Publications by authors named "Alexandru Ulici"

29 Publications

  • Page 1 of 1

The Role of Arthroereisis in Improving Sports Performance, Foot Aesthetics and Quality of Life in Children and Adolescents with Flexible Flatfoot.

Children (Basel) 2022 Jun 29;9(7). Epub 2022 Jun 29.

11th Department of Pediatric Orthopedics, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.

Flexible flatfoot represents one of the most common deformities of the lower limb, affecting children and adolescents. Aesthetic aspect, abnormal gait, pain and fatigue are by far the most important symptoms which determine parents to bring their children to the orthopedist. We set out to conduct a prospective study, case-controlled, including patients with symptomatic flexible flatfeet operated on by arthroereisis surgery and comparing them to a normal feet group of children age- and sex-matched (control group). Minimum follow-up time was 2 years. In total, 33 patients with bilateral arthroereisis were included and 36 patients formed the control group (12.12 +/- 1.85 years vs. 11.81 ± 2.40 years, = 0.54). Quality of life improved postoperatively ( = 0.18) and was not different from the control group. Median running time improved postoperatively by 2.25 s ( < 0.0001) and got closer to the median running time from the control group (22.30 s compared to 20.94 s, = 0.01). All radiological angles improved ( < 0.0001), but quality of life improvement was correlated with talonavicular coverage angle and Meary angle measurements. Flatfoot in children and adolescents may be a condition in which the quality of life and sports performance are decreased, compared to healthy children. Arthroereisis is a minimally invasive surgical procedure with a short recovery time and a short period before resumption of sport activities, which can be useful in certain types of flexible flatfoot due to its effectiveness on symptom reduction.
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http://dx.doi.org/10.3390/children9070973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9323989PMC
June 2022

Neurotoxicity and Other Clinical Manifestations of a Common European Adder ( Bite in Romania.

Toxins (Basel) 2022 Jul 18;14(7). Epub 2022 Jul 18.

Poison Control Centre and National Toxicology Information Centre, Toxicology Unit, IRCCS, Maugeri Foundation, 27100 Pavia, Italy.

Most cases of envenomation by common European vipers () have not been reported to have neurotoxic manifestations. However, these manifestations have been demonstrated in some cases of envenomation by subspecies of , found in the Carpathian Basin region of south-eastern Europe. Here, we report the case of a 5-year-old girl from the south of Romania who presented symptoms of neurotoxicity, as well as other systemic and local symptoms, after being bitten by an adder of the subspecies. Treatment consisted of monovalent antivenom, a corticosteroid, and prophylactic enoxaparin. Neurotoxic manifestations of envenomation as well as other local and systemic symptoms improved within 5 days of treatment. The presented case shows that venom from subspecies found in the Carpathian Basin can have neurotoxic effects. This case also confirmed the efficacy of monospecific antivenom treatment in bringing about rapid and complete remission, following envenomation.
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http://dx.doi.org/10.3390/toxins14070500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9318827PMC
July 2022

mRNA COVID-19 Vaccine Reactogenicity among Healthcare Workers: Results from an Active Survey in a Pediatric Hospital from Bucharest, January-February 2021.

Vaccines (Basel) 2022 May 25;10(6). Epub 2022 May 25.

Emergency Clinical Hospital for Children "Grigore Alexandrescu", 011743 Bucharest, Romania.

In Romania, health and social workers were prioritized for COVID-19 vaccination. We aimed to describe the vaccine adverse events identified through an active survey (using an electronic questionnaire) conducted among the staff of a pediatric hospital from Bucharest, vaccinated with the mRNA Pfizer-BioNTech vaccine. Data on the frequency and duration of adverse events were collected and analyzed using Microsoft Excel, Epi Info, and MedCalc. The questionnaire was sent to 426 persons. The participation rate was 81.2% after 1st dose and 63.8% after the 2nd dose. Overall, 81.9% were women, median age 42 (IQR 32-50 years). A total of 48 respondents (14.8%) reported no adverse event after the 1st dose and 35 (14.1) after the 2nd dose. No anaphylaxis was reported. The most frequent adverse event was pain at injection site, being reported by 261 responders (80.3%) after 1st dose and 187 (75.1%) after 2nd dose. Fatigue and headache were reported significantly less frequently in our study compared with data provided by the vaccine manufacturer. The current study has shown higher local reactogenicity after the first dose of the vaccine and higher systemic reactogenicity after the second dose. This real-world knowledge of the reactogenicity and safety profile may increase the vaccine's acceptance rate among healthcare workers.
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http://dx.doi.org/10.3390/vaccines10060836DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9230821PMC
May 2022

Quality of Life Evaluation Using SRS-30 Score for Operated Children and Adolescent Idiopathic Scoliosis.

Medicina (Kaunas) 2022 May 18;58(5). Epub 2022 May 18.

Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University of Galați, 800008 Galați, Romania.

