Classification of manual abilities in children with cerebral palsy under 5 years of age: how reliable is the Manual Ability Classification System?

OBJECTIVE: To assess the interobserver reliability of the Manual Ability Classification System (MACS) in young children (age 1-5 years) with cerebral palsy. DESIGN: Interobserver reliability study. SETTING: A cross-sectional study of a hospital-based population of children with cerebral palsy. SUBJECTS: Thirty children, 18 boys and 12 girls between 1 and 5 years of age (mean age 2.5 years +/- 14.2 SD, Gross Motor Function Classification System level I-IV). MEASURES: the children were classified by means of the MACS by two independent observers. Interobserver reliability was analysed using Cohen's kappa. RESULTS: Overall interobserver reliability of the MACS for children aged 1-5 years was moderate, with a linear weighted kappa (kappa) of 0.62 (95% confidence interval (CI) 0.49-0.76). According to the generally accepted categories of agreement, reliability was moderate for children under 2 years of age (kappa = 0.55), and good for children between 2 and 5 years of age (kappa = 0.67). CONCLUSION: Classification of manual ability of young children with cerebral palsy is possible between 2 and 5 years of age. For children younger than 2 years old, it should be done with caution. Further development of the MACS for children under 5 years of age is recommended with an emphasis on age-appropriate descriptions of manual abilities.

Surgical treatment for chronic lower-leg compartment syndrome in young female athletes.

Our experience in treating chronic lower-leg compartment syndrome suggests that women may be more susceptible to this injury than are men, an observation for which there is support in the literature. Furthermore, when we evaluated the 47 young female athletes (age range, 13 years 11 months to 21 years 10 months) from our practice on whom 78 separate surgeries were performed, we found a lower success rate than those generally reported in studies that combine male and female patients. We suspect, therefore, that for reasons as yet unclear, women may also respond less well than men to operative fasciotomy.

Anterior tibial stress fracture treated with intramedullary nailing: a case report.

This article describes the use of intramedullary rodding as a treatment for an anterior tibial stress fracture in a patient with high functional demands: a professional ballet dancer. In our patient, a year of conservative treatment and later tibial drilling was unsuccessful. After sustaining a complete fracture at the site of the stress fracture, he was treated with intramedullary rodding and was able to dance 21 weeks after surgery. The fracture went on to complete healing. The role of prophylactic intramedullary nailing in this difficult fracture is discussed.