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Lineham B, Maggs R, Pandit H, Sharma H, Foster P. Outcomes of ankle joint distraction in a paediatric and young adult cohort presenting with symptomatic ankle arthritis. J Pediatr Orthop B 2024; 33:246-250. [PMID: 37548659 DOI: 10.1097/bpb.0000000000001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Ankle arthritis in paediatric and young adult patients causes significant morbidity; therefore, joint-preserving procedures are preferable. Ankle joint distraction (AJD) is a technique that preserves the native joint. However, only short-term outcomes are reported in paediatric patients. Therefore, this study reports on intermediate-term outcomes in a paediatric cohort. Demographics for all patients who underwent AJD at two centres were prospectively collected. Case records were reviewed retrospectively for complications and further intervention. Mean joint space at baseline and follow-up radiographs were evaluated by two independent observers. All patients were contacted for completion of a Foot and Ankle Outcome Score (FAOS). Seven patients received AJD between February 2016 and June 2019. Median age at surgery was 15 years (9.0-24.6 years). Complications included one superficial pin-site infection and one patient death due to complications from juvenile idiopathic arthritis 6.2 years post-operatively. Two patients were converted to fusion, at 12.6 months and 26.2 months following frame removal; one patient underwent spontaneous fusion at 9 months following frame removal. The four patients who continued without further intervention achieved 2.59 mm mean joint space at last follow-up (0.65-5.08 mm) and FAOS of 35-79%. Mean follow-up length was 4.3 years (2.9-6.3 years) with final radiographs at mean 2.6 years. While recognising the limitations of this retrospective review, several patients had significant, sustained improvements in joint space with good clinical outcome. Complications for this procedure are minimal, and it is a potential joint-preserving option for managing end-stage ankle arthritis in young patients.
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Affiliation(s)
| | | | - Hemant Pandit
- University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Patrick Foster
- University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Jia Q, Peng Z, Huang A, Jiang S, Zhao W, Xie Z, Ma C. Is fracture management merely a physical process? Exploring the psychological effects of internal and external fixation. J Orthop Surg Res 2024; 19:231. [PMID: 38589910 PMCID: PMC11000308 DOI: 10.1186/s13018-024-04655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/02/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Internal and external fixation are common surgical procedures for treating fractures. However, the impact of different surgical approaches (including internal and external fixations) on patients' psychological status and Quality of Life (QoL) is rarely examined. Herein, we aimed to investigate the effects of internal and external fixation on anxiety, depression, insomnia, and overall mental and physical health in Distal Radius Fractures (DRF) patients. METHODS We performed a retrospective study on 96 fracture patients who underwent internal fixation (57 patients) or external fixation (39 patients). The Visual Analog Scale (VAS), the Hospital Anxiety and Depression Scale (HADS), the Athens Insomnia Scale (AIS), and the Medical Outcomes Study Short Form 36 (SF-36) questionnaire were used to assess the patients' pain, anxiety, depression, sleep, and QoL before surgery and at seven days, one month, and three months post-surgery. RESULTS The VAS scores were significantly lower in the Internal Fixation Group (IFG) than in the External Fixation Group (EFG) on the seventh day and one month postoperatively (P < 0.05). Although both groups showed no significant anxiety, depression, or insomnia before surgery (P > 0.05), the EFG showed significantly higher HADS-A, HADS-D, and AIS scores than the IFG at seven days and one and three months postoperatively (P < 0.05). Additionally, changes in HADS-A, HADS-D, and AIS scores were most significant at day seven post-surgery in the EFG (P < 0.05). Furthermore, no significant difference was found between the two groups in the average Physical Component Summary (PCS) and Mental Component Summary (MCS) scores before surgery (P > 0.05). However, both groups showed positive changes in PCS and MCS scores at postoperative day seven and one and three months postoperatively, with the IFG having significantly higher average PCS and MCS scores compared to the EFG (P < 0.05). CONCLUSION Compared to external fixation, internal fixation did not significantly impact patients' emotions regarding anxiety and depression in the early postoperative period, and physical and mental health recovery was better during the postoperative rehabilitation period. Furthermore, when there are no absolute indications, the impact on patients' psychological well-being should be considered as one of the key factors in the treatment plan during surgical approach selection.
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Affiliation(s)
- Qiyu Jia
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhenlei Peng
- Xinjiang Clinical Research Center for Mental Health, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Anqi Huang
- Nanjing Brain Hospital, Clinical Teaching Hospital of Medical School, Child Mental Health Research Center, Nanjing University, Nanjing, China
| | - Shijie Jiang
- Xinjiang Clinical Research Center for Mental Health, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wen Zhao
- Department of Orthopedics, Beijing Aerospace General Hospital, Beijing, China.
