Supracondylar osteotomy for the treatment of cubitus varus in children: a systematic review.

Cubitus varus is the most frequent complication following the treatment of supracondylar humeral fractures in children. We investigated data from publications reporting on the surgical management of cubitus varus found in electronic searches of Ovid/MEDLINE and Cochrane Library databases. In 894 children from 40 included studies, the mean age at initial injury was 5.7 years (3 to 8.6) and 9.8 years (4 to 15.7) at the time of secondary correction. The four osteotomy techniques were classified as lateral closing wedge, dome, complex (multiplanar) and distraction osteogenesis. A mean angular correction of 27.6º (18.5° to 37.0°) was achieved across all classes of osteotomy. The meta-analytical summary estimate for overall rate of good to excellent results was 87.8% (95% CI 84.4 to 91.2). No technique was shown to significantly affect the surgical outcome, and the risk of complications across all osteotomy classes was 14.5% (95% CI 10.6 to 18.5). Nerve palsies occurred in 2.53% of cases (95% CI 1.4 to 3.6), although 78.4% were transient. No one technique was found to be statistically safer or more effective than any other.

The assessment of scapular radiographs: analysis of anteroposterior radiographs of the shoulder and the effect of rotational offset on the glenopolar angle.

The glenopolar angle assesses the rotational alignment of the glenoid and may provide prognostic information and aid the management of scapula fractures. We have analysed the effect of the anteroposterior (AP) shoulder radiograph rotational offset on the glenopolar angle in a laboratory setting and used this to assess the accuracy of shoulder imaging employed in routine clinical practice. Fluoroscopic imaging was performed on 25 non-paired scapulae tagged with 2 mm steel spheres to determine the orientation of true AP views. The glenopolar angle was measured on all the bony specimens rotated at 10° increments. The mean glenopolar angle measured on the bone specimens in rotations between 0° and 20° and thereafter was found to be significantly different (p < 0.001). We also obtained the AP radiographs of the uninjured shoulder of 30 patients treated for fractures at our centre and found that none fitted the criteria of a true AP shoulder radiograph. The mean angular offset from the true AP view was 38° (10° to 65°) for this cohort. Radiological AP shoulder views may not fully project the normal anatomy of the scapular body and the measured glenopolar angle. The absence of a true AP view may compromise the clinical management of a scapular fracture.

Health and performance of young dairy calves vaccinated with a modified-live Mannheimia haemolytica and Pasteurella multocida vaccine.

OBJECTIVE: To evaluate the health and performance of young dairy calves vaccinated with a commercial Mannheimia haemolytica and Pasteurella multocida vaccine. DESIGN: Randomized clinical trial. ANIMALS: 358 Holstein dairy calves between 14 and 20 days of age on 8 farms. PROCEDURE: Calves were randomly assigned to a control or vaccinated group. The vaccine used was a commercial modified-live M. haemolytica and P. multocida vaccine that was administered on days 0 and 14. Calf weight was measured on day 0 and monthly for 3 months. Farmers were asked to record any treatment given to the calves and the reason for treatment during the 4 months of the study. Blood was collected from all calves on days 0 and 28, and titers of antibodies to M. haemolytica were determined by means of direct bacterial agglutination. RESULTS: Mean daily gain was not significantly different between vaccinated and control calves. Vaccinated calves had a significantly greater increase in antibody titers (5.3-fold increase), compared with control calves (3.6-fold increase). There was no significant difference between vaccinated and control calves for any of the treatment outcomes (number and duration of treatments and age at first and last treatments). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that the M. haemolytica and P. multocida vaccine, given twice 2 weeks apart, was effective in increasing titers of antibodies against M. haemolytica in young dairy calves but did not improve calf performance or health.