: Adolescent idiopathic scoliosis (A.I.S.) is a disorder with a significant impact on health and self-image. This spinal deformity can affect between 2% and 4% of the adolescent population and may alter one's quality of life. This study aims to assess the patient outcome, satisfaction, and quality of life following surgical treatment using the SRS-30 questionnaire. : A number of 49 children and adolescent patients diagnosed with idiopathic scoliosis that had surgery were included in this study. They thoroughly completed the SRS-30 questionnaire before and after the surgery, based on which data analysis was carried on. Correlations between the test results and imagistic data (pre- and postoperative Cobb angle, correction rate of Cobb angle, number of instrumented spinal segments, and number of pedicle screws/laminar hooks used in the surgery) were performed. Our results showed that 87.76% of the patients were girls, and the mean age at surgery was 14.83 years. Postoperatively, the Cobb angle improved significantly ( < 0.0001). The questionnaire domain "Satisfaction with management" improved dramatically after surgery, averaging 13.65 points (91% out of the maximum score). The average postoperative test score was 125.1 points. Statistically significant correlations were found between the correction rate and SRS-30 score improvement ( < 0.001), in total as well as per each domain of the survey, respectively. Comparing the questionnaire domains, "Self-image" was positively correlated with "Satisfaction with management" ( < 0.0001). : Better correction rate led to higher values of SRS-30 score. Additionally, the younger the age at surgery is, the higher the score. The number of instrumented spinal segments does not alter the quality of life. Overall, the most crucial factor influencing patient satisfaction after surgical treatment is self-image.
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http://dx.doi.org/10.3390/medicina58050674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9147138PMC
May 2022

Controlling the Progression of Curvature in Children and Adolescent Idiopathic Scoliosis Following the Administration of Melatonin, Calcium, and Vitamin D.

Children (Basel) 2022 May 21;9(5). Epub 2022 May 21.

Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, Dunărea de Jos University of Galați, 800008 Galați, Romania.

Idiopathic scoliosis affects a severe number of children. Their quality of life and development are also disturbed. Some therapeutic strategies have been developed to control illness progression and to optimize the quality of life. In this perspective, randomized, case-control, interventional study, the impact of using melatonin, calcium, and vitamin D, respectively, on idiopathic scoliosis patients was analyzed. Our preliminary results showed that these drugs positively affected the illness progression quantified by the spine curvature. Patients with idiopathic scoliosis may benefit from a novel treatment by supplementation with vitamin D, calcium, and melatonin.
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http://dx.doi.org/10.3390/children9050758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9140159PMC
May 2022

Traumatic Hip Dislocation Associated with Proximal Femoral Physeal Fractures in Children: A Systematic Review.

Children (Basel) 2022 Apr 25;9(5). Epub 2022 Apr 25.

Department of Pediatric Orthopedic Surgery, "Grigore Alexandrescu" Clinical Emergency Hospital for Children, 011743 Bucharest, Romania.

Traumatic hip dislocation might lead to serious complications and a poor outcome. Fortunately, it is a rare condition in pediatric patients. The purpose of this study is to establish and describe the complications caused by hip dislocations associated with transphyseal femoral neck fractures. Therefore, we conducted a literature review that resulted in 11 articles, including 32 patients, older than 10 years of age, suffering from traumatic hip dislocation associated with a transphyseal femoral neck fracture. We presented a case series of three patients with hip fracture-dislocation treated in our clinic that were also evaluated and included in the study. For the 35 patients included in the study group, the percentage of avascular osteonecrosis after hip fracture-dislocation was 88.57%. Traumatic hip dislocation associated with transphyseal femoral neck fracture is a rare condition and has a poor prognosis because of the high incidence of femoral head avascular necrosis (AVN). Reduction should be attempted within six hours the from injury, but this may not minimize the risk of AVN if transphyseal separation occurs. The approach may influence the development of AVN; lateral approach of the hip with great trochanter osteotomy seems to have the lowest number of cases of AVN.
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http://dx.doi.org/10.3390/children9050612DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9139479PMC
April 2022

Advantages of Telescopic Screw in Slipped Capital Femoral Epiphysis Treatment: A Retrospective Study and Review of the Literature.

Children (Basel) 2022 Mar 28;9(4). Epub 2022 Mar 28.

Pediatric Orthopedic Surgeon, Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 011743 Bucharest, Romania.

Background: Slipped capital femoral epiphysis is due to proximal femur physis failure in adolescent patients. Early iatrogenic closure of proximal growth cartilage in children with significant residual growth potential causes complications such as coxa breva, coxa vara, and lower limb length inequalities. The Free-Gliding SCFE Screw System is a self-extending cannulated screw used in Slipped Capital Femoral Epiphysis (SCFE) fixation and femoral neck fractures.

Materials And Method: We conducted a retrospective study on 16 patients. All patients under 11 years old were treated by telescopic cannulated screws fixation. The youngest patient was 7 years old.

Results: Out of the 22 operated hips, 2 screws have failed, thus resulting in a lack of telescoping of the screw. We discovered an average lengthening of approximately 10 mm at 24 months postoperative check-up in 20 hips in which lengthening took place. According to the Notzli method, none of the patients had an alpha angle value greater than 48 degrees.

Conclusion: Fixation with telescopic screw for SCFE in patients less than 11 years old, with mild to moderate slippage, allows the continuous growth and remodeling of the proximal femur, thus avoiding deformities such as coxa breva, coxa vara, FAI, AVN, limb length discrepancies and also allows good range of motion.
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http://dx.doi.org/10.3390/children9040469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9026982PMC
March 2022

Efficiency of platelet-rich plasma therapy for healing sports injuries in young athletes.

Exp Ther Med 2022 Mar 11;23(3):215. Epub 2022 Jan 11.

Department of Clinical Surgery, Faculty of Medicine and Pharmacy, Dunărea de Jos' University, 800008 Galați, Romania.