- Department of Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Zengru Xie
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Chuang Ma
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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Hafez M, Nicolaou N, Offiah A, Offorha B, Giles S, Madan S, Fernandes JA. Quality of life of children during distraction osteogenesis: a comparison between intramedullary magnetic lengthening nails and external fixators. INTERNATIONAL ORTHOPAEDICS 2022; 46:1367-1373. [PMID: 35385976 PMCID: PMC9117380 DOI: 10.1007/s00264-022-05399-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
Background Distraction osteogenesis is a very demanding process. For decades, external fixation was the only reliable option for gradual deformity correction. Recently, intramedullary magnetic nails have gained popularity. This research aimed to assess the quality of life in children during gradual deformity correction using intramedullary lengthening nails compared to external fixation. Method Prospective analysis included children who had gradual lower limb deformity correction between 2017 and 2019. Group A included children who had magnetic lengthening nails; patients in group B had external fixation devices. Child health utility 9D (CHU- 9D) and EuroQol 5D youth (EQ- 5D-Y) were used to measure the quality of life at fixed points during the distraction osteogenesis process. The results were used to calculate the utility at each milestone and the overall quality of life adjusted years (QALYs). Results Thirty-four children were recruited, group A had 16 patients, whilst group B had 18 patients. The average ages were 16.0 years and 14.7 years for groups A and B, respectively. Group A patients reported significantly better utility compared to group B. This was observed during all stages of treatment (P = 0.00016). QALYs were better for group A (0.44) compared to group B (0.34) (P < 0.0001). Conclusion The quality of life was generally better in group A compared to group B. In most patients, the health utility progressively improved throughout treatment. In the same way, QALYs were better with the lengthening nails compared to external fixators. The magnetic lengthening devices (PRECICE nails) which were used in this research were recently relabelled to restrict their applications in children; this study was conducted before these restrictions.
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Affiliation(s)
- Mohamed Hafez
- Paediatric Limb Reconstruction Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK. .,Oncology and Metabolism Department, Medical School, Sheffield University, Sheffield, UK.
| | - Nicolas Nicolaou
- Paediatric Limb Reconstruction Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.,Sheffield University, Sheffield, UK
| | - Amaka Offiah
- Oncology and Metabolism Department, Medical School, Sheffield University, Sheffield, UK
| | - Bright Offorha
- School of Health and Related Research, Sheffield University, Sheffield, UK
| | - Stephen Giles
- Paediatric Limb Reconstruction Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.,Sheffield University, Sheffield, UK
| | - Sanjeev Madan
- Paediatric Limb Reconstruction Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.,Sheffield University, Sheffield, UK
| | - James A Fernandes
- Paediatric Limb Reconstruction Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.,Sheffield University, Sheffield, UK
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Chhina H, Klassen AF, Kopec JA, Oliffe J, Iobst C, Dahan-Oliel N, Aggarwal A, Nunn T, Cooper AP. What matters to children with lower limb deformities: an international qualitative study guiding the development of a new patient-reported outcome measure. J Patient Rep Outcomes 2021; 5:30. [PMID: 33792793 PMCID: PMC8017030 DOI: 10.1186/s41687-021-00299-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/23/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Lower limb deformities include conditions such as leg length discrepancy, lower limb deficiency and associated angular and rotational deformities of the hips, knees, ankles and feet. Children with lower limb deformities often have physical limitations due to gait irregularities and pain. The differences in the appearance and function of their lower limbs can discourage participation in social, recreational and leisure activities, which may result in behavioural, emotional, psychological and social adjustment problems. The health-related quality of life (HRQL) of these children is often impacted due to the factors discussed above, as well as by the complex surgical procedures. Surgical treatment options for limb deformities in children vary from limb lengthening and reconstruction to amputation. The lack of evidence demonstrating superiority of either treatment options and their effect on HRQL limits the ability of healthcare providers to counsel families on the best evidence-based treatment option for them. This manuscript describes the international qualitative study which guided the development of a new patient-reported outcome measure (PROM). Individual semi-structured face-to-face interviews with children with lower limb deformities and their parents were conducted at five sites: Canada (2 sites), Ethiopia, India and the USA. RESULTS Seventy-nine interviews were conducted at five international sites. Five main themes emerged from the qualitative interviews and formed the basis of the conceptual framework. These themes were: 1) appearance, 2) physical health, 3) psychological health 4) school and 5) social health. CONCLUSIONS Lower limb deformities have a substantial impact on the HRQL of children. The concepts of interest identified in our study were similar across children from all countries. The conceptual framework guided the development of outcome scales specific to these patients. The information about the impact of various treatment options on the HRQL of children with lower limb deformities, collected using this new PROM, could be used to inform parents and children about outcomes (physical, social, psychological) associated with specific treatment options. This information could supplement other objective outcome information (e.g., complication rates, how the leg will look, etc.) to help families to come to a more informed decision on a child's course of treatment.
