Fractures of the proximal segments of the pediatric distal radial metaphysis exhibit less angular stability than fractures of the distal segments.

The distal part of the forearm is divided into the physis, metaphysis, diaphyseal metaphyseal junction (DMJ) and diaphysis. The treatment of radial DMJ fractures is challenging because this region has diaphyseal characteristics. We speculated that the stability of metaphyseal fractures could vary depending on their proximity to the DMJ or physis. Our study aimed to investigate the stability of pediatric distal radius fractures in the physis, metaphysis and DMJ. Ninety-five patients were classified into three groups: group D, fracture line located within 1/2 of the width of the radius (WOR) from the physis; group M, fracture line located between 1/2 and 1 WOR from the physis; and group P, fracture line located between 1 and 2 WOR from the physis. We measured sagittal angulation and coronal angulation. A correction loss of less than 9° was defined as a 'stable reduction' outcome and one greater than 10° as a 'loss of reduction' outcome. The correction losses for sagittal angulation were significantly greater in groups M and P than in group D. The correction losses for coronal angulation were significantly greater in group P than in groups D and M. The incidence of 'loss of reduction' outcomes was significantly higher in groups M and P than in group D. The proximal segments of distal radial metaphyseal and DMJ fractures showed less angular stability than distal segments.

Validity of the distance between the anterior humeral line and capitellum as a quantitative measure of supracondylar humeral fracture in children.

INTRODUCTION: The anterior humeral line (AHL) is a radiographic marker used to quantify anterior-posterior displacement in supracondylar humeral fractures on lateral radiographs. As both the anterior border of the capitellum and the undeveloped ossific nucleus are clearly recognisable on lateral radiographs, we analysed the distance between the AHL and capitellum (AC distance). We hypothesised that the AC distance would provide a highly reproducible and useful index of correction losses in supracondylar humeral fractures. MATERIALS AND METHODS: Forty-two patients (mean age: 6.5 years) who had suffered supracondylar humeral fractures were enrolled in this study. The fractures were corrected by cross pinning in 28 patients and by lateral or lateral and posterior pinning in 14 patients. The AC distance, Baumann angle, and tilting angle were measured in radiographs of the supracondylar humeral fractures obtained immediately after surgery and after bone union. Correction losses were calculated and defined as changes in the AC distance, tilting angle, and Baumann angle. We investigated inter-observer and intra-observer variability in all three radiological parameters and also compared these parameters between children who underwent lateral pin fixation and those who underwent crossed pin fixation. RESULTS: An analysis of intra-observer variability yielded values of 0.93, 0.73, and 0.92 for the AC distance, tilting angle, and Baumann angle, respectively. An analysis of inter-observer variability yielded corresponding values of 0.84, 0.46, and 0.79, respectively. Notably, the change in AC distance was significantly smaller in the cross pinning group than in the lateral pinning group. DISCUSSION: Compared with the Baumann angle and tilting angle, the AC distance was identified as the most reliable method for measuring radiographs. Moreover, smaller correction losses were observed with cross pinning than with lateral pinning. Therefore, the AC distance is a useful and accurate quantitative parameter when analysing supracondylar fractures in children using sagittal plane images.

Conservative treatment of distal ulna metaphyseal fractures associated with distal radius fractures in elderly people.

