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: Several so-called casting indices are available for objective evaluation of plaster cast quality. The present study sought to investigate four of these indices (gap index, padding index, Canterbury index, and three-point index) as compared to a reference standard (cast index) for evaluation of plaster cast quality after closed reduction of pediatric displaced distal forearm fractures. METHODS: Forty-three radiographs from patients with displaced distal forearm fractures requiring manipulation were reviewed. Accuracy, sensitivity, specificity, false-positive probability, false-negative probability, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were calculated for each of the tested indices. RESULTS: Comparison among indices revealed diagnostic agreement in only 4.7% of cases. The strongest correlation with the cast index was found for the gap index, with a Spearman correlation coefficient of 0.94. The gap index also displayed the best agreement with the cast index, with both indices yielding the same result in 79.1% of assessments. CONCLUSION: When seeking to assess plaster cast quality, the cast index and gap index should be calculated; if both indices agree, a decision on quality can be made. If the cast and gap indices disagree, the padding index can be calculated as a tiebreaker, and the decision based on the most frequent of the three results. Calculation of the three-point index and Canterbury index appears unnecessary.
Assuntos
Moldes Cirúrgicos/normas , Competência Clínica/normas , Traumatismos do Antebraço/diagnóstico por imagem , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Fraturas da Ulna/diagnóstico por imagem , Adolescente , Brasil , Moldes Cirúrgicos/efeitos adversos , Criança , Pré-Escolar , Feminino , Traumatismos do Antebraço/fisiopatologia , Traumatismos do Antebraço/terapia , Consolidação da Fratura , Humanos , Masculino , Avaliação de Resultados da Assistência ao Paciente , Fraturas do Rádio/terapia , Recidiva , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fraturas da Ulna/terapiaRESUMO
BACKGROUND: The majority of pediatric fractures are treated in casts due to the child's ability to heal rapidly and remodel. Unplanned cast changes are a time and economic burden with potentially adverse effects on fracture management. The purpose of this study is to document the incidence, etiology, and complications related to unplanned cast changes. METHODS: A prospective study was conducted over a 6-month period to determine the incidence of unplanned cast changes. All casts applied were nonwaterproof. Data collected include the reason for cast placement, type of cast placed, duration of wear before the unplanned change, reason for the unplanned change, experience level of the original cast applicator, and cast-related complications. RESULTS: A total of 1135 casts were placed with 58% placed by a resident, 38% by a cast technician, 2% by a physician's assistant, and 2% by an attending physician. Sixty casts (5.3%) required an unplanned change including 19 short-arm casts, 18 short-leg casts, 17 long-arm casts, 4 thumb spica casts, and 2 long-leg casts. The average duration from cast application until the unplanned change was 13 days. Twenty-eight (47%) were changed for wetness, 20 (33%) for wear/breakage, 2 (3%) for skin irritation, and 10 (17%) for other reasons including objects in the cast and patient self-removal. Two patients had superficial skin infections requiring oral antibiotics. No fracture reductions were lost secondary to an unplanned cast change. The need for an unplanned cast change did not correlate with the level of experience of the applicator. CONCLUSIONS: Most unplanned cast changes were the result of patient nonadherence to instructions and not related to cast application technique. Improved patient and family education regarding cast care may reduce the frequency of unplanned cast changes, thus reducing an economic and time burden on the health care system. LEVEL OF EVIDENCE: Level II--prognostic study.
Assuntos
Moldes Cirúrgicos , Fraturas Ósseas/terapia , Cooperação do Paciente , Traumatismos do Braço/terapia , Moldes Cirúrgicos/efeitos adversos , Criança , Pré-Escolar , Falha de Equipamento , Feminino , Corpos Estranhos/complicações , Humanos , Incidência , Lactente , Traumatismos da Perna/terapia , Masculino , Estudos Prospectivos , Retratamento , Dermatopatias Infecciosas/etiologia , Polegar/lesões , Fatores de TempoRESUMO
CONTEXT AND OBJECTIVE Femoral fractures are common in children between 2 and 12 years of age, and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. However, in some situations, a surgical approach is recommended. The objective here was to compare treatments for femoral shaft fractures using intramedullary nails (titanium elastic nails, TEN) versus traction and plaster casts in children. The hypothesis was that TEN might provide better treatment, with good clinical results in comparison with plaster casts. DESIGN AND SETTING This retrospective comparative study was conducted in a public university hospital. METHODS Sixty children with femoral fractures were evaluated; 30 of them underwent surgical treatment with TEN and 30 were treated conservatively using plaster casts. The patients' ages ranged from 5 to 13 years (mean of 9 years). RESULTS The mean duration of hospitalization was nine days for the surgical group and 20 days for the conservative group. The incidence of overgrowth in the patients treated with TEN was 60.0% and, for those treated conservatively, 13.3%. Partial weight-bearing was allowed after 3.5 weeks in the surgical group and after 9.6 weeks in the conservative group. New hospitalization was required for 90.0% in the surgical group and 16.7% in the conservative group. Patients treated with plaster casts presented higher incidence of complications, such as loss of reduction. CONCLUSIONS The surgical method presented better results for children.
