Displaced Physeal and Metaphyseal Fractures of Distal Radius in Children. Can Wire Fixation Achieve Better Outcome at Skeletal Maturity than Cast Alone?

@#Introduction:Redisplacement following fracture reduction is a known sequela during the casting period in children treated for distal radius fracture. Kirschner wire pinning can be alternatively used to maintain the reduction during fracture healing. This study was conducted to compare the outcomes at skeletal maturity of distal radius fractures in children treated with a cast alone or together with a Kirschner wire transfixation. Materials and Methods: This was a retrospective study involving 57 children with metaphyseal and physeal fractures of the distal radius. There were 30 patients with metaphyseal fractures, 19 were casted, and 11 were wire transfixed. There were 27 patients with physeal fractures, 19 were treated with a cast alone, and the remaining eight underwent pinning with Kirschner wires. All were evaluated clinically, and radiologically, and their overall outcome assessed according to the scoring system, at or after skeletal maturity, at the mean follow up of 6.5 years (3.0 to 9.0 years). Results: In the metaphysis group, patients treated with wire fixation had a restriction in wrist palmar flexion (p=0.04) compared with patients treated with a cast. There was no radiological difference between cast and wire fixation in the metaphysis group. In the physis group, restriction of motion was found in both dorsiflexion (p=0.04) and palmar flexion (p=0.01) in patients treated with wire fixation. There was a statistically significant difference in radial inclination (p=0.01) and dorsal tilt (p=0.03) between cast and wire fixation in physis group with a more increased radial inclination in wire fixation and a more dorsal tilt in patients treated with a cast. All patients were pain-free except one (5.3%) in the physis group who had only mild pain. Overall outcomes at skeletal maturity were excellent and good in all patients. Grip strength showed no statistical difference in all groups. Complications of wire fixation included radial physeal arrests, pin site infection and numbness. Conclusion: Cast and wire fixation showed excellent and good outcomes at skeletal maturity in children with previous distal radius fracture involving both metaphysis and physis. We would recommend that children who are still having at least two years of growth remaining be treated with a cast alone following a reduction unless there is a persistent unacceptable reduction warranting a wire fixation. The site of the fracture and the type of treatment have no influence on the grip strength at skeletal maturity.

Da empiria à metafísica do arquétipo: contribuições da psicologia analítica ao conceito de physis / From empiria to the metaphysics of the archetype: contributions of analytical psychology to the concept of physis / De la empiría a la metafísica del arquetipo: contribuciones de la psicología analítica al concepto de physis

Sob a égide de um clima intelectual firmado a partir do séc. XVII com o advento do mecanicismo e do empirismo, o conceito de "natureza" acompanhou o alvorecer de uma ciência moderna que se norteava pelos princípios de causalidade e materialidade. Breves percursos pela História da Ciência e da Filosofia, contudo, revelam conceituações díspares, algumas das quais pressupunham certa harmonia de fatores físicos com assertivas vitalistas e metafísicas, mediante ideias que se dispunham na forma de "pares de opostos". O objetivo deste ensaio é demonstrar a contribuição da teoria junguiana à noção de Physis, no sentido de integrar aspectos antagônicos no conjunto do conhecimento acerca da natureza. Como resultado desta reflexão, verifica-se que a epistemologia do pensamento junguiano, em muito sintonizada com a revolução quântica da física de partículas, resgata a antiga noção da Physis grega, na medida em que sua conceituação abarca o conjunto mais completo das diversas fenomenologias.

Under the aegis of an intellectual climate established from the 17th century, with the advent of mechanicism and empiricism, the concept of "nature" accompanied the dawn of a modern science that was guided by the principles of causality and materiality. Brief journeys through the History of Science and Philosophy, however, reveal disparate conceptions, some of which presupposed a certain harmony of physical factors with vitalist and metaphysical assertions, through ideas that were available in the form of "pairs of opposites". The purpose of this essay is to demonstrate the contribution of Jungian theory to the notion of Physis, in the sense of integrating antagonistic aspects into the set of knowledge about nature. As a result of this reflection, it is verified that the epistemology of Jungian thought, very attuned with the quantum revolution of the physics of particles, rescues the old notion of Greek Physis, insofar as its conceptualization encompasses the most complete set of diverse phenomenologies.

