Idiopathic toe walking and sensory processing dysfunction

<p>Abstract</p> <p>Background</p> <p>It is generally understood that toe walking involves the absence or limitation of heel strike in the contact phase of the gait cycle. Toe walking has been identified as a symptom of disease processes, trauma and/or neurogenic influences. When there is no obvious cause of the gait pattern, a diagnosis of idiopathic toe walking (ITW) is made. Although there has been limited research into the pathophysiology of ITW, there has been an increasing number of contemporary texts and practitioner debates proposing that this gait pattern is linked to a sensory processing dysfunction (SPD). The purpose of this paper is to examine the literature and provide a summary of what is known about the relationship between toe walking and SPD.</p> <p>Method</p> <p>Forty-nine articles were reviewed, predominantly sourced from peer reviewed journals. Five contemporary texts were also reviewed. The literature styles consisted of author opinion pieces, letters to the editor, clinical trials, case studies, classification studies, poster/conference abstracts and narrative literature reviews. Literature was assessed and graded according to level of evidence.</p> <p>Results</p> <p>Only one small prospective, descriptive study without control has been conducted in relation to idiopathic toe walking and sensory processing. A cross-sectional study into the prevalence of idiopathic toe walking proposed sensory processing as being a reason for the difference. A proposed link between ITW and sensory processing was found within four contemporary texts and one conference abstract.</p> <p>Conclusion</p> <p>Based on the limited conclusive evidence available, the relationship between ITW and sensory processing has not been confirmed. Given the limited number and types of studies together with the growing body of anecdotal evidence it is proposed that further investigation of this relationship would be advantageous.</p

Multiparameter quantitative computer-assisted tomography assessment of unicompartmental knee arthroplasties

BackgroundUnicompartmental knee arthroplasty is a popular alternative to total knee replacement in selected patients. Component alignment has not yet been described by computer-assisted tomography (CAT) imaging techniques; these have been developed for total knee arthroplasty analysis. The aims of this study were to report two new technologies; a new unicompartmental knee arthroplasty system was radiographically assessed with a new CAT scan protocol.MethodsIn a consecutive cohort study, 60 knees were analysed by the 'UniCAT Protocol'. Patients were implanted with a unicompartmental knee arthroplasty system that uses a unique ligament tensor for femoral component alignment. The uniCAT protocol requires a long anteroposterior and lateral scout scan to measure limb alignment and component orientation. A spiral computer-assisted tomography at the knee is used to measure component rotation. The total scan time was 20 s with a calculated unshielded radiation dose of 1 mSv or less.ResultsThe mechanical axis had a mean of 2.7 degrees varus. Femoral components were implanted with a mean of 0.37 degrees valgus and 1.3 degrees flexion. Tibial components were implanted with a mean 3.47 degrees varus and 5.1 degrees posterior slope. Femoral components were externally rotated a mean of 3.36 degrees, tibial components were externally rotated 6.59 degrees from the posterior tibia and 5.68 degrees from the transepicondylar axis.ConclusionThe UniCAT protocol uses less radiation than whole-limb spiral scans and is a method that can be used with all modern computer-assisted tomography machines. The coronal and sagital alignment results compare favourably with previous published reports without computer-assisted tomography. Component rotation has not previously been reported and its implications are yet to be defined.Campbell, David G.; Johnson, Luke J.; West, Simon C

Resección de hemivértebra con técnica de eggshell en cifoescoliosis congénita: resultados en niños entre uno y siete años Ressecção de hemivertébra com a técnica de eggshell em cifoescoliose congênita: resultados em crianças com idade entre um e sete anos Hemivertebrae resection with eggshell procedure for congenital kyphoscoliosis: results in children aged from one to seven years

