Short-term efficacy of digitally-assisted traditional Chinese medicine manual reduction combined with 3D printed splint in the treatment of AO type-A distal radius fractures / 中国骨伤

Objective To explore the short-term efficacy of digitally-assisted traditional Chinese medicine manual reduction combined with 3D printed splint in the treatment of AO type-A distal radius fractures, and explore the quantification of traditional Chinese medicine manual reduction and personalized improvement of splinting. Methods The clinical data of 50 patients with AO type-A distal radius fractures, who received treatment at the outpatient department of Cangzhou Integrated Traditional Chinese and Western Medicine Hospital in Hebei Province, were retrospective analyzed. The patient cohort included 22 females and 28 males, with ages ranging from 25 to 75 years old. Among them, 27 cases presented with distal radius fractures on the left side, and 24 cases on the right side. The patients were categorized into two groups: treatment group (n=25) and control group(n=25). There were 13 males and 12 females in the treatment group, with an average age of (56.2±5.5) years old. Treatment approach for this group involved several steps. Initially, Mimics Research software was used to conduct comprehensive analysis of complete CT data from the affected limb, resulting in the creation of a three-dimensional model. Subsequently, 3D models of the bones and skin contours, stored as STL format files, were imported into the Materialise Magics 23.0 software for model processing and repair. This facilitated the simulation of reduction and recording of displacement data, effectively generating a "digital prescription" to guide and quantify traditional Chinese medicine manipulation procedures. Finally, a personalized 3D printed splint was applied for fixation treatment. There were 15 males and 10 females in the control group, with an average age of (53.32±5.28) years old. These patients were treated with manualreduction combined with traditional splinting. The clinical efficacy of the two groups was assessed in terms of fracture reduction quality, fracture healing time, Gartland-Werley wrist joint score and X-ray parameters (palminclination angle, ulnar deviation angle, radius height) at 6 weeks post-operatively. Results The treatment group exhibited a shorter duration for achieving clinical healing compared to the control group (P<0.05). Six weeks post-operatively, the treatment group demonstrated higher wrist joint function scores, and a higher proportion of excellent and good outcomes than the control group(P<0.05). The treatment group was superior to the control group in terms of imaging parameters 6 weeks post-operatively (P<0.05). Conclusion By quantifying skin contours through digital simulation prescription reduction, a personalized 3D printed splint is developed to effectively stabilize fractures, enhancing localized fixation while ensuring greater adherence, stability, and comfort. This innovative approach offers personalized treatment for AO type-A distal radius fractures and presents a novel, precise treatment strategy for consideration.

A retrospective study on manual reduction combined with Chinese Orthopaedic ankle external fixator in the treatment of trimalleolar fracture / 中国骨伤

OBJECTIVE@#To evaluate the needle puncture safety and clinical efficacy of manual reduction combined with external fixation of ankle frame in the treatment of trimalleolar fracture under the guidance of Chinese Osteosynthesis (CO) theory.@*METHODS@#The clinical data of 118 patients with trimalleolar fractures admitted from December 2010 to December 2021 were retrospectively analyzed. Fifty-three patients were treated with manual reduction combined with external fixation of ankle frame(observation group). Sixty-five patients were treated with open reduction and internal fixation with plate and screws(control group). The operation time, hospitalization days, non-weight-bearing time of the affected limb, clinical healing time of fracture, incidence of complications, visual analogue scale (VAS) before and 1 month after operation, and American Orthopedic Foot and Ankle Society(AOFAS) score of ankle joint before and 1 year after operation were compared between the two groups.@*RESULTS@#Patients in both groups were followed up for more than 1 year. All patients were followed up, and the duration ranged from 14 to 70 months, with an average of(35.28±14.66) months. There were statistically significant in operation time, hospitalization days, non-load-bearing time of affected limbs, clinical healing time of fractures and VAS score one month after operation between the two groups. One month after operation, the VAS score of the observation group was lower than that of the control group(t=3.343, P=0.001). The operation time of the observation group was significantly shorter than that of the control group(t=9.091, P=0.000). The hospitalization days in the observation group were significantly less than those in the control group(t=5.034, P=0.000). The non-load-bearing time of the affected limb in the observation group was significantly shorter than that in the control group(t=11.960, P=0.000). The clinical healing time of fracture in the observation group was significantly shorter than that in the control group(t=4.007, P=0.000). There was no significant difference in AOFAS score between the two groups one year after operation(t=0.417, P=0.678). In the observation group, there were 2 cases of pinhole infection and 3 cases of loss of reduction less than 2 mm. There were 3 cases of surgical incision infection in the control group. There was no significant difference in the incidence of complications between the two groups(χ2=0.446, P=0.504).@*CONCLUSION@#Manual reduction combined with external fixation is safe and effective in the treatment of trimalleolar fracture under the guidance of CO theory, and the function of ankle joint recovers well after operation. This therapy has good clinical value.

