Abstract Introduction Unstable pelvic fractures in children are rare but severe injuries and are associated with high-energy trauma. Unlike adults, children have open growth plates, particularly the Risser growth plate (RGP), which is vulnerable to injury. The presence of growth plates, such as the triradiate cartilage and Risser’s plate, represents point of vulnerability that determines distinctive fracture patterns, similar to those seen with Salter–Harris growth plate injuries. Lateral compression fracture is the most common mechanism and results in an irreducible crushing of the sacral alae, causing a rotational deformity. Both vertical and lateral compression displaced pelvic fractures require careful evaluation of the posterior iliac apophysis-associated injury. Failure to treat Risser growth plate injury (RGPI) can lead to severe long-term problems such as limb length discrepancy and scoliosis. This study aimed to determine how commonly RGPI occurs in unstable paediatric pelvic fractures, link it to specific fracture patterns and propose a subgroup type to improve treatment. Materials and methods This multicentre retrospective study included 40 children aged up to 12 years with unstable pelvic fractures (AO/OTA 61B and 61C). The patients were treated between 1987 and 2022 at trauma centres in Italy, Argentina and Venezuela. We reviewed patient demographics, injury mechanisms and computed tomography (CT) scans to classify fractures using the AO/OTA system and identify RGPI. Statistical analysis was used to explore links between RGPI and specific fracture features. Results Forty children (25 males; mean age 7.3 ± 3.6 years) were included. RGPI occurred in 26/40 patients (65%), with 19/21 cases (90.4%) in AO/OTA type C fractures. RGPI significantly correlated with complex posterior fracture-dislocations ( p = 0.001) and AO/OTA type C injuries ( p = 0.0007). Three RGPI types were identified: type 1 (minimally displaced), type 2 (avulsed RGP with sacroiliac [SI] joint disruption) and type 3 (bilateral lesions). In total, 11 of 13 patients (84.6%) with at least 2 years of follow-up developed deformities. Discussion and conclusions RGPI is a common and critical part of unstable paediatric pelvic fractures, especially severe ones. In patients below the age of 7 years old with displaced and unstable pelvic fractures, the Risser’s growth plates and posterior iliac apophysis are involved in 50% of cases. The Tile/AO classification, adapted to include concurrent injuries of the growth plates, offers a useful framework for treatment planning. Although the Torode and Zeig classification remains the standard, it is incomplete because it does not consider injuries related to the Risser growth plate. Our findings suggest that unrecognised or inadequately reduced RGPI causes severe, progressive functional deformities, such as limb length discrepancy, rather than mechanical instability. Although further prospective validation is needed, we hypothesize that anatomical reduction of these specific physeal injuries should be considered to prevent severe growth arrest. Our proposed classification seeks to improve upon traditional frameworks by incorporating this critical structure. Level of Evidence Level 4 (case series).
OBJECTIVE:To evaluate the effectiveness and safety of using a modified menstrual cup for vaginal distention during vaginoscopic hysteroscopy and to assess patient's discomfort and its impact on surgical ergonomics. DESIGN:Prospective, single-arm feasibility study SETTING: Ambulatory minimally invasive gynecologic surgery units at a public teaching hospital and a private clinic in Caracas, Venezuela. PARTICIPANTS:Sixty-three women aged 16 to 70 years undergoing diagnostic or operative vaginoscopic hysteroscopy between February 1st and November 30th, 2024. INTERVENTIONS:A modified silicone menstrual cup (stem removed, central aperture created) positioned in the lower third of the vagina to facilitate distention and permit 2-handed instrumentation of the hysteroscopic procedure ("VaginosCUPy" technique). MEASUREMENTS AND MAIN RESULTS:Successful cup insertion and adequate vaginal distention occurred in 59/63 (93.7%) of the cases. Four postmenopausal women with severe vaginal atrophy could not tolerate the insertion of the CUP. Among successful cases, optimal distention and full visualization were achieved in 59/59 (100%). Cervical stenosis was encountered in 20/63 (31.7%) of the cases; all were overcome and treated using micro-scissors, electrodes, or graspers without complications. Five adolescents with obstructive Müllerian anomalies underwent resection of transverse or oblique vaginal septa with satisfactory immediate results. Patient discomfort was low: 49/63 (77.8%) reported mild pain (VAS 2/10), 10/63 (15.9%) moderate (VAS 3/10), and 4/63 (6.3%) severe. Surgeons rated insertion "easy" in 51/63 (81.0%) and reported improved ergonomics in all successful procedures. No adverse events occurred. CONCLUSION:Using a modified menstrual cup enables safe and reliable vaginal distension during vaginoscopic hysteroscopy, allowing for a hands-free approach that improves ergonomics and facilitates the hysteroscopic procedure. Further evaluation is warranted in postmenopausal and virginal patients.
