RESUMO
Purpose: Flexible intramedullary nailing is regularly applied for pediatric displaced unstable forearm fractures. When compared to closed reduction and casting (orthopedic treatment), flexible intramedullary nailing decreases malalignment, shortens immobilization time, and should decrease follow-up controls. Comparing flexible intramedullary nailing and orthopedic treatment in the clinical, radiological, and financial managements of these fractures was performed. Methods: Retrospective 5 years study of pediatric cases in two pediatric orthopedic university departments. Treatment method, post-operative course, and radiological follow-up were reviewed. Number of radiographs, follow-up controls, type and duration of immobilization, final bone angulation, and reported complications were compared. Extensive financial analysis was completed. Results: Of 73 girls and 168 boys included in the study, 150 were treated by flexible intramedullary nailing and 91 by orthopedic treatment. No difference was noted with regard to total number of radiographs (7.3 vs 7.2, respectively). Total number of follow-ups was 6.4 and 5.5, respectively. Malalignment occurred in two flexible intramedullary nailing and sixteen orthopedic treatments. The least expensive cost was ambulatory orthopedic treatment. Conclusion: Flexible intramedullary nailing treated children had similar numbers of radiographs or follow-up consultation, but less malunion when compared to orthopedic treatment. Orthopedic management was systematically cheaper than flexible intramedullary nailing. Unless post-operative management guidelines decreasing the number of radiographs and follow-ups are implemented, flexible intramedullary nailing will remain a costly procedure when compared to conventional orthopedic treatment. Level of evidence: level III case-control retrospective study.
RESUMO
Viral infections are extremely common and generally self-restricted, thus antiviral therapy is limited to precise indications. Apart from HIV (not reviewed in this article), the principal treatable viruses are HSV 1 and 2, VZV, CMV, Influenza A and B, and hepatitis B and C. Vaccination is another cornerstone of viral infections control. This article summarizes actual and available therapy. New treatments arrived recently on the market or are being developedâ : HCV can now be treated with a high success rate, baloxavir against the flu, a new zoster vaccine will probably soon be available in Switzerland and letermovir improves CMV prophylaxis in the case of hematopoietic stem cell transplant.
Les infections virales sont extrêmement fréquentes et guérissent le plus souvent spontanément. Un traitement antiviral est réservé à des indications précises. A l'exception du VIH (non abordé dans cet article), les principaux virus traitables sontâ : herpès simplex 1 et 2 (HSV-1 et 2), Varicella zoster (VZV), cytomégalovirus (CMV), influenza A et B ainsi que les virus des hépatites B et C. La vaccination est une autre stratégie de lutte importante. Ce domaine étant en plein développement, cet article effectue un survol des traitements actuellement disponibles sur le marché suisse. Durant ces dernières années, l'hépatite C a pu être traitée avec un haut taux de succès. Le baloxavir contre la grippe et un nouveau vaccin contre le zona seront sans doute prochainement disponibles en Suisse. Le letermovir améliore la prophylaxie du CMV en cas de transplantation de moelle osseuse.
