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(a) Spiral fracture of the right femur in a boy aged 2 years and 2 months. (b) Bone remodelling after 6 weeks of treatment with a special paediatric Orthofix ® fixator in the same patient.
Source publication
The versatile Orthofix modular system can be used to treat long-bone fractures in children from the 2nd year of life. It allows definitive fracture management over a short period of time without traumatizing the soft tissues. The possible early mobilization and full weight-bearing mean that the children are able to return early to school or kinderg...
Context in source publication
Context 1
... principle the fractures were stabilized as soon as possible. We used the fixator Orthofix ® exclusively. This modular system is adaptable to specific fractures from the 2nd year of life onwards. For the treatment of children from the 2nd to 4th year of life a special external fixator has been developed for use with self-drilling pins (Fig. ...
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Introduction: Ipsilateral fractures of the femur and tibia are called as floating knee injuries and may include a combination victims are usually young adults. As the byproduct of horse power race, high velocity accidents are now a common place. Major consideration from this injury is condition of knee. The aim of the study was to evaluate clinical...
Citations
... Seven types of physiotherapy interventions were identified while analysing all studies that provided any rehabilitation information, i.e., weight-bearing exercises, ROM exercises (ROM), strengthening exercises, gait training and walking exercises, split or orthosis usage, and education. The form of application of weight-bearing exercises varied on intensity and period of treatment for weight-bearing permission depending on the study [10,34,36,39,44,[50][51][52]56,[59][60][61][66][67][68][69][70][72][73][74][75]77,80,81,[84][85][86]89,91,92,94,95,98,[100][101][102][103][105][106][107]109,112,115]. The quantification of load during progression of weight-bearing was described as gradual, partial, or total. ...
... The description of ROM exercises also varied across studies [10,36,44,47,[49][50][51][52][54][55][56]59,61,[66][67][68]70,72,73,75,77,80,[84][85][86]89,91,94,95,98,100,103,106,107]. Active and passive ROM were the most common information regarding ROM exercises, however, most of studies that used ROM, only reported the use of ROM without any further details. ...
... The described strengthening exercises [10,[49][50][51][52]54,55,59,70,72,73,80,81,89,98,103,104,107,110] target manly the Quadriceps, Hamstrings, and Hip abductors muscles using Isometric, Isotonic, and Isokinetic modalities. Likewise, other modalities of strengthening were reported, such as stationary bike cycling, electromyostimulation, and stair climbing exercises. ...
Purpose:
To map evidence regarding physiotherapy assessment and treatment of patients with tibial external fixator (EF), and to point out literature gaps for further research.
Methods:
Systematic scoping review conducted in four databases. We included both experimental and non-experimental studies involving patients with tibial EF and outcomes of interest. We recorded study design, population, sample size, sample age, reason for EF use, type of surgery, type of EF used, instruments used for assessing function, pain, quality of life, satisfaction, psychosocial aspects, and physiotherapy treatment descriptions from included studies. We categorised data accordingly to outcomes assessed and physiotherapy treatments description.
Results:
Eighty-six studies were included involving 3070 patients. Causes of fixator use were traumatic conditions, acquired and congenital deformities, and non-traumatic conditions, like compartmental osteoarthritis. Function was assessed in about three-quarters of included studies, though other outcomes were not presented in most studies. Only one study described satisfactorily the physiotherapy treatment. Almost half of the studies did not provide any description of the rehabilitation process.
Conclusions:
There is little evidence about the assessment of function, pain, quality of life, satisfaction, psychosocial aspects, and other outcomes in tibial EF patients. Physiotherapy treatment in these patients is poorly reported.Protocol registration: Open Science Framework: doi:10.17605/OSF.IO/UT2DAIMPLICATIONS FOR REHABILITATIONRehabilitation programmes and research should consider that most studies with tibial external fixator (EF) patients did not evaluate outcomes routinely used in physiotherapy assessment.Rehabilitation programmes should consider that the instruments used in evaluation of tibial EF patients have unknown measurement properties.Rehabilitation programmes should consider that treatment of patients with tibial EF involves different types of interventions, however, they are poorly described or not described in most studies.
