Treatment of displaced supracondylar fracture of the humerus in children by open pining from lateral approach: an investigation of clinical and radiographical results

Supracondylar fracture of the humerus is the most common elbow fracture in children. This fracture needs immediate diagnosis and treatment, otherwise, it may lead to significant neurovascular and functional problems. The aim of this study was to assess the short term outcome of displaced supracondylar fracture of the humerus in children by open reduction and pining from lateral approach. During a period of 15 months from June 2012 to September 2013, 48 patients [25 boys and 23 girls] less than 10 years old were enrolled in the study. Inclusion criteria were extension type supracondylar fractures of humerus, Gaartland type III that closed reduction was unsuccessful and failed as the initial treatment. The clinical and radiographic results of the treatment using open reduction and internal fixation by lateral pinning were evaluated. Outcomes were assessed according to the Flynn's criteria. The average age of the patients was 6.3 years. The most prevalent range of age was found about 6-9 years old. All patients had extension type fracture [Gartland type III]. Overall, 47 [98%] patients had closed fracture and only one [2%] had open fracture. Eighteen patients [37.5%] and 30 patients [62.5%] had involvement of the dominant and non-dominant extremity respectively. No vascular injury and infection was seen in patients. One patient [2%] was identified with the radial nerve injury which, recovered after three months. In the three and six month follow-up, one patient [2%] was found with the median nerve injury. Since 15 patients were lost to follow-up, the analysis of the clinical and radiographical results at the end of the 6[th] month were done for 33 patients. According to the Flynn's criteria, the cosmetic results in 30 out of 33 patients that completed their follow-up [90.09%] were excellent, in 2 patients [6.1%] were good and one case [3%] was fair [P=0.051]. Also, the functional results in 31 patients [93.9%] were excellent and in 2 patients [6.1%] were good. Overall, all cases were graded satisfactory [P=0.047]. Treatment of the supracondylar humeral fracture in children by open reduction and internal fixation through lateral pinning is a safe approach with predictable good clinical and radiographical results

Efficacy of methylprednisolone acetate injection for the treatment of plantar heel pain

To assess the short term results of local methyl prednisolone acetate injection for the treatment of heel pain syndrome. This prospective study was carried out on 109 patients with plantar heel pain who were treated by local methyl prednisolone acetate injection. Reduction of pain and tenderness were the primary measurement outcome. Rest pain, walking pain and tenderness at 3 weeks was relived in 70 and 67 and 74 patients, and after 3 months in 72, 68 and 81 patients respectively. Mean patient's pain score was 8.2 +/- 2.2 before injection, 4.1 +/- 1.5 at 3 weeks, and 3.9 +/- 1.4 at 3 months after injection. Local injection of methyl prednisolone acetate was associated with a fairly high satisfactory short term results in the treatment of heel pain

Comparison of volar and dorsal approaches for surgical treatment in fracture of proximal half of the radius

Objective: Fracture of the proximal half of the radius shaft can be exposed by either one of volar or dorsal approaches. The aim of this study was to compare the results of volar and dorsal approach for surgical treatment of proximal half fracture of the radius

Methodology: This prospective study was performed from April 2008 to March 2012 in two teaching hospitals. Seventy adults patients with closed fracture in proximal half of the radius or radius and ulna were operated on and fixed using small plate and screw by volar approach [VA] [39 patients] and dorsal approach [DA] [31 patients]. Comparison of the results in both surgical approach were the primary measurement outcome. Duration and time of procedure, rate and time of fracture union and motion of the forearm were assessed at 4 months after operation

Results: Mean age of the patients with VA and DA was 25.3 and 26.5 years respectively. There was 26 male and 13 female in VD and 22 male and 9 female in DA patients. Radial nerve injury in VA and DA occurred in three and two patients, infection in one and nonunion in one other patient was seen in each group. There was no significant difference in duration of procedure or time of union after both approaches =0.643. Mean rotation of forearm was 135 deg. in VA, and 138 deg. in DA patients at 4 months post surgery

Conclusion: There was no significant difference in term of fracture union, early complications, and range of forearm rotation between volar and dorsal approach for the fixation of radius fractures in its proximal half

