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J. T. Lehner - One of the best experts on this subject based on the ideXlab platform.

  • Immediate hip Spica Casting for femur fractures in pediatric patients. A review of 175 patients.
    Clinical orthopaedics and related research, 2000
    Co-Authors: A. F. Infante, M. C. Albert, W. B. Jennings, J. T. Lehner
    Abstract:

    Abstract Immediate closed reduction and application of a well-molded hip Spica Cast is a safe and effective treatment option for closed, isolated femur fractures in children who weigh between 10 and 100 pounds. Between 1988 and 1996, 190 immediate hip Spica Casts were placed on children with isolated femoral shaft fractures who weight between 10 and 100 pounds. Fifteen patients were lost to followup leaving 175 children who were evaluated and followed up for at least 2 years after the hip Spica Cast was removed (range 2-10 years). The femur fractures were reduced closed and placed in a 1 1/2 hip Spica Cast in the emergency room with the patient under conscious sedation or in the operating room with the patient under general anesthesia. All of the children returned home within 24 hours of the procedure. All 175 femur fractures united within 8 weeks. The only complication was a refracture in a 25 pound child who fell 1 week after the Cast was removed. No significant residual angular deformities were present in any of the children at last followup. None of the children required external shoe lifts, epiphysiodesis, antibiotics, irrigation and debridements, or limb lengthening procedures for leg length inequalities. The authors think that immediate closed reduction and placement of a well-molded hip Spica Cast is a safe and reliable treatment option for isolated, closed femur fractures in children from birth to 10 years of age who weigh less than 80 pounds.

  • Immediate hip Spica Casting for femur fractures in pediatric patients : A review of 175 patients : Children's fractures
    Clinical Orthopaedics and Related Research, 2000
    Co-Authors: A. F. Infante, M. C. Albert, W. B. Jennings, J. T. Lehner
    Abstract:

    Immediate closed reduction and application of a well-molded hip Spica Cast is a safe and effective treatment option for closed, isolated femur fractures in children who weigh between 10 and 100 pounds. Between 1988 and 1996, 190 immediate hip Spica Casts were placed on children with isolated femoral shaft fractures who weighed between 10 and 100 pounds. Fifteen patients were lost to followup leaving 175 children who were evaluated and followed up for at least 2 years after the hip Spica Cast was removed (range 2-10 years). The femur fractures were reduced closed and placed in a 11/2 hip Spica Cast in the emergency room with the patient under conscious sedation or in the operating room with the patient under general anesthesia. All of the children returned home within 24 hours of the procedure. All 175 femur fractures united within 8 weeks. The only complication was a refracture in a 25 pound child who fell 1 week after the Cast was removed. No significant residual angular deformities were present in any of the children at last followup. None of the children required external shoe lifts, epiphysiodesis, antibiotics, irrigation and debridements, or limb lengthening procedures for leg length inequalities. The authors think that immediate closed reduction and placement of a well-molded hip Spica Cast is a safe and reliable treatment option for isolated, closed femur fractures in children from birth to 10 years of age who weigh less than 80 pounds.

Niloofar Akhoondzadeh - One of the best experts on this subject based on the ideXlab platform.

  • corticosteroid injection with or without thumb Spica Cast for de quervain tenosynovitis
    Journal of Hand Surgery (European Volume), 2014
    Co-Authors: Mohsen Mardanikivi, Mahmoud Karimi Mobarakeh, Farzaneh Bahrami, Kevyan Hashemimotlagh, Khashayar Sahebekhtiari, Niloofar Akhoondzadeh
    Abstract:

    Purpose To compare the corticosteroid injection (CSI) with or without thumb Spica Cast (TSC) for de Quervain tendinitis. Methods In this prospective trial, 67 eligible patients with de Quervain tenosynovitis were randomly assigned into CSI + TSC (33 cases) and CSI (34 cases) groups. All patients received 40 mg of methylprednisolone acetate with 1 cc lidocaine 2% in the first dorsal compartment at the area of maximal point tenderness. The primary outcome was the treatment success rate, and the secondary outcome was the scale and quality of the treatment method using Quick Disabilities of Arm, Shoulder and Hand and visual analog scale scores. Results The groups had no differences in mean age, sex, and occupation. The visual analog scale and Quick Disabilities of the Arm, Shoulder and Hand scores were similar in both groups before the treatment. The treatment success rate was 93% in the CSI + TSC group and 69% in the CSI group. Although both methods improved the patients' conditions significantly in terms of relieving pain and functional ability, CSI + TSC had a significantly higher treatment success rate. Conclusions The combined technique of corticosteroid injection and thumb Spica Casting was better than injection alone in the treatment of de Quervain tenosynovitis in terms of treatment success and functional outcomes. Type of study/level of evidence Therapeutic II.