Bajo la égida de un clima intelectual firmado a partir del s. XVII con el advenimiento del mecanicismo y del empirismo, el concepto de "naturaleza" acompañó el amanecer de una ciencia moderna que se orientaba por los principios de causalidad y materialidad. Breves recorridos por la Historia de la Ciencia y la Filosofía, sin embargo, revelan conceptualizaciones dispares, algunas de las cuales presuponen cierta armonía de factores físicos con asertivas vitalistas y metafísicas, mediante ideas que se disponían en la forma de "pares de opuestos". El objetivo de este ensayo es demostrar la contribución de la teoría junguiana a la noción de Physis, en el sentido de integrar aspectos antagónicos en el conjunto del conocimiento acerca de la naturaleza. Como resultado de esta reflexión, se verifica que la epistemología del pensamiento junguiano, en muy sintonizada con la revolución cuántica de la física de partículas, rescata la antigua noción de la Physis griega, en la medida en que su concepción abarca el conjunto más completo de las diversas fenomenologías.

Age Estimation of Adult Living Donor by Pubic MSCT Three-dimensional Recon-struction / 法医学杂志

Objective To establish a method for the age estimation of adult living donor based on pubic MSCT three-dimensional reconstruction and verify its accuracy and reliability. Methods The volume ren-dering (VR) image data of pubic symphysis surface were collected from 300 volunteers aged over 17 years old. According to different age groups, the age estimation of these volunteers was performed by the method and formula of pubic symphysis surface. Results In the 300 volunteers, the difference between biological age and actual age was <1 year in 117 cases, >1-2 years in 178 cases, >2 years in 5 cases. Conclusion MSCT three-dimensional reconstruction technology of pubic symphysis surface can be used to estimate the age of adult living donor, which can provide a high accurate and reliable result.

Tratamiento de la lesión del ligamento cruzado anterior en pacientes con fisis abiertas / Treatment of anterior cruciate ligament injury in patients with open physis

Contexto: las roturas del ligamento cruzado anterior (LCA) en pacientes con fisis abiertas representan el 3,3% de las roturas del LCA, En el tratamiento de las roturas intersticiales del LCA en pacientes con fisis abiertas existe controversia en la elección entre tratamiento conservador y tratamiento quirúrgico. Objetivo: analizar la reconstrucción del ligamento cruzado anterior LCA con fisis abierta en el Servicio de Ortopedia y Traumatología del Hospital de Especialidades FFAA No 1. Sujetos y métodos: estudio retrospectivo en pacientes sometidos a cirugía artroscópica para tratamiento de lesión del LCA con fisis abiertas, en el periodo enero 2012 y abril de 2015. En relación al tratamiento, se utilizó la técnica transfisaria completa (monotúnel); el injerto se fija al fémur con un endobotón y a la tibia con un tornillo de interferencia; el injerto fue obtenido del músculo semitendinoso. Resultados: fueron intervenidos 9 pacientes de sexo masculino, con edades entre 13 y 16 años, con lesiones del ligamento cruzado anterior en rodilla derecha (n=7, 78%) e izquierda (n=2, 22%); la ruptura del menisco es la lesión asociada más frecuente. Conclusión: las roturas del LCA con fisis abiertas son cada vez más frecuentes en la actualidad. La reconstrucción del LCA debe ser precoz para evitar lesiones condrales y meniscales. Se recomienda el tratamiento quirúrgico por los óptimos resultados clínicos y funcionales. (AU)

