Surgical treatment of supracondylar humerus fractures in children.

PURPOSE OF THE STUDY: Surgical techniques for the treatment of supracondylar fractures in children are repeatedly the subject of discussion. The aim of the present study was to compare experience with the technique of crossed Kirschner wires at our own hospital with current literature. PATIENTS AND METHODS: In the period from 2000-2006 a total of 86 children aged 1.7 to 12.7 years were treated by means of crossed K-wire osteosynthesis. Follow up was conducted at an average of 32 months. Outcomes were evaluated based on von Laer's criteria. RESULTS: Reported complications were migration of the K-wires in 7% of cases and secondary dislocation and re-operation in 4% of cases. Lesion of the radial nerve was diagnosed postoperatively in two cases. Hospital stay was 1.5 days on average. Postoperative immobilization in an upper arm splint and implant removal after 6 weeks on average. 57% of the children received physiotherapy during the course of treatment. Slight varization was found in 11% of children and an unsatisfactory range of motion in 13%. Satisfactory outcomes were recorded for 83% of patients. CONCLUSION: K-wire osteosynthesis is associated with a low complication rate and continues to be a safe standard procedure for the stabilization of supracondylar humerus fractures. Key words: supracondylar humerus fracture, Kirschner wires, paediatric fractures.

Teaching developmentally disabled children with chronic illness to swallow prescribed capsules.

Child noncompliance with prescribed medical regimens, including nonacceptance of oral medication, frequently impedes medical treatment and achievement of clinical aims. During this study, we used a single-subject experimental design to evaluate the effectiveness of a capsule-swallowing training curriculum specifically developed to promote acceptance of oral medication by multihandicapped children. Four such children participated, each diagnosed with a chronic pediatric illness requiring daily intake of oral medication. Training consisted of verbal instruction, demonstration, reinforcement for swallowing candies/capsules progressively larger in size, ignoring mild inappropriate behavior, and gradually providing less guidance and structure. In each case, the curriculum produced routine independent swallowing of prescribed capsules/tablets. Follow-up assessments, coupled with parent satisfaction ratings, suggest that skill acquisition was both enduring and clinically significant. This study validates a brief, readily exportable, and effective approach to teaching handicapped children to swallow capsules.

Communication skills training for parents: experimental and social validation.

Coordination of professional services of behalf of children often hinges on the involvement of informed parents. The purposes of this study were to identify and experimentally and socially validate skills required of parents for effective communication with professionals. Target skills were identified on the basis of judges' social validation ratings of (a) sample interactions between parents and professionals and (b) the behaviors comprising a resultant task analysis. Eight parents were then trained in these skills via an instructional package. Results of a multiple baseline design across subjects and grouped skill domains showed that each parent acquired the targeted skills during simulated conferences and that correct responding usually generalized to actual conferences. Independent judges validated training outcomes, and participating parents indicated satisfaction with the curriculum.