In recent years, platelet-rich plasma (PRP) therapy has been a subject of controversy in orthopedics field. Our objective was to assess the efficiency of PRP therapy for patients who have suffered grade 2 meniscal lesions and grade 2 anterior cruciate ligament (ACL) lesions, graded by magnetic resonance imaging (MRI). A retrospective observational study was conducted, which included 72 young recreational athletes who had been diagnosed with grade 2 meniscal injury, graded using MRI, that benefited from PRP therapy as an enhancement of the primary treatment, after cast immobilization. The Lysholm score, the pain intensity and the resuming of the physical activity before the PRP treatment and one month after were analyzed. Our study revealed that patients had an improved subjective perception of pain after PRP therapy and an improvement of the Lysholm score. Concurrently, 83.3% of patients could return to sports and daily physical activity. It can be concluded that PRP therapy is a safe, easy to manage treatment, efficient for pain relief and in resuming of sports activities for young recreational athletes who have sustained partial meniscal or ACL tears. In terms of pain relief, it appears that the PRP therapy could be more efficient for young patients with ACL injuries.
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http://dx.doi.org/10.3892/etm.2022.11139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8796279PMC
March 2022

Evaluating the Functional Outcomes and the Quality of Life for Pediatric Patients with Osteogenesis Imperfecta after Fracture Treatment with Intramedullary Rodding.

Children (Basel) 2021 Nov 19;8(11). Epub 2021 Nov 19.

Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University of Galați, 800008 Galați, Romania.

Background And Objectives: Osteogenesis imperfecta is a rare pathology involving the bones and the connective tissues, generating alterations that lead to frequent fractures during childhood. When fractures occur at birth, they are associated with an impairment of walking and the quality of life. Although surgical techniques have significantly improved in recent years, functional outcomes and the quality of life for pediatric patients that benefited from surgical management with telescopic rods have been less evaluated. This study aimed to measure functional results and determine the factors that influence the quality of life for the pediatric population diagnosed with Osteogenesis imperfecta and surgically treated using the telescopic rod approach after suffering a fracture or severe deformity.

Materials And Methods: We conducted a cohort study that consisted of 15 patients diagnosed with Osteogenesis imperfecta (average age of 11.6 years). All individuals possessed at least one intramedullary telescopic rod as a result of the surgical treatment.

Results: We observed that the pain, both acute and chronic, impairs the quality of life and interferes with daily living activities, for instance, self-care tasks.

Conclusions: Osteogenesis imperfecta is associated with a severely damaged level of walking. All of the aspects of the pediatric patient's daily life activity seem to be affected. Furthermore, these patients, especially those residing in rural areas, have a poor quality of life.
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http://dx.doi.org/10.3390/children8111066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8618628PMC
November 2021

A Prospective Cohort Study on Quality of Life among the Pediatric Population after Surgery for Recurrent Patellar Dislocation.

Children (Basel) 2021 Sep 22;8(10). Epub 2021 Sep 22.

Pediatric Orthopedics "Grigore Alexandrescu" Children's Emergency Hospital, 011743 Bucharest, Romania.

Patellofemoral instability is a frequent cause of knee pathology affecting quality of life among the pediatric population. Here, we present a prospective cohort study which included patients who had undergone surgical management using the lateral release and medial imbrication approach (LRMI) or medial patellofemoral ligament reconstruction (MPFL-R). The object of this study was to assess the quality of life among children that have undergone surgical treatment for patellar dislocation. Quality of life was assessed before and after surgery using the Pediatric International Knee Documentation Committee form (Pedi-IKDC), a questionnaire that aims to quantify knee functionality. Postoperative scarring was evaluated using The Stony Brook Scar Evaluation Scale. One hundred and eight patients were selected and grouped according to the type of procedure. Before surgery, the two groups had similar mean Pedi-IKDC scores (41,4 MPFL-R vs. 39,4 LRMI = 0.314). Improvements were observed in the postoperative scores. The MPFL-R technique showed promising outcomes. When comparing the two surgical groups, there was a significant difference in favor of MPFL-R group (MPFL-R 77.71 points vs. LRMI 59.74 points, < 0.0001-95% CI (11.22-24.72)). Using the Stony Brook Scar Evaluation Scale, a significant difference in scar quality in favor of MPFL-R was observed (4,5 MPFL-R vs. 2,77 LRMI = 0.002). In conclusion, this study provides objective evidence-based outcome assessments that support the medial patellofemoral ligament reconstruction technique as the gold standard for patellofemoral instability.
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http://dx.doi.org/10.3390/children8100830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8535121PMC
September 2021

The Relationship between the Dominant Hand and the Occurrence of the Supracondylar Humerus Fracture in Pediatric Orthopedics.

Children (Basel) 2021 Jan 15;8(1). Epub 2021 Jan 15.

Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University of Galați, 800008 Galați, Romania.

It is known that during a fall, a child would rather protect their dominant hand by using the non-dominant one, although the role of handedness in upper limb fractures has not been studied in-depth. We carried out a retrospective, cross-sectional cohort study, including pediatric patients who presented to the emergency room with a supracondylar humerus fracture following an injury by falling from the same height. In total, 245 patients were selected and grouped according to age. In the 1-3 years group, no statistical significance was found between hand dominance and the side of fracture ( = 0.7315). During preschool years (4-6 years old), the non-dominant hand is more often involved ( = 0.03, odds ratio: 3.5). In the 7-14 years group this trend was maintained and actually increased ( = 0.052, odds ratio: 3.8). We might conclude that children tend to protect their dominant hand by falling on their non-dominant one. The main objective of this study is to highlight a link between handedness and the side of the body where the hand fracture will be identified in the pediatric population, regarding supracondylar humerus fracture.
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http://dx.doi.org/10.3390/children8010051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830548PMC
January 2021

Revision Rates for Osteogenesis Imperfecta Patients Treated with Telescopic Nails. A follow-up Study After a 7-year Experience.