Glenoumeral dislocation: a prospective randomized study comparing spazo and kocher maneuvers

OBJECTIVE: To evaluate and to compare the Spaso and Kocher reduction maneuvers in terms of efficiency, time of reduction, facileness, pain, discomfort to the patient, complications and risks, besides promoting the comparison between the two maneuvers, aiming to ground the emergency conduct. METHODS: A prospective study with 105 patients with acute shoulder dislocations were enrolled in the study between February 2011 and September 2012. The patients were randomized into two groups and they were submitted to the reduction of dislocation using the Spaso maneuver (group A) or the Kocher technique (group B) by first, second or third-year orthopedic surgery residents from our service. The results were evaluated and compared. RESULTS: There was no statistically significant difference between the two groups in terms of age, gender, timing of reduction, number of precedent episodes and complications after reduction. However, reduction was achieved in more cases using the Spaso method than it was among the Kocher group, as well as the mean duration of the reduction maneuver and discomfort were shorter in the group A patients. CONCLUSIONS: Both methods presented good results in terms of dislocation reduction and low complications rates. Nevertheless, the Spaso maneuver was more efficient, fast and easily applicable in comparison with Kocher's method. Level of Evidence I, Therapeutic.

Aplicación de los modelos mecanobiológicos en los procesos de regeneración ósea / Application of mechano-biological models in bone regeneration process / Mise en application des modèles biomécaniques dans les processus de régénération osseuse

Los modelos computacionales constituyen una herramienta necesaria en las investigaciones científicas. En este trabajo se muestra la utilización de las nuevas tecnologías, a través del Método de los Elementos Finitos en la implementación de los modelos mecanobiológicos usados en ortopedia. Se exponen los principales modelos mecano-reguladores que aparecen en la bibliografía y se ejemplifican las ventajas que proporcionan las técnicas de modelación en el pronóstico de la formación de nuevo tejido óseo, como respuesta biológica del organismo debido a la aplicación de cargas externas.

Computational models are a necessary tool in scientific researches. This paper deals with the use of new technologies, by using the Finite Element Method for the implementation of mechano-biological models used in orthopedic. Also the main mechano-regulator models are shown in this article, which are described in literature. On the other hand, the advantages provided by the modeling techniques during the prognosis of the new tissue formation, as a response of the organism to the application of external loads are stated by these authors.

Les modèles informatisées constituent un outil nécessaire dans les recherches scientifiques. Dans ce travail, on montre l’usage des nouvelles technologies, telle que la méthode des Éléments finis, dans la mise en application des modèles biomécaniques utilisés en orthopédie. On fait une révision des modèles mécano-régulateurs principaux apparus dans la littérature, et on met des exemples des bénéfices obtenus par les techniques de modélisation dans le pronostic de formation du nouveau tissu osseux comme réponse biologique du corps aux charges externes.

