Edilson Forlin

Quality of life of children with cerebral palsy treated with botulinum toxin: are well-being measures appropriate?

AIM To analyze quality of life (QOL) of children with cerebral palsy (CP) treated with botulinum toxin type A (BTXA). METHOD Two QOL evaluation tools, translated into Portuguese, were used: Pediatric Outcomes Data Collection Instrument (PODCI) and Childs Caregiver Questionnaire (CCQ). Questionnaires were answered by caregivers on two occasions. Patients were divided into 3 groups: I--patients who had been previously treated with BTXA and who underwent a session of BTXA; II--patients who used BTXA for the first time; III--patients previously treated with BTXA but did not in this interval. RESULTS Sixty-eight patients were evaluated. In group I (n=26) the functional ability had improvement for all types of CP (p=0.04), and tetraplegic increased interaction/communication (p=0.02). In group II (n=14) positioning improved (p=0.02). Group III (n=28) showed no change in QOL. CONCLUSIONS PODCI and CCQ are able to capture outcome in children with CP.

Publication of studies presented as free papers at a Brazilian national orthopedics meeting

Objective To evaluate the rate and others factors related with the publication of free papers presented at a national orthopedic meeting. Methods Using virtual databases we reviewed the studies presented at the 2004 Brazilian Congress of Orthopedics and Traumatology that were published, as well as related factors such as institution, sub-specialty, year, level of evidence, results and comparison between abstract presented and published. Results There were 58 studies published from 267 presented (21.73%). Seven (12.1%) were published in international and 51 (87.9%) in national journals, mainly RBO (55%). The publication rate was higher in the year of the event and the following year (37.9%). The sub-specialties of spine and knee showed the best correlation between the numbers of papers presented and published (respectively 40.9% and 37.9%). Most of the studies were cohort (65%) and experimental studies have been 34.5%. There was a tendency to publish positive results or statistically significant. Three institutions were responsible for most of the publications (53.4%). Works with higher level of evidence showed the highest rate of publication. The abstract published was modified in 68.5% of the form the presentation. Conclusions This study presents data that compromises the quality of scientific of the abstracts presented at orthopedic meeting: most have a lower level of evidence and nearly 80% are not published.

Sucesso do tratamento conservador do polegar em gatilho em crianças após seguimento mínimo de cinco anos

OBJECTIVE: The aim of this study was to evaluate the outcome of conservative treatment of trigger thumb in children, in order to discuss the real need for surgical release in these patients. METHODS: This was a retrospective study on a group of children with trigger thumb who were treated conservatively by the same orthopedic surgeon with gentle manipulation at the time of the consultation and guidance on stretching to be performed at home. The cases were followed up for at least five years. RESULTS: Thirteen thumbs in 11 children (seven boys and four girls) were treated. The mean age at the first consultation was 26.3 months (range: 11 to 36 months). The mean follow-up was 10 years (range: 5 to 16 years). Ten thumbs showed satisfactory results (77%): eight of these were diagnosed when the child was younger than two years of age. The mean time taken from diagnosis to clinical improvement was 20.8 months (range: 6 to 36 months). The three thumbs that required surgical treatment were diagnosed after the age of two years and six months. CONCLUSIONS: Conservative treatment of trigger thumb in children showed a high rate of success, especially in children who were diagnosed up to the age of two years. This is important information to be passed on to parents and may avoid unnecessary surgery in many cases.

Evaluation of suspected physical abuse in children: a 500-case study ☆

Objective This study evaluated the epidemiological profile of patients with suspected physical abuse, especially regarding the occurrence of fractures, treated in a referral hospital. Methods The authors reviewed all reports of suspected abuse against children and adolescents (AACA) in this hospital from January 2005 to December 2015. They were assessed and separated by month and year. The characteristics of the victims of physical abuse with occurrence of fractures were studied. The features of the fractures were evaluated in those patients with available radiographs. Results Of the 3125 notifications, 500 were classified as physical injuries; of these, 63 had fractures. An annual progressive increase in notifications was observed. As for age group, 50 patients (80.6%) were up to three years old and 36 (58%) up to one year. Most were male (60%) and the likely aggressors were mother alone and both parents (27.5% each). In 30 patients with available images, fractures of long bones (femur, tibia, and humerus) predominated (71%), as well as a single fracture line (74%), diaphyseal location (73%), and a transverse line (57%). There were two deaths in fracture cases (3%). Conclusion All orthopedists should be alert to suspected AACA in children with trauma below the age of three, even without classic signs of abuse.

Hip dislocation in cerebral palsy: evolution of the contralateral side after reconstructive surgery

Objective To evaluate the progression of the contralateral hip after unilateral reconstruction of hip dislocation in patients classified as GMFCS IV–V; and to identify potential prognostic factors for their evolution. Methods This was a retrospective study on 17 patients with spastic cerebral palsy, who were classified on the GMFCS scale (Gross Motor Functional Classification System) as degrees IV and V, and who underwent unilateral reconstruction surgery to treat hip dislocation (adductor release, femoral varus osteotomy and acetabuloplasty). The minimum postoperative follow-up was 30 months. The clinical parameters evaluated were sex, age at time of surgery, length of follow-up after surgery and range of abduction. The treatment parameters were use/nonuse of femoral shortening, application of botulinum toxin and any previous muscle releases. The radiographic parameters were Reimers extrusion index (REI), acetabular angle (AA) and the continuity of Shentons line. Results Among the 17 patients evaluated, eight presented dislocation (group I) and nine did not (group II). Group I comprised three males and five females; group II comprised one male and eight females. The mean age at the time of surgery among the group I patients was 62 months and the mean follow-up was 62 months. In group II, these were 98 and 83 months, respectively. There was a trend in which patients of greater age did not evolve with contralateral dislocation. Among the nine patients with the combination of REI < 30% and AA < 25°, only one presented dislocation during the follow-up. Contralateral subluxation occurred within the first two years after the surgery. Conclusion Hips presenting REI < 30° and AA < 25° do not tend to evolve to subluxation and can be kept under observation. Preoperative clinical and radiographic measurements alone are not useful for indicating the natural evolution of non- operated hips. The critical period for subluxation is the first two years after surgery.