RESUMEN
Global health delivery is a complex initiative requiring dedicated personnel to achieve a successful program. To be most beneficial, global health delivery should focus on cultural competence, bidirectional education, and capacity building through direct and purposeful means. The authors present the expansion of their global health delivery program in Ecuador focusing on the evolution of the program from a medical mission trip to a multilayered program that helps foster engagement, education, and learning while helping children who might not otherwise have access to care, along with future directions and potential methods to decrease the need for such initiatives in Ecuador.
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Relaciones Comunidad-Institución/tendencias , Ortopedia/organización & administración , Ortopedia/tendencias , Desarrollo de Programa , Atención a la Salud/organización & administración , Atención a la Salud/tendencias , Ecuador , Predicción , Salud Global , Educación en Salud , Humanos , InternacionalidadRESUMEN
STUDY DESIGN: Retrospective case series. OBJECTIVES: The purpose of this study is to (1) describe the development of our Spinal Deformity Program; (2) assess the surgical outcomes, including health-related quality of life (HRQOL), radiographic measures, and complications; and (3) explore predictors for HRQOL outcomes. SUMMARY OF BACKGROUND DATA: The Scoliosis Research Society (SRS) is very interested in international program site development to provide safe surgical care for children in low- and middle-income countries (LMICs). There is a need for reporting program development and outcomes from these sites. After several years of building local relations and infrastructure, our program started performing spine surgery in 2008. METHODS: All operations were performed at Roberto Gilbert Elizalde Children's Hospital in Guayaquil, Ecuador. At a minimum of two years and average of four years postoperatively, patients received a clinical evaluation, radiographs, and the Spanish SRS-22r questionnaire. RESULTS: Twenty-eight (74%) of the 38 children who received spine surgery between May 2008 and 2015 are included in this study. Twenty-three (82%) were female with an average age of 14 years at the time of surgery and 18 years at follow-up. The mean total SRS-22r score was 4.3 and mean percentage major curve correction was 57%. Curve location was found to be a significant predictor of postoperative SRS-22r scores with double curves having poorer scores (p = .004). Two complications were pseudarthrosis and postoperative delayed paraplegia, both of which resolved after revision surgery. No infections or other long-term complications have occurred. CONCLUSIONS: The development of equitable surgical care for all children is a primary goal of the SRS. Undertaking the task to perform surgery in LMIC comes with the responsibility to monitor and maintain the highest quality. Our program was safely developed to address the surgical needs of children with good midterm HRQOL outcomes, adequate radiographic curve correction, and no permanent complications. LEVEL OF EVIDENCE: Level IV.
Asunto(s)
Desarrollo de Programa , Escoliosis/cirugía , Adolescente , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Masculino , Calidad de Vida , Estudios Retrospectivos , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To prospectively characterize pain locations in slipped capital femoral epiphysis (SCFE) and evaluate pain locations as predictors of a delay in diagnosis. STUDY DESIGN: This was an institutional review board approved prospective study of 110 children who underwent surgery for SCFE at a tertiary children's hospital between 2009 and 2015. Standardized pain diagrams were completed by 107 children. Pain zones were designated via a composite diagram. Hips without hip pain were categorized as atypical; hips with hip pain were typical. RESULTS: In total, 122 hips were eligible for pain zone analysis. Seventy hips (57.4%) had hip pain. Atypical pain was present in 52 hips (42.6%), which included groin pain in 17 hips (13.9%), thigh/leg pain in 43 (35.2%), knee pain in 32 (26.2%), and posterolateral pain of the hip and leg in 13 (10.7%). A combination of pain zones was present in 48 hips (39.3%). Forty-nine percent of patients had more than 1 visit until diagnosis. The three most common pain locations for typical hips were hip, hip/thigh, and hip/knee pain (77.2% of typical hips). The 3 most common pain locations for atypical hips were isolated thigh, knee, and groin (65.4% of atypical hips). The least common pain presentations had a longer duration of symptoms (P = .04) and more healthcare visits before diagnosis (P = .04). CONCLUSIONS: A combination of pain locations is common in SCFE. Less frequent pain presentations may delay diagnosis. Delays in diagnosis continue despite education efforts.
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Dolor/diagnóstico , Dolor/epidemiología , Epífisis Desprendida de Cabeza Femoral/complicaciones , Adolescente , Niño , Femenino , Humanos , Masculino , Dimensión del Dolor , Estudios Prospectivos , Epífisis Desprendida de Cabeza Femoral/diagnósticoRESUMEN
STUDY DESIGN: Comparing thoracic pedicle screw trajectories, screw lengths, and starting points by examining osteologic specimens. OBJECTIVE: Describe a medial screw trajectory (MST) compared to a screw trajectory along the anatomic pedicle angle (APA) in terms of trajectory, screw length, and starting point. SUMMARY OF BACKGROUND DATA: Although thoracic pedicle screw insertion is commonly used for posterior fusion and instrumentation, there is little data to quantify an MST that avoids the great vessels and allows for greater screw purchase. METHODS: Thirty adult female skeleton thoracic vertebral columns from the University of New Mexico Maxwell Museum of Anthropology Osteology Collection were photographed from axial and right and left lateral views from T1 to T12. Axial plane measurements included APA and MST (both measured from the midline), screw lengths, and APA/MST intersection on the superior articular facet (SAF). The MST was defined as an insertion angle through the midpoint of the pedicle isthmus intersecting the anterior midpoint of the vertebral body. The intersection of each trajectory with the SAF was measured in relation to the lateral base of the SAF, reported as a percentage of the SAF base width from the lateral SAF border. RESULTS: At every vertebral level, the APA was different from the MST for angle, screw length, and SAF intersection (p < .0001), with the largest difference at T12. The T12 differences were APA versus MST angles (-25.5°, 95% CI -22.7° to -28.4°), screw lengths (11.0 mm, 95% CI 9.2 mm to 12.9 mm), and percentage of SAF width from the lateral border of the SAF base (38.6%, 95% CI 29.1% to 48.1%). CONCLUSIONS: The MST was approximately 8° to 10° greater at T1-T10 (19° at T11 and 25° at T12) than the traditional APA insertion angle. This resulted in a much more lateral starting point on the SAF and longer screw length, greatest at T12.
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Tornillos Pediculares , Fusión Vertebral/métodos , Vértebras Torácicas/cirugía , Adulto , Femenino , Humanos , México , Esqueleto , Pared TorácicaRESUMEN
The burden of musculoskeletal conditions, especially injuries, is increasing in low-income and middle-income countries. Road traffic injuries have become epidemic. There are multiple barriers to accessing surgical services at both the individual (utilization) and the health system (availability) levels, and deficiencies in education and training of health providers. Specialty societies such as the Pediatric Orthopaedic Society of North America (POSNA) have an opportunity to play an important role through teaching and training. The POSNA Children's Orthopedics in Underserved Regions (COUR) committee has supported the Visiting Scholars Program, which invites surgeons from the developing world to attend a scientific meeting and facilitates the scholar's visit to North American pediatric orthopaedic centers. POSNA members have held global educational courses that support an educational exchange between lecturers and attendees. The COUR web site allows for submission of trip reports that document successes and obstacles experienced by members performing overseas clinical care and teaching. The web site also provides educational resources relevant to providing care in these environments. POSNA collaborates with other societies, such as the American Academy of Orthopaedic Surgeons and the Society of Military Orthopaedic Surgeons, to provide education in disaster management. In addition to increasing member involvement, specialty societies have the opportunity for continued data collection from overseas care, application of US registry data to disease processes in the developing world, and further collaboration with one another.