Comparison of Ponsetitechnique with Turco's posteromedial release in the management of congenital talipes equinovarus

To compare the results of Ponseti technique with one stage Turco's posteromedial release for correction of clubfoot in children of less than 12 month of age Comparative study Department of Orthopedics and Spine Surgery Postgraduate Medical Institute, Hayatabad Medical Complex Peshawar, from October 2008 September 2010. Patients were randomly selected by drawing lots, with even number included in group A [Ponseti Technique] and odd number in group B [Turco's posteromedial release]. Patients of either sex with age less one year having congenital talipes equinovarus were evaluated preoperatively by Pirani score, postoperatively by Mac Key score and were followed up for 2 years. Out of sixty patients, 23[38.3%] were males and 37 [61.7%] females. Fourteen [23.3%] patients had bilateral while 46 [76.7%] had unilateral deformity. Minimum age was 2 week, maximum 52 week and average 5.58 week. Using Pirani score preoperatively, there were 36[60%] patients with severe abnormality and 24[40%] feet were moderately abnormal. Using Mac Key score the functional results at last follow up in Group A were excellent in 16[26.7%], good in 13[21.7%] and failure noted in 1[1.7%] patient. At last follow up, functional results in Group B were excellent in 14[23.3%], good in 10[16.7%], fair in 4[6.7%] and poor in 1[1.7%] patient. Ponseti technique for an idiopathic clubfoot should be the choice for clubfeet. When there is recurrent deformity or resistant club foot then operative treatments may be considered

Experiencia del método Ponseti en tratamiento del pie Bot / Ponseti method as treatment of clubfoot

Introduction: The clubfoot is a common congenital foot condition. Classical methods as manipulations and surgery by itself have failed to effectively resolve the problem. Ponseti proposes a treatment by serial manipulations and Achilles tenotomy as needed which has excellent long term results. Objectives: Evaluate patients treated at our institution with Ponseti method between 2001 and 2007. Material and Methods: Review of 25 patients (34 feet) treated primary in our institution. Clinical follow up with Dimeglio score. Evaluation of recurrences, tenotomies and other additional surgeries. Results: An average of 7 manipulations and casts per child. 96 percent (24) required a percutaneous Achilles tenotomy. Dimeglio Score average pretreatment 12.44 and posttreatment 2.20 (p < 0.0001). 44 percent (11 children) required additional surgery: 8 percent (2) achilles lengthening, 16 percent (4) transposition of the anterior tibial and 20 percent (5) posteromedial lateral release. One of these children besides required a tibial and calcaneal osteotomy. In all cases of additional surgeries Dimeglio Score decreased from the pre surgery. Only one child presented a complication for avascular necrosis of the skin. Conclusions: The Ponseti method is reproducible and gives good results and few complications. In comparison with the literature, our rate of additional surgery is higher, which could be explained as part of a learning curve typical of a center with only 6 years of experience.

Introducción: El pie bot es una patología congénita frecuente del pie. Los métodos de manipulación clásicos y la cirugía por sí sola no han logrado solucionar efectivamente el problema. Ponseti plantea un tratamiento mediante manipulaciones seriadas y tenotomías aquilianas según necesidad, el cual presenta excelentes resultados a largo plazo. Objetivos: Evaluar los pacientes tratados en nuestro centro con método de Ponseti entre los años 2001 y 2007. Tipo de Estudio: Revisión de 25 pacientes (34 pies) tratados en forma primaria en nuestro centro. Seguimiento de la evolución clínica con el score de Dimeglio. Evaluación número de recidivas, tenotomías y requerimiento de cirugía adicional. Resultados: Se utilizó un promedio de 7 manipulaciones y yesos por niño. 96 por ciento (24) requirió una tenotomía aquiliana percutánea. Score Dimeglio promedio pretratamiento 12.44 y post tratamiento 2.20 (p < 0,0001). Un 44 por ciento (11 niños) requirieron cirugías adicionales: 8 por ciento (2) alargamiento aquiliano, 16 por ciento (4) transposición del tibial anterior y 20 por ciento (5) liberación posteromedial lateral. Uno de estos niños requirió además una osteotomía desrrotadora tibial y una osteotomía calcáneo bilateral. En todos los casos de cirugía adicional, el score de Dimeglio presentó una disminución respecto al de pre quirúrgico. Sólo un niño presentó una complicación correspondiente a la necrosis avascular de la piel. Conclusiones: El Método Ponseti es reproducible y ofrece buenos resultados y escasas complicaciones. En comparación con la literatura descrita, nuestra tasa de cirugías adicionales es mayor, lo cual se podría explicar como parte de una curva de aprendizaje propia de un centro con solo 6 años de experiencia.

