Comportamiento de fracturas diafisarias del fémur en el niño

Introducción: Las fracturas de la diáfisis del fémur en las edades pediátricas representan un problema de salud que necesita de la intervención del ortopedista, quien aplica una de las distintas modalidades de tratamiento, que van desde la conservadora a la quirúrgica. Objetivo: Describir las características epidemiológicas de un grupo de pacientes pediátricos diagnosticados y tratados con esta enfermedad traumática. Métodos: Se realizó un estudio observacional descriptivo en 54 pacientes atendidos en el Hospital Pediátrico Provincial Dr. Eduardo Agramonte Piña de la provincia Camagüey desde el primero de enero de 2018 al 31 de diciembre del año 2022 con un total de 60 meses. Resultados: La razón sexo masculino-femenino de los 54 pacientes fue de 2,8 a 1, fémur izquierdo-derecho de 1,2 a 1. El promedio de edades en general fue de 8,1 años. La estadía hospitalaria promedio fue de seis días. El tercio medio estuvo afectado en el 57,4 % de los casos. Los meses de julio y diciembre en conjunto con los días del martes y domingo fueron los que presentaron la mayor cantidad de pacientes. El tratamiento más empleado fue la colocación de espica de yeso en 28 pacientes para un 51,8 %, los clavos rígidos fueron utilizados en 16 enfermos y representó el 29,6 %. Por su parte, los clavos flexibles fueron colocados en 10 casos para un 18,5 %. Conclusiones: Las fracturas de la diáfisis femoral en las edades pediátricas son más frecuentes en el sexo masculino, lado izquierdo, en el tercio medio, con patrón transversal. Los meses del año con mayor incidencia fueron julio y diciembre y los días martes y domingo. El tratamiento depende de la edad, peso y configuración de la fractura.

Introduction: Fractures of the diaphysis of the femur in children, represent a health problem that requires the intervention of an orthopedist who applies various treatment modalities ranging from conservative to surgical. Objective: To describe the epidemiological characteristics of a group of pediatric patients with this traumatic entity. Methods: A descriptive observational study was carried out in 54 patients treated at the Dr. Eduardo Agramonte Piña Provincial Pediatric Hospital in the city of Camagüey from January 1st, 2018 to December 31st, 2022 with a total of 60 months. Results: The male-female sex ratio of the 54 patients was 2.8 to 1, left-right femur 1.2 to 1. The average age in general was 8.1 years. The average hospital stay was 6 days. The middle third was affected in 57.4 % of the cases. The months of July and December together with the days of Tuesday and Sunday were the ones that presented the largest number of patients. The most used treatment was the placement of a plaster spike in 28 patients for 51.8%, rigid intramedullary nails were used in 16 patients and represented 29.6 %. On the other hand, flexible intramedullary nails were placed in 10 cases for 18.5%. Conclusions: Femoral diaphysis fractures in children are more frequent in males, left side, in the middle third, with a transversal pattern. The months of the year with the highest incidence were July and December and on Tuesdays and Sundays. Treatment depends on age, weight, and configuration of the fracture.

Evaluation of an open access generic 3D software for Orthodontic diagnosis and treatment planning

Aim: To evaluate the accuracy and the validity of orthodontic diagnostic measurements, as well as virtual tooth transformations using a generic open access 3D software compared to OrthoAnalyzer (3Shape) software; which was previously tested and proven for accuracy. Methods: 40 maxillary and mandibular single arch study models were duplicated and scanned using 3Shape laser scanner. The files were imported into the generic and OrthoAnalyzer software programs; where linear measurements were taken twice to investigate the accuracy of the program. To test the accuracy of the program format, they were printed, rescanned and imported into OrthAnalyzer. Finally, to investigate the accuracy of editing capabilities, linear and angular transformation procedures were performed, superimposed and printed to be rescanned and imported to OrthoAnalyzer for comparison. Results: There was no statistically significant difference between the two groups using the two software programs regarding the accuracy of the linear measurements (p>0.05). There was no statistically significant difference between the different formats among all the measurements, (p>0.05). The editing capabilities also showed no statistically significant difference (p>0.05). Conclusion: The generic 3D software (Meshmixer) was valid and accurate in cast measurements and linear and angular editing procedures. It can be used for orthodontic diagnosis and treatment planning without added costs

Risk factors for avascular necorosis after closed reduction of developmental dysplasia of the hips / 中华骨科杂志

