Pharmacological Modulation of Ubiquitin-Proteasome Pathways in Oncogenic Signaling.

The ubiquitin-proteasome pathway (UPP) is involved in regulating several biological functions, including cell cycle control, apoptosis, DNA damage response, and apoptosis. It is widely known for its role in degrading abnormal protein substrates and maintaining physiological body functions via ubiquitinating enzymes (E1, E2, E3) and the proteasome. Therefore, aberrant expression in these enzymes results in an altered biological process, including transduction signaling for cell death and survival, resulting in cancer. In this review, an overview of profuse enzymes involved as a pro-oncogenic or progressive growth factor in tumors with their downstream signaling pathways has been discussed. A systematic literature review of PubMed, Medline, Bentham, Scopus, and EMBASE (Elsevier) databases was carried out to understand the nature of the extensive work done on modulation of ubiquitin-proteasome pathways in oncogenic signaling. Various in vitro, in vivo studies demonstrating the involvement of ubiquitin-proteasome systems in varied types of cancers and the downstream signaling pathways involved are also discussed in the current review. Several inhibitors of E1, E2, E3, deubiquitinase enzymes and proteasome have been applied for treating cancer. Some of these drugs have exhibited successful outcomes in in vivo studies on different cancer types, so clinical trials are going on for these inhibitors. This review mainly focuses on certain ubiquitin-proteasome enzymes involved in developing cancers and certain enzymes that can be targeted to treat cancer.

Evaluation of bioactivity of aqueous extracts of Bougainvillea spectabilis, Saraca asoca, and Chenopodium album against immature forms of Aedes aegypti.

BACKGROUND: Increasing rate of vector transmission of dengue has led to the exponential rise in the mortality and morbidity scales in the past five years. There are various natural and synthetic chemical agents available commercially as potent larvicides, but they are either highly toxic, difficult to obtain, have a high manufacturing cost, or show cross-resistance, hence do not suffice as ideal larvicides. The objective was to screen aqueous extracts of Bougainvillea spectabilis (B. spectabilis), Saraca asoca (S.asoca), and Chenopodium album (C. album) for larvicidal activity against Aedes aegypti (A. aegypti). METHODS: The larvae were exposed to increasing concentrations of aqueous extracts of B. spectabilis, S. asoca, and C. album under controlled laboratory environment. The mortality was checked after 24 hours, results were statistically analyzed, and LC50 and LC90 were determined. RESULTS: B. spectabilis and S. asoca were found effective as larvicides against A. aegypti with LC50 values of 0.22% and 0.26%, respectively. CONCLUSION: The aqueous extracts of B . spectabilis and S. asoca are efficient larvicides against A . aegypti and can be used as effective, accessible, and eco-friendly control options for management of A. aegypti, the vector of dengue/chikungunya.

Case of Hallervorden-Spatz Syndrome: A Tale of Twin Sisters.

Hallervorden-Spatz syndrome, now known as pantothenate kinase-associated neurodegeneration (PKAN), is a rare autosomal recessive disorder that is characterized by cerebral iron deposition and leads to progressive extrapyramidal dysfunction and dementia. Most commonly seen in the first two decades of a person's life, it is a differential for patients presenting with atypical progressive extrapyramidal disorder and cognitive impairment. It is characterized by progressive degeneration of the basal ganglia, globus pallidus, and the reticular part of the substantia nigra due to iron accumulation. The characteristic MRI brain pattern of the disease shows the eye-of-the-tiger sign. We report cases of early onset PKAN in two sisters of the same family, in which diagnosis was based on clinical features, lab parameters, and MRI imaging findings. This report aims to differentiate PKAN from other static and progressive neurological illnesses.

A Novel Method of Treatment of Small Osteolabral Avulsions Associated with Posterior Fracture dislocation of the Hip.

Small osteolabral avulsions of the hip can be easily missed, and postreduction stress testing and a computed tomography (CT) scan of the hip should be done to look for these injuries. The usual modality of treatment of these unstable osteolabral avulsions is suture anchors, Herbert screws or spring plates. But when the bony avulsion is small, the use of these implants becomes a tedious job. We present a novel technique of fixing small osteochondral avulsion fractures not amenable to fixation using screws or spring plates. We performed a retrospective analysis of 57 cases of patients who underwent open reduction and internal fixation for posterior fracture dislocation of the acetabulum, and we identified 6 cases of small posterior labral osteochondral fragments leading to instability. These injuries were fixed using a novelmethod. Themean Harris Hip Score at the final follow-up was of 92.5. Fixation of osteochondral avulsions associated with posterior hip fracture dislocation can be a difficult task if the bony fragment is small. Our technique is a simple, cost-effective and reliable way of fixing such avulsions with satisfactory outcomes.