... However, in adolescents the management of diaphyseal femoral fractures is highly debated. Treatment options in that age group include ESIN, external fixation [2], a combination of these two methods, submuscular plating [3], or rigid intramedullary rodding. ...
(1) Background: In adolescents, fractures of the femoral shaft that are not suitable for elastic-stable-intramedullary-nailing (ESIN), are challenging. We aimed to evaluate the health-related quality of life (HRQoL) and complications in adolescents treated with intramedullary rodding using the adolescent lateral trochanteric entry femoral nail (ALFN), and to assess if HRQoL was associated with additional injuries. (2) Methods: We followed-up on 15 adolescents with a diaphyseal femoral fracture who were treated with an ALFN from 2004 to 2017. Patients were asked to fill in a questionnaire that includes the iHOT, Peds-QL, and the Pedi-IKDC. (3) Results: The ALFN was used as a primary method of fixation in 13 patients, and as a fixation for failed ESIN in two cases. All 15 fractures healed radiographically. One distal locking screw broke. After a mean follow-up of 2.8 years, the mean iHOT-12 was 14.0 (SD 15.4), PedsQL-function was 85.7 (SD 19.3), PedsQL-social-score was 86.2 (SD 12.5), and the mean Pedi-IKDC was 77.2 (SD 11.3). In patients where the femoral fracture was an isolated injury, the HRQoL-scores were consistently higher compared with patients who sustained additional injures. (4) Conclusions: Treating diaphyseal fractures in adolescents with an ALFN resulted in good radiographic outcomes in all our cases. HRQoL, as measured by the iHOT, PedsQL, and Pedi-IKDC, was good to excellent; but it was consistently inferior in patients with additional injuries. These results suggest that the ALFN is a good alternative when patients are not suitable for ESIN, and that the HRQoL of adolescents who were treated with an ALFN is mainly influenced by the presence of additional injures, and less by the fracture of the femur itself.
... Fourth, the same fixator can be used for correction of limb length discrepancies once bony union is achieved. 6,7 However, an additional corticotomy and supplementary pin placement or pin readjustments may be required. Fifth, being less bulky than a circular ring fixator, which circumferentially encompasses the entire thigh, the level of patient as well as parent satisfaction is better with a rail fixator, especially with regards to dayto-day activities like toileting and nursing care. ...
Aim
To describe the surgical management of glaucoma in a patient with severe scleromalacia, and secondary angle closure.
Introduction
The management of glaucoma with coexisting scleromalacia plus secondary angle closure is challenging as most commonly performed incisional glaucoma surgery as well as minimally invasive glaucoma surgery (MIGS), which targets the drainage angle are all contraindicated.
Case report
Medically refractory glaucoma in a 60-year-old male with a 30-year history of granulomatosis with polyangiitis resulting in extensive severe scleromalacia, cicatricial lower lid retraction with significant conjunctival exposure, and widespread synechial angle closure from chronic anterior uveitis was managed with combined phacoemulsification cataract surgery, and endoscopic cyclophotocoagulation (ECP). Careful postoperative management with intensive immunosuppression was used to successfully prevent complications related to the surgery, which resulted in improved visual acuity, and control of intraocular pressure (IOP).
Conclusion
The ECP is a minimally invasive procedure that targets inflow of aqueous, and can be safely and successfully used to control IOP in challenging patients with complex secondary glaucoma, where the use of traditional incisional surgery, and other MIGS procedures are all contraindicated.
Clinical significance
The choice of surgical treatment for medically refractory glaucoma needs to be selected based on the circumstances of individual patients, and take into consideration the condition of the sclera, conjunctiva and drainage angle, against the safety and efficacy of possible treatments.
How to cite this article
Rodrigues IAS, Lindfield D, Stanford MR, Goyal S. Glaucoma Surgery in Scleromalacia: Using Endoscopic Cyclophotocoagulation where Conventional Filtration Surgery or Angle Procedures are contraindicated. J Curr Glaucoma Pract 2017;11(2):73-75.
