FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2980349211> ?p ?o ?g. }

• W2980349211 endingPage "e125" @default.
• W2980349211 startingPage "e125" @default.
• W2980349211 abstract "Commentary Most pediatric orthopaedic surgeons would agree that Ponseti cast treatment is the standard of care for infants with idiopathic congenital clubfoot. The vast majority of infants respond to the gentle, sequential manipulation and cast changes advocated by Ignacio Ponseti and, in all but the most rigid feet, the cavus, adduction, and varus components of the deformity are corrected with relative ease. The equinus component of the deformity, however, can offer resistance to passive stretching. Frequently, little or no correction of the deformity occurs with further cast treatment; this is referred to as hindfoot stall, and up to 80% of feet may require tenotomy of the Achilles tendon at this point in order to achieve satisfactory ankle dorsiflexion1. The tenotomy may be performed in the clinic with the use of local anesthesia1 or in the operating room with either sedation or general anesthesia. Healing of the tenotomized Achilles tendon has been studied in some detail, and it has been demonstrated that the continuity of the tendon is restored within 4 weeks and the nearly normal structure is restored in 12 weeks2. Over the first few months after the tenotomy, there is an appreciable increase in the girth of the tendon, which gradually reduces by the end of the first year but some ultrasonographic evidence of residual thickening and mild irregularity of the internal structure of the tendon may persist3. Some reduction in ankle push-off power, when measured at 5 years of age, is seen in all treated clubfeet, with no difference between children who have had a tenotomy of the Achilles tendon and those who have not4. The deformity recurs in a proportion of children treated with the Ponseti method, and this may not become manifest until 3 years of age5. It is against this background that we need to consider the results of the present study. The primary objective of this double-blind, placebo-controlled study was to determine whether clinical outcomes differ depending on whether, at the time of hindfoot stall, infants received a botulinum toxin type-A (BTX-A) or placebo injection into the gastrocnemius-soleus muscle. The results show that there is virtually no difference in the frequency of responders (i.e., those who achieved adequate ankle dorsiflexion) between the BTX-A group and the placebo group. The study, however, did not end there but permitted a crossover of non-responders from the placebo group to have BTX-A injection, following which all of them achieved adequate ankle dorsiflexion. This makes the interpretation of the results confusing. The dose of BTX-A used in unilateral cases was 10 U/kg of body weight, but only half of the dose was injected into each calf in bilateral cases. This means that a dose of 5 U/kg may suffice, and I would question the need for injecting the higher dose in any infant. The frequency of relapses may be underestimated at 2 years (the duration of the study) since relapses may not be evident until the child is older. This possibility warrants a longer study period. An impressive result of the study was that 92% of the entire study population did not require a tenotomy of the Achilles tendon, which is contrary to most reports of the Ponseti method of treatment1. A closer look at the study shows that this was achieved by a higher number of casts and consequently more frequent visits to the hospital, a longer period in casts, and up to 3 BTX-A injections, arguably at a considerably higher cost than that of a percutaneous tenotomy performed with local anesthetic in the clinic. Cost considerations are particularly relevant in low-income countries, where clubfoot is exceedingly common. Given the data that suggest that a tenotomy of the Achilles tendon causes very little morbidity in the long term, are the concerted efforts to avoid a tenotomy practiced by the authors of the study necessary? The authors have not yet documented the long-term effects of single or multiple BTX-A injections into the calf in infancy and hence cannot state if the long-term effects of a tenotomy of the Achilles tendon are more deleterious than the effects of BTX-A injections. Until the authors can clearly demonstrate a favorable cost-benefit ratio of avoiding an Achilles tenotomy, many surgeons may be reluctant to adopt the protocol described in this interesting report." @default.
• W2980349211 created "2019-10-25" @default.
• W2980349211 creator A5023503742 @default.
• W2980349211 date "2018-09-19" @default.
• W2980349211 modified "2023-09-23" @default.
• W2980349211 title "Needle or Knife at Hindfoot Stall?" @default.
• W2980349211 cites W1991207348 @default.
• W2980349211 cites W1998803233 @default.
• W2980349211 cites W2011454951 @default.
• W2980349211 cites W2568092099 @default.
• W2980349211 doi "https://doi.org/10.2106/jbjs.18.00586" @default.
• W2980349211 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/30234633" @default.
• W2980349211 hasPublicationYear "2018" @default.
• W2980349211 type Work @default.
• W2980349211 sameAs 2980349211 @default.
• W2980349211 citedByCount "0" @default.
• W2980349211 crossrefType "journal-article" @default.
• W2980349211 hasAuthorship W2980349211A5023503742 @default.
• W2980349211 hasBestOaLocation W29803492111 @default.
• W2980349211 hasConcept C141071460 @default.
• W2980349211 hasConcept C2776470705 @default.
• W2980349211 hasConcept C2776814716 @default.
• W2980349211 hasConcept C2776972785 @default.
• W2980349211 hasConcept C2778640784 @default.
• W2980349211 hasConcept C2779305710 @default.
• W2980349211 hasConcept C2779982284 @default.
• W2980349211 hasConcept C2780105995 @default.
• W2980349211 hasConcept C2780984734 @default.
• W2980349211 hasConcept C29694066 @default.
• W2980349211 hasConcept C71924100 @default.
• W2980349211 hasConceptScore W2980349211C141071460 @default.
• W2980349211 hasConceptScore W2980349211C2776470705 @default.
• W2980349211 hasConceptScore W2980349211C2776814716 @default.
• W2980349211 hasConceptScore W2980349211C2776972785 @default.
• W2980349211 hasConceptScore W2980349211C2778640784 @default.
• W2980349211 hasConceptScore W2980349211C2779305710 @default.
• W2980349211 hasConceptScore W2980349211C2779982284 @default.
• W2980349211 hasConceptScore W2980349211C2780105995 @default.
• W2980349211 hasConceptScore W2980349211C2780984734 @default.
• W2980349211 hasConceptScore W2980349211C29694066 @default.
• W2980349211 hasConceptScore W2980349211C71924100 @default.
• W2980349211 hasIssue "18" @default.
• W2980349211 hasLocation W29803492111 @default.
• W2980349211 hasLocation W29803492112 @default.
• W2980349211 hasLocation W29803492113 @default.
• W2980349211 hasOpenAccess W2980349211 @default.
• W2980349211 hasPrimaryLocation W29803492111 @default.
• W2980349211 hasRelatedWork W187769333 @default.
• W2980349211 hasRelatedWork W2068449786 @default.
• W2980349211 hasRelatedWork W2188814661 @default.
• W2980349211 hasRelatedWork W2323732682 @default.
• W2980349211 hasRelatedWork W2375438042 @default.
• W2980349211 hasRelatedWork W2898669469 @default.
• W2980349211 hasRelatedWork W2973736907 @default.
• W2980349211 hasRelatedWork W3047204373 @default.
• W2980349211 hasRelatedWork W3149953009 @default.
• W2980349211 hasRelatedWork W4252875881 @default.
• W2980349211 hasVolume "100" @default.
• W2980349211 isParatext "false" @default.
• W2980349211 isRetracted "false" @default.
• W2980349211 magId "2980349211" @default.
• W2980349211 workType "article" @default.