The image dataset of Indian coins: A machine learning approach for Indian currency.

In an increasingly digital world, the significance of creating a Comprehensive Image Dataset of Contemporary Indian Coins (CIDCIC) cannot be overstated. This research presents a dataset comprising 6,672 images of 53 different classes of Indian coins, including denominations of 25 Paisa, 50 Paisa, 1 Rupee, 2 Rupee, 5 Rupee, 10 Rupee, and 20 Rupee. The images of coins with various shapes and sizes are taken from obverse and reverse sides in various environments and different backgrounds. The core significance of this dataset unfolds in its potential to offer invaluable assistance to visually impaired individuals as they navigate their daily financial transactions. The dataset is a significant contribution to the domains of computer vision, artificial intelligence, and machine learning, specifically addressing the challenges related to coin detection, recognition, and monetary system integrity. These technologies can empower visually impaired individuals to independently and accurately recognize and distinguish between various coin denominations, thereby enhancing their participation in the financial realm. The dataset addresses limitations in existing dataset of having limited size, and scope. It addresses the limitations associated to the limited number of coins and the lack of diversity in images, encompassing various angles, environments, backgrounds, and directions of coins. The dataset provides a broader and more up-to-date representation of contemporary Indian coins.

Balloon Catheter Technique for Prevention of Vascular Injuries During Arthroscopic Posterior Cruciate Ligament Reconstruction.

Arthroscopic posterior cruciate ligament (PCL) reconstruction is a technically demanding procedure and is associated with several intraoperative and postoperative complications, although less-common but intraoperative iatrogenic popliteal artery injuries have been reported. At our center, we developed a simple and effective technique using a Foley balloon catheter that ensures a safe surgery to avoid possible neurovascular complications. Through a lower posteromedial portal, this inflated balloon acts as protective mechanism between the PCL and posterior capsule. Betadine or methylene blue dye is used to inflate this bulb, which provides easy identification if balloon ruptures, as evidenced by leakage of this solution in posterior compartment. This balloon increases significant distance, equivalent to the diameter of the balloon, between the PCL and popliteal artery by pushing the capsule more posteriorly. This balloon catheter protection technique combined with other methods will ensure a greater level of safety when performing an anatomical PCL reconstruction.

Comparison of Early and Long-Term Mortality in Patients With Reduced and Preserved Ejection Fraction Undergoing Coronary Artery Bypass Graft: A Systematic Review and Meta-Analysis.

The aim of this study was to compare early and long-term mortality in patients with reduced and preserved ejection fraction (EF) undergoing coronary artery bypass graft (CABG). This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Two investigators independently conducted a systematic and comprehensive search of PubMed, EMBASE, and Scopus from inception to July 15, 2023, using the search terms "reduced ejection fraction," "preserved ejection fraction," "coronary artery bypass surgery," and "mortality." Boolean operators (AND, OR) were used with medical subject heading (MeSH) terms to refine the search. The reference lists of all included articles were manually searched to identify potentially relevant studies. We restricted our search to studies published in the English language. The outcomes assessed in this meta-analysis included short-term mortality (including in-hospital and 30-day mortality) and long-term mortality. A total of five studies were included in this meta-analysis. The pooled sample size is 94,399 participants. Pooled analysis showed that the risk of early mortality was significantly higher in patients with reduced EF compared to patients with preserved EF (risk ratio, RR: 2.14, 95% CI: 1.50 to 3.06). The pooled analysis also reported that late mortality was significantly higher in patients with reduced EF compared to patients with preserved EF (RR: 1.67, 95% CI: 1.35 to 2.08). The pooled analysis of studies demonstrated a significantly higher rate of both early and late mortality in patients with reduced EF, emphasizing the importance of EF assessment in risk stratification for CABG patients.

Long-Term Outcome of Valgus Osteotomy and Fixation with Double Angled Dynamic Hip Screw for Nonunion Fracture of the Neck of the Femur in Young Adults.

