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1.
Am J Phys Med Rehabil ; 99(4): 285-290, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32195715

RESUMO

OBJECTIVE: Distal radius fractures in the older population significantly impair grip strength. The aim of the study was to investigate whether a hand strength focused exercise program during the period of immobilization for nonoperatively managed distal radius fractures in this population improved grip strength and quality of life. DESIGN: This is a single-center randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Fifty-two patients older than 60 yrs who experienced distal radius fractures managed nonoperatively with cast immobilization. The intervention group (n = 26) received a home hand strength-focused exercise program from 2 and 6 wks after injury while immobilized in a full short arm cast. The control group (n = 26) performed finger range of motion exercises as per protocol. Primary outcome was grip strength ratio of injured arm compared with uninjured arm. Secondary outcome included functional scores of the 11-item shortened version of the Disabilities of the Arm, Shoulder and Hand. Outcomes were measured at 2, 6, and 12 wks after injury. RESULTS: The intervention group significantly improved grip strength ratio at both 6 and 12 wks (6 wks: 40% vs 25%, P = 0.0044, and 12 wks: 81% vs 51%, P = 0.0035). The intervention group improved the 11-item Disabilities of the Arm, Shoulder and Hand score at 12 wks; however, this was not statistically significant (25 vs 40, P = 0.066). CONCLUSIONS: A hand strength-focused exercise program for elderly patients with distal radius fractures while immobilized significantly improved grip strength.


Assuntos
Terapia por Exercício/métodos , Fixação de Fratura/reabilitação , Força da Mão , Fraturas do Rádio/reabilitação , Traumatismos do Punho/reabilitação , Idoso , Moldes Cirúrgicos , Feminino , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/fisiopatologia , Método Simples-Cego , Resultado do Tratamento , Traumatismos do Punho/fisiopatologia
2.
Lancet ; 395(10222): 441-448, 2020 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-32035553

RESUMO

BACKGROUND: Patients with Achilles tendon rupture who have non-operative treatment have traditionally been treated with immobilisation of the tendon in plaster casts for several weeks. Functional bracing is an alternative non-operative treatment that allows earlier mobilisation, but evidence on its effectiveness and safety is scarce. The aim of the UKSTAR trial was to compare functional and quality-of-life outcomes and resource use in patients treated non-operatively with plaster cast versus functional brace. METHODS: UKSTAR was a pragmatic, superiority, multicentre, randomised controlled trial done at 39 hospitals in the UK. Patients (aged ≥16 years) who were being treated non-operatively for a primary Achilles tendon rupture at the participating centres were potentially eligible. The exclusion criteria were presenting more than 14 days after injury, previous rupture of the same Achilles tendon, or being unable to complete the questionnaires. Eligible participants were randomly assigned (1:1) to receive a plaster cast or functional brace using a centralised web-based system. Because the interventions were clearly visible, neither patients nor clinicians could be masked. Participants wore the intervention for 8 weeks. The primary outcome was patient-reported Achilles tendon rupture score (ATRS) at 9 months, analysed in the modified intention-to-treat population (all patients in the groups to which they were allocated, excluding participants who withdrew or died before providing any outcome data). The main safety outcome was the incidence of tendon re-rupture. Resource use was recorded from a health and personal social care perspective. The trial is registered with ISRCTN, ISRCTN62639639. FINDINGS: Between Aug 15, 2016, and May 31, 2018, 1451 patients were screened, of whom 540 participants (mean age 48·7 years, 79% male) were randomly allocated to receive plaster cast (n=266) or functional brace (n=274). 527 (98%) of 540 were included in the modified intention-to-treat population, and 13 (2%) were excluded because they withdrew or died before providing any outcome data. There was no difference in ATRS at 9 months post injury (cast group n=244, mean ATRS 74∙4 [SD 19∙8]; functional brace group n=259, ATRS 72∙8 [20∙4]; adjusted mean difference -1∙38 [95% CI -4∙9 to 2∙1], p=0·44). There was no difference in the rate of re-rupture of the tendon (17 [6%] of 266 in the plaster cast group vs 13 [5%] of 274 in the functional brace group, p=0·40). The mean total health and personal social care cost was £1181 for the plaster cast group and £1078 for the functional bract group (mean between-group difference -£103 [95% CI -289 to 84]). INTERPRETATION: Traditional plaster casting was not found to be superior to early weight-bearing in a functional brace, as measured by ATRS, in the management of patients treated non-surgically for Achilles tendon rupture. Clinicians may consider the use of early weight-bearing in a functional brace as a safe and cost-effective alternative to plaster casting. FUNDING: UK National Institute for Health Research Health Technology Assessment Programme.