Background: anterior cruciate ligament (ACL) tears in open physis patients represent 3.3% of ACL tears. In the treatment of ACL interstitial tears in patients with open physis, there is controversy in the choice between conservative treatment and surgical treatment. Objective: to analyze the reconstruction of the anterior cruciate ligament ACL with open physis in the Orthopedics and Traumatology Service of the Specialty Hospital FFAA No 1. Subjects and methods: retrospective study in patients undergoing arthroscopic surgery for treatment of ACL injury with open physis, in the period January 2012 and April 2015. In relation to the treatment, the complete transfusion technique (monotunnel) was used; the graft is fixed to the femur with an endobotton and to the tibia with an interference screw; the graft was obtained from the semitendinous muscle. Results: were operated on 9 male patients, with ages between 13 and 16 years, with injuries of the anterior cruciate ligament in the right knee (n = 7, 78%) and left (n = 2, 22%); the rupture of the meniscus is the most common associated lesion. Conclusion: ACL tears with open physis are becoming more frequent today. The reconstruction of the ACL must be early to avoid chondral and meniscal lesions. Surgical treatment is recommended for optimal clinical and functional results. (AU)

Distal femoral physeal crush injury with metaphyseal comminution - A report of two cases and a new perspective to physeal injury / 中华创伤杂志(英文版)

The physis of a long bone may get 'sandwiched' and crushed between the metaphysis and the epiphysis if it is traumatically loaded along its long axis. Such a physeal injury may lead to complications like angular deformities and growth restrictions and hence, management of such injuries requires adequate planning and attentive execution. Two patients with distal femoral physeal crush injury were treated using a ring fixator such that one ring had the wires passing through the epiphysis and the other through the femoral shaft. On table image intensifier controlled distraction of the crushed physis was done to bring the height of the physis similar to that of the opposite limb. Patients were followed up for more than two years clinically and radiologically. There was no clinical or radiological angular deformity of the operated limbs. MRI scans showed intact physes with no physeal bar formation in either of the two patients. The distraction obtained by the ring fixator appears to have provided ample 'breathing space' to the compressed physis and that the growth potential may have been re-gained by the procedure. However, two years is a relatively short duration of follow-up and further follow-up of longer duration and in greater number of patients is needed to gauge the actual effectiveness of the technique used by us.

Da natureza e do inconsciente coletivo / Of Nature and the Collective Unconscious / De la Naturaleza y del Inconsciente Colectivo

Este artigo tem como objetivo traçar um paralelo entre o conceito de inconsciente coletivo da psicologia analítica e a concepção de natureza dentro da tradição filosófica. Tenta demonstrar a proximidade do pensamento analítico, no que se refere à concepção de Natureza e inconsciente, com a concepção de Natureza no Romantismo alemão e na filosofia grega.

This article aims to draw a parallel between the concept of the collective unconscious of analytical psychology and the conception of Nature within the philosophical tradition. It tries to demonstrate the proximity of analytical thinking, regarding the conception of Nature and unconscious, with the conception of Nature in German Romanticism and Greek philosophy.

Este artículo tiene como objetivo trazar un paralelo entre el concepto de inconsciente colectivo de la psicología analítica y la concepción de la naturaleza dentro de la tradición filosófica. Intenta demostrar la proximidad del pensamiento analítico, en lo que se refiere a la concepción de Naturaleza e inconsciente, con la concepción de Naturaleza en el Romanticismo alemán y en la filosofía griega.

Electrocautery technique for proximal tibial epiphysiodesis in Labrador retriever puppies: experimental study / Técnica de eletrocauterização para epifisiodese proximal da tíbia em cães filhotes da raça Labrador Retriever: estudo experimental

There are few studies about the treatment options for cranial cruciate ligament rupture in growing dogs, especially with epiphysiodesis techniques. The aim of this study was to evaluate the electrocautery technique for proximal tibial epiphysiodesis in Labrador retriever puppies. The novel electrocautery technique was compared with the screw technique regarding the efficacy for tibial plateau leveling in growing dogs. Six healthy Labrador retriever puppies were divided into two groups. The screw technique was used in one group and the electrocautery technique was used in the other group. Both proximal tibial epiphysiodesis techniques for tibial plateau leveling were effective in achieving reduced tibial plateau angle and did not cause significant joint changes. The screw technique was more invasive and caused slightly greater morbidity than the electrocautery technique. The electrocautery technique seems to be a good alternative for proximal tibial epiphysiodesis in young dogs.(AU)