... Fourth, the same fixator can be used for correction of limb length discrepancies once bony union is achieved. 6,7 However, an additional corticotomy and supplementary pin placement or pin readjustments may be required. Fifth, being less bulky than a circular ring fixator, which circumferentially encompasses the entire thigh, the level of patient as well as parent satisfaction is better with a rail fixator, especially with regards to dayto-day activities like toileting and nursing care. ...
Introduction
Management of pathological diaphyseal fractures secondary to osteomyelitis in children still remains a nightmare for the treating orthopedic surgeon owing to the highly unpredictable clinical course and lack of certainty in achieving successful results. This study highlights the potential role of rail fixator in the management of pathological femur fracture secondary to osteomyelitis in children.
Materials and methods
A total of five children (8—13 years age group) with pathological diaphyseal fractures of femur (four cases) and tibia (one case), operated between January 2014 and December 2014, were included in the study. Chronic osteomyelitis was the underlying etiology in all the cases. The surgical management consisted of thorough debridement, lavage, freshening of fractured bone ends, opening of the bone ends, reduction and external stabilization using pediatric monorail fixator. All patients received postoperative antibiotics, based on intraoperative culture and sensitivity reports, for 6 weeks (intravenously for the initial 3 weeks, orally for the remaining 3 weeks). Weight bearing and knee range of motion were started in the early postoperative period as soon as the children were pain free.
Results
Staphylococcus aureus was the causative organism in all the cases. Out of five cases, four fractures united: Three femurs (between 9 and 12 weeks) and one tibia (11 weeks). There was one case of delayed union of femur (18 weeks). Septic pin tract loosening was seen in one case (femur) requiring prolonged antibiotic usage. Minimal limb length discrepancy (1—1.5 cm) was observed in all the cases.
Conclusion
Compression fixation achieved by monorail fixator can be considered as a viable option for the management of pediatric diaphyseal fractures secondary to active bony infection. It has the advantage of promoting bony union, aiding in early weight bearing, establishing successful joint mobilization, providing an option for future restoration of limb length, and improved patient comfort.
How to cite this article
Saibaba B, Gopinathan NR, Dhillon MS, Behera P, Santhanam SS. Prospective Role of Uniplanar Compressible External Fixation Devices in the Management of Pathological Diaphyseal Fractures Secondary to Osteomyelitis in Children. J Postgrad Med Edu Res 2017;51(1):17-21.
The treatment of polytrauma patients has been largely debated in the last decades. The main issue has been if an immediate definitive treatment (Early Total Care, ETC) is always indicated; actually, a staged, minimally invasive approach (Damage Control Orthopaedics, DCO) should be preferred considering the potential reduction of surgical time, bleeding and inflammatory response. External fixation is the preferred method of temporary fixation in polytrauma patients; however, in selected cases, it could become the definitive treatment, especially when fracture reduction is maintained and the priority is to promote adequate wound healing and tissue coverage.
We report a retrospective review of all paediatric trauma patients managed with an external fixator admitted to our institution over a 7-year period. We identified 30 fractures in 28 children. The fractures included 20 tibiae, 5 femurs, 2 humerii, 2 radii and 1 phalanx. The indications were 23 open fractures, 4 comminuted fractures and 3 closed fractures in polytraumatised patients. It was the definitive treatment in 13 fractures. The mean length of total time with an external fixator was 9.6 weeks (range 1-38 weeks.) Difficulties encountered were eight problems, one obstacle and two true complications. There were no cases of re-fracture following removal of the external fixator. This review confirms that there is a role for the use of external fixation in selected paediatric fractures
with a low complication rate.
Although long bone fracture in children is not life-threatening, it may cause major disability, loss of working days and severe psychological distress. We conducted this study to determine the pattern of extremity fracture due to trauma in children.
