Proceedings of the 68th Annual Meeting of the American Academy of Orthopaedic Surgeons, San Francisco, CA, February 28 through March 4, 2001
James H. Campbell, PhD, CO
Flexible Flatfoot: Thirteen-Year Outcome Study.
Ling et al.
There are numerous favorable reports advocating early operative treatment for flexible flatfoot in children, but little published information regarding the adult consequences of nonoperative management. The purpose of this study was to determine the long-term results of nonoperative treatment. The authors reviewed all patients who were evaluated Rochester, MN for flexible flatfoot between 1982 and 1998, reporting on a total of 97 feet in 50 patients (33 male, 17 female). Mean patient age was 7 years. In 47 of the patients, the condition was bilateral. The reason for referral for all of the children was flatfeet, with pain present in the arch region of 29 of the 97 feet (30%). All of the patients were managed nonoperatively, with orthoses used in 30 feet, corrective shoes in four, exercise in five, exercise combined with orthoses in four, education/reassurance/observation in 53, and activity modification in one. Mean patient follow-up was 13 years. Only one of the 97 feet underwent late operative treatment. Of the remaining 49 patients, three were found to have arch pain, which was described as mild/occasional in two patients and as moderate in one; however, none of these three patients had any limitation of daily activities, although one patient had limitations in recreational activities. At the time of follow-up, no patients were using orthoses or modified footwear. Dr. Ling and her colleagues concluded that, although some investigators recommend surgery for flexible flatfeet in children, this study indicated a high success rate of nonoperative management, with no complications and arch pain in only six of 97 feet (6%) at an average of 13 years of follow-up.
Benefits of Early Prosthetic Management of Transtibial Amputees: A Prospective Clinical Study of a Prefabricated Prosthesis. Schon et al.
The purpose of this study was to evaluate the use of a prefabricated, adjustable immediate/early postoperative prosthesis (IPOP) in transtibial amputees. The authors designed a prospective clinical study and compared its results with those of a matched historic control group of 31 consecutive patients who underwent transtibial amputation and were managed with soft dressings. Each residuum received a postoperative dressing and sock, after which the IPOP was applied. One patient was excluded from the study because of the size of the residuum. Of the remaining 30 patients, 11 discontinued IPOP use during the study (four because of mental incompetence, three due to a lack of confidence, two because of physician's orders, one as a result of noncompliance, and one because of an inability to doff/don the IPOP) and 19 used the IPOP until definitive prosthesis fitting. Data including complications, falls, time to definitive prosthesis fitting, and surgical revisions were collected retrospectively for the historic control group, then analyzed with Student's t test. The authors determined that the patients fitted with the IPOP had significantly fewer complications, fewer revisions, and a shorter time to a definitive prosthesis than patients in the matched historic control.
Correlates with the Patients' Perspective of Lower Extremity Amputation. Matsen et al.
Little attention has been directed at understanding the many factors that affect the result of amputation as perceived by the patient. To address this concern, the authors reported on 148 patients that had undergone lower extremity amputation. A standard questionnaire was used to assess patient demographics, co-morbidities, amputation characteristics, and prosthesis and social function at an average of 7 years after amputation surgery. The authors correlated each of these variables with four result metrics: general satisfaction, quality of life, freedom from frustration, and walking distance. These result metrics correlated significantly with the comfort of the residuum, the condition of the contralateral limb, the comfort, function and cosmesis of the prosthesis, social factors, and the ability to exercise recreationally. Interestingly, the authors determined that the level of amputation or bilateral amputations were not significant correlates with the patients' perceived result.
According to the authors, this study is one of the largest investigations to date of the statistical correlation of patient-assessed result with a broad range of demographic, co-morbidity, amputation, prosthetic, and social variables. The study revealed that the perceived result of amputation management is not fixed by the level or extent of the amputation, but rather by factors that may be optimized by surgical, prosthetic, and social management.
Long-Term Follow-up of Female Patients with Adolescent Scoliosis Treated with the Wilmington Brace. Gabos PG, Bowen JR.
The purpose of this study was to assess the long-term outcome of patients who completed a course of bracing for idiopathic scoliosis and to evaluate these patients for curve progression after skeletal maturity and discontinuation of the brace. The investigators reviewed the records of 605 adolescent female patients treated for idiopathic scoliosis with the Wilmington Brace between 1973 and 1983, with curves ranging from 20 to 49°, Risser 0 or 1 at initial treatment, and curves of <50° at skeletal maturity and end of brace treatment. Of the 77 patients that met these criteria, 55 were located and reevaluated with spinal radiographs. Average age at follow-up from the end of brace treatment was 30 years. At long-term follow-up, the authors noted an increase in spinal curvature of between 5 and 18° in 29% of the female patients that were managed nonoperatively for idiopathic scoliosis using the Wilmington Brace. However, none of the patients had an increase in curve magnitude of >10 degrees from the time of initial brace treatment of their curve.
Becker Orthopedic, Troy, MI
|
|