Assessment results of patellar fracture treatment after tension band wiring

To assess the results of patellar fracture treatment by tension band wiring. This retrospective study was performed to evaluate clinical and radiological results of patellar fracture during past 6 years. Twenty four patients were participated in follow-up. Union was occurred in the mean time of 2.67 +/- 0.61 months. Falling down and direct trauma were the most common cause of fracture. Most common complications were thigh muscle atrophy and pin irritation. Excellent and good results in 87.5% and fair results in 12.5% of the patients were seen. Fixation of patellar fractures with tension band wiring was associated with a high rate of union

Functional outcome of flexor tendon repair of the hand at zone 5 and post operative early mobilization of the fingers

There are few reports on outcome following flexor tendon repair of the hand in zone 5. We hypothesized that early mobilization of the fingers is possible if the suture site of repaired tendon is strong enough. The aim of this study was to assess the results of flexor tendon repair in this zone using modified Kessler method reinforced by peripheral running suture and a post operative early active and passive mobilization of the fingers. This prospective study was carried out between April 2006 and Feb 2010, and 171 digits flexor tendons cut in 42 patients were repaired by modified Kessler technique reinforced by running peripheral suture. Early active mobilization and gentle passive motion of the fingers was allowed in a dorsal wrist splint the day after surgery. Wrist Immobilization was performed for one month. Function of the tendons was assessed by Buck-Gramcko score at nine month follow up. Mean age of the patients was 25.4 years [range 17-46 y]. Twenty nine flexor policis longus, 77 flexor digitorum superficialis and 65 flexor digitorum profundus tendons of digits were repaired. Middle and index fingers were most commonly involved. Median and ulnar nerve repair was done in 17 and 12 cases respectively. Good to excellent results were seen in of 79.34% of FPL and 74.65% of other finger flexors. One case of FPL rupture was seen. Tenolysis of FDS was performed in one case. Recovery in thenar muscle function was good, fair and poor in 5, 2 and 10 cases after median nerve repair, while all 12 patients with ulnar nerve lesion showed some degrees of clawing of 4[th] and 5[th] fingers. Most patients following flexor tendon repair at zone 5 obtained good results. Early motion of the fingers seems to improve outcome in these patients. Concomitant nerve cut in particular of ulnar nerve were associated with a high rate of poor results

Comparison of displaced patellar fracture treatment by two methods: cerclage circumferential wiring versus tension band wiring

There are a variety of methods for operative treatment of patellar fractures. The aim of this study was to compare the outcome of cerclage wiring [CW] versus Tension Band Wiring [TBW] for treatment of displaced fractures of the patella. In this retrospective study we reviewed the medical files of the patients who had displaced transverse or comminuted patella fractures treated at two trauma hospitals between 2004 to 2010. Forty four patients were found that had been operated with either of these two methods: TBW=24, CW=20. Outcome was evaluated by Bostman rating score, at a mean follow up time of 2.3 years. Mean age of all patients was 32.7 years. There was no significant difference regarding the mean age, gender, and mechanism of the fractures in patients treated by two methods of TBW and CW. Atrophy of quadriceps muscle was [1.146 cm +/- 0.9cm] in 19 patients with TBW, and [2.3 +/- 0.6cm] in all patients with CW, which shows significant difference. No case of infection or nonunion had occurred. Good to excellent results in TBW and CW were found in 83.4% and 80% of patients respectively that reveals no major difference. Hardware removal due to pin irritation was performed in 66.6% of TBW and 10% of CW group. There was no significant difference between two groups with respect of PF osteoarthritis. Despite less secure fixation with CW, both TBW and CW methods had comparable outcome with a high rate of good to excellent results in the treatment of displaced patella fractures. Individualized treatment plan based on the type and pattern of the fracture is suggested.