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Affiliation(s)
- Harpreet Chhina
- Department of Experimental Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
- Department of Orthopaedics, BC Children's Hospital, 1D 18, Orthopaedics Research Office, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jacek A Kopec
- School of Population and Public Health, University of British Columbia, Arthritis Research Canada, Vancouver, BC, Canada
| | - John Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Iobst
- Department of Orthopaedic Surgery, The Ohio State University, College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Noemi Dahan-Oliel
- Shriners Hospitals for Children, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Aditya Aggarwal
- Department of Orthopaedic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tim Nunn
- CURE Ethiopia Children's Hospital, Addis Ababa, Ethiopia
| | - Anthony P Cooper
- Department of Orthopaedics, BC Children's Hospital, 1D 18, Orthopaedics Research Office, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Pawik Ł, Pawik M, Wrzosek Z, Fink-Lwow F, Morasiewicz P. Assessment of the quality of life in patients with varying degrees of equalization of lower limb length discrepancy treated with Ilizarov method. J Orthop Surg Res 2021; 16:62. [PMID: 33468173 PMCID: PMC7814564 DOI: 10.1186/s13018-021-02202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inequalities in leg length result in functional disorders, as they impair the biomechanics of the musculoskeletal system, significantly reducing the quality of life (QoL). This study used the WHOQoL-BREF questionnaire in patients with varying degrees of lower leg shortness who had undergone treatment by the Ilizarov method, compared to a healthy control group. METHODS Fifty-eight patients treated with the Ilizarov method for discrepancies in lower limb length were grouped by degree of limb equalization (group 1, 37 treated individuals with limb length discrepancy < 1 cm; group 2, 21 individuals with discrepancy ≥ 1 cm but not more than 4 cm). The control group 3 contained 61 healthy individuals. Patient quality of life (QoL) was assessed using a shortened version of the WHOQoL-BREF questionnaire, at least 24 months after the end of Ilizarov therapy. RESULTS Control subjects obtained higher scores in all domains than subjects in both treatment groups, as well as significantly higher self-assessed QoL, and health, in the physical, psychological, social, and general lifestyle domains, as compared to those with inequalities ≥ 1 cm. Furthermore, patients with inequalities ≥ 1 cm had higher odds ratios of low self-assessment (3.28 times; p = 0.043), low self-assessment of health (4. 09 times; p = 0.047), and low physical and psychological domains (respectively 6.23 times; p = 0.005 and 8.46 times, p = 0.049) compared with patients with inequality < 1 cm. The shortened version of the WHOQoL questionnaire was used. CONCLUSIONS After at least 24 months of treatment with the Ilizarov method, patients with limb length discrepancy < 1 cm did not differ significantly from healthy individuals in the WHOQoL self-assessment of mental functioning, social, or life satisfaction.
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Affiliation(s)
- Łukasz Pawik
- Department of Physiotherapy of Motor Disorders and Dysfunctions, University School of Physical Education, al. Paderewskiego 35, 51-612, Wrocław, Poland.
| | - Malwina Pawik
- Health Promotion, Faculty of Physiotherapy, University School of Physical Education, Wrocław, Poland
| | - Zdzisława Wrzosek
- Department of Physiotherapy of Motor Disorders and Dysfunctions, University School of Physical Education, al. Paderewskiego 35, 51-612, Wrocław, Poland
| | - Felicja Fink-Lwow
- Health Promotion, Faculty of Physiotherapy, University School of Physical Education, Wrocław, Poland
| | - Piotr Morasiewicz
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, Opole, Poland
- Department and Clinic of Orthopedic and Traumatological Surgery, Wrocław Medical University, Wrocław, Poland
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Xing J, Sun N, Li L, Lv D, Geng S, Li Y. Factors influencing self-care in outpatients with external fixation in China. J Int Med Res 2020; 48:300060520902603. [PMID: 32070173 PMCID: PMC7155739 DOI: 10.1177/0300060520902603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective This study was performed to investigate factors influencing self-care agency
in outpatients with external fixation support. Methods Using a cross-sectional study approach, 110 outpatients with external
fixation from a single Chinese hospital were evaluated from May 2018 to
October 2018. Consecutive sampling was performed, and variables included
demographic data, health knowledge regarding external fixation, and
self-care skills. Open and closed survey questions were used. Results The mean self-care agency score was 101.70 ± 20.14, with 36 (35.3%)
outpatients scoring high. Demographic variables did not significantly
influence the self-care level. However, health knowledge was significantly
correlated with self-care skills, indicating that knowledgeable outpatients
were more likely to be better at self-care. Conclusions Outpatients with external fixation support need higher levels of health
knowledge. The level of self-care agency in the present study was in the
moderate range. Outpatients with external fixation support with higher
health knowledge are more likely to have higher self-care skills.