Objective To evaluate the long-term results of valgus intertrochanteric osteotomy fixed with double angled dynamic hip screw for nonunion fracture of the neck of the femur in young adults. This implant allows more freedom of fixation in the sagittal plane. Very few studies have evaluated the long-term outcome for treatment of nonunion in fractures of the neck of the femur. Methods This is a prospective interventional study that included 20 patients with nonunion of the fracture of the neck of the femur aged < 60 years old without avascular necrosis of the head and significant resorption of the neck of the femur. A lateral closing wedge osteotomy was performed just above the lesser trochanter after inserting the Richard screw across the nonunion site, and it was fixed with a double-angle 120° barrel plate. The outcome was evaluated using union rate and the Harris Hip Score for functional outcome. Results The average postoperative decrease in the Pauwels angle was of 28.9°. A total of 80% of the cases progressed to union within a mean duration of 7.53 months. The mean Harris Hip Score at the final follow-up was 86.45. Conclusion Valgus intertrochanteric osteotomy and fixation with a double angled dynamic hip screw is a reliable and effective method for preservation of head and promoting union in an ununited fractured neck of the femur in young patients.

Transcriptome analysis and connectivity mapping of Cissampelos pareira L. provides molecular links of ESR1 modulation to viral inhibition.

Bioactive fractions obtained from medicinal plants which have been used for the treatment of multiple diseases could exert their effects by targeting common pathways. Prior knowledge of their usage could allow us to identify novel molecular links. In this study, we explored the molecular basis of action of one such herbal formulation Cissampelos pareira L. (Cipa), used for the treatment of female hormone disorders and fever. Transcriptomic studies on MCF7 cell lines treated with Cipa extract carried out using Affymetrix arrays revealed a downregulation of signatures of estrogen response potentially modulated through estrogen receptor α (ERα). Molecular docking analysis identified 38 Cipa constituents that potentially bind (ΔG < - 7.5) with ERα at the same site as estrogen. The expression signatures in the connectivity map ( https://clue.io/; ) revealed high positive scores with translation inhibitors such as emetine (score: 99.61) and knockdown signatures of genes linked to the antiviral response such as ribosomal protein RPL7 (score: 99.92), which is a reported ERα coactivator. Further, gene knockdown experiments revealed that Cipa exhibits antiviral activity in dengue infected MCF7 cells potentially modulated through estrogen receptor 1. This approach reveals a novel pathway involving the ESR1-RPL7 axis which could be a potential target in dengue viral infection.

Missing MRI Pulse Sequence Synthesis Using Multi-Modal Generative Adversarial Network.

Magnetic resonance imaging (MRI) is being increasingly utilized to assess, diagnose, and plan treatment for a variety of diseases. The ability to visualize tissue in varied contrasts in the form of MR pulse sequences in a single scan provides valuable insights to physicians, as well as enabling automated systems performing downstream analysis. However, many issues like prohibitive scan time, image corruption, different acquisition protocols, or allergies to certain contrast materials may hinder the process of acquiring multiple sequences for a patient. This poses challenges to both physicians and automated systems since complementary information provided by the missing sequences is lost. In this paper, we propose a variant of generative adversarial network (GAN) capable of leveraging redundant information contained within multiple available sequences in order to generate one or more missing sequences for a patient scan. The proposed network is designed as a multi-input, multi-output network which combines information from all the available pulse sequences and synthesizes the missing ones in a single forward pass. We demonstrate and validate our method on two brain MRI datasets each with four sequences, and show the applicability of the proposed method in simultaneously synthesizing all missing sequences in any possible scenario where either one, two, or three of the four sequences may be missing. We compare our approach with competing unimodal and multi-modal methods, and show that we outperform both quantitatively and qualitatively.

An Initial Study into the Role of Teriparatide in Absent or Delayed Regenerate Formation during Distraction Osteogenesis: A Case Series.

