Modified Kapandji technique in pediatric displaced distal radius fractures: results in 195 patients.

PURPOSE: The modified Kapandji technique has been proposed for fracture reduction in pediatric displaced distal radius fractures (DDRFs), but evidence is sparse. The purpose of this study was to evaluate our outcomes and complications, critically and systematically, when performing the modified Kapandji technique in pediatric DDRFs. Using this technique since 2011, we asked: (1) What is the quality of fracture reduction using this technique? (2) How stable is fracture alignment with this technique? (3) What are the postoperative complications and complication rates? METHODS: Retrospective observational study of 195 pediatric patients treated with the modified Kapandji technique. Quality of fracture reduction, fixation type (intrafocal, combined, or extrafocal), and coronal/sagittal angulation were recorded at surgery and healing. Perioperative complications were graded. Patients were stratified by fracture (metaphyseal or Salter-Harris) and fixation type, as well as age (≤ 6 years; 6 to 10 years; > 10 years). RESULTS: Fracture reduction was 'good' to 'anatomical' in 85% of patients. 'Anatomical' fracture reduction was less frequent in metaphyseal fractures (21% vs. 51%; p < .001). Mean angulation change was higher in metaphyseal fractures in both the sagittal (p = .011) and coronal (p = .021) planes. Metaphyseal fractures showed a higher mean change in sagittal angulation during fracture healing for the 'intrafocal' group. We observed a 15% overall complication rate with 1% being modified Sink Grade 3. CONCLUSION: The modified Kapandji technique for pediatric DDRFs is a safe and effective treatment option. Metaphyseal fractures that do not involve the physis should be treated with extrafocal or combined wire fixation. Complications that require additional surgical treatment are rare. LEVEL OF EVIDENCE: Level of evidence IV.

Subacromial Balloon Spacer Does Not Reduce the Retear Rate for Massive Rotator Cuff Tears: A Comparative Study.

PURPOSE: To determine whether a subacromial spacer decreases the recurrent rotator cuff tear rate in arthroscopically managed massive rotator cuff tears (MRCTs) with 1 year of follow-up. METHODS: We selected all patients who met the following criteria: (1) an MRCT excluding Collin type A, (2) Goutallier stage equal or less than 2, and (3) complete arthroscopic repair of the MRCT. Patients were allocated into 2 groups: A (without subacromial spacer) or B (with subacromial spacer) for a prospective evaluation 1 year after surgery. The primary outcome was the retear rate, determined with magnetic resonance imaging (MRI) according to the classification of Sugaya. Secondary outcome measures were the functional outcomes using visual analog score, Shoulder Subjective Value, and Constant-Murley Score. Preoperative rotator cuff characteristics such as number of tendons involved and the tear retraction also were evaluated. Patient-related data such as sex, age, laterality, history of smoking, and diabetes mellitus were analyzed. RESULTS: In total, 31 patients were included in group A and 33 in group B. Preoperatively, only 2 differences were found between both groups: a significant (but not clinical) greater Constant score in group A (P = .034) and a slightly greater retraction of the supraspinatus in group B (P = .0025). The overall retear rate between the 2 groups was similar regarding the number of patients (P = .746) and the total number of tendons involved in the recurrent tear (P = .112). At 1-year follow-up, no differences were found in VAS (P = .397), SSV (P = .309), and Constant score (P = .105). CONCLUSIONS: In reparable massive rotator cuff tears (excluding Collin type A), the augmentation of repair with a subacromial spacer did not significantly reduce the number of patients with recurrent rotator cuff tears identified by MRI. It was also ineffective in reducing the number of re-ruptured tendons in these patients. No patient-reported or clinically significant findings were noted in Constant, SSV, and VAS scores at 1-year postoperative follow-up. Patients with MRI findings of a healed rotator cuff (Sugaya 1-3) had better clinical outcomes compared with those without. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Radiographic technical quality of root canal treatment performed by a new rotary single-file system.

AIM: The aim of the present study was to evaluate radiographically the technical quality of root canal filling performed by postgraduate students with a new single-file Nickel-Titanium System (F6 Skytaper Komet) in clinical practice. METHODS: Records of 74 patients who had received endodontic treatment by postgraduate students at the School of Dentistry, Faculty of Medicine, University of Pavia in the period between September 2015 and April 2016 were collected and examined: the final sample consisted 114 teeth and 204 root canals. The quality of endodontic treatment was evaluated by examining the length of the filling in relation to the radiographic apex, the density of the obturation according to the presence of voids and the taper of root canal filling. Chi-squared analysis was used to determine statistically significant differences between the technical quality of root fillings according to tooth's type, position and curvature. RESULTS: The results showed that 75,49%, 82,84% and 90,69% of root filled canals had adequate length, density and taper respectively. CONCLUSIONS: Overall, the technical quality of root canal fillings performed by postgraduates students was acceptable in 60,78% of the cases.