[Pediatric disability of the upper extremity and quality of life questionnaire: reliability, validity, and sensitivity to change]. / Vaiku rankos funkcijos bei su ja susijusios gyvenimo kokybesklausimynas, jo patikimumas, pagristumas bei jautrumas.

OBJECTIVE: The aim of this study was to develop a specific questionnaire, designed to evaluate health-related quality of life of children and adolescents with congenital or acquired anomalies of the upper extremity. MATERIAL AND METHODS: Children who underwent operative or conservative treatment of the upper extremity at Kaunas University of Medicine Hospital and Kaunas Red Cross Hospital or conservative treatment at Kaunas Sanatorium "Zibute" and Druskininkai Sanatorium "Saulute" participated in the study. A total of 99 parents and 56 adolescents with congenital or acquired anomalies of the upper extremity filled out the questionnaires. The data were analyzed by the program SPSS 12.0.1 for Windows. RESULTS: Two versions of questionnaire were developed: one for parents of children and adolescents aged 5-18 years and another - for adolescents aged 11-18 years. Both versions consist of seven scales: self-care, daily activities, sports activities and hobby, self-image, emotional, social health, and patient's satisfaction with treatment. The testing of questionnaire reliability was performed by estimating a Cronbach alfa coefficient which varied from 0.80 to 0.97 for different scales of questionnaire designed for parents. The item-scale correlation was from 0.44 to 0.89. There was a statistically significant difference among separate items for all scales (p<0.001). The intraclass correlation coefficient ranged from 0.84 to 0.89 for all scales. Cronbach alfa coefficients of scales of questionnaire designed for children varied from 0.83 to 0.95, and item-scale correlation was moderate to strong. A statistically significant difference among separate items for all scales was obtained (p<0.001). The intraclass correlation coefficient varied from 0.79 to 0.86. The Pearson's correlation coefficient between questionnaires developed for parents and children was calculated, and strong correlation between corresponding scales was found. Sensitivity to changes was tested, and t-test was performed. A statistically significant difference in all scales was found (p<0.001).

Early and late reconstruction in brachial plexus palsy: a preliminary report.

OBJECTIVE: To evaluate the most effective surgical procedures in the early and late reconstruction of brachial plexus after its traumatic injury. MATERIAL AND METHODS: A total of 14 consecutive patients with brachial plexus injuries were examined and operated on at the Department of Plastic and Reconstructive Surgery and Burns at Kaunas University of Medicine Hospital. Less than half of them (43%) came for surgery in the early stage of disease--within 12 months after injury--and 57% in the late stage--1-15 years after trauma. Altogether, 23 operations--neurolysis, nerve transfer, tendon transfer, and arthrodesis--were performed. Patients were followed up for an average of 12.5 months (range 4 to 19 months) after surgery. Postoperative motor assessment of hand function was based on the motor classification M0-M6 of Mallet and British Medical Research Council Muscle grading system. Results were considered positive if the range of active movements increased no less than 5-10 degrees odependently from the level of injury and motor strength--no less than 1-2 grades (M0-->M2 or M2-->M3). RESULTS: Of the eight investigated, six patients from early group showed positive results. The most effective surgical procedures were neurolysis and nerve transfer. A significant improvement in the patients of late group was observed after tendon transfer procedure. Nevertheless, the recovery process of motor function was too slow or even minimal in 31% of patients to satisfy the patient and the surgeon. CONCLUSIONS: Neurolysis or nerve transfer in the early stage or tendon transfer in the late stage after brachial plexus injury may result in a significant improvement of motor function of the hand. Sharing the information concerning brachial plexus reconstruction with neonatologists, neuropathologists, traumatologists, and hand therapists would be helpful in operating such patients timely and treating them adequately after surgery.

[Importance of conservative treatment and physical load restriction to the course of Osgood-Schlatter's disease]. / Konservatyvaus gydymo ir fizinio kruvio ribojimo reiksme Osgood-Schlatterio ligos eigai.

Osgood- Schlatter's disease is one of most common causes of knee pain in young patients. In 2000-2002, 171 young patients were consulted for Osgood-Schlatter's disease in the Departments of Orthopedics and Traumatology in Kaunas University of Medicine. There were 41 (24%) females and 130 (76%) males; the age ranging from 10 to 27 years. Patients were divided into two groups: the first group (92 patients) underwent conservative treatment and physical load restriction; the second group (79 patients) had no physical load restriction or they neglected reduced physical load guidelines. In the first group 52 patients were treated by conservative measures and physical load restriction, while 40 patients had only physical load restriction. Pain disappeared faster (approximately after 13 months) in the first group patients, who were treated conservatively and had reduced physical load, compared to patients, who had only physical load restriction (pain disappeared approximately after 15 months), p<0.05 (p=0.0008). Pain disappeared faster in patients who had only physical load restriction (approximately after 15 months) compared to the second group patients who had no physical load restriction (approximately after 16.5 months), p<0.05 (p=0.006). There was 1 complication (encapsulated ossification producing pain) in the first group, compared with 8 complications in the second one (2 patients with 3 type avulsion fracture, 1 patient with 2 type avulsion fracture, and 5 patients with encapsulated ossification producing pain). Complications were treated intraoperatively. Physical load restriction is important for beneficial course of Osgood-Schlatter's disease and prevention of complications.

[Treatment of early and late obstetric brachial plexus palsy]. / Vaiku peties nervinio rezginio pazeidimo ir jo sukeltu padariniu gydymas.

The aim of this study was to review and to analyze treatment patterns of early and late obstetric brachial plexus palsy. Eighty-one children with early and late obstetric brachial plexus palsy were treated in the Department of Pediatric Orthopedics and in the Postintensive Care Unit within the period 1988-2002. Children were classified into 2 groups according to age: Ist group (67 newborns) was treated conservatively, and IInd group (14 children with late obstetric brachial plexus palsy with deformity) underwent operative treatment. Active hand movements and innervation were evaluated before and after treatment. Thirty newborns had full recovery, 32 newborns had incomplete recovery, and in 5 cases no improvement was seen. Fourteen children with late obstetric brachial plexus palsy underwent the following operations: rotation osteotomy of the humerus was performed in 10 cases, lengthening of biceps and brachialis muscle tendons--in 6 cases, transposition of triceps muscle tendon--in 1 case, transposition of pectoralis major tendon--in 3 cases and flexor carpi transposition--in 1 case. There was an improvement in active hand movements after operative treatment and rehabilitation. According to our experience, in most cases newborns recover spontaneously or after conservative treatment. Secondary reconstructive surgery of late brachial plexus palsy can improve the condition of these patients.