Traction does not decrease failure of reduction and femoral head avascular necrosis in patients aged 6-24 months with developmental dysplasia of the hip treated by closed reduction: a review of 385 patients and meta-analysis.

This study aimed to investigate the effects of preliminary traction on the rate of failure of reduction and the incidence of femoral head avascular necrosis (AVN) in patients with late-detected developmental dysplasia of the hip treated by closed reduction. A total of 385 patients (440 hips) treated by closed reduction satisfied the inclusion criteria. Patients were divided in two groups according to treatment modality: a traction group (276 patients) and a no-traction group (109 patients). Tönnis grade, rate of failure reduction, AVN rate, acetabular index, center-edge angle of Wiberg, and Severin's radiographic grade were assessed on plain radiographs, and the results were compared between the two groups of patients. In addition, a meta-analysis was performed based on the existing comparative studies to further evaluate the effect of traction on the incidence of AVN. Tönnis grade in the traction group was significantly higher than in the no-traction group (P = 0.021). The overall rate of failure reduction was 8.2%; no significant difference was found between the traction (9.2%) and no-traction groups (5.6%) (P = 0.203). The rates of failure reduction were similar in all Tönnis grades, regardless of treatment modality (P > 0.05). The rate of AVN in the traction group (14%) was similar to that of the no-traction group (14.5%; P = 0.881). Moreover, the rates of AVN were similar in all Tönnis grades, regardless of treatment modality (P > 0.05). The meta-analysis did not identify any significant difference in the AVN rate whether preliminary traction was used or not (odds ratio = 0.76, P = 0.32). At the last follow-up visit, the two groups of patients had comparable acetabular indices, center-edge angles, and Severin's radiographic grades (P > 0.05). In conclusion, preliminary traction does not decrease the failure of reduction and the incidence of AVN in developmental dysplasia of the hip treated by closed reduction between 6 and 24 months of age.

[Dynamic external fixation for stabilizing Baumman angle during midanaphase in supracondylar fracture of humerus in children].

OBJECTIVE: To evaluate the function of preventing supracondylar fracture of the humerus and cubitus varus in children by observing Baumann angle changes with self-made Orthopedic elastic elbow brace. METHODS: From October 2010 to April 2012,120 patients with closed Gartland II or III supracondylar fracture of the humerus diagnoised by X-ray were divided into two groups as follows:group A (62 cases, including 48 males and 14 females, with an average age of (7.27 +/- 4.36) years old, and the course of (1.48 +/- 1.26) days); group B (58 cases, including 47 males and 11 females, with an average age of (8.02 +/- 3.82) years old, and the course of (1.20 +/- 1.11) days. The two groups were treated by manipulative reduction and external fixation of small splints. Group A were used with elbow brace at 15 days after reduction, and treated for 90 days. Group B were used with external fixation of small splints and removed at 30 days. Baumann angle changes at different time periods (15 days, 30 days, 60 days, 90 days, 6 months, 1 year) after reduction and its' opposite side were recorded by X-ray. The angles of injured side and the opposite side were compared. The function of the elbow brace was evaluated at 90 days or 1 year after reduction according to Flynn. RESULTS: All cases were followed up for over 1 year and obtained fracture healing. The incidence of cubitus varus was no one in group A and 4 cases in group B. The Baumann angles of injured side were trended to be increased with the time passing. From 30 days after reduction to 90 days, the increased angles of group B is more than that of group A (P < 0.01). CONCLUSION: It is effective on stabilizing Baumman angle in the supracondylar fracture of the humerus of midanaphase treatment in Children by orthopedic elastic elbow brace.

[Clinicopathologic study of giant cell angioblastoma].

OBJECTIVE: to study the clinicopathological features, imaging characteristics, immunophenotypes and differential diagnosis of giant cell angioblastoma (GCAB). METHODS: a case of GCAB in the left middle-upper tibia and fibula was studied by light microscopy, X-ray and CT imaging, immunohistochemistry. RESULTS: X-ray and CT imaging showed a clearer lesion in the left middle-upper tibia than in the ipsilateral fibula with enlarged ostealleosis and increased inhomogeneously medullary cavity density, irregular thickening of cortical bone, local cortical default at the inner edge, soft tissue swelling around the abnormal bone. Histologically, tumor tissue was located between the bone trabeculae by nodular, linear and plexiform aggregates of oval-to-spindle cells, large mononucleate cells and multinucleate giant cells with prominent nucleoli and abundant granular eosinophilic cytoplasm. Some aggregates had uncentain amount of discernible lumens, either empty or containing few erythrocytes. A concentric arrangement of oval-to-spindle Cells around small-caliber vascular structures together with collagen fiber contributed to a so-called 'onion-skin' arrangement. The background showed a loose mesenchymal stroma formed of some inconspicuous spindle-fibroblast-like cells, stellate-shape mesenchymal cells, a moderate mononuclear inflammatory cell infiltrate and scattered mast cells. Immunophenotype showed the tumor cells and giant cells strongly positive for vimentin. A good many oval-to-spindle cells stained markedly for CD31 and CD34, but weakly for FVIII, while the giant cells are highlighted instead by CD68, occasionally, very few giant cells showed positive focally for FVIII, a-SMA decorated notedly the cells surrounding the endothelium-like cells but weakly positive in some other tumor cells. CONCLUSION: GCAB is a rare, locally infiltrative but slow growing neoplastic angiogenesis with unique morphological characteristics during infancy, which may occur not only in the skin, mucosa, subcutis and deep soft tissue but also in the bone.