Purpose: Distraction osteogenesis has been used for post-traumatic segmental bone defects. Absent or delayed callus formation in the distraction gap can lead to significant morbidity and affect the clinical outcome. Experimental evidence in animal models has demonstrated that teriparatide enhances the consolidation of regenerate and also strengthens it. This study aimed to report our experience with recombinant teriparatide therapy for patients with regenerate insufficiency. Materials and methods: Nine out of 43 patients undergoing limb lengthening using the limb reconstruction system (LRS) fixator were diagnosed with regenerate insufficiency. With informed consent, these patients received a therapeutic regime of 20 µg of teriparatide administered subcutaneously once daily for a period of 3 months. Results: The mean age in the sample was 40.22 years (SD 17.87). Regenerate insufficiency was diagnosed at a mean of 4.94 months (range 2.5-9 months) from surgery. Teriparatide injections were started at a mean of 6.94 months (range 4.5-11 months) from surgery. The sites of regenerate insufficiency were tibia (n = 5) and femur (n = 4). Favourable radiographic progress in visibility of callus was seen at a mean duration of 9.4 weeks (range 8-12 weeks) from the initiation of teriparatide therapy. No systemic complications were encountered. Conclusion: The initiation of teriparatide treatment as described in this study may be successful in triggering the osteogenic potential within poor regenerate and help in consolidation and avoid more invasive surgical procedures. How to cite this article: Patil B, Kansay R, Gupta S, et al. An Initial Study into the Role of Teriparatide in Absent or Delayed Regenerate Formation during Distraction Osteogenesis: A Case Series. Strategies Trauma Limb Reconstr 2020;15(2):117-120.

ERGO: Efficient Recurrent Graph Optimized Emitter Density Estimation in Single Molecule Localization Microscopy.

Single molecule localization microscopy (SMLM) allows unprecedented insight into the three-dimensional organization of proteins at the nanometer scale. The combination of minimal invasive cell imaging with high resolution positions SMLM at the forefront of scientific discovery in cancer, infectious, and degenerative diseases. By stochastic temporal and spatial separation of light emissions from fluorescent labelled proteins, SMLM is capable of nanometer scale reconstruction of cellular structures. Precise localization of proteins in 3D astigmatic SMLM is dependent on parameter sensitive preprocessing steps to select regions of interest. With SMLM acquisition highly variable over time, it is non-trivial to find an optimal static parameter configuration. The high emitter density required for reconstruction of complex protein structures can compromise accuracy and introduce artifacts. To address these problems, we introduce two modular auto-tuning pre-processing methods: adaptive signal detection and learned recurrent signal density estimation that can leverage the information stored in the sequence of frames that compose the SMLM acquisition process. We show empirically that our contributions improve accuracy, precision and recall with respect to the state of the art. Both modules auto-tune their hyper-parameters to reduce the parameter space for practitioners, improve robustness and reproducibility, and are validated on a reference in silico dataset. Adaptive signal detection and density prediction can offer a practitioner, in addition to informed localization, a tool to tune acquisition parameters ensuring improved reconstruction of the underlying protein complex. We illustrate the challenges faced by practitioners in applying SMLM algorithms on real world data markedly different from the data used in development and show how ERGO can be run on new datasets without retraining while motivating the need for robust transfer learning in SMLM.

Novel Method for Removal of Broken Intramedullary Interlocking Nail with a Subtrochanteric Fracture: A Case Report.

CASE: A 45-year-old man with ankylosing spondylitis with bilateral ankylosed hips presented with subtrochanteric femur fracture with a broken intramedullary nail in situ. The nail was removed by making a hole in the nail using a carbide bit and putting a Steinmann pin in this hole to extract the nail. CONCLUSIONS: This novel broken intramedullary nail extraction technique is especially useful for nonunions or implant failures that occur in the proximal shaft/subtrochanteric area, and the instruments used are also readily available. There is minimal radiation exposure, and it is an effective method to remove the distal part of the broken nail.

Correlation of nipple eczema in pregnancy with atopic dermatitis in Northern India: a study of 100 cases.

BACKGROUND: Nipple eczema is a less common presentation of atopic dermatitis. No studies in the literature have correlated nipple eczema in pregnancy as a manifestation of atopic dermatitis. OBJECTIVE: To evaluate whether nipple eczema presenting in pregnancy is a manifestation of atopic dermatitis. METHODS: This was a prospective observational study including 100 women who presented with nipple eczema for the first time during pregnancy. The exclusion criteria were any patient with previous history of nipple eczema, those already on oral or topical treatment for atopic dermatitis or nipple eczema, and other disorders mimicking eczema. Patients were divided into two groups ‒ nipple eczema with atopic dermatitis and without atopic dermatitis. Demographic data, clinical features, total leukocyte count, differential leukocyte count, absolute eosinophil counts, and serum IgE levels were compared between the two groups to detect association between nipple eczema in pregnancy and atopic dermatitis. RESULTS: Out of 100 patients, 39 were diagnosed with atopic dermatitis, whereas 61 were ruled out to have any features suggestive of atopic dermatitis. There were no statistically significant differences in mean age, mean duration of symptoms, and serum IgE levels. In patients with atopic dermatitis, bilateral symptoms were noted more commonly than in patients without the disease, but this was statistically insignificant. STUDY LIMITATIONS: Lack of long term follow-up and no large studies in literature to compare results. CONCLUSION: Nipple eczema in pregnancy follows a similar pattern as in other age groups. The clinical profile of patients is similar in cases with and without atopic dermatitis.

