Are Children Suffering From Congenital Pseudarthrosis of the Tibia Associated With Bone Quality Decreased?

Background: Congenital pseudarthrosis of the tibia (CPT) is a rare and difficult to treat congenital disease in neonates. Our team's previous study found that exosomes derived from serum of children with CPT can reduce the effect of bone formation. In this study, we used ultrasound bone densitometry to detect the bone quality between children with CPT and those non-metabolic disease children, to determine the bone strength of children with CPT. Methods: A total of 37 CPT children and 40 children without the bone metabolic disease (control group) were recruited in our hospital. The ultrasonic bone densitometer was used to examine the bilateral calcaneus of the subjects. According to the measurement results, we collected the broadband ultrasonic attenuation (BUA), sound transmission velocity (SOS), quantitative ultrasound index (QUI), bone strength index(STI) and bone mineral density estimation(BMDe) values. For the intergroup analysis, t test was used to determine the differences of various quantitative measurements. Multivariable regression was used to examine the associations between quantitive ultrasound measurements differences and age, body mass index (BMI), neurofibromatosis type 1 (NF1) and CPT Crawford type. Intra-class correlation coefficient (ICC) was calculated to estimate intra- and inter-rater agreements. Results: Seventy-four calcaneus scans from CPT patients (23 boys and 14 girls) and 80 calcaneus scans (24 boys and 16 girls) from the control. The CPT patients exhibited significantly lower SOS (1368.75±136.78 m/s), STI (7.2319±38.6525), QUI (8.2532±56.1720) and BMDe (-0.0241±0.3552 g/cm3) than the control (SOS: 1416.02±66.15 m/s, STI: 7.96±16.884, QUI: 28.8299±25.461, BMDe: 0.0180±0.1610 g/cm3). Multiple linear regression revealed that SOS, STI, QUI was statistically significant and negatively correlated with CPT Crawford classification.Conclusions: We found the incidence of decreased bone quality in CPT group was higher than that in the non-bone metabolic disease group. This phenomenon was not related to NF1 while related to CPT Crawford classification, which suggested that the higher grade of the CPT Crawford classification, the lower the bone strength and the higher the risk of fracture.

OUTCOME OF NON-SURGICAL TREATMENT OF MALLET FINGER

ABSTRACT Objective: To establish the association between initial and residual angulation of the distal interphalangeal joint (DIJ) in mallet finger treated conservatively. Methods: An observational, prospective, descriptive and analytical research developed with uncomplicated closed mallet finger patients between January and December 2017. A total of two measurements of the DIJ were done, at the initial trauma and 6 weeks after conservative treatment. All measurements were ranked according to the Crawford Classification and Relative Risk was measured. Results: In total, 43 patients were studied, in which 53.48% of outcomes obtained were excellent. The sample was divided in two groups; one with less than 30º of DIJ initial angulation, which had 28% of residual angulation. The second group with more than 30º presented 72.22% of residual angulation. The Relative Risk to present a residual angulation in patients that had 30º of DIJ initial angulation was 2.99 (CI 95%) with p = 0.0059. Conclusion: It is suggested that patients with an initial DIJ angulation more than 30º are more likely to present residual angulation with conservative treatment. Level of Evidence IV, Case series.

