Effect of unstable shoes on trunk posture during standing and gait in chronic low back pain

Chronic low back pain (CLBP) is a common painful condition affecting particularly medical hospital staff. Wearing unstable shoes could be proposed as an alternative treatment as a pain decrease was observed in a recent study. A six-week treatment showed pain decrease that could be linked to a more vertical trunk posture. Therefore, the aim of this study was to evaluate if unstable shoes allow a more vertical posture of the trunk in the sagittal plane explaining this decrease in pain after six weeks of wearing. Forty CLBP hospital employees were randomly distributed in intervention (IG, n = 17) and control group (CG, n = 16) wearing respectively unstable and stable shoes. Gait and orthostatic trunk kinematics were recorded before and after six weeks in barefoot and shoes conditions. IG participants were defined responders (R-IG, n = 8) if a pain reduction ≥ 2 points (difference in values obtained with a visual analogue scale pain scale (VAS) before and after 6 weeks) was observed; otherwise, IG participants were defined non-responders (NR-IG, n = 9) (pain reduction < 2). IG had a tendency to show a trunk more vertical than CG in orthostatic position and R-IG had a tendency to show a trunk more vertical than NR-IG during gait. Due to the small observed differences, it is difficult to conclude on the effect of unstable shoes on trunk posture and gait of CLBP patients after six weeks of wearing

Irradiation level related to intraoperative imaging device in paediatric elastic stable intramedullary nailing: preliminary prospective study on 51 patients using PCXMC software

PURPOSE : Radiation-induced cancers due to imaging devices concern above all the growing child, however, to date, intraoperative irradiation doses are not well-documented in children. The goal of the study was to evaluate the intraoperative doses received by patients operated with the use of a C-arm in traumatology, as well as the lifetime attributable risk of cancer death (LAR) related to the irradiation of the imaging device. METHODS : From 1 April 2017 to 31 March 2019, we started a multicentre study and prospectively recruited all consecutive children who needed elastic stable intramedullary nailing (ESIN) for long-bone fracture. We collected demographic and operative data, with dose reports including duration and doses. The main outcome was the effective dose (ED) in millisievert (mSv), calculated with PCXMC software, and the secondary outcome was the LAR expressed as a percentage. RESULTS : In all, 51 patients operated on using 2D C-arm imaging were included in this study. The mean ED was 0.085 mSv (SD 0.10; 0.002 to 0.649). Overall LAR was 6.5 x 10−4% (SD 6.7 x 10−4%; 0.1 x 10−4% to 28.3x10−4%). Univariate linear regression showed a significant association between ED and irradiation time (p 0.05). CONCLUSION : Treatment of long-bone fractures by ESIN found a low level of effective doses with utilization of the C-arm device in current practice. Further studies on a larger sample are needed to confirm these results. LEVEL OF EVIDENCE : I

Validity and Reliability of Spine Rasterstereography in Patients with Adolescent Idiopathic Scoliosis

Test-retest study. OBJECTIVE : This study aimed to evaluate the validity and reliability of rasterstereography in patients with adolescent idiopathic scoliosis (AIS) with a major curve Cobb angle (CA) between 10° and 40° for frontal, sagittal and transverse parameters

Osteoarticular Infections in Children: Accurately Distinguishing between MSSA and <i>Kingella kingae</i>

Introduction: Osteoarticular infections (OAIs) constitute serious paediatric conditions that may cause severe complications. Identifying the causative organism is one of the mainstays of the care process, since its detection will confirm the diagnosis, enable adjustments to antibiotic therapy and thus optimize outcomes. Two bacteria account for the majority of OAIs before 16 years of age: Staphylococcus aureus is known for affecting the older child, whereas Kingella kingae affects infants and children younger than 4 years old. We aimed to better define clinical characteristic and biological criteria for prompt diagnosis and discrimination between these two OAI. Materials and methods: We retrospectively studied 335 children, gathering 100 K. kingae and 116 S. aureus bacteriologically proven OAIs. Age, gender, temperature at admission, involved bone or joint, and laboratory data including bacterial cultures were collected for analysis. Comparisons between patients with OAI due to K. kingae and those with OAI due to S. aureus were performed using the Mann–Whitney and Kruskal–Wallis tests. Six cut-off discrimination criteria (age, admission’s T°, WBC, CRP, ESR and platelet count) were defined, and their respective ability to differentiate between OAI patients due to K. kingae versus those with S. aureus was assessed by nonparametric receiver operating characteristic (ROC) curves. Results: Univariate analysis demonstrated significant differences between the two populations for age of patients, temperature at admission, CRP, ESR, WBC, and platelet count. AUC assessed by ROC curves demonstrated an exquisite ability to discriminate between the two populations for age of the patients; whereas AUC for CRP (0.79), temperature at admission (0.76), and platelet count (0.76) indicated a fair accuracy to discriminate between the two populations. Accuracy to discriminate between the two subgroups of patients was considered as poor for WBC (AUC = 0.62), and failed for ESR (AUC = 0.58). On the basis of our results, the best model to predict K. kingae OAI included of the following cut-offs for each parameter: age 361,500/mm3. Conclusions: OAI caused by K. kingae affects primarily infants and toddlers aged less than 4 years, whereas most of the children with OAI due to MSSA were aged 4 years and more. Considering our experience on the ground, only three variables were very suggestive of an OAI caused by K. kingae, i.e., age of less than 4 years, platelet count > 400,000, and a CRP level below 32.5 mg/L, whereas WBC and ESR were relatively of limited use in clinical practice