Comparative analysis of treatment of basicervical femur fractures in young adults with CCS, DHS, and PFN.

OBJECTIVE: To the best of the authors' knowledge, no studies in the literature have compared the clinical outcome of the three most common implants used to treat basicervical fractures of the femoral neck in young adults, i.e. CCS, DHS, and PFN. The present study attempts to fill the void in the literature and reach a conclusion regarding the usefulness of these implants in these fractures. METHODS: This was a prospective interventional study including 90 patients with basicervical fracture of the neck of femur treated randomly with cancellous cannulated lag screws or dynamic hip screw, with a derotation screw or short PFN. RESULTS: Mean time for fracture union was 14.4, 13.9, and 13.5 weeks and union rate was 93.2%, 100%, and 100% in groups 1, 2, and 3, respectively. The mean Harris Hip Score at the final follow up was similar among all the groups, i.e. 79.4, 82.2, and 81.9 in CCS, DHS, and PFN groups, respectively. The highest proportion of good to excellent results was noted in the DHS group, i.e. 83.3%, whereas it was 73.6% and 80% in the CCS and PFN groups, respectively. CONCLUSION: Multiple cancellous screws do not provide a sufficiently stable construct during fracture healing. PFN, although associated with lesser implant failures than CCS, have a higher incidence of technical errors. DHS provides sufficient stability in well-reduced basicervical fractures in young adults; it is associated with highest fracture union rates and best functional outcome out of the three implants at final follow-up.

OBJETIVO: Tanto quanto é do conhecimento dos autores, nenhum estudo na literatura comparou o resultado clínico dos três implantes mais comumente utilizados para tratar fraturas basocervicais do colo femoral (CCS, DHS e PFN) em adultos jovens. O presente estudo tenta preencher esta lacuna na literatura e chegar a uma conclusão sobre a utilidade desses implantes nessas fraturas. MÉTODOS: Estudo prospectivo de intervenção, incluindo 90 pacientes com fratura basocervical do colo femoral tratada aleatoriamente com parafuso esponjoso canulado interfragmentário ou parafuso de quadril dinâmico, com um parafuso derrotativo ou um PFN curto. RESULTADOS: O tempo médio para a consolidação de fratura foi de 14,4, 13,9 e 13,5 semanas e a taxa de consolidação foi de 93,2%, 100% e 100% nos grupos 1, 2 e 3, respectivamente. A média do Harris Hip Score no seguimento final foi similar entre todos os grupos: 79,4, 82,2 e 81,9 nos grupos CCS, DHS e PFN, respectivamente. A maior proporção de resultados bons a excelentes foi observada no grupo DHS (83,3%), enquanto que foi de 73,6% e 80% nos grupos CCS e PFN, respectivamente. CONCLUSÃO: O uso de vários parafusos esponjosos não fornece uma construção suficientemente estável durante a consolidação da fratura. O PFN, embora associado a falhas de implantes menores do que o CCS, apresenta maior incidência de erros técnicos. O DHS proporciona estabilidade suficiente em fraturas basocervicais bem reduzidas em adultos jovens; seu uso está associado às maiores taxas de consolidação de fraturas e o melhor resultado funcional dentre os três implantes no seguimento final.

Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw: a comparative study.

OBJECTIVE: To evaluate and compare the clinical and radiological outcomes of patients with stable intertrochanteric fractures treated with proximal femoral nail vs. dynamic hip screw. METHODS: Sixty patients with stable intertrochanteric fractures, aged over 18 years, were randomly divided into the proximal femoral nail and dynamic hip screw groups. Dynamic hip screw with a three-hole side-plate and an anti-rotation screw were used, as well as a modified ultra-short proximal femoral nail for the smaller Asian population. The intra-operative, early and late complications were recorded, and the functional outcome of each group was assessed using the Harris Hip Score. RESULTS: In the dynamic hip screw group, the one-month mean Harris Hip Score was slightly lower than that of the proximal femoral nail group. However, at the three- and six-month monthly follow-ups, the dynamic hip screw group presented higher mean scores than the proximal femoral nail group; at the one-year follow-up, both the groups attained similar scores. CONCLUSION: Proximal femoral nail provides a significantly shorter surgery with a smaller incision that leads to less wound-related complications. However, the incidence of technical errors was significantly higher in proximal femoral nail when compared with dynamic hip screw as it is a technically more demanding surgery that leads to more implant failures and the consequent re-operations.