J Med Life 2020 Oct-Dec;13(4):543-547

Department of Pediatric Orthopedics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

Osteogenesis imperfecta (OI) is a genetically determined systemic pathology that involves a disturbance in the synthesis of type one collagen and is mainly characterized by bone brittleness and other abnormalities. The musculoskeletal system is the most affected by bone fracture after mild mechanical stress occurs. Pathologic bowing appears without trauma, and hyperlaxity is jeopardizing joint stability. Having such an abrupt debut, some patients report in-utero fractures, and treatment is very challenging since surgery has to be postponed until the children grow and become good candidates for intramedullary nailing. In this paper, we discuss the experience of "Grigore Alexandrescu" Hospital for Children in treating these patients and the results we obtained regarding the revision surgeries that we had done. Revision surgery is mandatory for OI patients, and there are multiple factors in deciding to use an implant. We looked back at the data collected for those cases where revision was not related to infection, trauma, or disengagement of the male-female system due to the overlengthening of the implant. The conclusions made are comparable to other centers worldwide with respect to lower limb surgery, and we changed the management protocol according to the problems encountered.
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http://dx.doi.org/10.25122/jml-2020-0161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803301PMC
January 2021

Quality of Life after Flatfoot Surgery in the Pediatric Population.

J Med Life 2020 Jul-Sep;13(3):356-361

Department of Pediatric Orthopedics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

Flatfoot is a common deformity in the pediatric population and has a multitude of causes. Sometimes, it can be a normal finding in children, and treatment should not be guided only based on the appearance, but rather after thoroughly assessing the patient and the impact it has on the child's daily life. In this paper, we describe the quality of life that the patients are experiencing after the surgical treatment of this pathology. We made a comparison between the most used techniques for correcting flatfoot and insisted on the postoperative comfort of the patient, rehabilitation, and the time it took to get back to their daily routine. The comparison was made between Mosca calcaneal lengthening osteotomy, Grice extraarticular arthrodesis, arthroereisis and triple arthrodesis of the foot. All of the surgeries were performed by the same doctor at "Grigore Alexandrescu" Emergency Hospital for Children in Bucharest. From the data collected, we propose that newer, minimally invasive techniques could be used in treating this pathology in order to help the patient feel better in the postoperative period and avoid some of the complications regularly encountered when using the old techniques.
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http://dx.doi.org/10.25122/jml-2020-0144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550133PMC
November 2020

Poor prognostic factors of femoral shaft fractures in children treated by elastic intramedullary nailing.

SICOT J 2020 31;6:34. Epub 2020 Aug 31.

Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32 Iancu de Hunedoara Blvd., 011733 Bucharest, Romania.

Introduction: Femoral shaft fractures in pediatric patients are treated by elastic intramedullary nailing using titanium or stainless-steel nails. The elastic stable intramedullary nailing behaves as an internal splint, promoting early mobilization. This type of treatment involves a minimally invasive approach, no damage to the growth plates, and no impairment of femoral head blood supply.

Purpose: The aim of our study was to identify the negative predicting factors that might lead to an increased complication rate after elastic stable intramedullary nailing of femoral shaft fractures in children.

Methods: We conducted a retrospective study on 137 patients with femoral shaft fractures treated by elastic stable intramedullary nailing. Patients' age ranged between 4 and 17 years. We used data from the medical records of the patients to evaluate postoperative complications. Plain radiographs were analyzed to determine the fracture type, fracture location, and postoperative complications such as delayed union, angular deformities, and limb length discrepancies. Multivariate analysis was conducted to identify predictors for poor outcomes.

Results: Complications occurred in 29 patients (21%) and consisted of delayed union, axial deformities, or lower limb length discrepancies. In the group of patients that suffered from complications, mechanism of injury, age, and weight were significant. They were older by an average of 5 years; half of them weighed more than 50 kg and over a half were involved in a road traffic accident.

Conclusions: Elastic nailing is a successful tool to treat femoral shaft fractures. Three factors were demonstrated to influence the outcome. The mechanism of injury, age > 11 years, and weight > 50 kg are the most important and are predictors for development of complications such as delayed union or deformity.
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http://dx.doi.org/10.1051/sicotj/2020031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7461699PMC
August 2020

Prevalence of 25-OH-Vitamin D and Calcium Deficiency in Adolescent Idiopathic Scoliosis.

J Med Life 2020 Apr-Jun;13(2):260-264

Department of Pediatric Orthopedics, "Grigore Alexandrescu" Emergency Hospital for Children, Bucharest, Romania.

