D istraction osteogenesis is widely used for leg lengthening, but often requires a long period of external fixation which carries risks of pin-track sepsis, malalignment, stiffness of the joint and late fracture of the regenerate. We present the results of 20 cases in which, in an attempt to reduce the rate of complications, a combination of external fixation and intramedullary nailing was used. The mean gain in length was 4.7 cm (2 to 8.6). The mean time of external fixation was 20 days per centimetre gain in length. All distracted segments healed spontaneously without refracture or malalignment. There were three cases of deep infection, two of which occurred in patients who had had previous open fractures of the bone which was being lengthened. All resolved with appropriate treatment. This method allows early rehabilitation, with a rapid return of knee movement. There is a lower rate of complications than occurs when external fixation is used on its own. The time of external fixation is shorter than in other methods of leg lengthening. The high risk of infection calls for caution.
This study examined substrate use during exercise in early-pubertal (EP), mid-pubertal (MP), late-pubertal (LP), and young-adult (YA) males. Fuel use was calculated using the RER and VO2 response during cycling exercise at 30 to 70% of VO2speak. Significant group by intensity interactions were found for lactate, RER, percent CHO, and fat use, in addition to fat and CHO oxidation rates, which suggest a maturation effect on substrate use during exercise. While significance was not achieved at all intensities, post hoc analyses revealed greater fat use, lower CHO use, and lower lactate concentrations in EP and MP compared to LP or YA. No differences were noted between EP and MP or LP and YA at any intensity, suggesting the development of an adult-like metabolic profile occurs between mid- to late-puberty and is complete by the end of puberty.
Distraction osteogenesis is widely used for leg lengthening, but often requires a long period of external fixation which carries risks of pin-track sepsis, malalignment, stiffness of the joint and late fracture of the regenerate. We present the results of 20 cases in which, in an attempt to reduce the rate of complications, a combination of external fixation and intramedullary nailing was used. The mean gain in length was 4.7 cm (2 to 8.6). The mean time of external fixation was 20 days per centimetre gain in length. All distracted segments healed spontaneously without refracture or malalignment. There were three cases of deep infection, two of which occurred in patients who had had previous open fractures of the bone which was being lengthened. All resolved with appropriate treatment. This method allows early rehabilitation, with a rapid return of knee movement. There is a lower rate of complications than occurs when external fixation is used on its own. The time of external fixation is shorter than in other methods of leg lengthening. The high risk of infection calls for caution.
Stimulant medication raises submaximal HR but does not affect other cardiorespiratory measures or perceived exertion. Without medication physiological responses at peak exercise are attenuated in some but not all boys with ADHD.
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