W/M serrated osteotomy for infantile Blount's disease in Ghana: Short-term results

Purpose: The W/M serrated high tibial osteotomy is a not frequently described surgical technique for simultaneously correcting the varus and torsional deformity in patients with Blount's disease. Without the need for internal fixation, this surgical treatment is well suited for developing countries. This study describes the short-term results of the bilateral and unilateral W/M serrated osteotomy in patients with infantile Blount's disease. Methods: Between May 2008 and January 2013, 52 patients were treated with uni- (n = 22) or bi-lateral (n = 30) W/M serrated osteotomy of the proximal tibia due to a tibial varus deformity in two district hospitals in Ghana. Other causes than infantile Blount's disease were excluded from the analysis. Pre- and post-operative clinical and radiological measurements were done, and complications were monitored up to 12 weeks after surgery. Results: Seventeen patients (five males, 12 females; mean age 4.9 [standard deviation: 2.10]) were included, which underwent a total of 25 W/M serrated osteotomies. The femorotibial angle was corrected from 34.1 degrees ([mean] range: 6u68 degrees) to 7.1 degrees ([mean] range: 28u5 degrees). Only one patient had developed a wound infection, and all reached full consolidation. Conclusions: The W/M serrated osteotomy seems a profitable alternative technique for treating the varus and torsional deformity in patients with Blount's disease in the circumstances of developing countries. The short-term outcomes are good and promising with a low complication rate and good consolidation. Long-term follow-up results of these patients are needed to observe possible complications. Level of Evidence: IV, therapeutic case series

Green spaces and child health and development.

The ongoing urbanisation worldwide has led to an increasing number of children living in urban areas. Urban children, compared to children from rural areas, are generally exposed to higher levels of a number of environmental hazards such as air pollution, noise and heat, and have limited access to natural environments, including green spaces. At the same time, urban lifestyle is predominantly associated with lower levels of physical activity and higher exposure to crime and psychological stress. Contact with green spaces, on the other hand, is thought to have a defining role in human brain development. An accumulating body of evidence has also associated such contact with improved mental and physical health in children. This chapter aims to present a synopsis of the current state-of-the-art of research linking green space and child health and development. Towards this aim, we (1) elaborate on potential mechanisms underlying health effects of green spaces, (2) highlight the importance of prenatal and postnatal periods as windows of vulnerability, and (3) provide an overview of the available evidence on effects of green spaces on (a) pregnancy outcomes, (b) brain development including structural brain development, as well as behavioural and cognitive development, (c) respiratory and allergic conditions, and (d) cardiometabolic risk factors