Assuntos
Tendão do Calcâneo/lesões , Braquetes , Moldes Cirúrgicos , Adulto , Braquetes/efeitos adversos , Braquetes/economia , Moldes Cirúrgicos/efeitos adversos , Moldes Cirúrgicos/economia , Análise Custo-Benefício , Feminino , Humanos , Imobilização/efeitos adversos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Ruptura/terapia , Suporte de Carga
4.
Bone Joint J ; 102-B(1): 48-54, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888371

RESUMO

AIMS: Distal radial fractures are the most common fracture sustained by the adult population. Most can be treated using cast immobilization without the need for surgery. The aim of this study was to assess the feasibility of a definitive trial comparing the commonly used fibreglass cast immobilization with an alternative product called Woodcast. Woodcast is a biodegradable casting material with theoretical benefits in terms of patient comfort as well as benefits to the environment. METHODS: This was a multicentre, two-arm, open-label, parallel-group randomized controlled feasibility trial. Patients with a fracture of the distal radius aged 16 years and over were recruited from four centres in the UK and randomized (1:1) to receive a Woodcast or fibreglass cast. Data were collected on participant recruitment and retention, clinical efficacy, safety, and patient acceptability. RESULTS: Over an eight-month period, 883 patients were screened, 271 were found to be eligible, and 120 were randomized. Patient-reported outcome measures were available for 116 (97%) of participants at five weeks and 99 (83%) at three months. Clinical outcomes and patient acceptability were similar between the two interventions and no serious adverse events were reported in either intervention arm. CONCLUSION: Both interventions were deemed efficacious and safe in the cohort studied. This study showed that a definitive study comparing Woodcast and fibreglass was feasible in terms of patient recruitment and retention. Cite this article: Bone Joint J 2020;102-B(1):48-54.


Assuntos
Moldes Cirúrgicos , Imobilização/instrumentação , Fraturas do Rádio/terapia , Adolescente , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Imobilização/métodos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Segurança do Paciente , Resultado do Tratamento , Madeira , Adulto Jovem
5.
J Pediatr Orthop ; 40(1): e6-e13, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30969197

RESUMO

BACKGROUND: Most distal radius fractures can be treated with closed reduction and casting in pediatric patients. These skills are traditionally developed treating real patients, however, there is growing interest in the use of simulation training to supplement traditional learning strategies. METHODS: Seventy-eight children with distal radius fractures that underwent closed reduction and casting by novice orthopaedic surgery residents were retrospectively reviewed. Radiographic measures of patients treated by simulation-trained residents were compared with patients treated by residents without simulation training. RESULTS: Patients treated by simulation-trained residents had less residual angulation in the anteroposterior radiograph (3.7 vs. 6.3 degrees, P=0.006) and translation on the lateral (14% vs. 21%, P=0.040) and anteroposterior radiograph (10% vs. 16%, P=0.029). Patients treated by simulation-trained residents also had lower rates of redisplacement (50% vs. 79%, P=0.016). CONCLUSIONS: Loss of reduction is common, particularly when novice trainees perform their first independent reductions. Residents who underwent simulation training had lower rates of loss of reduction, thus simulation training has potential as a supplement to the traditional apprentice model of medical education. LEVEL OF EVIDENCE: Level III.