Comparison of the efficacy of hook plate versus pinning in treatment of acute acromioclavicular joint dislocation

Type III acromioclavicular joint dislocation is treated by various methods including hook plate, pinning and fixiation by a screw. Each of these methods have their own advantages and disadvantages. This study was designed to compare the efficacy of hook plate and pinning methods in the treatment of type III acute acromioclavicular joint dislocation. In this study, 50 patients with type III acute acromioclavicular joint dislocation aged 20 to 40 years old who referred to Emam Khomeini and Razi Hospital of Ahvaz Iran, between the years of 1998 and 2010 were enrolled. Twenty patients were treated with pinning and 30 patients were treated with hook plate method. All the patients were hospitalized for 24 hours after surgery and were followed up one year after surgery. Data was collected by acquiring an x-ray and completing a questionnaire. The pins of the patients in the pinning group were removed using local anesthesia. In the hook plate group, the patients underwent another surgery to remove their plate. No further dislocation was reported in any patients. However, subluxation was seen in 25% of the pinning group and 23.3% of the hook -plate group. The mean surgery time was 35 minutes in the pinning and 45 minutes in the hook plate group and the amount of bleeding was estimated to be 70 and 100 respectively. Only one case of superficial infection was seen in the hook plate group. Also one of the pinning group patients and 10 hook plate patients complained of pain during activity. The pinning method had relatively less complications such as pain, post surgical infection and bleeding and the surgery time was shorter. Also the costs were lower and no further surgery was needed to remove the instruments. Therefore, it seems that pinning method was more suitable than hook plate method.

Comparative study between three methods of aspiration alone, aspiration plus steroid injection and aspiration plus ethanol injection for treatment of dorsal wrist ganglions

To compare the effect of aspiration alone, aspiration plus methyl prednisone injection and aspiration plus ethanol injection into the dorsal wrist ganglions. This prospective study was performed from March 2009 to May 2010 and 66 Patients with dorsal wrist ganglions were treated in three groups: A- aspiration alone in 24 patients, B-aspiration plus methylprednisolone injection into the cyst in 20 patients. C- Aspiration plus ethanol injection, then re aspiration of the ethanol from the cyst after 3-5 minutes, in 22 patients. Elastic compression bandage was applied in all patients and recommended for 3 weeks. Follow up was done at 1. 3. 6 and 12 months. The success rate in group A was seen in 9 patients [37.5%], in group B in 11[55.%] and in group C in 14 [63.5%] patients. The most frequent side effect was pain during ethanol injection which relived by cyst re aspiration. Injection of ethanol into the dorsal wrist ganglion was associated with higher success rate compared to aspiration and methyl prednisolone injection. Further studies with larger sample size should be performed in particular to assess the effect of ethanol injection in this disease

Short term outcome of congenital clubfoot treated by Ponseti method

To assess the effectiveness of the Ponseti technique in the treatment of congenital clubfoot in children in Ahvaz, Iran. The data of 42 patients [60 feet], who presented with clubfoot were treated with the Ponseti casting technique between October 2008 and November 2010 at Emam Khomeini Hospital, Ahvaz, south of Iran, were collected and studied retrospectively. The outcome was evaluated using the Pirani score for clubfoot. All the patients were followed up for 12 months. The mean age of patients was 3.7 days [ranged 1-24 days]. The average time to achieve acceptable correction was 7.6 weeks [range: 6-10 weeks]. Eight patients [10 feet] [16.7%] were not corrected with initial casting and required early surgery. Full correction was obtained in 34 patients [50 feet, 83.3%]. Subcutaneous tenotomy of the Achilles tendon was performed in 36 feet [72%] and in 14 other feet it was not performed [28%]. Tenotomy was performed more in children with higher Pirani score [P < 0.0001], and those with sever clubfoot had more chance for surgery [p < 0.0001]. The Ponseti casting technique is a safe and effective conservative treatment for clubfoot that decreases the need for surgical interventions. It is an easy method to be applied by most orthopaedic surgeons

Outcome of forearm shaft fractures in adults treated by open reduction and internal fixation with dynamic compression plate [DCP]