OBJETIVO: Avaliar e comparar os resultados clínicos e radiológicos de pacientes com fraturas intertrocantéricas estáveis tratados com hastes femorais proximais vs. parafuso dinâmico de quadril. MÉTODOS: Sessenta pacientes com fraturas intertrocantéricas estáveis, maiores de 18 anos, foram divididos aleatoriamente em dois grupos, um grupo de hastes femorais proximais e outro grupo de parafuso dinâmico de quadril. Um parafuso dinâmico de quadril com placa lateral de três furos e um parafuso antirotação foram utilizados, bem como uma hastes femorais proximais ultracurtas, modificadas para a população asiática de menor estatura. As complicações intraoperatórias, precoces e tardias foram registradas; o resultado funcional de cada grupo foi avaliado usando o Harris Hip Score. RESULTADOS: No grupo parafuso dinâmico de quadril, o Harris Hip Score foi um pouco menor do que o do grupo hastes femorais proximais. Entretanto, nos seguimentos de três e seis meses, o grupo parafuso dinâmico de quadril apresentou maior média do que o grupo hastes femorais proximais; no seguimento de um ano, ambos os grupos atingiram valores similares. CONCLUSÃO: A hastes femorais proximais proporciona uma cirurgia significativamente mais curta, com uma menor incisão e consequentemente menos complicações relacionadas à ferida. Entretanto, a incidência de erros técnicos foi significativamente maior no grupo hastes femorais proximais quando comparada ao grupo parafuso dinâmico de quadril visto que esta é uma cirurgia tecnicamente mais exigente, que apresenta mais falhas de implantes e as consequentes reoperações.

Long-Term Outcome of Valgus Osteotomy and Fixation with Double Angled Dynamic Hip Screw for Nonunion Fracture of the Neck of the Femur in Young Adults / Desfecho a longo prazo da osteotomia valgizante e fixação com parafuso dinâmico de quadril de ângulo duplo de fratura não consolidada do colo femoral em adultos jovens

Abstract Objective To evaluate the long-term results of valgus intertrochanteric osteotomy fixed with double angled dynamic hip screw for nonunion fracture of the neck of the femur in young adults. This implant allows more freedom of fixation in the sagittal plane. Very few studies have evaluated the long-term outcome for treatment of nonunion in fractures of the neck of the femur. Methods This is a prospective interventional study that included 20 patients with nonunion of the fracture of the neck of the femur aged < 60 years old without avascular necrosis of the head and significant resorption of the neck of the femur. A lateral closing wedge osteotomy was performed just above the lesser trochanter after inserting the Richard screw across the nonunion site, and it was fixed with a double-angle 120° barrel plate. The outcome was evaluated using union rate and the Harris Hip Score for functional outcome. Results The average postoperative decrease in the Pauwels angle was of 28.9°. A total of 80% of the cases progressed to union within a mean duration of 7.53 months. The mean Harris Hip Score at the final follow-up was 86.45. Conclusion Valgus intertrochanteric osteotomy and fixation with a double angled dynamic hip screw is a reliable and effective method for preservation of head and promoting union in an ununited fractured neck of the femur in young patients.