Assuntos
Redução Fechada/educação , Internato e Residência/métodos , Ortopedia/educação , Fraturas do Rádio/cirurgia , Treinamento por Simulação , Moldes Cirúrgicos , Criança , Feminino , Humanos , Masculino , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento
6.
J Pediatr Orthop ; 40(1): e25-e29, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30969199

RESUMO

BACKGROUND: Foot abduction orthoses (FAO) are believed to decrease recurrence following treatment of congenital talipes equinovarus (CTEV) as described by Ponseti. The purpose of this project is to examine the outcomes of FAO bracing following treatment by the Ponseti method in a cohort of idiopathic CTEV patients. METHODS: After IRB approval, a cohort of patients aged 3 to 46 days with idiopathic CTEV was identified in a previous prospective study of brace compliance by family report and sensor. Dimeglio score and family demographic information were collected. Initial treatment was by the Ponseti method, with or without Achilles tenotomy. Following correction, patients had three months of full-time FAO bracing during which parents kept a log of compliance. Patients were followed until recurrence (need for further treatment) or age 5. RESULTS: In total, 42 patients with 64 affected feet met the above criteria and were included in the final analysis. Twenty-six feet (40%) went on to develop recurrence requiring further treatment, including casting, bracing, or surgery. Because of poor tolerance of the original FAO, 20 feet were transitioned to an alternative FAO, and 14 of these (70%) went on to recur (P<0.01). The casting duration (P=0.02) had a statistically significant relationship to recurrence. Patients who were casted for 9 weeks or more had a higher rate of recurrence (57.1% vs. 27.8%; P=0.02). Age at treatment start, Dimeglio score, demographic factors, and compliance during full-time bracing, whether by report or sensor, did not show a significant relationship with recurrence. CONCLUSIONS: The study showed a statistically significant relationship between the difficulty of CTEV correction and the risk of recurrent deformity requiring treatment. This relationship could be used to provide prognostic information for patients' families. Caregiver-reported compliance was not significantly related to recurrence. LEVEL OF EVIDENCE: Level III-Prognostic Retrospective Cohort Study.


Assuntos
Moldes Cirúrgicos , Pé Torto Equinovaro/terapia , Órtoses do Pé , Tendão do Calcâneo/cirurgia , Braquetes , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Cooperação do Paciente , Estudos Prospectivos , Recidiva , Estudos Retrospectivos , Tenotomia , Resultado do Tratamento
7.
J Pediatr Orthop ; 40(1): e49-e52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30994578

RESUMO

BACKGROUND: Hip dysplasia, congenital muscular torticollis, plagiocephaly, and metatarsus adductus are known to be associated. The etiology of infantile idiopathic scoliosis and its association with the aforementioned conditions is unknown. This study reviews a series of infantile scoliosis patients to address this gap. METHODS: The medical records of all patients treated with casting for early-onset scoliosis (EOS) from 2001 to 2016 were retrospectively reviewed. Inclusion criteria were a diagnosis of idiopathic EOS and age below 4 years at the time of the first cast. Demographic information, comorbid conditions, and radiographic measurements including Cobb angle and acetabular index (AI) were collected. The first acceptable anteroposterior pelvis radiograph for each patient was measured. An AI≥30 degrees was defined as hip dysplasia. A measurement between 25 and 30 degrees was defined as a "hip at risk." RESULTS: Between 2001 and 2016, 142 patients were treated with casting. Eighty-one patients met the inclusion criteria. The mean age at the first cast was 19.3 (±7.5) months and the mean Cobb angle was 53.6 (±18.8) degrees. There was no significant correlation between Cobb angle and AI. Nine patients met radiographic criteria for hip dysplasia (11.1%), only 4 of whom had been previously diagnosed. Thirty-six patients (44.4%) met the criteria of having at least 1 hip "at risk" of hip dysplasia. Ten patients (12.3%) had been diagnosed with torticollis and 13 patients (16.0%) with plagiocephaly. Three patients (3.7%) had been diagnosed with metatarsus adductus or clubfoot. In total, 30.9% of patients (25/81) had at least one of the above comorbid conditions. CONCLUSIONS: In a large group of children treated for idiopathic EOS, we found a high prevalence of commonly associated conditions-hip dysplasia, torticollis, plagiocephaly, metatarsus adductus, and clubfoot. In 6.2% of our sample, a diagnosis of hip dysplasia was not made in a timely manner despite routine radiographic spine follow-up. With increasing subspecialization within pediatric orthopaedics, surgeons need to maintain vigilance in assessing the entire child. LEVEL OF EVIDENCE: Level IV.


