RESUMO
BACKGROUND: The prevalence of untreated congenital clubfoot among children older than walking age is higher in developing countries due to limited resources for early care after birth. The Ponseti method represents an intervention option for older, untreated children. METHODS: A metanalysis was conducted of observational studies selected through a systematic review of articles included in electronic databases (Medline, Scopus, Embase, Lilacs, and the Cochrane Library) until June 2017. A pooling analysis of proportions with 95% confidence intervals (CIs) and a publication bias assessment were performed as routine. Estimates of success, recurrence, and complication rates were weighted and pooled using the random effects model. RESULTS: Twelve studies, including 654 feet diagnosed with congenital clubfoot in children older than walking age (older than 1 year old), were included for analysis. The rate of satisfactory outcomes found via a cluster metanalysis of proportions using the random effects model was 89% (95% CI = 0.82-0.94, p < 0.01), relative to the total analysed. The recurrence rate was 18% (95% CI = 0.14-0.24, p = 0.015), and the rate of casting complications was 7% (95% CI = 0.03-0.15, p = 0.19). CONCLUSION: Application of the Ponseti method in children with untreated idiopathic clubfoot older than walking age leads to satisfactory outcomes, has a low cost, and avoids surgical procedures likely to cause complications. The results obtained exhibited considerable heterogeneity.
Assuntos
Pé Torto Equinovaro/terapia , Manipulação Ortopédica/métodos , Moldes Cirúrgicos/efeitos adversos , Criança , Pré-Escolar , Pé Torto Equinovaro/fisiopatologia , Pé Torto Equinovaro/cirurgia , Feminino , Humanos , Lactente , Masculino , Manipulação Ortopédica/efeitos adversos , CaminhadaRESUMO
BACKGROUND: Treatment of the Slipped Capital Femoral Epiphysis remains a cause of concern due to the fact that the true knowledge of the etiopathogeny is unknown, as well as one of its major complications: chondrolysis. The conservative treatment remains controversial; it has been overlooked in the studies and subjected to intense criticism. The purpose of this study is to investigate the results of treatment on the hip of patients displaying slipped capital femoral epiphysis, using the plaster cast immobilization method and its link to chondrolysis. METHODS: The research was performed based on the study of the following variables: symptomatology, and the degree of slipping. A hip spica cast and bilateral short/long leg casts in abduction, internal rotation with anti-rotational bars were used for immobilizing the patient's hip for twelve weeks. Statistical analysis was accomplished by Wilcoxon's marked position test and by the Fisher accuracy test at a 5% level. RESULTS: A satisfactory result was obtained in the acute group, 70.5%; 94%; in the chronic group (chronic + acute on chronic). Regarding the degree of the slipping, a satisfactory result was obtained in 90.5% of hips tested with a mild slip; in 76% with moderate slip and 73% in the severe slip. The statistical result revealed that a significant improvement was found for flexion (p = 0.0001), abduction (p = 0.0001), internal rotation (p = 0.0001) and external rotation (p = 0.02). Chondrolysis was present in 11.3% of the hips tested. One case of pseudoarthrosis with aseptic capital necrosis was presented. There was no significant variation between age and chondrolysis (p = 1.00).Significant variation between gender/non-white patients versus chondrolysis (p = 0.031) and (p = 0.037), respectively was verified. No causal association between plaster cast and chondrolysis was observed (p = 0.60). In regard to the symptomatology group and the slip degree versus chondrolysis, the p value was not statistically significant in both analyses, p = 0.61 and p = 0.085 respectively. CONCLUSIONS: After analyzing the nonoperative treatment of slipped capital femoral epiphysis and chondrolysis, we conclude that employment of the treatment revealed that the method was functional, efficient, valid, and reproducible; it also can be used as an alternative therapeutic procedure regarding to this specific disease.
Assuntos
Moldes Cirúrgicos , Manipulação Ortopédica/métodos , Escorregamento das Epífises Proximais do Fêmur/terapia , Adolescente , Moldes Cirúrgicos/efeitos adversos , Morte Celular , Criança , Condrócitos/patologia , Estudos de Coortes , Feminino , Humanos , Imobilização/efeitos adversos , Imobilização/instrumentação , Imobilização/métodos , Estudos Longitudinais , Masculino , Manipulação Ortopédica/efeitos adversos , Manipulação Ortopédica/instrumentação , Radiografia , Estudos Retrospectivos , Escorregamento das Epífises Proximais do Fêmur/diagnóstico por imagem , Escorregamento das Epífises Proximais do Fêmur/patologia , Resultado do TratamentoAssuntos
Quiroprática , Criança , Pré-Escolar , Doença , Humanos , Manipulação Ortopédica/efeitos adversos , NeoplasiasRESUMO
An infant with congenital torticollis underwent chiropractic manipulation, and within a few hours had respiratory insufficiency, seizures, and quadriplegia. A holocord astrocytoma, with extensive acute necrosis believed to be a result of the neck manipulation, was found and resected. We believe that every child with torticollis, regardless of age, should undergo neurologic and radiologic evaluation before any form of physical treatment is instituted.