Assuntos
Pinos Ortopédicos , Moldes Cirúrgicos/efeitos adversos , Fraturas do Fêmur/terapia , Fixação Intramedular de Fraturas/métodos , Desigualdade de Membros Inferiores/etiologia , Tempo de Internação/estatística & dados numéricos , Adolescente , Análise de Variância , Criança , Pré-Escolar , Feminino , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/instrumentação , Humanos , Masculino , Estudos Retrospectivos , Titânio , Resultado do TratamentoRESUMO
Femoral fractures are common in children between 2 and 12 years of age, and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. However, in some situations, a surgical approach is recommended. The objective here was to compare treatments for femoral shaft fractures using intramedullary nails (titanium elastic nails, TEN) versus traction and plaster casts in children. The hypothesis was that TEN might provide better treatment, with good clinical results in comparison with plaster casts. This retrospective comparative study was conducted in a public university hospital. Sixty children with femoral fractures were evaluated; 30 of them underwent surgical treatment with TEN and 30 were treated conservatively using plaster casts. The patients' ages ranged from 5 to 13 years (mean of 9 years). The mean duration of hospitalization was nine days for the surgical group and 20 days for the conservative group. The incidence of overgrowth in the patients treated with TEN was 60.0% and, for those treated conservatively, 13.3%. Partial weight-bearing was allowed after 3.5 weeks in the surgical group and after 9.6 weeks in the conservative group. New hospitalization was required for 90.0% in the surgical group and 16.7% in the conservative group. Patients treated with plaster casts presented higher incidence of complications, such as loss of reduction. The surgical method presented better results for children.
Fraturas femorais são comuns em crianças entre 2 e 12 anos de idade, e 75% das lesões acometem a diáfise. Tração seguida de aparelho gessado (“gesso”) é universalmente aceita como tratamento conservador. Entretanto, em algumas situações o tratamento cirúrgico é recomendado. O objetivo foi comparar o tratamento de fraturas diafisárias do fêmur com hastes intramedulares (titanium elastic nails, TEN) com tração e gesso em crianças. A hipótese era de que TEN pode ser melhor tratamento, com bons resultados clínicos em comparação com o gesso. Este estudo retrospectivo e comparativo foi conduzido num hospital público universitário. Sessenta crianças com fraturas de fêmur foram avaliadas, 30 delas foram submetidas a tratamento cirúrgico com TEN e 30 foram tratadas de forma conservadora usando gesso. A idade dos pacientes variou de 5 a 13 anos (média de 9 anos). O tempo médio de internação foi de 9 dias para o grupo cirúrgico e 20 dias para o grupo conservador. A incidência de crescimento excessivo nos pacientes tratados com TEN foi de 60,0% e, para aqueles tratados de forma conservadora, 13,3%. Sustentação parcial de peso foi permitida após 3,5 semanas no grupo cirúrgico e após 9,6 semanas no grupo conservador. Houve 90,0% de novas internações no grupo cirúrgico e 16,7% no grupo conservador. Pacientes tratados com gesso apresentaram maior incidência de complicações, tais como perda de redução.