Assuntos
Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/epidemiologia , Escoliose/diagnóstico por imagem , Escoliose/epidemiologia , Idade de Início , Moldes Cirúrgicos , Pré-Escolar , Pé Torto Equinovaro/epidemiologia , Comorbidade , Feminino , Humanos , Lactente , Masculino , Plagiocefalia/epidemiologia , Prevalência , Radiografia , Estudos Retrospectivos , Escoliose/terapia , Torcicolo/epidemiologia , Estados Unidos/epidemiologia
8.
J Pediatr Orthop ; 40(1): 29-35, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31815859

RESUMO

BACKGROUND: The prevention and treatment of relapsed clubfoot remained challenging tasks. There were controversies as to treatment options and management, such as complete subtalar release, application of an Ilizarov external frame, or repeated Ponseti method; and different options were available in different treatment centers. This study was designed to evaluate the clinical outcome of relapsed clubfeet treated by repeated Ponseti method in comparison with the cases without relapse in term of gait analysis and to clarify the clinical efficacy of repeated Ponseti method in treating the relapsed clubfeet. METHODS: Thirty-seven patients (53 feet) were retrospectively identified from our database according to the inclusion and exclusion criteria. Among the 37 patients, 17 cases (25 relapsed clubfeet) were assigned to group I, whereas 20 cases (28 clubfeet without relapse) were assigned to group II. Clinical examination, gait analysis, and kinematic gait deviation criteria from Texas Scottish Rite Hospital for Children were used for evaluation. RESULTS: There was statistically significant difference in the parameters of foot length, stride length, and single limb support time (%gait cycle) between the 2 groups (P<0.05). No statistically significant difference was found in the kinematic parameters of total hip, knee, and ankle excursion, peak knee and ankle flexion and extension, and internal foot progression (P>0.05). There was no statistically significant difference in peak hip, knee, and ankle flexion moment, peak knee valgus moment, and peak ankle power (P>0.05). No statistically significant difference was found in equinus and calcaneus gait, increased ankle dorsiflexion, foot drop, and internal foot progression angle (P>0.05). CONCLUSIONS: Repeated Ponseti method for relapsed clubfeet can yield good or excellent clinical results. We recommend repeated Ponseti method as the treatment choice for relapsed clubfeet in the early stage. LEVEL OF EVIDENCE: Level III-retrospective comparative study.


Assuntos
Articulação do Tornozelo/fisiopatologia , Pé Torto Equinovaro/fisiopatologia , Pé Torto Equinovaro/terapia , Pé/fisiopatologia , Articulação do Joelho/fisiopatologia , Fenômenos Biomecânicos , Moldes Cirúrgicos , Feminino , Análise da Marcha , Articulação do Quadril/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Manipulação Ortopédica , Amplitude de Movimento Articular , Recidiva , Retratamento , Estudos Retrospectivos , Resultado do Tratamento
9.
Muscle Nerve ; 61(1): 58-62, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31588576

RESUMO

BACKGROUND: Disuse atrophy from immobilization is the result of decreased neural activity and muscle unloading. METHODS: We studied the impact of disuse on hand intrinsic compound muscle action potentials (CMAPs) in a cohort of 39 patients with unilateral 6-week immobilization of the hand in a cast, after distal radius fracture. We excluded patients with nerve injury. We compared side-to-side CMAP characteristics at the time of cast removal and at a subsequent follow-up visit, after a mean interval of 7.8 weeks. RESULTS: Statistically significant reductions in CMAP amplitude were noted for the abductor pollicis brevis (29.2%), abductor digiti minimi (19.0%), and first dorsal interosseus (24.9%). There was partial repair of the relative CMAP reduction at the follow-up visit (20.1%, 10.7%, and 8.7%, respectively). There was no significant change in CMAP duration. CONCLUSIONS: These results provide a framework for quantifying the degree of hand intrinsic CMAP amplitude reduction attributed to disuse.