Resumo Objetivo Avaliar os resultados a longo prazo da osteotomia intertrocantérica valgizante, fixada com parafuso dinâmico de quadril (DHS, na sigla em inglês) de ângulo duplo, em fraturas não consolidadas do colo femoral em adultos jovens. Este implante permite uma liberdade maior de fixação no plano sagital. Muito poucos estudos avaliaram o desfecho do tratamento a longo prazo da fratura não consolidada do colo femoral. Métodos Trata-se de um estudo prospectivo de intervenção que incluiu 20 pacientes com fratura não consolidada do colo femoral com idade < 60 anos, sem necrose avascular da cabeça femoral e significativa reabsorção do colo femoral. Foi realizada uma osteotomia em cunha de fechamento lateral logo acima do trocânter menor após a inserção do parafuso tipo Richard no sítio do retardo da consolidação óssea, sendo fixada com uma placa cilíndrica de ângulo duplo de 120°. O resultado foi avaliado com o uso da taxa de consolidação e da escala Harris Hip Score quanto ao desfecho funcional. Resultados Foi obtida uma redução pós-operatória média de 28,9° do ângulo de Pauwels. Os casos que evoluíram para a consolidação alcançaram 80%, em um período médio de 7,53 meses. A média da escala Harris Hip Score foi de 86,45 no acompanhamento final. Conclusão A osteotomia intertrocantérica valgizante e a fixação com DHS de ângulo duplo é um método confiável e eficaz para a preservação da cabeça do fêmur, promovendo a consolidação de uma fratura não consolidada do colo femoral em pacientes jovens.

Transolecranon and lateral Kirschner wire fixation for displaced supracondylar humeral fracture in children.

PURPOSE: To evaluate the outcome after closed reduction and pinning using a Kirschner wire inserted laterally and another inserted vertically through the olecranon for displaced supracondylar humeral fractures. METHODS: 39 boys and 11 girls aged 2 to 12 (mean, 7.27) years underwent closed reduction and pinning using a Kirschner wire inserted laterally and another inserted vertically through the olecranon for posteromedially (n=28), posterolaterally (n=7), or posteriorly (n=15) displaced extension-type supracondylar humeral fractures (Gartland types II and III). RESULTS: Compared with the uninjured elbows, the injured elbows had a mean loss of flexion of 4.52º (p<0.001), a mean loss of extension of 1.7º (p=0.008), and mean change in carrying angle of 3.47º (p<0.001). According to the Flynn grading system, outcome was excellent in 35 patients, good in 9, fair in 2, and poor in 4. Outcome did not differ significantly between patients aged 2 to 4, 5 to 8, and 9 to 12 years or between those operated on within 24 hours of injury and those operated on 2 to 5 days after injury. One patient developed superficial pin tract infection, and 2 patients developed cubitus varus deformity. No patient sustained iatrogenic nerve injury. CONCLUSION: Transolecranon vertical and lateral Kirschner wire fixation is a viable option for displaced supracondylar humeral fractures in children, especially when there is massive swelling.

Early results of displaced supracondylar fractures of humerus in children treated by closed reduction and percutaneous pinning.

BACKGROUND: Displaced supracondylar fractures are notorious for difficulty in reduction, maintenance of reduction and frequent involvement of neurovascular structures. No general agreement on the treatment is evident with controversy prevailing regarding the ideal timing of surgery, method of maintenance of reduction and configuration of the pin fixation. A crossed pin configuration, though believed by some to be mechanically more stable than the lateral pins alone, has the risk of ulnar nerve injury due to the medial pin. Lateral pins alone impart less rotational stability to the fracture although it has been attributed mainly to technical errors of pin placement. The aim of this study was to assess the efficacy of treatment of this fracture using one lateral and one trans-olecranon K-wires or lateral entry K-wires alone. MATERIALS AND METHODS: Ninety cases of displaced supracondylar humerus fractures were included in the study. The mean age of the patients was 6.7 years (range 3-12 years). The male/female ratio was 5:1 and left side was involved in 70% whereas 30% had right sided injuries. The most common mode of trauma was fall from height with elbow in extension. All the 90 consecutively admitted patients had extension type injury with 73.3% fractures being Gartland type III and 26.7% were type II. Posteromedial displacement was noted in 70% whereas 30% fractures were posterolaterally displaced. In 60 cases, lateral entry wires alone were used whereas, in 30 cases, one lateral and another transolecranon transarticular K-wire was used. K-wires were removed at 3 weeks postoperatively and followup was done at 6 weeks and 12 weeks when they were evaluated according to the criteria described by Flynn. Chi-square test was used as a statistical test of significance to compare results among different variables. RESULTS: Results were graded according to Flynn's criteria. Excellent results were achieved in 12 (13.3%), good in 54 (60%), fair in 15 (16.7%) while in nine patients (10%) poor results were obtained. CONCLUSIONS: Both lateral entry K-wires and lateral-trans-olecranon wire techniques provide stable fixation when observing the guidelines for wire placement and consistently satisfactory results can be obtained, both cosmetically and functionally with both the techniques.