Scott W Wolfe - One of the best experts on this subject based on the ideXlab platform.

  • regarding corticosteroid injection with or without thumb Spica Cast for de quervain tenosynovitis
    Journal of Hand Surgery (European Volume), 2014
    Co-Authors: Scott W Wolfe
    Abstract:

    To the Editor: I was interested in the January 2014 article by Mardani-Kivi et al concerning the efficacy of a thumb Spica Cast when used to supplement corticosteroid injection for de Quervain tendinopathy. Their findings differ markedly from those of Weiss et al, that immobilization did not add to the benefit of injection alone, and I applaud the authors for studying this in a prospective fashion. However, I am concerned that the authors used methylprednisolone acetate (Depo-Medrol 40 mg) for their injections. Depo-Medrol, a fat-soluble glucocorticoid preparation, is not specifically indicated for use in subdermal locations in the United States. The package insert contains abundant bold-font warnings concerning the risk of subcutaneous placement of the drug (shown below). A quick review of the literature demonstrates several serious complications from the injection of fat-soluble corticosteroids in patients with de Quervain disease, including but not limited to subcutaneous atrophy, skin depigmentation, capillary fragility, bleeding, scar revision, and tendon rupture. Mardani-Kivi et al reported no complications in their series, and I would like to know whether they identified any of the complications mentioned above, or others in longer-term follow-up. It is difficult to inject the first dorsal compartment without at least some leakage of the injected material into the surrounding subcutaneous tissue. Most authors document a 2to 3-month lag time before the appearance of skin depigmentation. I advise considerable caution with the use of methylprednisolone acetate injection for the treatment of de Quervain disease. From the package insert LAB-0160-3.0 Pfizer, Inc. (New York, NY), revised August 2008:

A. F. Infante - One of the best experts on this subject based on the ideXlab platform.

  • Immediate hip Spica Casting for femur fractures in pediatric patients. A review of 175 patients.
    Clinical orthopaedics and related research, 2000
    Co-Authors: A. F. Infante, M. C. Albert, W. B. Jennings, J. T. Lehner
    Abstract:

    Abstract Immediate closed reduction and application of a well-molded hip Spica Cast is a safe and effective treatment option for closed, isolated femur fractures in children who weigh between 10 and 100 pounds. Between 1988 and 1996, 190 immediate hip Spica Casts were placed on children with isolated femoral shaft fractures who weight between 10 and 100 pounds. Fifteen patients were lost to followup leaving 175 children who were evaluated and followed up for at least 2 years after the hip Spica Cast was removed (range 2-10 years). The femur fractures were reduced closed and placed in a 1 1/2 hip Spica Cast in the emergency room with the patient under conscious sedation or in the operating room with the patient under general anesthesia. All of the children returned home within 24 hours of the procedure. All 175 femur fractures united within 8 weeks. The only complication was a refracture in a 25 pound child who fell 1 week after the Cast was removed. No significant residual angular deformities were present in any of the children at last followup. None of the children required external shoe lifts, epiphysiodesis, antibiotics, irrigation and debridements, or limb lengthening procedures for leg length inequalities. The authors think that immediate closed reduction and placement of a well-molded hip Spica Cast is a safe and reliable treatment option for isolated, closed femur fractures in children from birth to 10 years of age who weigh less than 80 pounds.

  • Immediate hip Spica Casting for femur fractures in pediatric patients : A review of 175 patients : Children's fractures
    Clinical Orthopaedics and Related Research, 2000
    Co-Authors: A. F. Infante, M. C. Albert, W. B. Jennings, J. T. Lehner
    Abstract:

    Immediate closed reduction and application of a well-molded hip Spica Cast is a safe and effective treatment option for closed, isolated femur fractures in children who weigh between 10 and 100 pounds. Between 1988 and 1996, 190 immediate hip Spica Casts were placed on children with isolated femoral shaft fractures who weighed between 10 and 100 pounds. Fifteen patients were lost to followup leaving 175 children who were evaluated and followed up for at least 2 years after the hip Spica Cast was removed (range 2-10 years). The femur fractures were reduced closed and placed in a 11/2 hip Spica Cast in the emergency room with the patient under conscious sedation or in the operating room with the patient under general anesthesia. All of the children returned home within 24 hours of the procedure. All 175 femur fractures united within 8 weeks. The only complication was a refracture in a 25 pound child who fell 1 week after the Cast was removed. No significant residual angular deformities were present in any of the children at last followup. None of the children required external shoe lifts, epiphysiodesis, antibiotics, irrigation and debridements, or limb lengthening procedures for leg length inequalities. The authors think that immediate closed reduction and placement of a well-molded hip Spica Cast is a safe and reliable treatment option for isolated, closed femur fractures in children from birth to 10 years of age who weigh less than 80 pounds.