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Affiliation(s)
- Jun Xing
- Nine Ward of the Orthopedic, The Second Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Ning Sun
- Ningbo College of Health Sciences, Ningbo, P. R. China
| | - Laiyou Li
- Ningbo College of Health Sciences, Ningbo, P. R. China
| | - Dongmei Lv
- Nursing Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Shuling Geng
- Nine Ward of the Orthopedic, The Second Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Yuqian Li
- Nine Ward of the Orthopedic, The Second Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
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Rogers GP, Tan HB, Foster P, Harwood P. Complex Tibial Shaft Fractures in Children Involving the Distal Physis Managed with the Ilizarov Method. Strategies Trauma Limb Reconstr 2019; 14:20-24. [PMID: 32559263 PMCID: PMC7001592 DOI: 10.5005/jp-journals-10080-1421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Segmental fractures in the juvenile distal tibia with physeal involvement present specific challenges. Injury to the growth plate may be overlooked, potentially resulting in late sequelae. Fracture stabilization can be complex. Previous reports of management of such an injury are by open reduction and internal fixation. This study reviews the management and outcome of a group of such patients treated with Ilizarov external fixators. Materials and methods Patients aged 16 or younger treated in our unit between March 2013 and November 2014 by Ilizarov circular fine wire fixation for tibial fractures with ipsilateral physeal injuries were identified. Retrospective collection of patient demographics, fracture classification, treatment pathways, fixation methods, postoperative follow-up, outcomes, and complications was undertaken. Results Eight patients were identified; two had Gustilo and Anderson grade IIIA open injuries. All were managed definitively using an Ilizarov external fixator in combination with percutaneous screw fixation of the physeal component as required. All patients were ambulant during treatment and were allowed unrestricted weight-bearing immediately postoperative. All but one attended school. All fractures united. In follow-up, one patient had a distal tibial physeal growth arrest, but there were no other complications. Conclusion Pediatric patients with complex distal tibial fractures should be scrutinized for concomitant physeal injury. Where identified treatment, using a combination of internal fixation and an Ilizarov fixator can be considered. How to cite this article Rogers GP, Tan HB, Foster P, et al. Complex Tibial Shaft Fractures in Children Involving the Distal Physis Managed with the Ilizarov Method. Strategies Trauma Limb Reconstr 2019;14(1):20-24.
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Affiliation(s)
- Gareth P Rogers
- Trauma and Orthopaedics Department, Leeds Teaching Hospitals NHS Trust, UK
| | - Hiang B Tan
- Trauma and Orthopaedics Department, University of Leeds, Faculty of Medicine and Health, UK
| | - Patrick Foster
- Trauma and Orthopaedics Department, Leeds Teaching Hospitals NHS Trust, UK
| | - Paul Harwood
- Trauma and Orthopaedics Department, Leeds Teaching Hospitals NHS Trust, UK
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Messner J, Johnson L, Taylor DM, Harwood P, Britten S, Foster P. Treatment and functional outcomes of complex tibial fractures in children and adolescents using the Ilizarov method. Bone Joint J 2018; 100-B:396-403. [PMID: 29589503 DOI: 10.1302/0301-620x.100b3.bjj-2017-0863.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Aims The aim of this study was to report the clinical, functional and radiological outcomes of children and adolescents with tibial fractures treated using the Ilizarov method. Patients and Methods Between 2013 and 2016 a total of 74 children with 75 tibial fractures underwent treatment at our major trauma centre using an Ilizarov frame. Demographic and clinical information from a prospective database was supplemented by routine functional and psychological assessment and a retrospective review of the notes and radiographs. Results Of the 75 fractures, 26 (35%) were open injuries, of which six (8%) had segmental bone loss. There were associated physeal injuries in 18 (24%), and 12 (16%) involved conversion of treatment following failure of previous management. The remaining children had a closed unstable fracture or significant soft-tissue compromise. The median follow-up was 16 months (7 to 31). All fractures united with a median duration in a frame of 3.6 months (interquartile range 3.1 to 4.6); there was no significant difference between the types of fracture and the demographics of the patients. There were no serious complications and no secondary procedures were required to achieve union. Health-related quality of life measures were available for 60 patients (80%) at a minimum of six months after removal of the frame. These indicated a good return to function (median Paediatric quality of life score, 88.0; interquartile range 70.3 to 100). Conclusion The Ilizarov method is a safe, effective and reliable method for the treatment of complex paediatric tibial fractures. Cite this article: Bone Joint J 2018;100-B:396-403.