Assuntos
Adolescente
, Criança
, Pré-Escolar
, Feminino
, Humanos
, Masculino
, Pinos Ortopédicos
, Moldes Cirúrgicos/efeitos adversos
, Fraturas do Fêmur/terapia
, Fixação Intramedular de Fraturas/métodos
, Desigualdade de Membros Inferiores/etiologia
, Tempo de Internação/estatística & dados numéricos
, Análise de Variância
, Fraturas do Fêmur/cirurgia
, Fixação Intramedular de Fraturas/efeitos adversos
, Fixação Intramedular de Fraturas/instrumentação
, Estudos Retrospectivos
, Titânio
, Resultado do Tratamento
RESUMO
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 TratamentoRESUMO
La incorporación de fibras de refuerzo a resinas compuestas se ha convertido en una alternativa de tratamiento protésico altamente conservador. De esta investigación fue evaluar la resistencia flexural (RF) de una resina compuesta indirecta reforzada con tres diferentes marcas comerciales de fibras de vidrio, variando su ubicación y sometidas a envejecido físico ó químico. Se fabricaron 98 especímenes de resina compuesta Gradia (GC-America Inc.) de 22 mm x 2 mm x 3 mm; a 14 muestras no se les colocó fibras (SF), se almacenaron en agua destilada por 60 días, luego se subdividieron en dos grupos de 7 muestras,G1 - SFA y G2 - SFT el cual se sometió a termociclado (3000 ciclos de 5°/55°C en intervalos de 1 min); las otras 84 muestras se reforzaron fibras unidireccionales: 42 muestras para ser almacenadas en agua por 60 días (CFA), divididas en dos sub-grupos de 21, en relación a la ubicación de la fibra en la zona de compresión (CFAC) ó tracción (CFAT); finalmente en tres grupos de 7, dependiendo de la marca; Fibrex-Lab® (Angelus) los grupos G3 - CFACFLab y G6 - CFATFLab, FibreKor® (Jeneric/Penton) los grupos G4 - CFACFKor y G7 - CFATFKor y Vectris® (Ivoclar/Vivadent) los grupos G5 - CFACVectris y G8 - CFATVectris. Las 42 restantes después del almacenamiento en agua se sometieron al termociclado , se dividieron en dos subgrupos de 21, en relación a la ubicación de la fibra en la zona de compresión (CFTC) ó de tracción (CFTT); finalmente se dividió en tres grupos de 7, entonces Fibrex-Lab® conformó los grupos G9 - CFTCFLab y G12 - CFTTFLab, FibreKor® los grupos G10 - CFTCFKor y G13 - CFTTFKor y Vectris® los grupos G11 - CFTCVectris y G14 - CFTTVectris. Las muestras fueron sometidas a la prueba de flexión de tres puntos hasta su fractura, en maquina de pruebas universales (Shimadzu AGS-J) a una velocidad de 1mm/min. Los datos fueron recolectados, tabulados en hoja de cálculo y luego analizados con un estadístico de t de student....
The incorporation of reinforce fibers to composite has turned into an alternative of high conservative prosthetic treatment. The aim of this study was to evaluate the flexure strength (RF) of a indirect reinforce composite using three fiber glass commercial brands, varying the location and submitted to physical o chemical aging. 98 specimen were made of 22 mm x 2 mm x 3 mm Gradia resin compound (GC-America Inc.); 14 samples were not reinforce with fiber glass (SF), They were store in distilled water for 60 days then divided in 2 groups of 7 samples, G1 - SFA and G2 - SFT was thermocycled (3000 cycles of 5 °/55°C in intervals of 1 min); the other 82 samples were reinforce with unidirectional fibers: 42 to be stored in distilled water for 60 days (CFA), divided in 2 subgroups of 21, in relation with the localization of the fiber on the compression zone (CFAC) or traction (CFAT); Finally divided in 3 groups of 7, depending on the brand; Fibrex-Lab® (Angelus) the groups G3 - CFACFLab and G6 - CFATFLab, FibreKor® (Jeneric/Penton) the groups G4 - CFACFKor and G7 - CFATFKor and Vectris® (Ivoclar/Vivadent) the groups G5 - CFACVectris and G8 - CFATVectris. The remaining 42 samples after storage in water were submitted to thermocycling, divided in 2 subgroups of 21, in relation with the localization of the fiber on the compression zone (CFTC) or traction (CFTT); Finally divided in 3 groups of 7 then G9 was conformed Fibrex-Lab® CFTCFLab and G12 - CFTTFLab, FibreKor® the groups G10 - CFTCFKor and G13 - CFTTFKor and Vectris® the groups G11 - CFTCVectris and G14 - CFTTVectris. The samples were submitted to the three points flexion test until fracture, in a universal testing machine (Shimadzu AGS-J) to a speed of 1mm/min. The information was gathered, tabulated in spreadsheet and then analyzed with a statistician t of student to determine differences between the groups without fibers and 3 factors ANOVA on the reinforced groups for the varying location...
Assuntos
Prótese Dentária , Senescência Celular , Moldes Cirúrgicos/efeitos adversos , Resinas Compostas/uso terapêutico , OdontologiaRESUMO
Two children aged 9 and 11 years suffered from left elbow sprain and right anterior tibial tuberosity cortical fracture respectively and were treated with plaster cast immobilization for about 30 days. They regained normal strength afterwards, but 9 and 2 months later developed insidious progressive weakness and wasting in the affected limb, mainly evident in the musculature surrounding the site of injury and sparing hand and foot muscles. Two to three years later the condition stabilized. Sensory abnormalities were not found. Electromyographic examination showed neurogenic pattern confined to the impaired extremity. The focal quality and the unusual disposition of muscle involvement suggest a correlation between trauma and/or immobilization and monomelic amyotrophy.