Assuntos
Potenciais de Ação , Músculo Esquelético/fisiopatologia , Transtornos Musculares Atróficos/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Moldes Cirúrgicos , Eletromiografia , Feminino , Mãos , Humanos , Imobilização , Masculino , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Fraturas do Rádio/fisiopatologia , Fraturas do Rádio/terapia , Sensação , Adulto Jovem
11.
Bone Joint J ; 101-B(12): 1472-1475, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31787004

RESUMO

The Ankle Injury Management (AIM) trial was a pragmatic equivalence randomized controlled trial conducted at 24 hospitals in the United Kingdom that recruited 620 patients aged more than 60 years with an unstable ankle fracture. The trial compared the usual care pathway of early management with open reduction and internal fixation with initially attempting non-surgical management using close contact casting (CCC). CCC is a minimally padded cast applied by an orthopaedic surgeon after closed reduction in the operating theatre. The intervention groups had equivalent functional outcomes at six months and longer-term follow-up. However, potential barriers to using CCC as an initial form of treatment for these patients have been identified. In this report, the results of the AIM trial are summarized and the key issues are discussed in order to further the debate about the role of CCC. Evidence from the AIM trial supports surgeons considering conservative management by CCC as a treatment option for these patients. The longer-term follow-up emphasized that patients treated with CCC need careful monitoring in the weeks after its application to monitor maintenance of reduction. Cite this article: Bone Joint J 2019;101-B:1472-1475.


Assuntos
Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/cirurgia , Moldes Cirúrgicos , Redução Fechada/métodos , Tratamento Conservador/métodos , Fixação Interna de Fraturas/métodos , Idoso , Idoso de 80 Anos ou mais , Redução Fechada/instrumentação , Tratamento Conservador/instrumentação , Estudos de Equivalência como Asunto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Ensaios Clínicos Pragmáticos como Assunto , Resultado do Tratamento
12.
J Am Podiatr Med Assoc ; 109(6): 445-450, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31755772

RESUMO

BACKGROUND: Although total-contact cast (TCC) systems are considered the gold standard for off-loading plantar ulcers, less than 6% of patients with diabetic foot ulcers receive them due to negative perceptions of special technique requirements and time investment in their application and removal. We compared the ease of use and casting time of four TCC systems. METHODS: Four novice casters applied each of the four TCC systems three times using the manufacturer's written instructions for cast application and removal of each cast type. For each TCC system, casters also provided ratings of quality and effectiveness, their level of confidence in applying each system, and overall ease of use. RESULTS: The time to complete the first application of each cast type was not different among TCC systems. However, by the third application, TCC-EZ had a significantly faster application time than the other three TCC systems. In addition, TCC-EZ was considered better overall in packaging and instructions, quality of cast components, and casting method than the other TCC systems. Half of the casters rated TCC-EZ and MedE-Kast as the easiest to apply after the third and final trial, and TCC-EZ and MedE-Kast were rated as being the cast chosen to use in the casters' clinical practices. CONCLUSIONS: One of the obstacles to use of TCC systems, despite being recognized as the gold standard of off-loading, is the perception of a prolonged learning curve on application. This study demonstrated that TCC-EZ can be applied by novice casters in less than 14 minutes after their third application experience.


Assuntos
Moldes Cirúrgicos , Pé Diabético/terapia , Análise de Variância , Competência Clínica , Desenho de Equipamento , Humanos , Podiatria/educação , Fatores de Tempo , Estudos de Tempo e Movimento
13.
Rev Prat ; 69(6): 616-619, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31626416

RESUMO

The off-loading of diabetic foot ulcers is the most urgent and theoretically the easiest treatment to implement. Its effectiveness has been proven for decades by randomized controlled studies on neuropathic ulcers that heal with a cast in an average of 6 weeks with a high level of evidence. Total contact casts are not widely used throughout the world, although it is the standard treatment. Off-loading shoes are certainly effective but only if they are worn. It is the prescriber's challenge to obtain maximum compliance that makes it possible to avoid infections and secondary amputations that are totally avoidable most of the time and only related to the delay in optimal care, of which off loading is the essential part.