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Affiliation(s)
- J Messner
- Leeds Major Trauma Centre and Limb Reconstruction Unit, Leeds Children's Hospital at Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - L Johnson
- Leeds Major Trauma Centre and Limb Reconstruction Unit, Leeds Children's Hospital at Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - D M Taylor
- Leeds Major Trauma Centre and Limb Reconstruction Unit, Leeds Children's Hospital at Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - P Harwood
- Leeds Major Trauma Centre and Limb Reconstruction Unit, Leeds Children's Hospital at Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - S Britten
- Leeds Major Trauma Centre and Limb Reconstruction Unit, Leeds Children's Hospital at Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - P Foster
- Leeds Major Trauma Centre and Limb Reconstruction Unit, Leeds Children's Hospital at Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
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Internal Distraction Resulted in Improved Patient-Reported Outcomes for Midface Hypoplasia. J Craniofac Surg 2018; 29:139-143. [DOI: 10.1097/scs.0000000000004109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Fenton P, Bose D. Patient-reported outcomes following treatment of tibial non-union with circular frames. Strategies Trauma Limb Reconstr 2014; 9:33-5. [PMID: 24519370 PMCID: PMC3951624 DOI: 10.1007/s11751-014-0187-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 01/26/2014] [Indexed: 12/01/2022] Open
Abstract
The management of tibial non-union is challenging with protracted, often arduous, treatments. The purpose of this study was to assess patient-reported outcomes following treatment of tibial non-union in circular external fixators. Twenty-one patients with tibial non-unions who successfully completed treatment at a mean of 10.1 months (range 6–20) in a circular external fixator were sent questionnaires utilising the Enneking scoring system and Euroqol EQ-5D. There were 14 responses. The mean Enneking score was 58.0 % (34.3–77.1). Two patients were enthusiastic about their treatment, while three accepted but would not repeat the treatment. The Euroqol questionnaire found that 8 patients had difficulty with mobility, 10 had difficulty with usual activities and 12 had moderate pain. There was no statistically significant difference in the EQ VAS score of overall health state for treated patients compared with predicted scores for an age- and sex-matched UK population (77.7 vs 83.1, p = 0.07).
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Affiliation(s)
- P Fenton
- Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2WB, UK,
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Abstract
Limb deformity can occur in the pediatric and adolescent populations from multiple etiologies: congenital, traumatic, posttraumatic sequelae, oncologic, and infection. Correcting these deformities is important for many reasons. Ilizarov popularized external fixation to accomplish this task. Taylor expanded on this by designing an external fixator in 1994 with 6 telescoping struts that can be sequentially manipulated to achieve multiaxial correction of deformity without the need for hinges or operative frame alterations. This frame can be used to correct deformities in children and has shown good anatomic correction with minimal morbidity. The nature of the construct and length of treatment affects psychosocial factors that the surgeon and family must be aware of prior to treatment. An understanding of applications of the Taylor Spatial Frame gives orthopedic surgeons an extra tool to correct simple and complex deformities in pediatric and adolescent patients.
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Affiliation(s)
- Michael Paloski
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Khan SK, Abraham A. Telesurveillance of circular frame pin sites: one year's experience at a specialist unit. J Telemed Telecare 2011; 17:210-3. [PMID: 21398388 DOI: 10.1258/jtt.2010.100618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Circular frame treatment for limb reconstruction involves repeated follow-up visits, and a substantial number of these appointments are for pin site review only. We have encouraged our frame patients to take photographs of their pin sites when they carry out their weekly dressing changes. The photographs are taken with mobile phones or digital cameras by the patients themselves, and the images sent to us by email. We reply within 24 hours, with either reassurance or appropriate instructions as indicated. In the past 12 months, five patients have had their pin sites reviewed remotely using this method, and have expressed a high level of satisfaction. These early results are encouraging.
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Affiliation(s)
- Sameer K Khan
- Department of Trauma and Orthopaedics, Leicester Royal Infirmary, UK.
