Journal of pediatric orthopedics. Part B
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Buckle or torus fractures in the distal forearm are characterized by a bulging of the cortical bone. They are a frequent reason for consultation in pediatric emergencies. The treatment and follow-up of this type of fractures varies from soft immobilizations to a plaster cast. ⋯ None of these fractures displaced further, regardless of the treatment given. Buckle or torus fractures do not need follow-up radiographs. As they are stable, the simpler immobilization treatment is sufficient.
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This study describes a new procedure for a safer and easier access for the intrathecal injection of the recently approved nusinersen therapy in spinal muscular atrophy. This therapy changed the natural history of the disease, but, to date, scoliosis surgery was an excluding criteria for nusinersen therapy. The bone mass, due to the posterior spinal fusion of the scoliosis surgery, prevents the needle for the nusinersen administration from intervertebral access. ⋯ Two patients underwent PSF after the nusinersen therapy was available. All of them underwent a laminotomy with a fat grafting at the L3-L4 laminotomy level and received nusinersen therapy without complications. The procedure described is simple and effective in providing safe intrathecal access to make these patients eligible for such important therapy.
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The aim of this study was to evaluate whether short-term positive effects on bimanual function after surgery of the paretic arm in cerebral palsy are maintained long term. Assisting Hand Assessment (AHA) and active range of motion was tested before surgery and at 7 month and 9-year follow-up (n=18). ⋯ Surgery of wrist and elbow flexors significantly improved active extension. Improvement in wrist and elbow extension was maintained at the 9-year follow-up, but usefulness of the hand measured with AHA had returned to the same level as before surgery.
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Osteogenesis imperfecta (OI) is a rare congenital osteodystrophy. Patients with OI present with osteoporosis, extreme bone fragility and severe deformities of the lower limbs, which predispose them to frequent fractures. The aim of our study is to describe the minimally invasive osteotomy technique to correct the tibial deformities in patients with OI type III, using the Fassier-Duval (FD) intramedullary nailing, which is considered the gold standard in this kind of surgery. ⋯ The Pediatric Outcomes Data Collection Instrument questionnaire values were satisfactory in both groups. The osteosynthesis with the FD telescopic nail, performed with the minimally invasive surgical technique, has improved the management of deformities in OI. The minimally invasive technique, however, requires the maturation of three distinct learning curves: surgery on patients with OI, open technique with the FD nail, and percutaneous technique with the FD nail.
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Clubfoot is an important aspect of pediatric orthopedics and is a readily prevalent condition presenting to orthopedic clinics worldwide. To identify landmark articles and important contributions to this field, we sought to do a citation analysis of the top 100 most-cited articles on clubfoot. Using the Scopus database and the search strategy 'Clubfoot', 'Clubfeet' OR 'Talipes Equinovarus', we identified 5753 articles. ⋯ Most publications were level IV and level V studies. Although citation analysis has it flaws, this is a comprehensive list of the top 100 articles significantly affecting literature on clubfoot. On the basis our study, we conclude that there is marked deficiency of high-level articles with respect to the number of citations, and future researches need to cater to this question to produce high-quality studies.