Assuntos
Pé Diabético , Suporte de Carga/fisiologia , Cicatrização , Amputação , Moldes Cirúrgicos , Pé Diabético/prevenção & controle , Pé Diabético/terapia , Humanos , Pressão , Sapatos
14.
J Pediatr Orthop ; 39(10): 527-533, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31599864

RESUMO

BACKGROUND: Individuals with clubfoot, treated in infancy with either the Ponseti method or comprehensive clubfoot release, often encounter pain as adults. Multiple studies have characterized residual deformity after Ponseti or surgical correction using physical exam, radiographs and pedobarography; however, the relationship between residual foot deformity and pain is not well defined. The purpose of the current study was 2-fold: (1) to evaluate the relationship between foot morphology and pain for young adults treated as infants for idiopathic clubfoot and (2) to describe and compare pedobarographic measures and outcome measures of pain and morphology among surgically treated, Ponseti treated, and typically developing feet. METHODS: We performed a case-control study of individuals treated for clubfoot at 2 separate institutions with either the Ponseti method or comprehensive clubfoot release between 1983 and 1987. All subjects (24 treated with comprehensive clubfoot release, 18 with Ponseti method, and 48 controls) were evaluated using the International Clubfoot Study Group (ICFSG) morphology scoring, dynamic pedobarography, and foot function index surveys. During pedobarography, we collected the subarch angle and arch index as well as the center of pressure progression (COPP) on all subjects. RESULTS: Foot morphology (ICFSG) scores were highly correlated with foot function index pain scores (r=0.43; P<0.001), although the difference in pain scores between the surgical and Ponseti group did not reach significance. The surgical group exhibited greater subarch angle and arch indexes than the Ponseti group, demonstrating a significant difference in morphology, a flatter foot. Finally, we found more abnormalities in foot progression, decreased COPP in the forefoot and increased COPP in the midfoot and hindfoot, in the surgical group compared with controls. CONCLUSIONS: Measures of foot morphology were correlated with pain among all treated for clubfoot. Compared with Ponseti method, comprehensive surgical release lead to greater long-term foot deformity, flatter feet and greater hindfoot loading time. LEVEL OF EVIDENCE: Level III-Therapeutic.


Assuntos
Moldes Cirúrgicos , Pé Torto Equinovaro/patologia , Pé Torto Equinovaro/terapia , Dor Musculoesquelética/etiologia , Procedimentos Ortopédicos , Adulto , Estudos de Casos e Controles , Pré-Escolar , Pé Torto Equinovaro/complicações , Feminino , Seguimentos , Pé/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Pressão , Fatores de Tempo , Resultado do Tratamento , Suporte de Carga , Adulto Jovem
15.
J Bone Joint Surg Am ; 101(19): 1761-1767, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577681

RESUMO

BACKGROUND: Isolated femoral and tibial fractures are 2 of the top 5 causes of pediatric orthopaedic hospital admission, yet their simultaneous ipsilateral presentation, the "floating knee" injury, remains rare. Historically, treatment consisted of traction and cast immobilization, which resulted in prolonged periods of immobilization, lengthy hospitalizations, and high rates of malunion. As such, previous authors have recommended fixation of at least 1 bone in the setting of a floating knee injury. This strategy, however, has never been evaluated and the outcomes of modern treatment are unknown. METHODS: We performed a multicenter retrospective review of the records of pediatric patients with ipsilateral femoral and tibial fractures that had been treated at 11 tertiary care level-I pediatric trauma centers from 2004 to 2014. Outcomes and treatment strategies were assessed with standardized means. RESULTS: Over the study period, 130 floating knees in 129 patients met the inclusion criteria for evaluation. The average patient age was 10.2 years, and 63.1% were male. One-third of the patients presented with open injuries, and 83.8% of injuries were related to vehicular trauma. Simple diaphyseal fractures (OTA/AO 32-A and B femoral fractures and OTA/AO 42-A and B tibial fractures) were most common. Intramedullary fixation (rigid or flexible) was the most common treatment strategy for femoral fractures (69.2%). Tibial fractures were treated most commonly with casting (27.7%), followed by flexible intramedullary nailing (24.6%). The mean duration of hospitalization was 9.7 days. Outcomes were excellent in 66.6% of cases and good in 26.4% of cases. CONCLUSIONS: Previous literature on pediatric floating knee injuries consisted of small case series that were published prior to the introduction of flexible intramedullary nailing to North America. This multicenter study of a large cohort demonstrates a change in practice pattern from a largely nonoperative treatment strategy to operative fixation of at least the femoral fracture. In the present study, this approach led to good or excellent results in 93.1% of cases and was associated with a short duration of hospitalization. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Moldes Cirúrgicos , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Traumatismos do Joelho/cirurgia , Fraturas da Tíbia/cirurgia , Acidentes de Trânsito , Criança , Feminino , Fraturas do Fêmur/fisiopatologia , Consolidação da Fratura/fisiologia , Humanos , Traumatismos do Joelho/fisiopatologia , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fraturas da Tíbia/fisiopatologia , Resultado do Tratamento
16.
J Pediatr Orthop B ; 28(6): 542-548, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31584922