[Comparison the method of wrist supination with elbow flexion as classical method with hyperpronation method in reduction of radial head subluxation in less than 7 years old children]

The radial head subluxation is a common cause in less than 7 years old children who refered to emergency center after pulling of their wrist by parents. Compare the method of wrist supination with elbow flexion as classical method with hyperpronation method in reduction of radial head subluxation [pulled elbow] in children less than 7 years old referig to poorsina hospital during 2004-2009. In this randomized clinical trial, children who had referred to Poursina orthopedic emergency center with clinical diagnosis of radial head subluxation were studied consequent. Patients were randomly treated as consequent male and female with one of two methods. The patients were checked in order to diagnosis extremity functions return every 5 minutes. If extremity function had not returned, the primary method was repeated after 15 minutes. Unsuccessful treatment led to treatment with another method 30 minutes after first try. That method repeated if replacing method was not successful after 15 minutes. If both methods were unsuccessful, elbow radiography to roll-out other injury was performed. After collecting data, analysis was performed using chi- square test and T- test with SPSS software version 16. Among 110 patients were included in this study with average age [4.05 +/- 1.51 years] 58 patients [3.91 +/- 1.41 years] with first method [SF] and 52 patients [4.21 +/- 1.62 years] with second method were treated. [P=0.31]%62.7 of patients were male and the remaining were female [%37.3]. In 47 patients [%90.4] of 52 patients who were treated by [HP] method. This was 46 patients [%79.3] from 58[P=0.11]. Five patients of [HP] group needed second attempt where as this number were 12 about [F] group. Treatment with [HP] method was successful in 100 percent patients, but successful rate was%87.9 for [SP] method. There was significant superiority of [HP] success in comparison to [SF] [P+0/006]. In reduction of radial head subluxation [HP] method was more successful upination method in reduction of radial head, it is more successful than supination, when supination was not successful than [SF] method

Terapia manipulativa ortopédica na dor vertebral crônica: uma revisão sistemática / Manipulative orthopedic therapy for chronic spinal pain: a systematic review

Analisar a eficácia da Terapia Manipulativa Ortopédica (TMO) nos casos de dores vertebrais crônicas. Métodos: Uma busca sistematizada foi realizada nas bases de dados PEDro, Medline e Science Direct no mês de junho de 2010, reunindo ensaios clínicos randomizados recentes que documentassem os efeitos da TMO na Dor Vertebral Crônica. Todos os trabalhos tiveram suas qualidades metodológicas avaliadas pela escala de PEDro e somente os estudos com notas acima de cinco foram revisados. Os dados foram extraídos de forma padronizada de cada estudo. Resultados: Foram revisados oito artigos sobre dor cervical crônica e onze sobre dor lombar crônica. Quanto a dor cervical crônica, seis estudos mostraram que a TMO associada a exercícios são eficazes, mantendo a melhora dos sintomas por até 24 meses. Um estudo mostrou que a TMO (sem exercícios) é superior à massagem e outro estudo mostrou que a TMO proporciona alívio imediato da dor. Quanto a dor lombar crônica, cinco ensaios clínicos mostraram que a TMO associada a exercícios são eficazes a curto e longo prazo; dois trabalhos mostraram que a TMO é mais eficaz do que analgésicos e anti-inflamatórios. Três estudos mostram que a TMO como único tratamento é eficaz, um estudo mostra que a manipulação não é mais eficaz que exercícios de extensão. Conclusão: As técnicas de TMO (exceto osteopatia) são recursos eficazes nos casos de dores crônicas da coluna. Entretanto, seus efeitos de redução da dor ocorrem somente a curto prazo, sendo necessário a associação de exercícios terapêuticos para um resultado eficaz a longo prazo. Mais estudos devem ser feitos para comparar diferentes técnicas de TMO e diferentes técnicas de exercícios entre si nos casos de dores crônicas da coluna.