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Moraal JM, Elzinga-Plomp A, Jongmans MJ, Roermund PMV, Flikweert PE, Castelein RM, Sinnema G. Long-term psychosocial functioning after Ilizarov limb lengthening during childhood. Acta Orthop 2009; 80:704-10. [PMID: 19995320 PMCID: PMC2823305 DOI: 10.3109/17453670903473024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Accepted: 07/17/2009] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Few studies have been concerned with the patient's perception of the outcome of limb lengthening. We describe the psychological and social functioning after at least 2 years of follow-up in patients who had had a leg length discrepancy and who had undergone an Ilizarov limb lengthening procedure. PATIENTS AND METHODS Self-esteem and perceived competence were measured in 37 patients (aged 17-30 years) both preoperatively and at a mean follow-up of 7 (2-14) years. At follow-up, health-related quality of life, functioning at school, daily activities, and treatment-related experiences were measured, and also retrospectively for the preoperative period. RESULTS Preoperative and follow-up scores for self-esteem were similar. Overall perceived competence scores at follow-up were comparable to that of a healthy normal population. Patients' perceived athletic competence was lower and their perceived level of behavioral conduct was higher. At follow-up, patients had more positive appraisal of their physical appearance. Most health-related quality of life scores were not significantly different to those of the healthy normal population, apart from a reduced gross motor function, less vitality, and more pain. Patients with a remaining leg length inequality (LLI) of more than 2 cm had lower quality of life scores for gross motor function, sleep, pain, vitality, and depressive feelings. INTERPRETATION At an average of 7 years after an Ilizarov limb lengthening procedure, patients still have physical restraints, but they appear to have normal psychosocial functioning, self-esteem, and perceived competence. These patients have quality of life scores comparable to those of norm groups, apart from a reduced gross motor function, less vitality and more pain. Residual LLI of more than 2 cm remains important even after long-term follow-up; these patients report lower quality of life.
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Affiliation(s)
- Judith M Moraal
- Department of Paediatric Psychology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
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Measurement of health-related quality of life in children undergoing external fixator treatment for lower limb deformities. J Pediatr Orthop 2009; 29:920-6. [PMID: 19934710 DOI: 10.1097/bpo.0b013e3181c1e2e2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND External fixator treatment (EFT) of lower limb deformities is expected to optimize gait and physical appearance, which might improve the child's health-related quality of life (HRQOL). Although EFT can impose a significant psychologic burden on the children and their families, there is a lack of studies on the HRQOL of children undergoing EFT. The purpose of this paper is to determine the construct validity and the responsiveness of the Pediatric Quality of Life Inventory (PedsQL) generic module in children with lower limb deformities undergoing EFT and to describe the use of other outcome measures in this population. METHODS Fifty-two children (mean age: 13.0 y, SD: 4.2) who enrolled in the pilot phase of a randomized controlled trial to examine the safety and efficacy of botulinum toxin type A injections in children undergoing EFT of the lower limb were included in this study. Pain and functional mobility were measured at baseline. HRQOL was assessed with the child self-report and parent proxy-report formats of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) at baseline, at mid-distraction, mid-consolidation, 1-week post-frame removal, and 3 months post-frame removal time points. The known groups method was used to measure the construct validity of the PedsQL; paired t tests, Cohen's d estimate of effect size (ES) and standardized response mean were used to calculate its responsiveness. RESULTS Children and parents reported significantly lower HRQOL scores on all PedsQL domains compared with norms. ES and standardized response mean calculations both show largest amounts of change in the Physical Health domain, with children and parents reporting worse HRQOL at mid-distraction than at baseline. The PedsQL shows statistically significant changes only in the emotional functioning score of the child self-report from 3 months post-frame removal compared with baseline. CONCLUSIONS The PedsQL is able to discriminate HRQOL between children with leg length discrepancy and the normal population. The responsiveness of the PedsQL in children with lower limb deformities was shown through patient change over time as a result of EFT. Our findings indicate the importance of assessing a wide range of domains including physical, psychosocial, and emotional components of health in children with leg length discrepancy undergoing EFT. LEVELS OF EVIDENCE Level IV. Case series.
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Botulinum toxin type A injection in alleviating postoperative pain and improving quality of life in lower extremity limb lengthening and deformity correction: a pilot study. J Pediatr Orthop 2009; 29:427-34. [PMID: 19568011 DOI: 10.1097/bpo.0b013e3181aad628] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Ilizarov technique is commonly used for lengthening and deformity corrections of the lower limbs in children. Postoperative pain can be significant, affecting quality of life and functional mobility, and often requiring prolonged medication use. Several studies have investigated the antinociceptive actions of botulinum toxin type A (BtX-A), yet evidence for its use in this population is limited. The objectives were to (1) establish the feasibility of a randomized clinical trial in children undergoing limb lengthening or deformity correction and (2) provide preliminary evidence of the beneficial effects of BtX-A in this population. METHODS Fifty-two patients with a mean age of 13.7 years (range, 5 to 21 y) were randomized to receive either BtX-A or an equivalent volume of sterile saline solution (placebo group), as a single dose during the surgical procedure. Pain, medication use, quality of life, and functional mobility outcomes were assessed in all patients. Adverse events were reported for all patients and classified as minor or major. RESULTS Differences between groups did not reach statistical significance; however, pain at mid-distraction was found to be slightly lower in the BtX-A group, as compared with the placebo group. Patients in the BtX-A group used less parenteral pain medication in the first 4 days after the surgery, had higher quality of life scores at 3 of the 5 time points assessed, and slightly higher functional mobility scores. All adverse events were expected complications of the lengthening process. No event was considered to be a serious adverse event related to the BtX-A injection itself. There was a trend toward fewer major adverse events in the BtX-A group. CONCLUSIONS This pilot study established the feasibility of a randomized controlled trial design for in this population. Its findings indicate that BtX-A injections appear to be safe and effective for reducing pain and improving the quality of life and functional mobility of children undergoing lengthening or deformity corrections of the lower limbs. A larger-scale study is currently underway to confirm these preliminary findings.