Several etiologies have been proposed as a basis and evolution theory for the development of adolescent idiopathic scoliosis, but limited data were published until now that link vitamin D and calcium deficiency to this condition. The present study aims to evaluate the relationship between 25-OH-Vitamin D, total calcium, and the following data: Cobb angle, age, and patient sex. The seasonal variation for vitamin D will also be taken into consideration. A total of 101 patients with a mean age of 11.61 ± 2.33 years had vitamin D and calcium levels tested. The mean Cobb angle was 26.21o ± 12.37. The level of vitamin D was, on average, 24 ng/mL ± 9.64. Calcium values were within the normal range, with an average of 9.82 mg/dL ± 0.42. The male group showed lower levels of vitamin D compared to the female group (19.6 vs. 25.45 ng/mL) (p = 0.02). Seasonal variations showed significant differences for vitamin D (p=.0001). Vitamin D level was positively correlated with the calcium level (p=0.01, r=0.973), but also with the patient's age (p <0.001, r=0.158). The Cobb angle was negatively correlated with serum vitamin D levels (p<0.01, r=-0.472). Patients included in this study had low vitamin D levels, significant differences being observed between boys and girls, boys being more affected. The positive correlation between vitamin D and calcium, together with the negative correlation with the Cobb angle, is yet another proof that patients with idiopathic scoliosis should be investigated regularly for these pathologies.
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http://dx.doi.org/10.25122/jml-2020-0101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378343PMC
August 2020

Extracorporeal Membrane Oxygenation for Poisonings Reported to U.S. Poison Centers from 2000 to 2018: An Analysis of the National Poison Data System.

Crit Care Med 2020 08;48(8):1111-1119

Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN.

Objectives: To assess trends in the use of extracorporeal membrane oxygenation for poisoning in the United States.

Design: Retrospective cohort study.

Setting: The National Poison Data System, the databased owned and managed by the American Association of Poison Control Centers, the organization that supports and accredits all 55 U.S. Poison Centers, 2000-2018.

Patients: All patients reported to National Poison Data System treated with extracorporeal membrane oxygenation.

Interventions: None.

Measurements And Main Results: In total, 407 patients met final inclusion criteria (332 adults, 75 children). Median age was 27 years (interquartile range, 15-39 yr); 52.5% were male. Median number of ingested substances was three (interquartile range, 2-4); 51.5% were single-substance exposures. Extracorporeal membrane oxygenation use in poisoned patients in the United States has significantly increased over time (z = 3.18; p = 0.001) in both adults (age > 12 yr) and children (age ≤ 12 yr), increasing by 9-100% per year since 2008. Increase in use occurred more commonly in adults. We found substantial geographical variation in extracorporeal membrane oxygenation use by geospatially mapping the ZIP code associated with the initial call, with large, primarily rural areas of the United States reporting no cases. Overall survival was 70% and did not vary significantly over the study period for children or adults. Patients with metabolic and hematologic poisonings were less likely to survive following extracorporeal membrane oxygenation than those with other poisonings (49% vs 72%; p = 0.004).

Conclusions: The use of extracorporeal membrane oxygenation to support critically ill, poisoned patients in the United States is increasing, driven primarily by increased use in patients greater than 12 years old. We observed no trends in survival over time. Mortality was higher when extracorporeal membrane oxygenation was used for metabolic or hematologic poisonings. Large, predominantly rural regions of the United States reported no cases of extracorporeal membrane oxygenation for poisoning. Further research should focus on refining criteria for the use of extracorporeal membrane oxygenation in poisoning.
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http://dx.doi.org/10.1097/CCM.0000000000004401DOI Listing
August 2020

Isolated Meniscus Tears in Adolescent Patients Treated with Platelet-Rich Plasma Intra-articular Injections: 3-Month Clinical Outcome.

Biomed Res Int 2020 21;2020:8282460. Epub 2020 May 21.

Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", Bucharest, Romania.

Objectives: Meniscus repair is a challenge for a practitioner, as an injured meniscus can lead to osteoarthritic joint changes with a greatly disabling outcome. Platelet-rich plasma has been regarded as a promising therapy to help induce healing. The purpose of the study is to clinically assess the effectiveness of PRP treatment in adolescents with meniscal lesions.

Methods: This retrospective study analyzed 30 patients with meniscal tears, aged 12 to 17 years, who had documented MRI meniscal lesion and persistent knee pain. In order to evaluate the outcome, the Lysholm knee scoring scale and numerical rating scale were used before injection and 3 months after treatment.

Results: Patients had a mean age of 13.93 years, 70% girls and 30% boys. The most affected was the medial meniscus. The mean value before injection on the numerical rating scale (NRS) of pain was 7.73, after the treatment being of 2.0. After treatment, 76.7% of the patients had "excellent" and "good" outcomes, while before injection, just 3% of the patients had a "good" score.

Conclusions: Platelet-rich plasma treatment can be effective in improving the clinical outcomes of adolescent patients with meniscus tears, for whom conservative management and physical therapy have failed to achieve pain relief.
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http://dx.doi.org/10.1155/2020/8282460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273443PMC
March 2021

Acute hematogenous osteomyelitis in pediatric patients: epidemiology and risk factors of a poor outcome.

J Int Med Res 2020 Apr;48(4):300060520910889

President of the Romanian Pediatric Orthopedic Society, Chief of Surgery, Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", Bucharest, Romania, Associate Professor at Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

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http://dx.doi.org/10.1177/0300060520910889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136940PMC
April 2020

Combined Anterolateral, Anterior, and Anteromedial Ankle Impingement in an Adolescent Soccer Player: A Case Report and Review of the Literature.

Clin J Sport Med 2019 11;29(6):e80-e82

Department of Pediatric Orthopedics, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania.

A unique case of combined anterolateral, anterior, and anteromedial ankle impingement in an adolescent soccer player is presented in this article. To the best of our knowledge, this is the only report of circumferential, massive, anterior ankle impingement in children described in the literature. The importance of proper diagnosis and treatment of such a lesion is illustrated in this case report. We also emphasize that clinical examination combined with 3D computed tomography scan reconstruction is an excellent and cost-effective imaging modality that can help with the diagnosis of anterior ankle impingement. Finally, open surgical treatment showed excellent results in an elite athlete.
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http://dx.doi.org/10.1097/JSM.0000000000000576DOI Listing
November 2019

Nursemaid's Elbow - Supination-flexion Technique Versus Hyperpronation/forced Pronation: Randomized Clinical Study.