To examine the effectiveness of Manipulative Orthopedic Therapy (MOT) in cases of Chronic Vertebral Pain. Methods: a systematic search was performed in PEDro, Medline, and Science Direct databases in June 2010, retrieving recent randomized clinical trials that documented the effects of MOT in Chronic Vertebral Pain. All of the studies had their methodological quality assessed by the PEDro scale and only those studies with scores higher than five were reviewed. Data were extracted in a standardized manner for each study. Results: Eight articles about chronic cervical pain and eleven articles about chronic low back pain were reviewed. On chronic cervical pain, six papers showed that MOT associated with exercises was effective, maintaining the improvement of symptoms for up to 24 months. One study showed that MOT (with no exercises) was better than massage and another study showed that MOT provided immediate pain relief. In chronic low back pain, five clinical trials showed that MOT associated with exercises was effective in the short and long term; two papers showed that MOT was more effective than analgesics and anti-inflammatory drugs. Three studies showed that MOT is effective as a single treatment and one study showed that MOT is no more effective than stretching exercises. Conclusion: The MOT techniques (except osteopathy) are effective remedies in cases of chronic spinal pain. However, its effects in reduction of pain occur only in the short term and the combination of therapeutic exercises is needed for an effective long term result. More studies should be made to compare different MOT techniques and different exercise techniques with each other in cases of chronic spinal pain.

Clubfoot management by the Ponseti technique in Saudi patients

To assess the effectiveness of the Ponseti technique in the treatment of clubfoot in Saudi children. The data of 175 patients [235 feet], who presented with clubfeet from September 2002 to June 2008 and who were treated with the Ponseti technique at King Abdulaziz Medical City in Riyadh, Kingdom 0f Saudi Arabia were collected and studied retrospectively. The Pirani score for clubfoot evaluation was used in this study. Age ranged from one week to 48 weeks, with an average age of 6.5 weeks. The average follow up was 37 months [range one year to 6 years and 7 months]. The average time to obtain correction was 5.3 weeks [range 4-10 weeks]. Six patients [8 feet] [3.4%] were not corrected with initial casting and required early surgery. Full correction was obtained in 169 patients [227 feet] [96.6%]. Tenotomies were performed in all but one patient [2 feet] [0.9%]. Thirty-four patients [48 feet] [21.1%] relapsed. One hundred and seventy-nine feet [78.9%] required no further treatment, and only 4 feet [1.8%] required a more extensive posterior-medial release. Minor complications were noted in 14 patients [18 feet] [7.9%]. The Ponseti technique is a safe and effective conservative treatment of clubfoot that decreases the number of surgical interventions needed for the correction of the deformation in our Saudi patients. It is an easy method to understand and to apply by most orthopedic surgeons

La importancia de la traslación anterior del talus en el esguince de tobillo / The importance of talus anterior translation in ankle sprain