RESUMO

Telehealth has seldom been used in the field of pediatric orthopaedics. The purpose of this study is to assess the efficacy of telehealth as a tool for the follow-up of children with nondisplaced elbow fractures. We hypothesize that patients treated via telehealth will have comparable clinical outcomes as those treated at our institution, with increased patient satisfaction. We conducted a randomized trial, which included 52 children with type I supracondylar humeral fractures, or occult elbow injuries, divided in two groups, based on the type of care provided during the fourth-week follow-up appointment: cast removal at our institution (group A) or cast removal at home via telehealth appointment (group B). The time duration and professional fees for this week 4 follow-up were calculated. Patients in both groups returned to our institution for a final follow-up in week 8. We measured the amount of fracture displacement, range of motion, pain, and patient satisfaction. There was no statistically significant difference in fracture displacement, range of motion, or pain scores between groups. The mean length of the fourth-week clinical encounter was higher in group A than group B (47.2 vs. 17.6 min, respectively; P < 0.001). Initially, the mean patient satisfaction scores were nearly identical in both groups (97%) until patients in group A were made aware of this difference in time duration, at which their mean satisfaction score decreased to 76.4% (P = 0.05). The use of telehealth as a tool in the treatment of nondisplaced pediatric elbow fractures is appealing. Patients managed via telehealth had higher satisfaction rates and spent only a third of the time for their clinical encounter.


Assuntos
Moldes Cirúrgicos , Continuidade da Assistência ao Paciente , Fraturas do Úmero/terapia , Telemedicina , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Medição da Dor , Satisfação do Paciente , Amplitude de Movimento Articular
18.
J Bone Joint Surg Am ; 101(17): 1530-1538, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31483395

RESUMO

BACKGROUND: With the exception of Mehta's 2005 report on her experience treating early-onset scoliosis with serial casting, all subsequent studies have had limited follow-up. This current study sought to assess the results of serial casting at a minimum 5-year follow-up and to identify the predictors of the sustained resolution of scoliosis. METHODS: This study is a retrospective review of children treated for idiopathic early-onset scoliosis with serial casting at a children's hospital between 2001 and 2013 with a minimum 5-year follow-up. A Cobb angle of ≤15° and a decrease in the Cobb angle of >20° at the most recent follow-up were separately assessed. The differences between groups based on these criteria were tested with Student t tests with alpha = 0.05. RESULTS: Fifty-four children were treated during the study period; of these, 38 had at least 5 years of follow-up and comprised the study sample. The mean follow-up (and standard deviation) was 8 ± 2 years (range, 5 to 13 years). The mean patient age at the time of the first cast was 24 ± 15.1 months (range, 9 to 63 months), with a mean Cobb angle of 56.2° ± 20.1° (range, 22° to 109°). Forty-nine percent of children had scoliosis of ≤15° at the time of the most recent follow-up, and 73% of children were improved by at least 20°. Children with ≤15° scoliosis, compared with children with >15° scoliosis, had significantly lower initial Cobb angle (48.2° compared with 63.7°; p = 0.016), supine traction Cobb angle (22.5° compared with 33.2°; p = 0.048), first-in-cast Cobb angle (24.1° compared with 37.6°; p = 0.01), and first-in-cast rib-vertebral angle difference (12.8° compared with 26.2°; p < 0.01). Age at the time of the first cast, initial rib-vertebral angle difference, flexibility, and body mass index were not significantly different (p > 0.05) between the groups. Three children who initially achieved scoliosis of ≤15° after casting substantially relapsed. CONCLUSIONS: At a minimum follow-up of 5 years, the initial Cobb angle, first-cast Cobb angle, rib-vertebral angle difference, and traction Cobb angle were all predictive of sustained scoliosis of ≤15°. However, with continued growth, relapse of scoliosis was seen in 3 patients. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Moldes Cirúrgicos , Escoliose/terapia , Adolescente , Idade de Início , Criança , Pré-Escolar , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
19.
Niger J Clin Pract ; 22(9): 1266-1270, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489864