There have been a few reports on outcome after operative treatment of the adult diaphyseal forearm fractures. The aim of this study was to evaluate the clinical and radiographic outcome after open reduction and internal fixation of the forearm diaphyseal fractures by Dynamic Compression Plate [DCP]. We prospectively investigated the clinical and Radiographic outcome for 47 adult patients with 77 forearm shaft fractures including 10 Radius, 7 ulna and 30 [66] both bones. The study group included 35 males, and 12 females. Patients were treated by open reduction and internal fixation with small DCP and followed up for 12 months. Time to union, Rate of union, complications and outcome were assessed according to the modified system of Price and Daruwalla score. Out of 77 fractures 75 [97.4%] had united at a mean time of 15.4 weeks [range 11- 21 weeks]. There was two superficial infection that healed by debridement and antibiotics, and one deep infection which caused to delayed union and underwent reoperation including change of implant and bone graft. Two radial nerve injuries occurred after operation for radius fracture. Full recovery in one and partial in another patient was observed after 6 months. Excellent and good results were seen in 20 [66.7%] and 10 [33.3%] of the patients with both bone fractures. In radius excellent and good results were seen in 8 [80%] and 2 [20%] patients respectively. In ulna excellent and fair results were observed in 85.7% [n=6] and 14.3% [n=1] of the patients. Outcome of adults forearm shaft fractures with conventional 3.5 mm DCP was associated with a high rate of success. The results with this type of plate are comparable with the newer and more expensive implants

Four-screw plate fixation vs conventional fixation for diaphyseal fractures of the forearm

Standard treatment of diaphyseal fractures of the forearm is open reduction and fixation using dynamic compression plates [DCP] and screws. This technique uses screw placement in all 6 or more of the plate holes except the hole over the fracture line. We hy-I pothesized that DCP with selective 4-screw bicortical placement can provide adequate fixa tion for these fractures. The aim of this study was to evaluate the results of conventional 6 or more screw fixation versus 4 screw fixation for adults with diaphyseal fractures of the forearm. In this prospective study, 128 fractures of the ulna, radius or both I bones of the forearm in 87 patients were treated in either one of these two groups: Open j reduction and internal fixation [ORIF] with conventional DCP and screws or ORIF using DCP and selective 4-screw placement. Fractures were transverse or oblique in pattern without | gross comminution. In a total of 41 patients with fractures, 28 single ulnar and 18 single radius fractures were included. Follow-up visits were done at 3-6 and 12-16 weeks and at 6 months. Outcome with respect to union an nonunion rates, union time, infection, and device failure was noted. No change in alignment was noted in any patient. Union time in conventional and selective bicortical 4-screw fixation was 74.8 days and 73.6 days respectively which showed no significant difference [P=0.064]. Union rate and infection was 92.1% and 3.2% in conventional and 95.3% and 0% in the selective group respectively. Non-union was observed in 5 and 3 cases of fractures in conventional and the selective group respectively. For treatment of the transverse or oblique diaphyseal fractures of the forearm, fixation by a same length 3.5 mm DCP with selective 4-screw cortical fixation [2 screws on each side of the fracture site] had similar results in comparison with conventional 6 or more DCP screws. Because of lesser impact on host bone and smaller incision, the selective 4-screw insertion can be an alternative technique for treatment of these fractures

Short term results of concomitant intranasal administration of salmon calcitonin in intertrochanteric femur fractures operated upon using dynamic hip screw

To evaluate the effect of nasal calcitonin spray in union of the intertrochanteric fractures of elderly female patients. Fifty female patients aged above 60 years [mean age = 73.9 years] old with Intertrochanteric fracture were operated from Sept 2005 to August 2006 by dynamic hip screw. In a randomized controlled trial, patients were divided into two groups A and B. Each group had 25 patients. After hospitalization 200 IU of salmon calcitonin as a single dose nasal spray was administered to patients of group A, daily for 3 months and a placebo spray was used in patients of group B. serum level of alkaline phosphatase and time of appearance of a bone callus in a plain radiograph were compared in the two groups twice weekly for 8 weeks. About 72% of patients in group A showed signs of union as the appearing of bone callus in radiograph in the 3rd week, compared to 40% in group B. Twenty of patients in group A [80%] and 20% of the group B had an increase in serum alkaline phosphatase from the 15th day after injury [P<0.005]. Meanwhile alkaline phosphatase levels in group A was 185 IU on 15 the day compared to 140 IU on group B. and values were 443 IU and 210 IU on 90th day respectively. As regards the time of appearance of the union signs in a plain bone radiograph, 72% of patients in group A have shown signs of appearance of a bone callus in the 3rd week after surgery, while the rate has been 40% in group B. Using nasal spray of calcitonin in old females with intertrochanteric fracture is effective for earlier and increased rate of bone union

