Submuscular Bridge Plating for Complex Pediatric Femur Fractures Is Reliable.

Submuscular Bridge Plating for Complex Pediatric Femur Fractures Is Reliable.

Clin Orthop Relat Res. 2013 Mar 29;
Abdelgawad AA, Sieg RN, Laughlin MD, Shunia J, Kanlic EM

BACKGROUND: Complex, high-energy pediatric femur diaphyseal fractures cannot be treated reliably by conventional methods: casting is not suitable for polytrauma and large children, external fixation is associated with a high rate of malalignment and refractures, elastic nails are unsuitable for unstable fractures and metaphyseal areas, and lateral trochanteric entry rigid nails cannot address proximal and distal fragments and need relatively large medullary canals. A few centers have reported that submuscular bridge plating (SBP) is associated with minimal complications, but these findings require confirmation. QUESTIONS/PURPOSES: We asked whether SBP (1) reproducibly leads to union in unstable fractures with a low complication rate, (2) leads to reasonable alignment and leg length equality (3), is unaffected by age, weight, or location of fracture, and (4) is associated with no or minimal refracture after hardware removal. METHODS: We retrospectively reviewed 60 fractures in 58 patients with pediatric diaphyseal femoral fractures treated with SBP from 1999 to 2011. The average age was 9 years. Forty (67%) of the fractures were unstable. Minimum followup was 2.4 months (average, 15.5 months; range, 2.4-50.6 months). RESULTS: All fractures healed well and all patients returned to full activity. Two of the 58 patients (3%) had major complications leading to unplanned surgeries: one implant failure and one deep infection in an old open fracture. None of the patients developed clinically important malalignment or leg length discrepancy. Implant removal was performed in 49 patients without complications. CONCLUSIONS: SBP provided reliable fixation and healing for complex pediatric femur fractures and can have a broader application in the orthopaedic community. SBP is our preferred method for unstable fractures or fractures of the proximal and distal shaft. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence. HubMed – rehab


Distress, Coping, and Drug Law Enforcement in a Series of Patients Using Medical Cannabis.

J Nerv Ment Dis. 2013 Apr; 201(4): 292-303
Aggarwal SK, Carter G, Sullivan M, Morrill R, Zumbrunnen C, Mayer J

Patients using medical cannabis in the United States inhabit a conflicting medicolegal space. This study presents data from a dispensary-based survey of patients using medical cannabis in the state of Washington regarding cannabis-specific health behaviors, levels of psychological distress, stress regarding marijuana criminality, past experiences with drug law enforcement, and coping behaviors. Thirty-seven subjects were enrolled in this study, and all but three completed survey materials. The median index of psychological distress, as measured by the Behavioral Symptom Inventory, was nearly 2.5 times higher than that found in a general population sample but one third less than that found in an outpatient sample. The subjects reported a moderate amount of stress related to the criminality of marijuana, with 76% reporting previous exposure to 119 separate drug law enforcement tactics in total. The subjects reported a wide range of coping methods, and their responses to a modified standardized survey showed the confounding influence of legality in assessing substance-related disorders. HubMed – rehab


The Impact of Disabled Children on Parent Health-related Quality of Life and Family Functioning in Kelantan and Its Associated Factors.

J Dev Behav Pediatr. 2013 Mar 27;
Isa SN, Aziz AA, Rahman AA, Ibrahim MI, Ibrahim WP, Mohamad N, Othman A, Rahman NA, Harith S, Van Rostenberghe H

OBJECTIVES:: Caring for children with disabilities brings about a significant impact on the parents and families. The purposes of this study were to determine the impact of having disabled children on parents’ health-related quality of life (HRQOL), family functioning, and total family impact and to identify the associated factors. METHOD:: A total of 425 parents/caregivers of disabled children who were registered to community-based rehabilitation centers in 5 districts in Kelantan, Malaysia, participated in this study. The Malay version of PedsQL Family Impact Module was used as research instrument. General linear regression was applied to analyze the association between family impact scores (Total Impact, Parent HRQOL Summary, and Family Functioning Summary) and study factors using Stata/SE 11 software. RESULTS:: The mean (SD) Total Impact Score and Parent HRQOL Summary Score of the parents/caregivers was 75.1 (16.85) and 75.0 (18.74) respectively, and the median (IQR) of Family Functioning Summary Score was 84.4 (28.13). Mothers, non-Malays, and widowed parents/caregivers, parents/caregivers having male disabled children, and children with more complex disability had significantly lower parent HRQOL and family functioning. CONCLUSIONS:: Both parents/caregivers’ characteristics and children’s characteristics contributed to family impact in local setting. Results of this study emphasize the importance of the whole family involvement as the focus of services and supports by health care providers. HubMed – rehab