En Chile, el Esguince de tobillo es una de las consultas más frecuentes en los diversos establecimientos de salud, así también es una de las lesiones más recurrentes en las distintas disciplinas deportivas. La concepción patomecánica de la lesión conlleva a conceptos que comúnmente no son incorporados en la evaluación y tratamiento del paciente. Específicamente la traslación anterior del talus, limitando los movimientos osteokinemáticos como los artrokinemáticos que sumados a la alteración del Sistema Capsuloligamentoso, la Geometría Articular y el Sistema Activo, favorecen a la inestabilidad y prolongan el tiempo de recuperación funcional. Es por eso que la Terapia Manual, propone como acción terapéutica una técnica de alta velocidad y baja amplitud, que permita restaurar la relación de congruencia articular en esta disfunción. Se ha demostrado que una técnica de alta velocidad y baja amplitud, permite mejorar el pronóstico, optimizando el resultado y disminuyendo los tiempos de recuperación. En esta revisión de la literatura actualizada se pone en evidencia la importancia que tiene la traslación anterior del talus en el Esguince de Tobillo grado II.

In Chile, the ankle sprain is one of the most frequent consultation at health departments, and also one of the most recurrent injuries in athletic activities. The pathomecanic understanding of the injury leads findings that are commonly not incorporated in evaluation and treatment of patients. Specifically the anterior translation of the talus, limiting the osteokinematic and arthrokinematic motions, that add to the alteration of capsule and ligaments, joint geometry and active system leads to instability and long term functional recovery. That is way Manual Therapy, offers as a therapeutic action a high velocity and low amplitude technique, that allows to restore the joint congruence of this dysfunction. It has been proved that a high velocity and low amplitude technique, allows to improve prognoses, optimizing the results and decreasing time of recovery. This revision of actualized literature put in evidence the importance of talus anterior translation.

Luxação glenoumeral anterior aguda: estudo comparativo entre métodos de redução incruenta / Acute anterior glenohumeral dislocation: comparative study between methods of bloodless reduction

Objetivo: Avaliar a efetividade da manobra de Spaso, utilizada para a redução incruenta da luxação glenoumeral anterior aguda, tendo como parâmetro a comparação com a manobra de tração e contratração. Métodos: Fo-ram alocados 40 pacientes de forma randomizada em dois grupos, segundo a manobra de redução utilizada. No grupo I foi realizada a manobra de Spaso e, no grupo II, a de tração e contratração. Os dois grupos não apresentaram diferenças quanto ao sexo, idade, tempo de luxação e número de episódios anteriores de luxação glenoumeral anterior aguda. Resultados: A avaliação realizada após a redução mostrou que a dor, medida pela escala visual analógica, foi, em média, de 4,2 no grupo I e de 6,9 no grupo II (p < 0,05). Quanto ao tempo para a realização da manobra, no grupo I foi, em média, de 2,2 minutos e, no grupo II, de 7,4 minutos (p < 0,05). O índice de sucesso no grupo I foi de 89,5% e, no grupo II, de 85%, resultados compatíveis com os da literatura. Não foram observadas complicações relacionadas aos dois métodos. Conclusão: Os autores observaram que a manobra de Spaso se mostrou de fácil reprodutibilidade, rápida aplicação, sendo alternativa viável para a redução incruenta da luxação glenoumeral anterior aguda.

A capsular dilatation facilitated shoulder manipulation for treating patients with frozen shoulder.

Forty patients with a diagnosis of frozen shoulder who had symptom for an average of 8 months and failed conservative treatment of at least 6 weeks of physical therapy were treated with capsular dilatation facilitated shoulder manipulation. Post-manipulation, the patient underwent arthroscopy for visualization, fibrin debridement and bleeding point coagulation. All the essential intra-articular structures ie, glenohumeral ligament, rotator cuff were intact. Post-operatively, all patients revealed substantial gain in shoulder range of motion as well as diminished shoulder pain. The average flexion, abduction, and internal rotation gain were 76.9+/-8.9, 18.1+/-5.7, 9.6+/-7.1 degrees respectively. External rotation gain in the position of 90 degrees shoulder abduction and shoulder adduction were 53.0+/-9.97 and 31.4+/-7.2 degrees respectively. The average pain score by visual analogue scale pre and 6-month post-manipulation were 80.6+/-8.6 and 7.6+/-7.3 respectively with the average of pain score of 73.0+/-10.4. The authors proposed an effective and safe technique employing intra-articular pressure to facilitate shoulder manipulation in order to treat frozen shoulder.

