Although both methods are effective in stopping the growth, the 8-plate has better grasp to the bone or epiphyseal cartilage avoiding extrusion in small children. The correction is faster using a staple and that is the reason why we prefer its usage in patients with little remnant growth.
Mears technique provides significant improvement in range of motion and a considerable appearance improvement with a low morbidity. Further clinical experience will be needed to confirm these outcomes.
Leg length discrepancy is when the length of one leg is different from the other, and is a common reason for consultation at the pediatrician's and pediatric orthopedist's office. The objective of this study was to develop recommendations for the follow-up, pre-surgical planning, and treatment of children with leg length discrepancy based on expert consensus. Material and methods. The Delphi method was used. A coordinating group selected a panel of experts, designed and analyzed each of the rounds of consultations. Semistructured questionnaires were sent by personalized e-mail. Agreement among experts ≥ 80 % was established as the criterion for consensus. At each round of consultation, non-consensual aspects were reformulated and new aspects suggested in the previous round were included. A measure of stability to conclude the consultation was determined when more than 70 % of experts sustained their opinion in successive rounds. Results. Eight experts in orthopedics and six experts in imaging studies participated. After three rounds of consultations, consensus was reached in terms of 39 recommendations for follow-up, pre-surgical planning, and treatment. These were reorganized into 32 final recommendations. Conclusions. These are the first recommendations for the follow-up of children with leg length discrepancy agreed by expert consensus.
<p>RESUMEN</p><p><strong>Introducción:</strong> La Osteodistrofia Renal provoca desejes progresivos en los miembros inferiores, siendo la deformidad más frecuente el genu valgo.</p><p>El crecimiento guiado (hemiepifisiodesis) es útil en la corrección de deformidades angulares en la edad pediátrica.</p><p>El objetivo de este trabajo es mostrar los resultados y complicaciones de esta técnica quirúrgica aplicada a fisis patológicas.</p><p><strong>Materiales y métodos: </strong>Se presentan 11 pacientes (20 rodillas) con diagnóstico de insuficiencia renal crónica y genu valgo, tratados en nuestro servicio con hemiepifisiodesis transitoria. Se colocaron placas en 8 en 4 pacientes y grapas en 7 casos restantes. Se evaluó el eje mecánico radiográfico pre y post operatorio y las complicaciones relativas a cada implante.</p><p><strong>Resultados: </strong>Se logró la corrección completa en 4 pacientes, 1 caso sobrellevó deformidad rebote, y en los restantes se obtuvo mejoría sin llegar a la normalización óptima del eje mecánico.</p><p><strong>Conclusiones: </strong>La corrección obtenida se relaciona claramente con la normalidad de la función renal. Los pacientes trasplantados consiguieron una normalización en el crecimiento óseo remanente. No tuvimos diferencia en los resultados ni en las complicaciones entre los dos tipos de implantes empleados.</p>
<p><strong><em>Introducción:</em></strong><strong> </strong>El objetivo de tratamiento del pie Bot está enfocado en lograr un pie plantígrado, indoloro y que permita el uso del calzado habitual.</p><p>El objetivo del trabajo fue medir la incidencia de recidiva luego de obtenida la corrección de la deformidad en pacientes con pie bot tratados con tutor de Ilizarov, y analizar los factores pronósticos asociados.</p><p><strong><em>Material y Método: </em></strong>Cohorte retrospectiva de factores pronóstico. Se trató con este método a 48 pacientes (70 pies) desde 1988. Se excluyeron los pacientes con falta de corrección de la deformidad en el momento de retirar el tutor (deformidad residual o corrección incompleta). La variable de estudio fue la recidiva.</p><p><strong><em>Resultados:</em></strong></p><div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>El 77% de los 70 pies eran idiopáticos. Solo 18 pies no habían sido tratados. Todos eran pacien- tes pediátricos. El promedio de edad en el momento de la cirugía era de 7,9 años. Se incluyeron tres grupos de pacientes: tratados con Ilizarov solo (40,2%), en combi- nación con cirugía de partes blandas (38,5%) y asociado con osteotomías (21,3%). El seguimiento promedio posoperatorio fue de 10,6 años (de 5,5 a 22). En el 71% de los pies, los resultados fueron pobres, la deformidad recidivó en un promedio de 38 meses, y fueron necesarias cirugías complementarias para lograr un pie plantígrado.</span></p></div></div></div><p><strong><em>Conclusi</em></strong><strong><em>ó</em></strong><strong><em>n:</em></strong> Presentamos una importante casuística con seguimiento alejado de pie bot recidivado o inveterado, con una alta recidiva de la deformidad (71%). No encontramos diferencias estadísticamente significativas entre los subgrupos estudiados (edad, diagnóstico, trata- mientos previos y procedimientos asociados).</p><p>Actualmente no consideramos a esta técnica de primera elección, pues nuestros resultados fueron poco alentadores.</p><p> </p><p><strong><em>Palabras clave: Pie Bot Recidivado, Inveterado, Ilizarov.</em></strong></p><p> </p><p> </p><p> </p><p> </p><p><strong>Abstract:</strong></p><p><strong><em>Introduction:</em></strong> The goal of treatment for clubfoot is to achieve a pain-free, plantigrade foot that allows walking comfortably with normal shoes.</p><p>The aim of the study was to assess the relapse rate after having achieved correction of the deformity in patients with clubfoot treated with the Ilizarov method and to analyze associated prognostic factors.</p><p><strong><em>Material and method:</em></strong> In a retrospective cohort study of prognostic factors we evaluated 48 patients, 70 feet, treated with the Ilizarov method between 1988 and 2006.</p><p>Patients in whom correction of the deformity with the external fixator failed (residual deformity or incomplete correction) were excluded from the study. The study variable was relapse.</p><p><strong><em>Results:</em></strong> Etiology was idiopathic in 77% of 70 feet. Only 18 feet had not been treated previously. All patients were children. Mean age at surgery was 7.9 years. The patients were divided into three groups according to the treatment with the Ilizarov fixator alone (40%), in combination with soft-tissue release (38%), or associated with osteotomies (21%).</p><p>Mean post-operative follow-up was 10.6 years (range: 5.5-22 years).</p><p>Outcome was poor in 71% of the feet, which relapsed after a mean of 38 months, requiring additional surgeries to achieve a plantigrade foot.</p><p><strong><em>Summary:</em></strong> The present is a large series of neglected or relapsed clubfeet treated with the Ilizarov method with good initial results, but a high rate of recurrence of the deformity after a long follow-up period (71%). We did not find statistically significant differences among the subgroups comparing age, diagnosis, previous treatments, and associated procedures and no prognostic factors for relapse could be identified.</p><p>Currently, we do not consider the Ilizarov method the technique of choice for the treatment of neglected or relapsed clubfoot as our results were not very promising.</p><p> </p><p><strong><em>Key Words: Ilizarov; Treatment; Recurrence; Neglected Clubfoot.</em></strong></p>
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