Objective:To analyze the risk factors of avascular necrosis (AVN) after closed reduction and spcia casting in treating developmental dysplaisa of the hip (DDH).Methods:The patients with DDH who received closed reduction in our department from January 2016 to December 2017 were retrospectively reviewed. The inclusion criteria included aged at reduction ≥6 months, achieving successful reduction, having complete data with more than 2 years follow-up. A total of 48 cases with 54 hips were included in the present study. Among them, there were 2 males and 46 females, 41 unilateral hips and 13 bilateral hips. The mean age at closed reduction was 16.4±3.8 months (range 6-24 months). The mean follow-up duration was 2.9±1.8 years (range 2.3-4.1 years). Closed reduction was conducted under general anesthesia followed with a spcia cast immobilization. The abduction angle of the cast was recorded. The stability of reduction was evaluated by Ramsey safety zone. The maximum abduction and re-dislocation abduction were recorded. The quality of reduction was evaluated by the medial gap and femoral head coverage on intraoperative arthrography and post-reduction MRI. AVN was diagnosed according to Salter criteria. The risk factors of AVN were analyzed by univariate and binary logistic regression analysis.Results:AVN occurred in 12 hips (22.2%) of 54 hips. International Hip Dysplasia Institute (IHDI) grade and the difference between maximum abduction and cast abduction (Max-Cast abduction) were related to the occurrence of AVN in univariate analysis. The incidence of AVN in hips of IHDI grade 4 (42.9%, 9/21) was significantly higher than that in hips of IHDI grade 3 (9.7%, 3/31) (χ 2=6.007, P=0.018). However, the hips of IHDI grade 3 and 2 (0%, 0/2) presented a similar incidence of AVN (χ 2=0.000, P=1.000). The Max-Cast abduction was -0.7°±5.9° in the AVN group and 6.1°±7.6° in the AVN group ( t=2.125, P=0.038). Finally, IHDI grade ( OR=8.256, P=0.015) and Max-Cast abduction ( OR=0.832, P=0.047) were both independent factors of AVN in multivariate analysis. Conclusion:Most of the hips with AVN are IHDI grade 4 after closed reduction for DDH. The abduction angle in a spica cast could not be significantly related to the occurrence of AVN. However, the risk of AVN might be increased when the cast abduction is close to or beyond the maximum abduction. Safe abduction in the cast should be 5 to 10 degrees less than maximum abduction at least.

Thermoplastic nipple splint: A simple method of maintaining nipple projection

Maintaining projection of the reconstructed nipple is important for achieving natural and aesthetically appealing outcomes in breast reconstruction. Although various methods of avoiding mechanical force on the reconstructed nipple have been developed, the existing methods are inconvenient, crude, non-reusable, and difficult to clean or adjust. In the present study, a simple method of creating a nipple splint using a thermoplastic material is described. This splint can be easily manipulated, washed, and reused, and it is comfortable to wear for long-term use without any complications and convenient for the patient to apply.

Treatment of children with femoral subtrochanteric fractures by the external fixation combined with single hip plaster / 中国骨伤

<p><b>OBJECTIVE</b>To explore curative effects of external fixation combined with single hip plaster in treating children with femoral subtrochanteric fracture.</p><p><b>METHODS</b>Form March 2009 to July 2016, 15 children with femoral subtrochanteric fracture were treated with external fixation combined with single hip plaster, including 9 males and 6 females with a mean age of 8.5 years old ranging from 5 to 14 years old. According to fracture classification of Seinsheimer, 3 cases were type IIA, 4 cases were type IIB, 3 cases were type IIC, 2 cases were type IIIA, 1 case was type IIIB, 1 case was type IV, 1 case was type V. Complications and radiographs were retrospectively reviewed. Postoperative function of hips were evaluated according to Sanders criteria.</p><p><b>RESULTS</b>All children were followed up from 16 to 48 months with an average of 32 months. No early closure of epiphysis, bone nonunion and breakage of screw occurred. According to the Sanders score standard of hip function, the result was excellent in 14 cases, good in 1 case. There were no hip inversion, limb shortening, excessive growth and other malformations.</p><p><b>CONCLUSIONS</b>External fixation combined with single hip plaster for the treatment of children is a safe and effective fixation, which provide a new choice of femoral subtrochanteric fracture.</p>

A Nipple Splint Using a Textile-Like Thermoplastic Cast

Nipples are protected by nipple splints after reconstructing or reshaping them using various materials. We have devised a nipple splint using textile-like thermoplastic tape, which is made out of knitted hybrid fabric, is latex-free, and keeps its position well beneath a brassiere with simple taping. Its conformation is readily modifiable according to each patient's breast shape, if it is soaked into hot water. A patient who underwent nipple reconstructive surgery had this thermoplastic cast applied for a month, and the contour of the nipple was well preserved without reports of skin irritation or pressure sores developing on the areola.

