Subject(s)
Osteotomy , Humans , Osteotomy/methods , Elbow Joint/surgery , Humeral Fractures/surgery , Child , Treatment OutcomeABSTRACT
OBJECTIVES: The primary objective of the present study is to compare the radiographic outcomes and complications of two different techniques for lateral closing-wedge osteotomy in pediatric patients with cubitus varus. METHODS: We retrospectively identified patients treated at five tertiary care institutions: 17 underwent the Kirschner-wire (KW) technique, and 15 patients were treated with the mini external fixator (MEF) technique. Demographic data, previous treatment, pre- and postoperative carrying angle (CA), complications and additional procedures were recorded. Radiographic evaluation included assessment of the humerus-elbow-wrist angle (HEW), and the lateral prominence index (LPI). RESULTS: Patients treated with both KW and MEF achieved significant improvements in clinical alignment (mean pre-op CA -16 ± 6.1 degrees to mean post-op 8.9 ± 5.3 degrees, P < 0.001). There were no differences in final radiographic alignment or radiographic union time; however, time to achieve full elbow motion was faster in the MEF group (13.6 versus 34.3 weeks, P = 0.4547). Two patients (11.8%) in the KW group experienced complications, including one superficial infection and one failed correction that required unplanned revision surgery. Eleven patients in the MEF group underwent a planned second surgical procedure for hardware removal. CONCLUSIONS: Both fixation techniques are effective at correcting cubitus varus in the pediatric population. The MEF technique may have the advantage of shorter recovery of elbow range of motion but may require sedation for hardware removal. The KW technique may present a slightly higher complication rate.
Subject(s)
Elbow Joint , Humeral Fractures , Joint Deformities, Acquired , Humans , Child , Humeral Fractures/complications , Humeral Fractures/diagnostic imaging , Humeral Fractures/surgery , Retrospective Studies , Treatment Outcome , Joint Deformities, Acquired/diagnostic imaging , Joint Deformities, Acquired/surgery , Osteotomy/methods , Elbow Joint/diagnostic imaging , Elbow Joint/surgery , Range of Motion, ArticularABSTRACT
Growth modulation (GM) with tension-band plates (TBPs) by tethering part of the growth plate is an established technique for the correction of angular deformities in children, and it has increasingly supplanted more invasive osteotomies.Growth modulation with TBPs is a safe and effective method to correct a variety of deformities in skeletally immature patients with idiopathic and pathological physes. The most common indication is a persistent deformity in the coronal plane of the knee exceeding 10°, with anterior and/or lateral joint pain, patellofemoral instability, gait disturbance, or cosmetic concerns. GM has also shown good results in patients with fixed flexion deformity of the knee and ankle valgus.This paper reviews the history of the procedure, current indications, and recent advances underlying physeal manipulation with TBPs. Cite this article: EFORT Open Rev 2021;6:658-668. DOI: 10.1302/2058-5241.6.200098.
ABSTRACT
Introducción: El tratamiento actual de la úlcera péptica en su etapa aguda es la erradicación del Helicobacter pylori (HP) junto con tratamiento de la úlcera con inhibidores de la bomba de protones (IBP). Objetivos Determinar el costo del tratamiento de erradicación con 2 antibióticos por 7 ó 14 días y el costo de diferentes inhibidores de la bomba de protones por 42 días. material y Método: Se revisó un documento farmacológico que contenía los precios de todos los medicamentos con un valor promedio de dólares de 670 pesos. Se analizó presentaciones, dosis y costo del tratamiento. Resultados: Hubo una importante variación de precios de los 2 antibióticos evaluados: Claritromicina y Amoxicilina, con costos que variaban entre 11.000 y 26.000 por 7 días. En cuanto a IBP hay 19 Omeprazoles en el merfcado nacional, con costos de tratamiento por 42 días que varían entre 2.922 pesos y 33800 pesos. Hay 5 Lanzoprazoles y 3 Pantoprazoles. El costo final de todo el tratamiento completo puede variar entre 14.229 pesos y 116.936 pesos. Conclusiones: Los costos de este tratamiento son muy variables y afectan fuertemente el presupuesto de los pacientes. por lo tanto, los médicos que prescriben estos tratamientos deben estar informados claramente de los costos.