São descritos poucos estudos sobre as opções de tratamento para a ruptura do ligamento cruzado cranial em cães na fase de crescimento, especialmente em relação às técnicas de epifisiodese. O objetivo deste estudo foi avaliar a técnica de eletrocauterização para epifisiodese proximal da tíbia em cães filhotes da raça Labrador Retriever. A nova técnica de eletrocauterização foi comparada com a do parafuso em relação à eficácia para nivelamento do platô tibial em cães na fase de crescimento. Seis filhotes saudáveis da raça Labrador foram selecionados e divididos aleatoriamente em dois grupos. A técnica do parafuso foi usada em um grupo, enquanto no outro foi usada a da eletrocauterização. Ambas as técnicas de epifisiodese proximal da tíbia para nivelamento do platô tibial foram eficazes na redução do ângulo do platô tibial e não causaram alterações articulares importantes. A técnica do parafuso foi considerada mais invasiva e causou morbidade um pouco mais acentuada do que a da eletrocauterização. Assim, a técnica da eletrocauterização parece ser uma boa alternativa para a epifisiodese proximal da tíbia em cães jovens.(AU)

Los principios de la homeopatía, a medio camino entre lo antiguo y lo moderno / The principles of homeopathy, halfway between the old and new

Los críticos de la Homeopatía han señalado que esta materia carece de bases científicas y que hay pocas evidencias documentales que den cuenta de su eficacia.El presente trabajo es un ensayo que coloca al lector en el contexto histórico,filosófico y político que nació la Homeopatía, como un punto de partida que despuésse transforma en una exposición en la que se discute si la medicina configuradapor Samuel Hahnemann es antigua o moderna. El autor dedica gran parte de su ensayo a destacar algunas ideas fundamentales de Crítica de la razón pura, obra del célebre filosofo alemán (1724-1804) Immanuel Kant,y señala cómo, a partir de ellas, es que la medicina alopática empezó a interesarse por atender las consecuencias de la enfermedad y no la enfermedad misma. Kant actuó de buena fe y coloco en la mesa de discusión ideas revolucionarias que dieron pie a la sistematización de las ciencias modernas. Sin embargo, ello no significa, señala el autor de este artículo, que algunos conceptos utilizados en Homeopatía, como “totalidad”, “organismo” o “fuerza vital” deban ser ignorados a priori.

Critics of homeopathy have pointed out that this matter has no scientific basis andthe existing evidence is too insufficient to account for their effectiveness. This paper is a trial that places the reader in the historical, philosophical and political in which homeopathy came as a starting point, this point then transformed into an exhibition in which it is discussed whether the regime of Samuel Hahnemann is ancient or modern. The author devotes much of his trial will highlight some fundamental ideasof “Critique of Pure Reason”, by the famous German philosopher (1724-1804) ImmanuelKant, and shows how, from them, is that allopathic medicine became interestedto address the consequences of the disease and not the disease itself. Kant acted in good faith and placed on the table for discussion revolutionary ideas that led to the systematization of modern science. However, this does not mean, says the author of this article, some concepts used in homeopathy as “all”, “body” or “life force” should be ignored a priori.

The Identity of the Author's Opponents of On Ancient Medicine / 의사학

The identity of the author's opponents of On Ancient Medicine is an attractive and problematic question. In 1963, Lloyd suggested that the author was attacking Philolaus or medical thinkers influenced by him. In 1998, Vegetty argued that the author's attack was directed at Empedocles himself. But Lloyd's hypothesis need to solve Philolaus' paradox and there is a strong evidence that the author is not criticizing a specific text or thinker at all, but rather a general trend or tendency in the medicine of his time. It is that the author regularly refers to the opponents in the plural(chh. 1, 13, 15, 20). Jouanna in his introduction Bude edition(p. 18) supposes that the author means to say that he has completed his discussion of his initially announced opponents and that he is now launching an independent criticism of philosophical medicine in general, as if there is no essential connection between the two groups. But the distinction between the polemic of chh 1-19 and that of chapter 20 is largely a matter of emphasis. In chh 1-19 the author focuses on the aspect of the opponents' causal reductionism, i.e. reduction of the causes and cures of disease to a few factors. And in chapter 20 he steps back to discuss more general physis theory on which such a position was based. At any rate, We can readily see that initial opponents and the thinkers of chapter 20 at least belong the same intellectual milieu. The answer to the question "Who is attacked in On Ancient Medicine?" is not a specific thinker or different groups, but all those who attempted to reduce the cause of disease to a few factors, and to base their medical practice on a theory of the human physis. An opinion that this work attacked a special thinker involves some of the same pitfalls as the traditional Hippocratic question.