Abordaje lateral directo vs abordaje posterolateral en artroplastía total primaria de la cadera / Lateral versus postero-lateral approach for primary total hip replacement

La elección de la vía de acceso a la articulación de la cadera puede parecer de fácil decisión sin embargo deben considerarse aspectos importantes que nos brindan una mayor exposición, seguridad y éxito en la colocación del implante. El objetivo es determinar los eventos no deseados en la realización de la vía de acceso a la articulación de la cadera y que aumentaron la morbilidad de los pacientes en la artroplastía total de la cadera. Se revisaron 267 pacientes en el periodo de marzo de 1993 a diciembre de 1997 todos con artroplastía total primaria de la cadera, utilizando abordaje lateral directo en 153 de los cuales 25 (9.36 por ciento) cursaron con insuficiencia del glúteo medio. El abordaje posterolateral se hizo en 114 pacientes presentando en su evolución postoperatoria paresia del nervio ciático en 12 (4.49 por ciento). Estos como principales eventos no deseados y secundarios a la realización del abordaje. La elección del abordaje no influyó en los resultados para la colocación del implante ya que los dos tipos dan amplia exposición, las lesiones que se presentaron son dependientes de la habilidad del cirujano por lo que la elección depende de la habilidad quirúrgica del cirujano para el manejo de las estructuras anatómicas que se exponen

Criterios para el tratamiento de las lesiones fisiarias / Criteria for treatment of physeal fractures

Se presenta una serie de 20 niños con fracturas fisiarias, con la siguiente distribución: tipo I, 2 casos. Tipo II, 11. Tipo III, 5 casos y tipo IV, 2. Los tipos I, II y III (18 casos) se trataron mediante manipulación cerrada y los 2 de tipo IV, mediante reducción abierta y fijación con alambres de kirschner. Esta últimas son las que tienen el mayor riesgo de consolidación viciosa por la formación de puentes epifisiometafisiarios

Management of idiopathic congenital talipes equino varus [CTEV] at Jinnah post graduate medical center, Karachi

A total of 146 patients with 208 congenital talipes equino-varus [CTEV] deformities were registered for study from August 1978 to July 1986. The patients presenting with idiopathic CTEV were included in this study and those having deformities secondary to other causes such as cerebral palsy, meningomyelocele, arthrogryposis multiplex congenita or poliomyelitis were excluded. There were 94 male and 52 female patients with age range of one day to four years. Hundred four patients with 160 deformed feet completed the five year follow up. The deformities in these patients were classified according to Harrold and Walker grading system. Sixty four patients with 96 CTEV were treated non-operatively with serial gentle manipulation and plaster casts. Forty patients with 64 deformed feet were managed by modified Turco's posteromedial release. 86.4% good and fair results were achieved in non-operative group and 90.6% good and fair in operative group

Tratamiento del mal de Pott con déficit neurológico / Treatment of Pott's disease with neurologic damagae