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Modin M, Ramos T, Stomberg MW. Postoperative impact of daily life after primary treatment of proximal/distal tibiafracture with Ilizarov external fixation. J Clin Nurs 2009; 18:3498-506. [PMID: 19732246 DOI: 10.1111/j.1365-2702.2009.02859.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe patients' experience of the impact of their health-related life situation on their daily life two and four weeks after primary fracture treatment with Ilizarov external fixation. BACKGROUND A few studies have been conducted postoperatively focussing on fracture treatment with Ilizarov fixation. DESIGN A prospective descriptive research design. METHOD Patients who had been treated for a proximal/distal tibial fracture were invited to participate in the study. Data were collected with a semi-structured questionnaire where 20 patients described in their own words their situation at home two and four weeks postoperatively. The process used when analysing the data was similar to content analysis. RESULTS Four key themes were identified: 'limitations in the home environment', 'limitations outside the home', 'limitations to social relations' and 'experience of having an Ilizarov fixation'. The patient's life situation was strongly affected during the first postoperative month. This took the form of clear limitations on activities outside the home and a degree of limitation on coping with household chores and personal hygiene. These limitations became less severe after between 2-4 weeks and were very much a consequence of using crutches. CONCLUSION This study points to limitations in the patient's daily life situation in the home. The results from the study make it obvious that the information given to patients prior to discharge, concerning the value of putting weight on the leg, had not been clear or that the patients had not understood it. This had a negative impact on the patient's daily life after discharge. Further data are needed to uncover the extent of the issue to be able to optimise patient outcomes. RELEVANCE TO CLINICAL PRACTICE There is a need for clearer and more active information from the nurse before discharge but also a need to follow up how the information given is understood.
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Affiliation(s)
- Marina Modin
- Department of Surgery, Central Hospital, Skövde, Sweden.
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Evaluation of body image and self-esteem in patients with external fixation devices: a Turkish perspective. Orthop Nurs 2009; 28:169-75. [PMID: 19657261 DOI: 10.1097/nor.0b013e3181ada7fa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This descriptive study aimed to describe the body image and self-esteem of patients with external fixation devices. SAMPLE Fifty patients with external fixation devices who came for follow-up to the Ilizarov Outpatient Clinic of a university hospital in Turkey were included in this study. INSTRUMENTS Data were collected by using a Demographic Questionnaire Form, Multidimensional Body-Self Relations Questionnaire (MBSRQ), and Coppersmith Self-Esteem Inventory. RESULTS The perceived body image (197.58 +/- 25.14) and self-esteem (65.28 +/- 17.97) of the patients with external fixation devices were in the moderate range. There was no significant correlation between body image and self-esteem. Self-esteem was correlated with one's perception of whether external fixation impacted one's appearance and whether one wanted to avoid being seen by certain individuals because of the appearance of the external fixator. CONCLUSION The study highlighted that body image disturbance and threats to self-esteem are not universal with the use of external fixation and need to be assessed individually.
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Newton Ede MP, Malik MHA, Prudhoe L, Miller C, Khan SA, Wilkes RA. Supporting limb reconstruction patients: a fine-wire circular fixator support group. Ann R Coll Surg Engl 2008; 91:63-5. [PMID: 18990262 DOI: 10.1308/003588409x359051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION External fixator frames are widely used in limb reconstruction surgery. They are used for relatively long periods and the multidimensional impact on patients is documented. We examined the role of a nurse-led specialist group when supporting patients both pre-operatively and postoperatively. PATIENTS AND METHODS All patients with external fixators were contacted via postal questionnaire. Questions asked covered regularity of attendance at the specialist group, information received and problems with the frames. RESULTS Thirty-seven patients replied. Twenty-one had attended the clinic and nearly all (32) had been offered the opportunity to attend. Most reported being well prepared for surgery and felt that the information given was satisfactory. Problems were generally addressed within the group and patients attended the group with frame-related problems before attending their general practitioner or the accident and emergency department. All patients found the group environment supportive. CONCLUSIONS We describe a unique patient support group. To our knowledge, it is the first in the country. It is a valuable resource in equipping patients prior to surgery as well as dealing with problems that arise with the frame in situ. We recommend it to other limb reconstruction units.