Indian J Orthop 2019 Jan-Feb;53(1):117-121

Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu," Bucharest, Romania.

Background: Nursemaid's elbow (NE) represents the most common pathology met in the pediatric orthopedics ambulatory. There are two techniques of reducing the NE: the supination-flexion technique and the hyperpronation or forced pronation technique.

Materials And Methods: In this randomized clinical study, we aim to compare the two reduction techniques of the NE, by measuring the effectiveness of each and scaling the pain felt by the child, by using the Faces Pain Scale. The study included 116 patients with typical presentation for NE with age under 7 years old (mean age ~3 years old), 45% of males and 55% of females.

Results: Hyperpronation was found to be more successful than supination-flexion technique as a first attempt (85% vs. 53%), second attempt (50% vs. 28%), and as a crossover technique (100% vs. 50%) when supination-flexion failed.

Conclusions: This study concludes that hyperpronation technique should be used as a first maneuver reduction in treating NE, a simple one-movement technique.
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http://dx.doi.org/10.4103/ortho.IJOrtho_442_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394198PMC
March 2019

Negative pressure wound therapy in reconstructing extensive leg and foot soft tissue loss in a child: a case study.

J Wound Care 2018 Jun;27(Sup6):S14-S19

President of the Romanian Pediatric Orthopedic Society, Chief of Surgery, Associate Professor, Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children 'Grigore Alexandrescu', Bucharest, Romania, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

Open fractures of the leg with large loss of tissue require extensive reconstructive methods that can injure the donor area. The use of negative pressure wound therapy (NPWT) may minimise the impact of these reconstructive methods because of its capacity to create granulation tissue that will form a wound bed for the skin graft, thus reducing the volume of soft tissue defect and saving the donor region. This case study describes the effectiveness of NPWT in the treatment and reconstruction of an open fracture of the leg, with massive loss of soft tissue, associated with elastic intramedullary nailing in a 10-year-old female patient, who was a victim of a car accident. Clinical examination revealed a Gustilo-Anderson IIIB open fracture of the left leg, with the avulsion of the fifth toe, disarticulation of the fifth metatarsal bone, extensively damaged skin and subcutaneous tissue in the medium and distal third of the left leg and left foot. The bone was exposed in the distal part of the leg, external malleolus and left calcaneus. Profuse lavage, reduction of the tibial fracture and elastic intramedullary nailing, amputation of the fifth left toe, necrectomy and debridement of devitalised tissue were performed. NPWT was started, with the dressing changed every five days. After 55 days of using NPWT, granulation tissue covered the soft tissue defect and created a wound bed for the skin graft. NPWT helped the management of this open wound, achieving a wound bed for the skin graft, avoiding the use of complex reconstructive methods.
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http://dx.doi.org/10.12968/jowc.2018.27.Sup6.S14DOI Listing
June 2018

Treatment of the aneurysmal bone cyst by percutaneous intracystic sclerotherapy using ethanol ninety five percent in children.

Int Orthop 2018 06 28;42(6):1413-1419. Epub 2018 Feb 28.

Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32, Iancu de Hunedoara Bvd, 011733, Bucharest, Romania.

Introduction: Aneurysmal bone cyst (ABC) is a benign intraosseous lesion filled with blood that can determine a blowout distension of the bone. The purpose of this study is to evaluate the efficacy of sclerotherapy by percutaneous intralesional administration of ethanol 96% for the treatment of this pathology in paediatric patients.

Method: The retrospective study includes 17 paediatric patients with ABC who were treated by repeated intracystic injection with ethanol 96%, 1 ml/kg, in our clinic between December 2015 and July 2017. Fluoroscopic guidance was used to inject the cyst with contrast agent. The mean follow-up period was 11 months.

Results And Discussion: All cysts are healed or are in the healing process. The mean age was 11 years old. Seven patients needed three repeated injections and ten patients needed two injections until healing. We observed a mean reduction in the size of the lesions, measured on plain X-rays, of 68%. The complications that were observed included the following: dizziness after injection, skin pigmentation at the injection site, local inflammatory reaction, and pain after injection. The current study approves the importance of this minimally invasive treatment with no recurrence after a follow-up of 19 months. The healing rate was 100%. A limitation of this study consists in the small number of patients.

Conclusion: Sclerotherapy with ethanol 96% is a useful method for the treatment of ABC. It is a minimally invasive method, with no major complications, which lowers the risks of open surgical intervention and has a good rate of success.
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http://dx.doi.org/10.1007/s00264-018-3841-yDOI Listing
June 2018

Outcome of pinning in patients with slipped capital femoral epiphysis: risk factors associated with avascular necrosis, chondrolysis, and femoral impingement.

J Int Med Res 2018 Jun 6;46(6):2120-2127. Epub 2017 Dec 6.

2 Department of Orthopaedics and Trauma, Rehabilitation Clinical Hospital Cluj Napoca, University of Medicine and Pharmacy Cluj Napoca.