Protótipo para realização de cranioplastia de baixo custo / Prototype for cranioplasty low cost in postoperative decompressive craniotomy

Objetivo: O presente trabalho propõe uma técnica para realização de cranioplastia com metilmetacrilato em formas pré-moldadas e esterilizadas visando evitar cranioplastia com prototipagem pré-moldada.Método: Conforme rotina apresentada, o flap ósseo realizado para craniotomia descompressiva é armazenado em recipientes com formol e enviado para o serviço de patologia do hospital. Quando realizamos a cranioplastia, utilizamos o flap ósseo armazenado para realização dos moldes que serão utilizados na cranioplastia. Resultado: O resultado estético é muito bom e os índices de complicação e infecção são baixos. Conclusão: Apresenta resultados estéticos semelhantes aos casos de prototipagemcom baixo custo na confecção.

Objective: This paper proposes a technique for cranioplasty with methyl methacrylate and molded into shapes pre-sterilized to avoid aiming cranioplasty with pre molded prototyping. Method: As presented routine bone flap performed to decompressive craniectomy is stored in containers with formalin and sent to the pathology service of the hospital. When we performed the cranioplasty, we used the bone flap stored for realization of molds that will be used in cranioplasty. Result: The aesthetic result is very good and the rates of complication and infection are lo

Splint versus plaster cast external fixator for the treatment of distal forearm buckle fracture in children:systematic review / 中国组织工程研究

BACKGROUND:The distal forearm buckle fracture in children has no secondary displacement risk, and the literatures have reported that the fracture can be treated with external fixators of plaster cast, palm side plate, splint, brace and bandage, and obtain good effect. But different external fixators have different effects on the functional recovery and viability. OBJECTIVE:To assess the clinical efficacy and safety of splint versus plaster cast for the treatment of distal forearm buckle fracture in Children. METHODS: The Medline database, Embase database, Cochrane Library, CNKI database and CBM database were searched from the database establishment to April 2011 with the computer;the relative conference papers were hand searched;the Important Clinical Trial Register was searched online without limitation of language. Randomized control ed trials and quasi-randomized control trials were selected for quality evaluation, and the Meta-analysis was performed with Revman 5.1. RESULTS AND CONCLUSION:Two published trials including a total of 314 patients were included, and one randomized control ed trial was evaluated as B scale, another one quasi-randomized control trial was evaluated as C scale. The results demonstrate that no fracture, un-union or re-fracture occurred after treated with splint and plaster case external fixator, and there were no significant differences in pain scores as wel as the daily activities of writing, drawing, self-eating and washing;while the early bathing ability of the patients in the splint group was earlier than that in the plaster cast group, and had no significant difference in the advanced bathing ability. The regular exercise participation in the splint group was better than that in the plaster cast group. There were no significant differences in the incidence of adverse events between two groups. The results indicate that the pain score of the patients with distal forearm buckle fracture in children do not improved after treated with splint and plaster cast, but splint fixation is better than plaster cast fixation in maintaining the batching and regular exercise participation ability with good safety. But the wel-designed and implement large sample and multi-center randomized control ed trials are needed for validation.

Treatment options of unstable distal radial fractures in elderly patients / 中华老年医学杂志

Objective To study the advantage and disadvantage of different treatments of unstable distal radial fractures in elderly patients. Methods In the period from August 2005 to January 2010, 55 elderly patients with unstable d istal radial fractures were treated with manual diaplasis and external plaster splint fixation, operation and internal plate fixation, or external fixation. Clinical outcomes were evaluated by Gartland-Werley wrist scoring systems and questionnaire of the disabilities of the Arm, Shoulder and Hand (DASH). We used SPSS13.0 software package for statistical analysis. Results Compared with the manual diaplasis group, the operation and internal plate fixation group or external fixation group was better in Gartland-Werley scores, the differences were statistically significant (P<0.05), but there were no differences in DASH scores among the 3 groups. Conclusions The treatment of unstable distal radial fractures in elderly patients should be chosen based on the characteristics of the fractare and patients desire.