The purpose of our study was to evaluate the effectiveness of treating paediatric femoral shaft fractures by early (<48 h) versus late (>48 h) hip spica casting. A retrospective review of 44 patients with 44 femoral shaft fractures treated by either early or late hip spica application with at least 9-month follow-up was undertaken. Both groups were treated on an inpatient basis. The late hip spica group had skin traction applied before the application of a hip spica. The outcome measures involved both clinical [Pediatric Outcomes Questionnaire (POQ) and Activities Scale for Kids (ASK)] and radiological outcomes. Complications were noted. A total of 44 patients with a mean age of 33 months (range: 7–66 months) were evaluated. Overall, 20 patients underwent early and 24 had late hip spica casting. At follow-up, the ASK was similar amongst the two groups (44.2 vs. 44.8, P=0.8). However, the POQ was better in the early hip spica casting group (24.7 vs. 28.9, P=0.01). Length of hospital stay and duration of immobilization in the hip spica were significantly shorter in the early group (P<0.001). There were no differences in leg lengths, lateral distal femoral angles and medial proximal tibia angles between the fractured and nonfractured limbs in both groups. Early hip spica casting is a safe procedure for paediatric femoral shaft fractures and was associated with less time in hospital and hip spica with a better POQ score. However, early hip spica casting was associated with more hip spica changes and required wedging. At follow-up, radiological parameters were similar in both groups. Level of Evidence: III.
» Bones are a common site for metastases; however, muscle metastases recently have been more commonly reported, not only as a result of the multidisciplinary approach in the treatment of these patients but also because of more sensitive imaging modalities such as positron emission tomography-computed tomography (PET-CT) that identify these lesions in early stages.» The most common carcinoma is lung carcinoma, with a hematogenous route of spread mainly to the axial region of the body (the psoas muscle, the gluteal muscles, and the paravertebral muscles).» Clinically, skeletal muscle metastases from carcinomas frequently present as painful palpable masses with or without swelling and are commonly found before diagnosis of the primary carcinoma.» Multiple imaging modalities, including radiographs, CT, magnetic resonance imaging (MRI), and PET-CT, have been used for diagnosis and staging, but tissue sampling is needed for a final diagnosis. The most important differential diagnosis of skeletal muscle metastases is with soft-tissue sarcomas.» Treatment is mainly based on chemotherapy and/or radiation; surgery is performed in cases of symptomatic lesions that fail to respond to nonoperative treatment.
Due to discrepancies in the performance of various IgG and IgM assays, seroprevalence studies should be based on furher confirmatory testing for decisive conclusions to be reached.
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