Breaking bony bridges by physeal distraction

Physeal distraction for breaking bony bridges and the late treatment of long bone deformities in children near maturity, has been used in our Department since June, 1983. In all cases (4 bones in 3 patients) a deformity was present at the extremity of a long bone due to a bony bridge caused by a previous injury to the growth cartilage. The results were excellent and in our opinion there are advantages over other methods. The operation itself is not extensive and very little damage is done. There is no need for internal fixation or bone grafts. It is possible to obtain lengthening and to adjust the angular correction during treatment. We conclude that it is possible to correct angular deformities and bone shortening due to bony bridges by physeal distraction without the need for resection of the bony bridge. At present we recommend this method in children near skeletal maturity, especially in those cases with bone shortening

Experimental physeal distraction in immature sheep

An experimental study on physeal distraction was carried out in the distal femur of 45 two-month-old lambs for the purpose of identifying the basic mechanism of lengthening as well as assessing growth cartilage viability after lengthening. The animals were divided into three groups, each with three subgroups, according to the distraction rate employed (2 mm/day, 1 mm/day, 0.5 mm/day) and the time at which the animals were killed (end of lengthening, 1.5 months postlengthening, and at six months of age). Another group of three animals whose femurs were lengthened at a rate of 0.5 mm/day was killed ten days postoperatively. Roentgenologic, specimen measurements, and histologic studies were performed on all animals. The results obtained showed that the basic mechanism for lengthening is the production of a physeal fracture between degenerative and calcified layers; this finding was consistent. It was also observed that the lower the rate of distraction employed, the greater was the short- and long-term viability of the growth cartilage. More specifically, optimal viability was observed when a distraction rate of 0.5 mm/day was employed

Correction of angular deformities by physeal distraction

Physeal distraction is an alternative to more conventional treatments for the correction of angular deformities of the long bones. Twenty deformities of the femur and tibia, nine of which also involved associated shortening, were partially or completely corrected. In eight cases, there was physeal bony bridge. Complete correction of the angular deformity was achieved in 17 patients, and in seven patients, more than 80% correction was achieved. There were complications in four patients that hindered complete correction of the deformity, or shortening, or both. The external control of the correction until consolidation occurs is progressive and fairly noninvasive. The method allows external control of the correction until consolidation; it acts at the site of the deformity itself and permits lengthening and angular correction during therapy. In deformities with a physeal bony bridge, correction can be achieved with physeal distraction alone, prior resection of the bridge is not unnecessary. The technique is indicated in cases of angular deformities in patients nearing skeletal maturity and particularly in subjects in whom there is associated shortening

La fijación externa monolateral en el tratamiento de las fracturas femorales del niño: experiencia preliminar en 20 casos

Veinte niños con fracturas femorales diafisarias simples fueron tratados mediante fijación externa con el aparato de Wagner. Once eran niños y 9 niñas, con una edad media de 8 años (3-15). Doce fracturas eran mediodiafisarias, 6 en el tercio proximal y 2 en el tercio distal. La hospitalización media fue de 9 días (5-20). La duración media de fijación externa fue de 61 días. Cinco casos precisaron de algún tratamiento adicional. En 3 pacientes se detectó una infección en el trayecto de los clavos y 1 de ellos necesitó retirada prematura del aparato. La movilidad articular de la rodilla se restableció de modo completo y constante excepto en 1 caso. En los casos seguidos más de 18 meses se observó un hipercrecimiento medio del fémur fracturado de 0,8 cm (0,5- 1,5). No hubo desaxaciones ni malrotaciones. Las ventajas de la fijación externa en el tratamiento de las fracturas femorales del niño incluyen Un mejor control de los fragmentos fracturarlos, una menor hospitalización y un cuidado más fácil y confortable de los pacientes. La infección del trayecto de los clavos parece ser la complicación más seria. En esta serie se detectó una curva de aprendizaje.Twenty children with simple femoral-shaft fractures were treated by monolateral external fixation with the Wagner device. There were 11 boys and 9 girls with a mean age of 8 years (3-15). Twelve fractures were located at the midshaft, 6 at the proximal third, and 2 other at the distal third of the femur. The mean hospital stay was 9 days (5-20). Mean external fixation time was 61 years. In 5 cases, additional methods of treatment were required. Pin tract infection occurred in 3 cases (one needed premature removal of the device). Except for one case, full range of knee motion was usually achieved after treatment. In patients followed for more than 18 months, a mean femoral overgrowth of 0.8 cm (0.5-1.5) was detected. Neither angular deformities nor malrotations were observed. In our experience, the main advantages of external fixation for femoral-shaft fractures in children include less hospitalization time and an easier and more confortable nursing. External fixation allows a better control of the bone fragments, providing an adequate stability. Pin tract infection seems to be the most important drawback. A learning curve was observed in this series

Decision-making in school-age sport measured through a digital tool.

El objetivo de este estudio ha sido doble. Por un lado, diseñar y crear un software de evaluación de toma de decisiones en edad escolar, en base a aspectos espacio-temporales, contextualizado en voleibol, denominado “Juego Interactivo de Voleibol”. Por otro lado, analizar y establecer su fiabilidad y validez. El software diseñado se aplicó a una muestra de 132 escolares (64 niños y 68 niñas) de entre 10 y 13 años, de los centros educativos públicos de Educación Primaria y Secundaria de las localidades sevillanas de Arahal y Paradas (España). Para determinar la fiabilidad se estudió la consistencia interna a través del coeficiente alfa de Cronbach. Para calcular el número óptimo de repeticiones se utilizó el Coeficiente de Correlación Intraclase. La validez se comprobó en base a la evaluación de un grupo de 5 expertos. Los resultados indicaron que este nuevo software de evaluación alcanza altos niveles de fiablidad y validezThe aim of this study was twofold. On the one hand, the design and creation of an evaluation software for decision-making in school-age children based on spatial-temporal aspects in the context of volleyball called ‘Interactive Volleyball Game’. On the other hand, the analysis and establishment of its reliability and validity. The designed software was applied to a sample of 132 students (64 boys and 68 girls) aged between 10 and 13 years in public Elementary and Secondary Education schools of Seville towns, Arahal and Paradas (Spain). To determine the reliability, internal consistency was studied through Cronbach's alpha. The intraclass correlation coefficient (ICC) was also analyzed to calculate the optimal number of repetitions for future research. The validity was tested based on the assessment of a group of 5 experts. The results indicated that this new evaluation software reaches high levels of reliability and validit

Bone lengthening by physial distraction. An experimental study.

Experimental physial distraction was carried out in the distal part of the femur in 45 two-month old lambs in order to study the basic mechanisms of lengthening as well as the viability of the growth cartilage after using this method. The animals were divided into three groups (A, B and C), and each group into three subgroups (1, 2 and 3) according to the rate of distraction used (2 mm/day, 1 mm/day, 0.5 mm/day) and the time of sacrifice. The results obtained show that the basic lengthening mechanisms consists, firstly, in the production of a fracture between the metaphysis and the epiphysis and, secondly, that the lower the distraction speed employed, the greater is the short-term and long-term viability of the growth cartilage. Optimum viability was observed at a distraction rate of 0.5 mm/day. On this basis we conclude that in clinical practice physical distraction could be indicated for children at an early stage of skeletal growth and repeated later provided that the rate of distraction is kept within reasonable limits