Long-term Stack splint immobilization for closed tendinous Mallet Finger

Background Closed tendinous mallet finger can be treated non-operatively by extension splinting of the distal interphalangeal joint (DIPJ) for 6 to 8 weeks. However, method of conservative treatment in detail differs among various reports, especially in type of orthosis, duration of full-time immobilization and additional night orthotic wear after full-time immobilization. In our institution, full-time Stack splint is applied with distal interphalangeal joint (DIPJ) in extension for 12 weeks and night orthosis is worn for 4 weeks. Purpose The purpose of this study was to evaluate clinical and functional outcomes of tendinous mallet finger using our treatment protocol. Patients and Methods Between March 2007 and December 2017, patients with tendinous mallet finger who were managed conservatively according to our treatment protocol were retrospectively reviewed. A total of 100 patients (101 cases) were enrolled, including 77 males and 23 females. Extension lag was measured before, soon after treatment, and at the final follow-up. Flexion angle of DIP joint was measured at the final follow-up. Patients were clinically evaluated based on the Crawford classification scale and Abouna & Brown criteria. Results The mean age of patients was 40 years and the mean follow-up was 48 months. The mean extension lag was 28.3 degrees initially and 2.6 degrees at the final follow-up. (p-value < 0.001) Flexion angle at the final follow-up was 68.3 degrees. Based on the Crawford classification scale, 56 % of patients had excellent results, and 25 % of patients had good results. According to Abouna & Brown criteria, 78 % of patients had success results and 7.5 % of patients had improved results. Conclusions Wearing orthosis for up to 16 weeks (12 weeks full time and 4 weeks night orthosis) in the treatment of tendinous mallet finger injuries can achieve satisfying result.

Surgical treatment of thoracoabdominal aortic aneurysms

INTRODUCTION. Aneurysms simultaneously involving the thoracic and abdominal aortas or those aneurysms that include the visceral aortic segment are defined as thoracoabdominal aortic aneurysms (ThAAA). Their treatment is one of the most difficult surgical problems today. OBJECTIVE. The purpose of this paper is to present the early results of the surgical treatment of type IV ThAAA, according to the Crawford classification, as well as to analyse the main problems encountered during this procedure. METHOD. Between January 2001 and the end of 2004, 79 patients with type IV ThAAA, according to the Crawford classification were treated at the Clinic for Vascular Surgery of the Institute for Cardiovascular Diseases of the Serbian Clinical Centre. Lumbotomy combined with extrapleural resection of the XI or X rib was used as the operative approach in 70 cases, while thoracophrenolumbotomy was performed in 9 cases. The aneurysm was repaired using the bifurcated Dacron graft in 38 cases and with the tube Dacron graft in 41 cases. In 47 cases, visceral arteries were reattached using the Carrel patch technique, while in 31 cases, separate revascularisation of the left kidney was required. RESULTS. 60 (76%) of our patients survived the first 30 postoperative days, while 19 (24%) died during this period. The causes of mortality included: haemorrhaging, in 4 patients; pulmonary embolism, in 1 patient; myocardial infarction, in 4 patients; ARDS, in 2 patients; and finally, multi-organ system failure, in 8 patients. Statistical analysis showed that advanced age (over 70 years), the need for more extensive reconstructive surgery along with the implantation of the bifurcated graft, as well as the presence of ruptured aneurysms, significantly increased the mortality of the patients. CONCLUSION. The surgical management of ThAAA requires a multidisciplinary approach. We introduced this procedure in our hospital 4 years ago. The further development of this surgery will be of great medical, social, and economic importance to our country.

Intraaortic balloon pump counterpulsation after implantation of infrarenal and thoracoabdominal aortic protheses

Highly complex vascular surgery interventions have nowadays become possible due to sophisticated operative techniques and modern intra- and postoperative anesthesiological strategies. Accordingly, the number of high risk vascular surgery interventions rises continuously and thus, the number of secondary complications after high risk interventions increases as well and requires likewise extraordinary treatment concepts. We report of a 68-year old patient who 6 months previously was operated on a ruptured abdominal aneurysm, before he was admitted to our institution for the treatment of a type IIIb (Crawford classification) thoracoabdominal aneurysm. Intraoperatively we implanted a 26 mm Dacron prosthesis which was anastomosed with the previously existing infrarenal graft. Postoperatively the patient suffered from a hemodynamically significant myocardial infarction and acute coronary catheter intervention was necessary. However, circulatory stability could not be reestablished by interventional measures and we therefore decided to implant the intraaortic balloon pump despite the presence of two synthetic aortic grafts. However, the chance of success of such a manoeuver as well as the effectiveness of intraprosthetic counterpulsation was unclear and our literature research undertaken to predict the risk of such a manouver was unsatisfactory. We therefore want to report this case and compile the literature dealing with perceptions and complications of intraaortic counterpulsation after the implantation of synthetic aortic prostheses, since such a treatment option comes to an increased clinical application in comparable constellations.