Federico Canavese - One of the best experts on this subject based on the ideXlab platform.

  • radiographic outcome of children older than twenty four months with developmental dysplasia of the hip treated by closed reduction and Spica Cast immobilization in human position a review of fifty one hips
    International Orthopaedics, 2019
    Co-Authors: Yueming Guo, Xiantao Shen, Hang Liu, Haibo Mei, Federico Canavese
    Abstract:

    This study aimed to investigate the radiographic outcomes, rate of redislocation, and avascular necrosis of proximal femoral epiphysis (AVN) in patients aged 24 to 36 months with developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and Spica Cast immobilization in human position. We reviewed the medical records of 39 patients (51 hips) aged 24 to 36 months with DDH treated by CR and Spica Cast immobilization in human position. The Tonnis grade, rate of redislocation and AVN, acetabular index (AI), centre-edge angle (CEA), and Severin radiographic grade were evaluated on plain radiographs. Among the included 39 patients (51 hips), 15 hips (29.4%) were Tonnis grade II, 24 hips (47.1%) were grade III, and 12 hips (23.5%) were grade IV. In 47 hips (92.2%), the ossific nucleus was present at the time of CR. Stable reduction was achieved by CR in 39/51 hips (76.5%) and redislocation occurred in 12/51 hips (23.5%). Among the 12 hips that redislocated, 11 underwent open reduction and one repeated CR. Two out of 40 hips (5%) treated by CR developed AVN. Overall, 54.6% of the hips had satisfactory outcomes (39.2% Severin type I and 17.6% type II), while 45.4% had unsatisfactory outcomes (39.2% Severin type III and 3.9% type IV). Of the 40 hips treated by CR, 57.5% and 42.5% of cases had satisfactory outcomes and residual acetabular dysplasia, respectively. Six out of 11 hips (54.6%) treated by open reduction and pelvic osteotomy had satisfactory outcomes. Our study showed that stable CR could be achieved in 76.5% of patients aged 24 to 36 months with DDH at the time of index procedure. Satisfactory outcomes can be expected in 56.4% of the cases (5.0% AVN rate), although late acetabular dysplasia may develop in 43.6% of the hips.

  • post operative radiograph assessment of children undergoing closed reduction and Spica Cast immobilization for developmental dysplasia of the hip does experience matter
    International Orthopaedics, 2018
    Co-Authors: Bicheng Yong, Antonio Andreacchio, Vito Pavone, Bruno Pereria, Federico Canavese
    Abstract:

    Closed reduction and Spica Cast immobilization are routinely used for young patients with developmental dysplasia of the hip with reducible hips. Our primary objective was to assess the interpretation quality of immediate post-operative pelvis radiographs after treatment. A series of 28 randomly selected patients (30 hips) with pre- and post-operative pelvis radiographs and post-operative magnetic resonance imaging were included. Each was presented twice with an interval of two weeks, in alternating orders. Raters with different experience and specialties from different institutions rated the quality of reduction (hip in or out) after treatment. Thirteen surgeons and three radiologists evaluated 30 hips (28 patients). Agreement was not satisfactory (κ = 0.12). Experienced clinicians demonstrated similar agreement to inexperienced raters (κ = 0.04). Consistency at a two week interval was moderate (κ = 0.48, percent of agreement at 82%). The mean number of errors from the two ratings were 8.6 ± 2.5 and 8.9 ± 2.7, respectively (P = 0.72). There was no significant difference between surgeons with different levels of experience; radiologists did better than surgeons, but the difference was insignificant. Raters from different institutions had similar performance in poor judgment. Our results show poor concordance between observers and ratings. Post-operative radiographs are unreliable for assessing the quality of hip reduction. The level of experience, subspecialty, and geographical origin do not impact the radiographic assessment. Based on the present findings, we recommend performing post-operative magnetic resonance imaging rather than anteroposterior pelvis radiograph to assess the hip. Compared to standard radiographs, magnetic resonance imaging allows more reliable interpretation while decreasing radiation exposure.