During one year in six general hospitals in Tehran, trauma patients who were hospitalized for more than 24 hours and sustained injuries within seven days before admission were included in the study. The records of children (< or = 16 years old) hospitalized in six general hospitals in Tehran due to trauma were reviewed prospectively.
During the study period, 1 274 children had sustained extremity fractures. Male to female ratio was 3.6/1, with the mean age of (10.3+/-4.2) years. Falls and traffic crashes were the main causes of injuries, with the percentages of 57.3% and 37.1%, respectively. Simple fall (falling on the ground) consisted 60% of patients that sustained fall-related injuries. Pedestrians and bicycle riders comprised most of the cases that were injured due to traffic crashes. Of our cases, 56.8% sustained fractures in the upper extremities and 43.2% in the lower extremities. Forearm was the most common fracture site (34.1%). Comparing our results in preschool and school-age children, falls were the main cause of injuries in both groups, but fractures of lower extremities were significantly more common in preschool children.
Improvement of physical condition of sidewalks and crossings in roads will be necessary for prevention of injuries. More attention to safety of home environment should be paid for control of preschools'injury at home. Education of children and adults is necessary to reduce injuries resulting from road traffic crashes.
This paper evaluates and compares basic emotional reactions towards the illness, as well as the quality of life in relation to the various types of treatment of isolated long tubular bone fractures of extremities in children and adolescents. This prospective clinical research comprehends 135 patients (94 males and 41 females), aged 10 to 18, treated for the mentioned bone fractures in the period from October 2003 till March 2005 at The Departments for Pediatric Surgery of three hospitals: the Clinical Hospital Centre in Rijeka (88.8% of the patients), the Clinical Children's Hospital in Zagreb (9.7% of the patients) both in Croatia, and 1.5% of the patients in the Clinical Hospital in Mostar (Bosnia and Herzegovina). 53.3% of the patients were treated conservatively, 29.6% of them underwent the elastic stable intramedullary nailing (ESIN), while the remaining 17.1% of the patients were treated with other surgical techniques (AO-plates or Kirschner-wire ostheosyntheses). The basic methods were self-reported questionnaires: the Spielberg State Trait Anxiety Inventory (STAIl) to establish momentary anxiety and the Short Form-36 Health Survey (SF-36) to evaluate quality of life, i.e. the perception of the illness during treatment. The STAI1 was administered twice to the patients: within 1 week of the experienced trauma (at baseline) and 6 months after the trauma, whereas the SF-36 was administered only once, i.e. a month after the experienced trauma. Our results point at an increased anxiety indicators in all the patients immediately after the experienced trauma, mostly in patients treated surgically, especially those who underwent the ESIN method; whereas after 6 months from the experienced trauma the anxiety indicators were greatly reduced. The quality of life was better in patients who underwent a conservative treatment, both physically and mentally, than in those surgically treated. This points to the fact that the surgical method itself despite its type, is an additional stressor which causes additional anxiety and depressive reaction. Our results suggest (from psychological point of view) that the conservative method of treating long bone fractures in children and adolescents should be used since it causes less emotional reactions on the illness ascertaining a better health experience during the treatment than the active surgical treatment (regardless of the type), which should be practised with criticism and according to strict surgical indications. If the surgical treatment should be necessarily adopted, we should take into consideration the possibility of psychologically preparing the patients in order to diminish the psychological reaction on the surgical treatment.
New properties are being modified in the external fixator instrumentation that are leading to the more indicated use of this type of fixation especially in children's lower limb fractures. Dynamization, the ability to lengthen the limb and easy wound care are among the new properties of the monoplane external fixator, along with greater stability than older models. These new properties are now making the external fixator an indication rather than a choice in many cases. We have retrospectively studied 21 children with lower limb fractures treated by 28 external fixators. The results of this study show advantages such as lower infection rate, consolidation without the need of reoperation, easy physiotherapy, easy wound care and the ability to perform shortening and lengthening in the same set. Disadvantages are mostly complications that are due to the external fixation such as iatrogenic vascular lesions, pins tract infections and iatrogenic fractures.
