ABSTRACT
Changes of bone during pregnancy and during lactation evaluated by bone mineral density (BMD) may have implications for risk of osteoporosis and fractures. We studied BMD in women of differing ages, parity, and lactation histories immediately postpartum for BMD, T-scores, and Z-scores. Institutional Review Board approval was received. All women while still in hospital postpartum were asked to participate. BMD was performed by dual-energy X-ray absorptiometry (DXA) machine at femoral neck (FN) and lumbar spine (LS) by a single technician. Of 132 participants, 73 (55.3%) were ≤30 years; 27 (20.5%) were primiparous; 36 (27.3%) were grand multiparous; 35 (26.5%) never breast fed. Mean FN T-scores and Z-scores were higher than respective mean LS scores, but all means were within the normal limits. Mean LS T-scores and Z-scores were highest in the grand multiparas. There were only 2 (1.5%) outliers with low Z-scores. We conclude that, in a large cohort of Israeli women with BMD parameters assessed by DXA within two days postpartum, mean T-scores and Z-scores at both the LS and FN were within normal limits regardless of age (20-46 years), parity (1-13 viable births), and history of either no or prolonged months of lactation (up to 11.25 years).
ABSTRACT
BACKGROUND: Ponseti demonstrated the correction of clubfoot in infants using manipulation followed by the application of well-molded long-leg plaster casts. Percutaneous Achilles tenotomy was recommended to correct residual equinus contracture in approximately 80% of cases. In the current study, we evaluated the safety of this practice for the treatment of clubfoot when performed as an "office procedure" without sedation or general anesthesia during the final stage of the serial casting protocol. PATIENTS AND METHODS: We retrospectively collected data regarding babies who underwent serial manipulation and casting according to the Ponseti protocol for the treatment of clubfoot. All babies managed in the outpatient clinic between 2006 and 2010 were included. Tenotomy was indicated when the forefoot was completely corrected and if the hind-foot showed rigid equinus. Tenotomy was performed by a single scalpel stab in the outpatient clinic, using topical and local anesthesia (without general anesthesia or sedation). The cast was then applied and kept on for 3 weeks. Babies were discharged home after 1 hour of supervision. Surgical reports regarding Achilles tenotomy were reviewed, and data were collected from postoperative notes. We specifically looked for perioperative complications, recovery unit notes, and hospital readmission. RESULTS: Fifty-six babies (83 feet) were included in the current study. There were 40 males and 16 females, and 27 of them had bilateral clubfoot. Three babies (0.5%) had complex (syndrome-related) clubfoot; familial risk was known in 6 (11%) babies. Forty-one (73%) babies were indicated for Achilles tenotomy. Tenotomy was performed after an average of 5 casts (range, 3 to 9). No adverse events were related to local anesthesia and/or the procedure itself, and there was no delay in discharge in any of the operated babies. One baby was evaluated in the emergency room 3 days after the procedure because of (unfounded) parental concern of swelling inside the cast. All other babies had an uneventful course. Retenotomy was performed in 7 babies (12 feet); 2 of them (4 feet) had complex clubfoot. All of these babies (ie, their parents), except 1, had moderate to poor compliance with the treatment protocol. CONCLUSIONS: Tenotomy as an office procedure using topical and local anesthesia is a safe procedure. It does not incur a substantial rate of readmission to the emergency room, either because of parental concern or because of actual complications. The need for retenotomy is related to a low compliance with the treatment protocol. LEVEL OF EVIDENCE: Level II.