Objective This study aimed to assess the principal risk factors that could lead to the most common long-term complications of slipped capital femoral epiphysis, such as avascular necrosis, chondrolysis, and hip impingement. Methods We conducted a single-centre, retrospective study and evaluated patients (70 patients, 81 hips) who were treated for slipped capital femoral epiphysis from 2010 to 2015 and who underwent pinning. We measured the severity of displacement radiologically using the Southwick angle. Postoperative radiographs were evaluated for the most frequent long-term complications of avascular necrosis (AVN), chondrolysis, and femoral acetabular impingement (FAI). Results We found seven cases of AVN, 14 cases of chondrolysis, and 31 hips had an α angle of 60°. Sex, ambulation, and symptoms did not affect development of these complications. Patients with a normal weight were almost two times more likely to develop FAI. Patients with moderate and severe slips had a similar percentage of AVN. In severe slips, 85.7% of patients had an α angle higher than 60°. Conclusions This study shows that severe slips have a higher risk of developing AVN and hip impingement. Every patient who suffers from SCFE (even the mildest forms) should be regularly checked for FAI.
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http://dx.doi.org/10.1177/0300060517731683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023047PMC
June 2018

Aggressive development of an aneurysmal bone cyst of the proximal femur in a paediatric patient: a case report.

J Int Med Res 2018 Jan 23;46(1):538-545. Epub 2017 Aug 23.

2 Department of Orthopaedics and Trauma, Rehabilitation Clinical Hospital Cluj-Napoca, University of Medicine and Pharmacy, Cluj-Napoca, Romania.

We report development of an aneurysmal bone cyst (ABC) that was located in the proximal region of the femur in an 11-year-old girl. Over a period of 30 weeks, the ABC showed fulminant local progression, with destruction of the bone, which led to an abrupt loss of function of the left hip. The standard tumour treatment protocol was followed. We performed embolisation of the tumour followed by a biopsy, which confirmed the diagnosis of ABC. The outcome was negative with total destruction of the proximal third of the femur, despite repeating the embolisation. Because of the unfavourable local progression, a second biopsy was performed and we reconfirmed the initial diagnosis. The final decision regarding the therapeutic approach was total hip arthroplasty with femoral reconstruction with a prosthesis. Following this treatment, the patient's outcome was favourable, with complete recovery of function and no local relapse.
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http://dx.doi.org/10.1177/0300060517722244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6011312PMC
January 2018

Clevidipine versus sodium nitroprusside in acute aortic dissection: A retrospective chart review.

Am J Emerg Med 2017 Oct 16;35(10):1514-1518. Epub 2017 Jun 16.

Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415, United States. Electronic address:

Aim: Intravenous vasodilators are often added to beta-blocking agents to reach blood pressure (BP) goals in aortic dissection. Control of BP using clevidipine has been described in hypertensive emergencies and cardiac surgery but not in aortic dissection. The aim of this study was to compare clevidipine versus sodium nitroprusside (SNP) as adjunct agents to esmolol for BP management in aortic dissection.

Methods: A single-center retrospective chart review evaluated patients diagnosed with aortic dissection. The primary outcome measure was time to reach patient specific systolic blood pressure (SBP) goals after initiation of esmolol infusion. Efficacy of clevidipine and SNP was assessed using area under the curve analysis of positive and negative excursions outside of SBP goals (AUC). Cost data was calculated using average wholesale price in U.S. dollars.

Results: Fourteen patients were included in final analyses. Median systolic BP immediately prior to initiation of esmolol was 162mm Hg vs 161mm Hg for clevidipine and SNP groups, respectively (p=0.99). Median time to reach SBP goal was similar between clevidipine and SNP (1.68 versus 1.03h [p=0.99]). Median AUC was similar for clevidipine and SNP (206.9 versus 538.9 mm Hg∗min∗hr [p=0.11]). Cost was significantly reduced using clevidipine versus SNP ($1223.28/day versus $7674.24/day [p<0.001]).

Conclusions: Clevidipine administration during initial medical management of aortic dissection showed similar efficacy compared to SNP when used as adjunct therapy to esmolol. These data suggest clevidipine is a less costly, reasonable alternative to SNP in acute aortic dissection as adjunct therapy to esmolol. Further studies are needed to validate these results.
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http://dx.doi.org/10.1016/j.ajem.2017.06.030DOI Listing
October 2017

Surgical Treatment of an Aneurysmal Bone Cyst with Avascular Bone Graft.

Chirurgia (Bucur) 2017 Mar-Apr;112(2):172-177

Aneurysmal bone cyst is a solitary bone tumor, expansile and lytic most often seen in the second decade of life, more frequently in men than in women (2: 1). They can occur in any bone, most common in the metaphysis of the long bones of the lower limbs. Although it is a benign tumor formation, aneurysmal cysts may have an aggressive local evolution and can cause a significant decrease in bone strength. The pacient may present local pain, the appearance of local deformation due to a tumor mass or occurrence of pathological fractures. Traditionally these lesions were treated surgically (curettage or resection and bone grafting) with a relapse rate of about 20%. Because bone resection may lead to bone defects, deformations or damage in the affected limb's function, lately the preferred treatement percutaneous sclerotherapy using fibrosing alcoholic agents.

Case Report: We present the case of a 14 year old pacient submitted for pain and deformity at the distal third of the right forearm with insidious onset and exacerbated lately. Following clinical investigations, laboratory and histopathology he was diagnosed with aneurysmal bone cyst of the right ulna. Since sclerotherapy is not available in our clinic, we initially performed an excisional biopsy with curettage of the lesion. Because the tumor still had an aggressive postoperative evolution, we decided for a bone resection and reconstruction using an avascular peroneal graft. Postoperative, the patient presents a favorable short and medium term evolution, the disappearance of pain and resumed function of the affected segment. Radiologically bone graft integration can be observed, with no evidence of local recurrence.

