticas, atendidos no mesmo período da realização do presente estudo. Resultados Um total de 97 pacientes formaram o grupo de estudo e 100 o grupo controle. A média de idade no início da marcha no grupo de estudo foi de 14,7 ± 3,2 meses, e 12,6 ± 1,5 meses (p< 0,05) no grupo controle. Fatores relacionados à marcha tardia foram: idade de início do tratamento > 3 semanas, número de trocas gessadas > 7, recidiva e não realização da tenotomia de Aquiles. Idade de início do tratamento > 3 semanas esteve relacionada a maior número de trocas de gessos. Gênero e lateralidade não tiveram relação com a marcha tardia. Conclusão Pacientes com PTC tratados com o método de Ponseti apresentam marcha independente aproximadamente 2 meses mais tarde do que o grupo controle. Início mais tardio do tratamento, maior número de trocas de gessos, recidiva e não realização da tenotomia de Aquiles foram relacionados com atraso da marcha.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pé Torto Equinovaro , Moldes Cirúrgicos , Grupos Controle , Caminhada , Resultado do Tratamento , Idade de Início , Deformidades Congênitas das Extremidades Inferiores , Tempo para o Tratamento , Marcha , Identidade de Gênero , Lateralidade Funcional , Manipulação Ortopédica
19.
Bone Joint J ; 102-B(10): 1399-1404, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993325

RESUMO

AIMS: The study was undertaken to compare the efficacy of Woodcast splints and plaster-of-Paris casts in maintaining correction following sequential manipulation of idiopathic clubfeet. METHODS: In this randomized prospective trial, 23 idiopathic clubfeet were immobilized with plaster-of-Paris casts and 23 clubfeet were immobilized with a splint made of Woodcast that encircled only two-thirds the circumference of the limb. The number of casts or splints needed to obtain full correction, the frequency of cast or splint-related complications, and the time taken for application and removal of the casts and splints were compared. RESULTS: The mean number of casts required to obtain full correction of the deformity (Pirani Score 0) was 4.35 (95% confidence interval (CI) 3.74 to 4.95) when plaster-of-Paris was used and 4.87 (95% CI 4.33 to 5.41) when the Woodcast splint was used (p = 0.190). The time required for application and removal of the Woodcast splint were significantly less than that required for application and removal of plaster-of-Paris casts (p < 0.001). Woodcast splint-related complications were not more frequent than plaster-of-Paris cast related complications. CONCLUSION: Though Woodcast splints covering two-thirds of the circumference of the lower limbs of infants were effective in maintaining the correction of clubfoot deformity during serial manipulation and casting treatment, the superiority of Woodcasts over plaster-of-Paris could not be established. Cite this article: Bone Joint J 2020;102-B(10):1399-1404.


Assuntos
Moldes Cirúrgicos , Pé Torto Equinovaro/terapia , Contenções , Sulfato de Cálcio , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Manipulação Ortopédica , Estudos Prospectivos
20.
Neuron ; 107(3): 580-589.e6, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32778224

RESUMO

To induce brain plasticity in humans, we casted the dominant upper extremity for 2 weeks and tracked changes in functional connectivity using daily 30-min scans of resting-state functional MRI (rs-fMRI). Casting caused cortical and cerebellar regions controlling the disused extremity to functionally disconnect from the rest of the somatomotor system, while internal connectivity within the disused sub-circuit was maintained. Functional disconnection was evident within 48 h, progressed throughout the cast period, and reversed after cast removal. During the cast period, large, spontaneous pulses of activity propagated through the disused somatomotor sub-circuit. The adult brain seems to rely on regular use to maintain its functional architecture. Disuse-driven spontaneous activity pulses may help preserve functionally disconnected sub-circuits.


Assuntos
Córtex Motor/diagnóstico por imagem , Plasticidade Neuronal/fisiologia , Restrição Física , Atividades Cotidianas , Moldes Cirúrgicos , Feminino , Lateralidade Funcional , Neuroimagem Funcional , Humanos , Imagem por Ressonância Magnética , Masculino , Córtex Motor/fisiologia , Destreza Motora/fisiologia , Força Muscular/fisiologia , Vias Neurais/diagnóstico por imagem , Vias Neurais/fisiologia , Extremidade Superior
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