Osteoid osteoma of the patella presenting as chronic anterior knee pain case report and review of the literature

Osteoid osteoma is a benign bone forming tumor with a characteristic radiographic appearance. Femur and tibia is the frequent site of involvement. Osteoid osteoma in the patella is a rare condition of which only a few cases have been reported in the literature. Non-specific knee pain, difficulty to distinguish nidus, and lack of typical sclerotic bone formation in plain radiographs cause a delay in diagnosis. We report a 15 years old girl with anterior left knee pain since 1.5 year. Imaging findings and biopsy of the lesion confirmed osteoid osteoma. The pain was relieved after surgical resection of the tumor and patient was symptom free with no evidence of recurrence at 12 months after surgery

Antley-Bixler syndrome: a case report and result of radiohumeral synostosis resection

Antley-Bixler syndrome [ABS] is a rare congenital disorder with multiple skeletal and cartilaginous anomalies that demand orthopedic management. In this report we address the diagnostic features and associated malformations of this syndrome and describe the functional outcome of resection of radio humeral synostosis in a 9 month old girl with Antley-Bixler Syndrome

Anterior cruciate ligament reconstruction using patellar tendon and quadriceps tendon: a comparative study

The goal of this study was to compare the results of knee anterior cruciate ligament reconstruction with the use of patellar tendon and quadriceps tendon. In this study 30 patients with rupture of anterior cruciate Ligament of knee were compared in two 15-person group with the use of patellar tendon and quadriceps tendon. After precise rehabilitation program for six month, patients were compared according to scoring system. Variables of this system included: Knee extension, knee flexion, anterior drawer test, quadriceps muscle weakness, patellofemoral symptoms, infrapatellar symptoms, effusion, giving way symptoms, and radiographic changes of degenerative arthritis. Each variable was given scores [0,5.10] depending to symptoms, and sum of scores was recorded and compared for each person in each group. The use of quadriceps tendon had lesser infrapatellar symptoms as compared with patellar tendon [p<0.04]. This difference was significant. Average of total score for group PT was 78.6 and group QT was 81; both of them were in the excellent range and there was no significant difference between these two groups. In reconstruction of anterior cruciate Ligament of knee, using quadriceps tendon was more appropriate for conditions in which patients require longtime kneeling [knee flexion] and will result in patient's earlier return to activity and more satisfaction

Short term outcome of treatment of femoral shaft fractures in children by two methods: Traction plus casting, versus intramedullary pin fixation - A comparative study

There is no consensus on treatment of closed femoral shaft fractures in children 6-12 years old .The aim of this study was to evaluate and compare the short term results of pediatric femoral shaft fractures at above ages with two different methods of treatment: skeletal traction followed by a hip spica cast and surgical treatment by intramedullary pin fixation and to determine which of these methods results in earlier union of fracture and independent ambulation of the patients. This study was performed prospectively at two hospitals during a period of 32 months from 2003 through 2006. Sixty six children with closed fractures of the femoral shaft were treated and followed at least through the time of fracture healing, spica cast removal and onset of unprotected walking in two separate groups: [A] skeletal traction by 90 - 90 technique followed by spica cast [n=30], [B] open reduction and internal fixation with intramedullary pin and cast [n=36]. The length of hospital stay, casting period, union of fractures, time to start walking and the rate of complications was evaluated and compared using Chi-Squar test. Mean age of all patients was 7.4 years old. Average follow-up was 6 months. Healing of the fractures was observed in all cases of both groups between 8 and 12 weeks. The length of immobilization was longer in traction versus surgery group. Average treatment duration from admission to hospital till independent walking was 75.3 days for the traction and 61.2 days for surgery group. Limb shortening and malrotation were more in traction versus intramedullary pin patients. Both methods of traction plus spica casting and intramedullary pinning can be used to treat femoral shaft fractures in 6-11 years old children. Intramedullary pin due to its less hospital stay, earlier walking and less complication rates can be used as the first choice in treatment of this fracture at school aged children