RESUMO

Objective: The aim of this study was to evaluate the initial experience and outcome of clubfoot treated using the Ponseti technique in a regional orthopedic hospital setting of a developing country. Methods: This was a retrospective review of all the clubfoot patients who were treated at the clubfoot clinic of National Orthopaedic Hospital Enugu from 1st of August 2013 to 31st January 2015. Result: There were 175 patients with 273 clubfeet. The male to female ratio was 1.2:1, and the age range was 1 week to 27 years with a median age of 11 months. One hundred and fifty-one patients (86.5%) had congenital clubfoot, whereas 24 (13.5%) had acquired clubfoot. The mean Pirani score of the patients at presentation was 4. The mean number of cast sessions needed for correction was 6.3. The majority of the feet (96.6%) were treated and correction achieved with Ponseti method alone, whereas 3.4% had other additional surgical procedures. Seventy-two (41.1%) patients afforded and used foot abduction brace as prescribed. Plaster sores in 12.5% of patients were the most common complication. At a mean follow-up period of 6 months, a relapse rate of 3.4% was observed. Conclusion: Ponseti clubfoot management technique alone is very effective in most cases of clubfoot in our setting. Late presentation of patients and foot abduction brace related challenges observed call for a policy response aimed at educating the public on the importance of early presentation and improving the use of foot abduction brace.


Assuntos
Pé Torto Equinovaro/terapia , Manipulação Ortopédica/métodos , Procedimentos Ortopédicos/métodos , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Moldes Cirúrgicos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Manipulação Ortopédica/efeitos adversos , Nigéria , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
20.
Emerg Nurse ; 27(5): 23-30, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31475502

RESUMO

AIM: Stable ankle injuries are highly prevalent in the UK. Prevention of complications and reoccurrence is essential. The literature shows that plaster of Paris and AirLoc brace are clinically effective treatments for such injuries. However, there is no research measuring patients' satisfaction with these treatments. This study compared options in the treatment of severe ankle sprains and distal fibular avulsion fractures from patients' perspectives. The aim was to determine patients' preferred treatment between below knee plaster cast and AirLoc brace in the management of stable ankle injuries. METHOD: A total of 39 patients who presented at an urban hospital with stable ankle injuries were recruited into a randomised controlled trial. Patient satisfaction levels were measured by questionnaire one week into treatment. The null hypothesis was 'there is no significant difference in satisfaction levels between the two devices'. FINDINGS: There were statistically significant higher patient satisfaction levels in the AirLoc group compared to the plaster cast group. After analysis by the unrelated t -test, the null hypothesis was rejected. Comfort, daily activities, sleep, work and social life were the main contributing factors. Additionally, 67% of the AirLoc group compared to 46% of the plaster cast group were able to return to work. The number needed to treat for one additional AirLoc patient to return to work was 4.8 (five patients). CONCLUSION: Patients' preferred treatment is the AirLoc brace. The inquiry method could be used to provide patient-centred care in other fields.


Assuntos
Fraturas do Tornozelo/terapia , Traumatismos do Tornozelo/terapia , Entorses e Distensões/terapia , Atividades Cotidianas , Adolescente , Adulto , Braquetes , Moldes Cirúrgicos , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Inquéritos e Questionários , Reino Unido
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