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Affiliation(s)
- M P Newton Ede
- Limb Reconstruction Unit, Department of Trauma and Orthopaedics, Hope Hospital, Salford, UK.
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Quality of life in patients with varus gonarthrosis treated with high tibial osteotomy using the circular external fixator. Knee Surg Sports Traumatol Arthrosc 2008; 16:311-6. [PMID: 18183369 DOI: 10.1007/s00167-007-0473-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 11/28/2007] [Indexed: 10/22/2022]
Abstract
Generally, surgeon-driven musculoskeletal evaluation systems are used for evaluating outcomes of patients who are treated with high tibial osteotomy. In this study, we investigated the effects of high tibial osteotomy using circular external fixator on quality of life. Twenty-one high tibial osteotomy of 19 patients were evaluated. Quality of life assessment was made using Short Form -36 at preoperative, before fixator removal and 6 months after fixator removal. After applying fixator, the physical function and physical role scores of Short Form-36 decreased and emotional role score did not improve. In other categories, significant improvements were observed when fixator in place. At the sixth month after fixator removal, significant improvements were dedected in all categories of Short Form-36. Although there was a decrease in physical functions after fixator application in patients who were treated with high tibial osteotomy using circular external fixator, significant improvement occurred in quality of life after fixator removal.
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Niemelä BJ, Tjernström B, Andersson G, Wahlsten VS. Does leg lengthening pose a threat to a child's mental health?: An interim report one year after surgery. J Pediatr Orthop 2007; 27:611-7. [PMID: 17717458 DOI: 10.1097/bpo.0b013e31814256c6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
UNLABELLED Previous studies suggest that children react with functional and psychological disturbances after leg lengthening (LL). Long-term effects are not known, and there is a lack of prospective studies. The aim of this interim prospective study was to investigate the psychological impact of the Ilizarov technique on a sample of children 1 year after surgery. METHODS : The subjects were 27 patients aged 6 to 16 years treated using the Ilizarov technique at the Pediatric Orthopaedic Department, Uppsala University Hospital, between 1997 and 2005. A control group of healthy children matched for age and sex were also included.Semistructured interviews and psychometric measures (anxiety, depression, self-esteem, behavior) were administered to patients and parents before surgery and 1 year after. Psychological measures were correlated with medical records (days of hospitalization, gained length, etc). The control group was examined at initial assessment only. RESULTS : Before reconstructive surgery, the LL group had a significantly lower self-esteem compared with the control group. Aggressive behavior, attention and externalization problems, anxiety, and depression were significantly reduced after LL. Parents' state anxiety was also reduced. There were no differences in trait anxiety between the parents of patients and the parents of the control children. CONCLUSIONS : Patients reported pain, psychological discomfort, complications, and restrained function during LL. However, there were no adverse psychological effects at 1-year follow-up; rather, there were signs of improved mental health. No single psychological parameter could predict the outcome after LL.
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Abstract
PURPOSE To define the state of nursing knowledge about the psychological impact of treating adolescents with external fixation devices (EFDs). METHOD An integrated research review was conducted on literature available from CINAHL, MEDLINE, and PsycINFO. Keywords used were external fixation, fracture fixation, orthopaedic or orthopaedic, limb lengthening, Ilizarov, halo traction, Orthofix, EBI fixator, pelvic fixator, ring fixator, body image, self-concept, self-esteem, self-perception, adaptation, emotional, behavior, and outcome. Inclusion criteria for studies were (a) publication from 1990 to 2003, (b) focus on psychosocial and functional outcomes of treating adolescents with EFDs, and (c) publication in English. Studies were categorized by author, year, discipline(s), design, focus, sample, measurement, findings, and research recommendations. Findings and recommendations were compared across publications. RESULTS All studies reported psychological and behavioral changes after EFD treatment. Pain and pin-site infections were the most problematic physical findings. Depression was universally evident to varying degrees, with some suicidal ideation and self-destructive behaviors, although mostly reported as transient. This predominantly retrospective cohort of studies reported social isolation as well as eating and sleep disturbances. Family and nursing support, a multiple disciplinary approach, and better preoperative preparation were crucial to adolescents psychological health after EFD treatment. CONCLUSION Adolescents treated with EFDs require significant psychosocial support. The findings reveal major gaps in the knowledge on adolescents treated with external fixation for traumatic injury and none focused on EFD treatment in the acute period.
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Affiliation(s)
- Miki Patterson
- University of Massachusetts Graduate School of Nursing, Department of Orthopedics, UMass Memorial Medical Center, Worcester, MA, USA
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