Modified arthroscopic internal fixation of avulsion fracture of the anterior cruciate ligament from the tibial insertion site with cannulated screw and washer / 第三军医大学学报

Objective To evaluate more than 5-year follow-up outcome of avulsion fracture of the anterior cruciate ligament from the tibial insertion site in skeletally immature patients treated with modified arthroscopic internal fixation with cannulated screw and washer. Methods Thirty-nine patients with open physis were treated by modified arthroscopic internal fixation with cannulated screw and washer from March 2000 to November 2003. Regular X-ray plain films at AP and lateral views were conducted to detect the healing of avulsed fragments. Follow-up period of 31 patients was more than 5 years. Functional outcome before and after surgery was evaluated using the Lysholm Knee Score and the Tegner Activity Score. Angular deformity, or leg length discrepancy was assessed by clinical examination and anteroposterior-lateral radiographs of the knee. Instrumented knee laxity was performed using the KT-2000 arthrometer. Results Arthroscopic removal of implants was performed between 3 and 6 months postoperatively, when all fractures were revealed to have healed on X-ray films. No growth disturbance, angular deformation or knee instability was found in 31 patients during more than 5-year follow-up. The Lysholm score was improved from (19.2?14.8) (range 12-48) preoperatively to (98.5?3.1) (range 97-100) postoperatively, with significant statistical difference by the student-t test (t=18.395, P=0.000); The Tegner score was improved from (4.1?1.1) (range 3-5) preoperatively to (8.5?0.8) (range 7-9) postoperatively, with significant statistical difference by the student-t test (t=4.13, P=0.008). Physical examination showed Lachman test (+) in 14 of 31 patients. Instrumented knee laxity (KT-2000) showed manual-maximum side-to-side difference greater than 2 mm (range 2.1-3.8 mm) in 14 of 31 patients. Conclusion Modified arthroscopic internal fixation of avulsion fracture of the anterior cruciate ligament from the tibial insertion site with cannulated screw and washer in skeletally immature patients is a simple, safe, and effective ARIF procedure without growth disturbance.

The Proximal Tibial Physeal Changes in the Skeletally Immature Rabbits after the physeal Distraction / 대한정형외과학회잡지

Physeal distraction is used for limb lengthening or correction of deformities in skeletally immature patients. But the effect of distraction on the physis is uncertain. The young rabbits were arranged into five groups according to the slow distraction rates: Group I (no distraction), Group II (distraction rate of 0.25mm per day), Group III (distraction rate of 0.5mm per day), Group IV (distraction rate of 0.75 mm per day), Group V (distraction rate of 1mm per day). The tibial length, size of proliferating zone, microscopic findings of physis immunostained with bromodeoxyuridine, and physeal response to physeal distraction on each group were studied. The results were as follows. 1. There was an increase in bone length on the distracted side (1.8 to 4.2mm). 2. There was an irregular increase in the thickness of the distracted physis. 3. There was an abnormal accumulation of hypertrophic chondrocytes in hypertrophic zone in distracted physis. 4. There was no evidence of anomalous cell proliferation, in the resting, proliferating and hypertrophic zones. These results conclude that the physeal distraction does not stimulate cell proliferation in the physis, even when it is seen to be thickened after the chondrodiatasis.

Extra-articular Triplane Fracture of Distal Tibial Physis / 대한정형외과학회잡지

We describe an extra-articular triplane fracture of distal tibia in a twelve-year-old boy. This variant of the triplane fracture has been largely ignored in the literature. The clinical significance of recognizing this fracture is that, although it constitutes an epiphyseal fracture, it remains extra-articular. We treated this case by open reduction and internal fixation of both distal tibia and fibula. However, unlike the standard triplane fracture that exits through the tibiot alar joint, this variant may be treated acceptably with less that an anatomical reduction, therefore avoiding the need for surgical management.