ABSTRACT
BACKGROUND: The Ponseti method has been shown to be the most effective treatment for congenital clubfoot. The current challenge is to establish sustainable national clubfoot treatment programs that utilize the Ponseti method and integrate it within a nation's governmental health system. The Brazilian Ponseti Program (Programa Ponseti Brasil) has increased awareness of the utility of the Ponseti method and has trained >500 Brazilian orthopaedic surgeons in it. METHODS: A group of 18 of those surgeons had been able to reproduce the Ponseti clubfoot treatment, and compiled their initial results through structured spreadsheet. RESULTS: The study compiled 1040 patients for a total of 1621 feet. The average follow-up time was 2.3 years with an average correction time of approximately 3 months. Patients required an average of 6.40 casts to achieve correction. CONCLUSIONS: This study demonstrates that good initial correction rates are reproducible after training; from 1040 patients only 1.4% required a posteromedial release. LEVEL OF EVIDENCE: Level IV.
Subject(s)
Casts, Surgical , Clubfoot/therapy , Manipulation, Orthopedic/methods , Tenotomy , Achilles Tendon/surgery , Child, Preschool , Developing Countries , Female , Health Services Accessibility/standards , Humans , Infant , Male , Program Evaluation , Tenotomy/methods , Treatment OutcomeABSTRACT
BACKGROUND: After hearing about the reproducible and excellent results of the Ponseti method for clubfoot treatment, a group of Brazilian orthopaedic surgeons organized and participated in a standardized national program to teach the Ponseti technique in 21 different cities across Brazil. METHODS: A total of 21 Ponseti symposiums were organized in a standard fashion from January, 2007 to December, 2008. They consisted of a two-day program with lectures, hands-on cast application, and discussion of local clinical cases presented by orthopaedic surgeons. Thirteen Brazilian orthopaedic surgeons, who had been trained by the University of Iowa or centers recognized by them, taught the method. Financial support for travel was provided by an English charity: La Vida (Vital Investment for Developing Aid in Latin America). The physicians who attended the symposiums answered questionnaires before and after the training. RESULTS: About 7% of the 8000 orthopaedic surgeons in Brazil (556 orthopaedic surgeons) were trained. These orthopaedic surgeons stated that they had treated about 4905 babies in the previous year via other methods, including extensive surgery. Seventeen percent of the surgeons did not know about the Ponseti technique at the start of the symposium. Eighty-eight percent reported they felt able to treat children with the Ponseti technique after the symposium. Ninety-four percent of respondents reported that the symposium changed their way of treating clubfoot CONCLUSIONS: These Ponseti symposiums brought about an exchange of medical information and empowered the participants. This program is a good educational tool which can be used in eradicating neglected clubfoot in Brazil.
Subject(s)
Casts, Surgical , Clubfoot/therapy , Education, Medical, Continuing/organization & administration , Musculoskeletal Manipulations , National Health Programs/organization & administration , Orthopedics/organization & administration , Attitude of Health Personnel , Brazil/epidemiology , Casts, Surgical/statistics & numerical data , Child , Clubfoot/ethnology , Education, Medical, Continuing/standards , Education, Medical, Continuing/statistics & numerical data , Health Services Accessibility/organization & administration , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Humans , Information Dissemination , Musculoskeletal Manipulations/statistics & numerical data , National Health Programs/standards , National Health Programs/statistics & numerical data , Orthopedics/education , Orthopedics/statistics & numerical data , Physicians/psychology , Physicians/statistics & numerical data , Pilot Projects , Program Evaluation , Surveys and QuestionnairesABSTRACT
Congenital femoral deficiency in children can be treated with femoral lengthening. A common complication is fracture soon after removal of the external fixator, often despite prophylactic hip spica cast application. These fractures present special challenges because the patients have tight soft tissues and sclerotic intramedullary canals. We treated nine such fractures in eight children (average age, 5.4 years). Most were 'spontaneous' events resulting in transverse fracture through regenerate bone or pin sites. All were stabilized with intramedullary Rush pins using special insertion techniques. Union was achieved (average, 6 weeks); no significant complications occurred. We describe details of the surgical technique.
Subject(s)
Bone Lengthening/methods , Femoral Fractures/surgery , Fracture Fixation, Intramedullary/methods , Leg Length Inequality/surgery , Bone Nails , Child, Preschool , Female , Humans , Male , Treatment OutcomeABSTRACT
Objetivo. Evaluar los resultados del tratamiento quirúrgico efectuado en pacientes con complicaciones de la úlcera péptica (perforación y hemorragia) en un grupo de pacientes mayores de 61 años, comparándolos con un grupo de enfermos menores de 60 años. Sede. Servicio de Cirugía General del Hospital General del Centro Médico Nacional La Raza del IMSS en México. Diseño. Estudio observacional, retrospectivo, longitudinal. Pacientes. Se revisaron los expedientes clínicos de 65 sujetos menores de 60 años y los de 39 mayores de esa edad(total0=104). Se formaron 4 grupos. Métodos. Se analizaron las siguientes variables: tipo de complicación, tipo y localización de la úlcera, factores de riesgo, tipo de operación realizada, morbilidad y mortalidad encontradas. Resultados. cincuenta y dos pacientes menores e 60 años presentaron úlcera perforada (duodenal en 10, gástrica en 3) (Grupo III). Fueron 31 pacientes mayores de 61 años los que presentaron úlcera perforada (duodenal 22 y gástrica en 9) (Grupo II). En 8 enfermos mayores de 61 años se presentó hemorragia (en el duodeno en 5 y en estómago en 3) (grupo IV). Los factores de riesgo encontrados en los pacientes mayores de 61 años fueron: Cronicidad de la enfermedad (más de 10 años de evolución) en 40 por ciento, enfermedades asociadas tales como: Hipertensión arteriar, diabetes mellitus, enfermedad pulmonar restrictiva y cardiopatía aterosclerosa en un 80 por ciento. El tipo de tratamiento quirúrgico realizado fue el siguiente: Grupo I: 92 por ciento (48 pacientes) fueron tratados sólo con cierre primario lavado y drenaje de la cavidad, en 4 enfermos (7.7 por ciento) se realizó cirugía definitiva. En el Grupo II: 87 por ciento (27 pacientes) fueron tratados con cierre primario, lavado y drenaje de la cavidad abdominal, en 4 (13 por ciento) se realizó cirugía definitiva. En el Grupo III: En el 77 por ciento (10 sujetos) se empleó cirugía definitiva y en 3(23 por ciento) sólo ligadura del vaso hemorrágico. En el Grupo IV: al 75 por ciento (6 sujetos) se les practicó cirugía definitiva y en 2 (25 por ciento) sólo ligadura. Las complicaciones fueron más frecuentes en los pacientes tratados con cirugía conservadora y la mortalidad fue mayor en el grupo de pacientes con edad superior a 60 años, con un 30 por ciento de mortalidad en los operados con cirugía definitiva, contra un 6.9 por ciento de los tratados con cirugía conservadora.