INTRODUCCIÓN: La hemivértebra es la causa de 50% de las cifoescoliosis congénitas y en general requiere tratamiento quirúrgico. OBJETIVO: evaluar los resultados clínicos y radiológicos de la resección de hemivértebra con técnica de eggshell en niños entre uno y siete años. DISEÑO DEL ESTUDIO: análisis retrospectivo de pacientes sometidos a resección de hemivértebra con técnica de eggshell. MÉTODOS: entre Enero del 2006 y Junio del 2008, siete hemivértebras fueron resecadas en siete pacientes consecutivos, entre uno y siete años de edad. Se revisó retrospectivamente las fichas clínicas y radiografías. La edad promedio al momento de la cirugía fue 3,2 años (rango de uno a siete años) y el seguimiento promedio fue de 17 meses (rango 7 a 35 meses). Se registró ángulo de Cobb de la escoliosis y cifosis en el preoperatorio y al término del seguimiento, tiempo operatorio, transfusión de glóbulos rojos y complicaciones. RESULTADOS: el ángulo preoperatorio promedio de la escoliosis fue 35° y 19° al término del seguimiento, con un 40% de corrección. El ángulo preoperatorio promedio de la cifosis fue 42° y 25° al término del seguimiento, con un 33% de corrección. Cuatro pacientes necesitaron transfusión de glóbulos rojos, promedio 1,25 unidades. El tiempo quirúrgico promedio fue 225 minutos. Dos pacientes presentaron complicaciones, una rotura dural y una fractura pedicular. No se presentaron complicaciones neurológicas. Todos los pacientes presentaban fusión sólida al término del seguimiento. CONCLUSIÓN: la resección de hemivértebra con técnica de eggshell es un procedimiento seguro, que permite una excelente e inmediata corrección de la cifoescoliosis congénita, la que se mantiene en el corto plazo.<br>INTRODUÇÃO: A hemivértebra associa-se a 50% das cifoescolioses congênitas e geralmente requer tratamento cirúrgico. OBJETIVO: avaliar os resultados clínicos e radiológicos da ressecção da hemivértebra, utilizando a técnica de eggshell em crianças entre um e sete anos. FORMA DO ESTUDO: análise retrospectiva dos pacientes submetidos à ressecção de hemivértebra com a técnica eggshell. MÉTODOS: Entre Janeiro de 2006 e Junho de 2008, sete hemivértebras foram ressecadas em sete pacientes consecutivos, entre um e sete anos de idade. Realizou-se análise retrospectiva dos prontuários e exames radiográficos. A média de idade no momento da cirurgia foi de 3,2 anos (variação entre um a sete anos) e o seguimento médio foi de 17 meses (variação de 7 a 35 meses). Registrou-se ângulo de Cobb na escoliose e cifose no pré-operatório e no término do seguimento, o tempo operatório, transfusão de glóbulos vermelhos e complicações. RESULTADOS: o ângulo pré-operatório médio da escoliose foi de 35° e 19° no término do seguimento, com um 40% de correção. O ângulo pré-operatório médio da cifose foi de 42° e 25° no término do seguimento, com 33% de correção. Quatro pacientes precisaram de transfusão de glóbulos vermelhos, 1,25 unidades como média. O tempo cirúrgico médio foi de 225 minutos. Dois pacientes apresentaram complicações, uma rotura dural e uma fratura pedicular. Não houve complicações neurológicas. Todos os pacientes apresentaram sólida fusão no término do seguimento. CONCLUSÃO: a ressecção de hemivértebra utilizando a técnica de eggshell é um procedimento seguro que permite uma excelente e imediata correção da cifoescoliose congênita, a qual é mantida no curto prazo.<br>INTRODUCTION: Hemivertebrae is associated with 50% of the congenital kyphoscoliosis and surgical treatment is usually required. OBJECTIVE: to evaluate clinical and radiographic results of hemivertebra resection with an eggshell procedure in children aged from one to seven years old. STUDY DESIGN: retrospective review of patients who underwent hemivertebrae resection with an eggshell procedure. METHODS: from January 2006 to June 2008, seven hemivertebrae were resected in seven consecutive patients aged one to seven years old. A retrospective chart and a radiographic review were performed. The mean age at surgery was 3,2 years (range from one to seven years). The mean follow-up was 17 months (range from 7 to 35 months). Cobb's angle in the coronal and sagittal planes preoperative and at follow-up, operating time, transfusion requirements and complications were analyzed. RESULTS: the mean pre-operative scoliosis Cobb's angle was 35° and the average at follow-up was 19°. The mean correction at follow-up was 40%. The average of the pre-operative kyphosis Cobb's angle was 42° and average at follow-up was 25°. Rate of correction at follow-up was 33%. Four patients required transfusion, with an average of 1,25 blood units. The average of operating time was 225 minutes. Complications were encountered in two patients; one dural tear and one pedicular fracture. No neurological complications. All patients achieved solid fusion at follow-up. CONCLUSION: hemivertebra resection with the eggshell procedure is a safe surgical technique and provides an excellent and immediate correction of congenital kyphoscoliosis at short term follow-up