Short, double elastic nailing of severely displaced distal pediatric radial fractures: A new method for stable fixation.

RATIONALE: Short double elastic nailing is a minimal invasive, modified ESIN (elastic stable intramedullary nailing) technique for severely displaced distal radial fracture in children. The aim of this technical report is to introduce our new method and evaluate the final results of the procedure. PATIENT CONCERNS: We reviewed retrospectively 24 patients who underwent short double elastic nailing due to distal radial fractures between November 2012 and December 2015. Indications for surgery included closed, severely displaced, unstable metaphyseal or diametaphyseal fractures of the radius. INTERVENTION: The fractures were stabilized by 2 prebent short elastic titanium nails inserted from the distal side of the fracture. In cases of associated ulnar fracture, a classic anterograd ESIN nailing was also performed. Patients were mobilized immediately in a removable short splint which was removed after 1 to 2 weeks. There has been no additional splinting or casting. OUTCOMES: There were 17 males and 7 females with an average age of 9.8 years (range, 4-16 years). The right hand was involved in 16 cases and the left hand in 8 cases. The average follow-up was 17.8 months (range, 7-28 months). Of the 24 patients, 3 presented irritation of the skin, which resolved after removal of the radial nail. All the patients regained full range of motion without any complications. LESSONS: Our technique is an effective, safe, and easily learnable procedure for unstable fractures of the distal third of the radius. It achieves good functional and radiological results, and allows early mobilization without the need of casting. Avoiding the physeal plates, we reduce the risk of iatrogenic postoperative deformity. Further prospective and biomechanical investigations are necessary to verify our experience.

Above-knee amputation followed by femoral replantation: 21-year follow-up results after lower limb replantation.

In this article, we report successful treatment of serious complications of replantation after traumatic mid-third femoral amputation. To the best of our knowledge, no similar case has been reported in the literature. A 38-year-old healthy male sustained a mid-third right traumatic femoral amputation. We performed replantation. Oliguria and anuria occurred and were treated successfully with hemofiltration and hemodialysis. Six years later, patient walked wearing orthopedic shoes and also protective sensibility recovered on the limb. Serious complications of proximal lower limb replantation can be treated successfully and the limb can be saved.

[Clinical classification of congenital limb abnormalities]. / Veleszületett végtagfejlodési rendellenességek klinikai osztályozása.

Limb developmental defects are well-known, conspicuous abnormalities. Until this day, the background has still not been completely revealed, however, the development of scientific methods provides more and more opportunities which may help to understand developmental processes and defects of this compound system. Considering these aspects, following data collection from patients with limb developmental defects, we began a study with the purpose of finding/establishing a classification system that is suitable for morphological and clinical distinctions, besides considering developmental aspects, and may help to indicate adequate genetic examinations. To classify 195 patients included in our database, we chose a worldwide accepted table from Swanson. Based upon our observations we proposed some alterations, which finally lead to a table, suitable for patient classification based upon morphology and clinical features. Furthermore it allows comparisons concerning developmental aspects, gives reasonable background for genetic studies and is suitable for everyday clinical usage.