INTRODUCTION: Although volar locking plates (VLPs) have been exclusively used for unstable distal radius fractures (DRFs), the optimal management of distal ulna fractures (DUFs) remains controversial. Internal fixation using a plate for DUFs might be challenging because of the presence of osteoporotic bone and fragile bone fragments in elderly patients. HYPOTHESIS: We hypothesized that a strategy including VLP fixation for DRFs and non-intervention for DUFs with early wrist mobilization would provide encouraging results in elderly patients. MATERIALS AND METHODS: Eighteen patients (17 women and one man, mean age 74.7 years) were included in the study. According to the Biyani classification, there were seven patients with type-1, three with type-2, five with type-3, and three with type-4 DUFs. Radiological results were analyzed in 18 patients and the clinical results could be evaluated in 10 patients who attended the necessary follow-up meetings. Ulnar angular deformity (UAD) and ulnar shortening amount (USA) were measured using anteroposterior radiographs. USA was defined as the difference in ulnar variance between just after surgery and at the final visit. Clinical results were assessed using the modified Gartland and Werley score, disability arm shoulder hand (DASH) score, range of motion, grip strength, pain, and distal radioulnar joint (DRUJ) instability. RESULTS: All ulna metaphyseal fractures united. The mean UAD just after surgery was 5.9° (range, 0-22). At the final visit, the mean UAD was 6.4° (range, 0-17). The mean USA was 0.35mm, and only one patient showed ulnar shortening of >2mm. The results were "excellent" in nine patients and "good" in one, according to the modified Gartland and Werley score. The mean DASH score was 4.2. Mean flexion and extension angles were 58° and 71°. One patient complained of ulnar-sided pain during exertion and no patients complained of DRUJ instability. DISCUSSION: All DUFs achieved good radiological results, including comminuted fractures. Functional outcomes were promising, including wide wrist ROM and no DRUJ instability. An approach including VLP fixation for DRFs and non-intervention for DUFs is a good option for elderly patients. LEVEL OF EVIDENCE: IV retrospective study.

Disaster Victim Identification using Orthopedic Implants in the 2011 East-Japan Earthquake and Tsunami.

On March 11, 2011, an earthquake (magnitude 9.0) devastated Japan's east coast, and the associated tsunami resulted in social and mechanical destruction. Search for the missing people is still ongoing. Surgical implants are common in the general population. Medical implants usually have lot numbers, and their forensic use is common for victim identification. This investigation was conducted mainly in the cities of Kamaishi and Otsuchi, both of which were affected by the tsunami disaster in 2011. We visited 6 mortuaries with the police between March 20 (9 days after the tsunami) and April 20 (40 days after the tsunami) to examine the presence of surgical scars and related information. Unidentified human remains were investigated by visual and tactile examination. We also visited temples where the ashes were preserved. If implants were found, their lot numbers and estimated surgical procedures were recorded to determine positive identification. Ten of 233 sets of unidentified human remains before cremation displayed characteristics of a potential past surgical history. However, only 2 of these 233 sets had orthopedic implants. Instead, non-combustible orthopedic implants were found and recognized in 8 of the 331 sets of unidentified human ashes in the temples after cremation; the lot numbers were fully legible in 2 of the 8 sets. We estimated the surgical procedures, which led to positive identification. In conclusion, lot numbers and the surgical knowledge of orthopedic surgeons could assist with the positive identification of disaster victims. However, the relevant information can be erased after cremation.

The right-sided aortic arch with unusual course of bilateral recurrent laryngeal nerves: a report of rare variations.

We describe a rare case of the right-sided aortic arch, the unusual origin of the main arterial vessels and the unusual courses of bilateral recurrent laryngeal nerves in a Japanese cadaver. Chiefly, the right-sided aortic arch turned to the left side from the dorsal part of the trachea and esophagus, and Kommerell's diverticulum was found at the end of the arch. The right common carotid artery arose from the end part of the ascending aorta, but the left common carotid artery arose from the proximal portion of the ascending aorta. The right subclavian artery arose from the upper edge of the aortic arch, but the left one arose from the front wall at the upper side of the ligamentum arteriosum. The right recurrent laryngeal nerve hooked around the aortic arch (but not the right subclavian artery) dorsoventrally, and the left recurrent laryngeal nerve hooked around the ligamentum arteriosum and arose from the ventral side (but not dorsal) of the aortic arch. These variations are very rare, and understanding them is useful and important for clinical research.

Use of pacemaker programmers for disaster victim identification.

Disaster victim identification (DVI) presents a number of physical and legal challenges, involving the degeneration of human remains and legal obstacles to forensic examinations. One non-invasive method for positive identification may be the use of a pacemaker programmer to detect and obtain data from pacemakers recovered from unidentified remains. To test the usefulness of this method, this investigation examined the efficiency and utility of 5 different pacemaker programmers in the positive identification of victims of the March 2011 tsunami in Japan at 8 disaster sites in May 2011. On scanning 148 sets of remains, data were successfully obtained from 1 implant in 1 set of remains, allowing for the rapid positive identification of the individual. Scanning pacemakers with pacemaker programmers can be a non-invasive method of positive identification that meets Japanese legal and institutional requirements, but this method is ineffective without a preceding whole-body X-ray scan.