Conclusion: Although modern tehniques for treating anurysmal bone cyst include either injecting fibrosing alcoholic agents or resection and grafting using vascular bone graft, the traditional tehnique described by Merle d'Aubigne which implies the usage of avascular bone graft is still heplful, leading to succesful results especially in the upper limbs.
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http://dx.doi.org/10.21614/chirurgia.112.2.172DOI Listing
July 2017

Surgical Treatment of a Rare "Reverse" Madelung Deformity in 11 Years Female Patient.

Chirurgia (Bucur) 2017 Jan-Feb;112(1):72-76

Madelung deformity is an abnormality of the distal part of the forearm due to a growth arrest in the distal radial physis creating an increase of the radial tilt angle associated with a dorsal subluxation of the distal ulna in most cases. It is a rare condition which represents only 1.7% of hand deformities being characterized by the presence of an abnormal structure, Vickers ligament, that tethers the distal radius to the lunate bone. Although it is believed to be a congenital disorder, the symptoms are absent till late childhood. We present a case of a 11 years old girl patient, who came to our clinic for deformity of both forearms, which consisted of an anteriorly curved radius, volar proeminence of the distal ulna, partial limitation of supination and pain in the last 6 months, with and insidious onsed and aggravated lately. The mother of the patient, at the age of 13, was diagnosed with the same deformity which was surgically treated at that time. Furthermore, the patient has an older sister with no deformity of the forearms. X-rays revealed an increased radial tilt and anterior luxation of the distal ulna. Considering the deformity and the presence of pain we decided to excise the Vickers ligament and make an opening and derotation wedge osteotomy of the distal radius.
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http://dx.doi.org/10.21614/chirurgia.112.1.72DOI Listing
June 2017

Total Hip Replacement in Congenital Hip Dislocation in 14 Years Female Patient.

Chirurgia (Bucur) 2016 May-Jun;111(3):279-82

Introduction: development dysplasia of the hip is one of the common disorders in pediatric orthopaedics. This requires an early orthopaedic treatment. Neglected cases can lead to hip dislocation, which has an incidence of 1.4 / mille new-borns, being bilateral in 70-80% of cases and prevalence of girls being 7 / 1-4 / 1 (girls / boys). Congenital hip dislocation requires a complex surgical and orthopaedic treatment. In most cases develop hip osteoarthritis in adulthood, requiring total hip replacement. In certain selected cases total hip replacement is required since the pediatric age.

Methods: We present the case of a 14 year old patient who was admitted to our clinic for limping with leg-length discrepancy, pain in the right groin. The disease has an insidious onset at the start of the walking age. The treatment was denied until the age of 9, when was performed open reduction of the hip, shortening osteotomy of the femur, right hip adductor tenotomy muscles. Despite treatment the disease has an poor outcome, patient was presenting at age of 14 a shortening of the right leg 7 cm, with the greater trochanter elevated, positive Trendelenburg sign, limiting of daily activities, Harris score 48. We performed transkeletal traction for one month, after that performing total hip replacement. The postoperative evolution was excellent, the patient having no pain, with a 2 cm leg-length discrepancy, starting to walk at 3 month after surgery.

Conclusions: Although total hip replacement in congenital hip dislocation at pediatric age is an exceptional procedure, in some cases carefully selected it proves to be a viable alternative in the medium term.
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September 2016

Negative Pressure Wound Therapy (NPWT) to Treat Complex Defect of the Leg after Electrical Burn.

Chirurgia (Bucur) 2016 Mar-Apr;111(2):175-9

Negative pressure wound therapy is a non-invasive treatment that uses under atmospheric pressure to increase blood supply to the wound, stimulating the formation of granulation tissue, angiogenesis, proliferation of fibroblasts and endothelial cells. Negative pressure therapy has also the ability to decrease the bacterial load, reduce swelling and decrease exudate while maintaining a moist environment that facilitates healing. Our patient, a 17 year old male, suffered major third and fourth-degree high voltage electrical burns on 60% of the body surface, in November 2011. After the excision of the necrotic tissue (muscles and tendons), the lower extremity of the right leg- the tibial bone, the fibula, external and internal malleoli became exposed circularly. The soft-tissue defect was partially covered by using an internal twin muscle flap and free split skin. Then, a cross leg flap technique has been used, partially covering the defect with a contralateral thigh flap. Surface swab cultures were positive for Pseudomonas aeruginosa. In October 2013 the patient was transferred to our department. The clinical examination of the right leg showed that the tibial bone had been exposed on an area of 15/3 cm in the lower half. The peroneal malleolus had also been exposed. The resection of the devitalized, exposed tibia and the avivement of the wound edges were performed. Then the NPWT was started and performed by intermittent suction. Local cleansing, soft-tissue avivement and dressing changes were performed twice a week for 6 weeks. After six weeks of NPWT and eleven dressing changes under general anaesthesia, the wounds were ready for skin grafting. Granulation tissue was formed, covering the entire surface of both the tibia bone and the peroneal malleolus. Both receptor beds were covered with free skin graft harvested from the ipsilateral thigh. The mechanical suture of the skin grafts was performed and the grafts were covered with damp dressing. By using the NPWT it was possible to cover major chronic soft tissue defects, thus avoiding the amputation of the member.
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July 2016
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