Treinta pacientes con mal de Pott cérvico-torácico, torácico-lumbar o lumbar y con déficit neutológico fueron tratados con drenaje del absceso, descompresión, vertebrectomía, colocación de injerto por vía anterior y por vía posterior con resección del arco posterior, artrodesis e instrumentaci'pon segmentaria con barras de Luque en un segundo tiempo. Se midieron las cifosis radiográficasmente (método de Cobb) y se clasificaron de acuerdo a su lesión neurológica (clasificación de Frankel). El promedio de la angulación cifótica preoperatoria, 69 grados, se redujo a 47 grados postoperatoriamente y a 50 grados en su última medición (se perdieron 3 grados de corrección). Veintitrés pacientes (76.7 por ciento) recuperaron una función neurológica normal (Frankel E); seis pacientes (20 por ciento) pudieron caminar con ayuda de muletas axilares (Frankel D) y un paciente realiza la marcha asistido por muletas axilares y con aparato maslopodálico bilateral (Frankel B). Tuvimos una complicación significativa con deterioro neurológico. Otras complicaciones fueron protrusión y ruptura de las barras, infección supurativa superficial, entre otras, que se manejaron sin mayor deterioro. En conclusión, se obtuvieron buenos resultados ya que se corrigió la cifosis y cambió por lo menos un grado de mejoría neurológica por lo cual algunos pasaron de B a E en la clasificación neurológica de Frankel utilizando el tratamiento completo de descompresión por vía anterior y fijación posterior.

Epifisiodesis parcial unilateral: informe preliminar / Partial unilateral epiphysiodesis: preliminar report

A dos grupos de niños con genu valgo o varo excesivo se les practicó una epifisiodesis parcial unilateral que permitió que el crecimiento restante alineara la extremidad. En el grupo I (16 extremidades), se utilizó una guía de predicción para determinar la edad ósea en que se debía efectuar la epifisiodesis parcial. En el grupo II (15 extremidades) sólo se estimó la edad para efectuar el procedimiento. La epifisiodesis parcial se efectuó mediante la técnica abierta descrita por Phemister, o mediante la técnica percutánea descrita por Bowen; en el grupo I la corrección del genu valgo/varo siguió la evolución precicha, mientras que el grupo II hubo diferencia promedio de 9.1 grados. La técnica percutánea dio el mismo resultado que la técnica abierta. Nuestra conclusión es que el genu valgo/varo en niños con un adecuado potencial de crecimiento puede ser corregido usando la guía de predicción de crecimiento para determinar la edad ósea adecuada en que debe efectuarse el procedimiento percutáneo que da un resultado cosméticamente excelente.

Tratamiento de discrepancias en miembros inferiores con el método de Ilizarov / Treatment of lower limb discrepancy by the Ilizarov technique

Se trataron 45 pacientes con aparato de Ilizarov para distracción de deformidad angular. A 35 enfermos de les realizó distracción en siete casos el aparato se utilizó como fijador, en cuatro para transportación ósea, en ocho para compresión y para corrección de deformidad angular en un paciente. La valoración periódica de los niños nos permite identificar y resolver problemas, obstáculos o complicaciones en una forma temprana. Los mejores resultados en alargamiento se obtuvieron con corticotomías de baja enegía y con localización metafisaria. El ritmo de distracción fue de un milímetro por día fraccionado, con una variante de medio a dos milimetros dependiendo de la edad y características de la producción del hueso. El periodo de consolidación fue aproximadamente el doble del de distracción. De los 45 pacientes, cinco presentaron infecciones superficiales de los trayectos de los clavos, las cuales cedieron con antibióticos y lavado diario.

Tratamiento de la luxación congénita de la cadera en niños mayores de 18 meses / Treatment of congenital dislocation of the hip in children over 18 months

Se presentan 24 casos de luxación congénita de la cadera tratados mediante reducción abierta y osteotomía innominada tipo Salter. La edad de los pacientes fue desde año y medio hasta ocho años y nueve meses. Se establecen las indicaciones para realizar el procedimiento, se enuncian los conceptos de la reducción abierta y las bases de la osteotomía. Los resultados fueron calificados de acuerdo con la clasificación de Wilkinson. En 19 caderas los resultados fueron satisfactorios. Los mejores resultados se obtuvieron en los pacientes menores de cuatro años. Hubo cuatro complicaciones, todas ellas en mayor de cuatro años: dos necrosis avasculares y dos reluxaciones.