New method of Scoliosis Deformity Assessment: ISIS2 System.

Scoliosis deformity has been assessed using radiographic angle measurements. Surface topography systems are an alternative and complementary methodology. Working systems include the original ISIS1 system, Quantec and COMOT techniques. Over the last five years the new ISIS2 (Integrated Shape Imaging System) has been developed from basic principles to improve the speed, accuracy, reliability and ease of use of ISIS1. The aim of this study was to confirm that ISIS2 3D back shape measurements are valid for assessment and follow up of patients with scoliosis. Three-dimensional back measurements were performed in Oxford. ISIS2 includes a camera/projector stand, patient stand with a reference plane, and Mac computer. Pixel size is approximately 0.5 mm with fringe frequency of approximately 0.16 fringes/mm ( approximately 6.5 mm/fringe). Clinical reports in pdf format are of coloured images with numerical values. Reports include a height map, contour plot, transverse section plots, coronal plot, sagittal sections and bilateral asymmetry maps. A total of 520 ISIS2 scans on 242 patients were performed from February 2006 to December 2007. There were 58 male patients (median age 16 years, SD 3.71, min 7, max 25) and 184 female patients (median age 14.5 years, SD 3.23, min 5, max 45). Average number of scans per patient was 2.01 with the range of 1-10 scans. Right sided thoracic curves were the most frequent pattern. The median values and 95% CI are reported of back length; pelvic rotation; flexion/extension; imbalance; lateral asymmetry; skin angle; kyphosis angle; lordosis angle; volumetric asymmetry. ISIS2 scoliosis measurements are non-invasive, low-cost, three-dimensional topographic back measurements which can be confidently used in scoliosis assessment and monitoring of curve progression.

Modified mini-open technique with skin transillumination for decompression fasciotomy in the treatment of chronic exertional compartment syndrome.

Fasciotomy for chronic exertional compartment syndrome can be achieved by a variety of methods, many of which involve the blind passage of scissors or a fasciotome to release the affected compartments. We describe a modified open technique of fasciotomy which provides direct visualization of the fascia and the superficial peroneal nerve, using a single small incision. This technique requires a 4-cm longitudinal incision centered at the midpoint of the fibula. Subcutaneous tissues are dissected and a fascial incision is made. Langenbach retractors are used to lift the skin from either end of the wound. A light is used to transilluminate the skin proximal and then distal to the wound, and a fasciotome is used to extend the fasciotomies for both anterior and lateral compartments. Fasciotomy using this method was carried out on 20 cadaveric legs from 10 specimens. After decompression, a fulllength skin incision was made and the subcutaneous tissues were dissected to assess adequacy of release, anatomic course of the superficial peroneal nerve and complications. Fasciotomy was completed in twenty legs for both the anterior and lateral compartments. A complete fascial release was attained for both compartments in all legs. There were no retained fascial bands or nerve injuries. Fasciotomy using this method may be a safe and reliable method for compartment decompression, and may reduce iatrogenic risk to neurovascular and muscular structures in clinical practice.

Minor head injuries in children.

Traumatic head injury continues to be a major problem facing the pediatric specialists despite efforts to reduce its incidence. Aims of our study were assessment of the incidence of hospital admissions of children with minor head injuries, their treatment and outcome. In this prospective study we included 101 patient with head injury. We assessed the hospital admission criteria of children with minor head injuries, their length of stay, symptoms and neurological status, in-hospital imaging and consultations to other medical specialities, together with the outcome of patients on their discharge from the hospital. Of 101 patient 54 (53.46%) were male and 47 (46.53%) female. Average age was 3 years with age range from 5/52 to 12 years. Majority of patients (46.53%) were less than 1 year old. Fall was the most common mechanism of injury (92.07% of all patients). Injuries were witnessed in 51 case (50.49%), unwitnessed in 19 cases (18.81%) and unknown in 31 cases (30.69%). 95 patients did not have associated extracranial injuries, while 5 patients had associated lacerations and one had associated extracranial fracture. Length of stay was from 1 day in 80.19% of all cases to more than 2 days in 6.93%. GCS was recorded on admission and discharge and majority of patients were discharged with GCS of 15. 93% of admissions had no neurological deficit. 79% had 1 or more symptoms including vomiting, sleepiness, LOC and headaches. Over half of patients (55%) had no imaging done. 45 patients (45%) had skull x-ray. CT was performed in 7 (15%) patients and 7 fractures were found on x-ray and CT. 3 patients were admitted to ICU. All injuries were closed and all received conservative treatment. In less than 1 year old group of patients 95% of them were also seen by medical team and social worker. The outcome was good for all patients. We conclude that majority of patients with minor head injury could be supervised and observed at home by a competent care giver. Admitted patients need radiological evaluation, preferably a CT scan.