Background:Transcatheter aortic valve implantation (TAVI) is a minimally invasive option for severe aortic stenosis (AS). The Crea Aortic Valve (CAV) is a new self-expanding transcatheter aortic valve implant that has been successfully tested in preclinical studies. Aims:We aimed to assess the technical success, device performance, and early safety of the CAV System in a first-in-human study for the device in patients with severe AS. Methods:We prospectively evaluated the CAV using the Valve Academic Research Consortium (VARC)-3 criteria in three high-risk patients with severe AS. A computed tomography angiography and transthoracic echocardiographic (TTE) assessment were carried out, which was followed by TAVI according to standard protocol. TTE was performed before and after the procedure, before discharge, and at the 1- and 6-month clinical follow-ups to monitor the aortic valve area, the maximum velocity (Vmax), the mean (MG) and peak pressure gradients, and paravalvular leak (PVL). Results:The CAV was successfully implanted, using the cusp-overlap technique for patient 1 and the coplanar view for patients 2 and 3, with good usability of the delivery system for optimal positioning, reduction of the Vmax to <2 m/s and MG to <10 mmHg, and trivial PVL. An atrioventricular block necessitating a permanent pacemaker occurred in one patient. There was no incidence of stroke, heart failure, or renal failure at 6 months of follow-up. Conclusions:The CAV was implanted with success, and the system performed as intended as per VARC-3 criteria. The device should be evaluated in a larger clinical study for further efficacy and safety data.
Resumen: Este estudio abordó la necesidad crítica de humanizar la formación del médico residente, que a menudo se centra en la tecnología y datos, sobre la experiencia humana de la enfermedad. El objetivo fue analizar el impacto de la escritura creativa, como herramienta reflexiva para que los médicos residentes pudieran develar y comprender sus perspectivas sobre su práctica y el componente humano de la enfermedad. La justificación central fue proporcionar un recurso para dotar al médico de la habilidad para interpretar y actuar sobre las historias del paciente y de sí mismo. Además, desarrollar la empatía, fomentar la reflexión ética y emocional, mejorar la comunicación efectiva entre: médico con el paciente, cuidador y sí mismo. Metodológicamente, se trató de un estudio cualitativo con enfoque descriptivo y de investigación-acción, involucrando a 7 médicos RAMH 2025. La metodología se centró en realizar talleres de EC y la producción de narrativas personales. Los resultados confirmaron una necesidad palpable de contar con un espacio formal de reflexión o apoyo emocional en la formación médica. Cuantitativamente, la pertinencia del tema fue del 100%. Además, el 85% de los participantes estuvo "De Acuerdo" o "Totalmente de Acuerdo" en que la escritura es una herramienta terapéutica efectiva para la gestión del estrés y que profundizó su comprensión de la relación médico-paciente. Conclusión: se valida la pertinencia del Taller de EC como estrategia esencial y una respuesta directa a una necesidad sentida, confirmando la utilidad de esta como herramienta epistemológica y pedagógica para la formación integral del médico.
