[A retrospective study on manual reduction combined with Chinese Orthopaedic ankle external fixator in the treatment of trimalleolar fracture].

OBJECTIVE: To evaluate the needle puncture safety and clinical efficacy of manual reduction combined with external fixation of ankle frame in the treatment of trimalleolar fracture under the guidance of Chinese Osteosynthesis (CO) theory. METHODS: The clinical data of 118 patients with trimalleolar fractures admitted from December 2010 to December 2021 were retrospectively analyzed. Fifty-three patients were treated with manual reduction combined with external fixation of ankle frame(observation group). Sixty-five patients were treated with open reduction and internal fixation with plate and screws(control group). The operation time, hospitalization days, non-weight-bearing time of the affected limb, clinical healing time of fracture, incidence of complications, visual analogue scale (VAS) before and 1 month after operation, and American Orthopedic Foot and Ankle Society(AOFAS) score of ankle joint before and 1 year after operation were compared between the two groups. RESULTS: Patients in both groups were followed up for more than 1 year. All patients were followed up, and the duration ranged from 14 to 70 months, with an average of(35.28±14.66) months. There were statistically significant in operation time, hospitalization days, non-load-bearing time of affected limbs, clinical healing time of fractures and VAS score one month after operation between the two groups. One month after operation, the VAS score of the observation group was lower than that of the control group(t=3.343, P=0.001). The operation time of the observation group was significantly shorter than that of the control group(t=9.091, P=0.000). The hospitalization days in the observation group were significantly less than those in the control group(t=5.034, P=0.000). The non-load-bearing time of the affected limb in the observation group was significantly shorter than that in the control group(t=11.960, P=0.000). The clinical healing time of fracture in the observation group was significantly shorter than that in the control group(t=4.007, P=0.000). There was no significant difference in AOFAS score between the two groups one year after operation(t=0.417, P=0.678). In the observation group, there were 2 cases of pinhole infection and 3 cases of loss of reduction less than 2 mm. There were 3 cases of surgical incision infection in the control group. There was no significant difference in the incidence of complications between the two groups(χ2=0.446, P=0.504). CONCLUSION: Manual reduction combined with external fixation is safe and effective in the treatment of trimalleolar fracture under the guidance of CO theory, and the function of ankle joint recovers well after operation. This therapy has good clinical value.

Effects of younger siblings on the brace compliance and recurrence in children with clubfoot during Ponseti treatment.

OBJECTIVE: This study aimed to determine the effects of the number of total siblings, younger siblings, and complex clubfoot deformity on the brace compliance and recurrence in the management of children with clubfoot deformity using the Ponseti technique. METHODS: The data from 91 children, including 22 girls and 69 boys (total 130 idiopathic clubfeet), seen from 2016 to 2019 were prospectively collected and retrospectively reviewed. The deformity was unilateral in 52 (57.1%) children (32 right, 20 left) and bilateral in 39 (42.9%). The mean age at presentation was 2 (range, 1-30) weeks, and the mean follow-up was 21.5 (range, 12-36) months. All the clubfeet were treated according to the Ponseti method. After removing the cast, a foot abduction brace (Dennis Brown splint) was worn. A complex clubfoot deformity was identified in 12% (n=11) children. At the follow-up, the Pirani score, recurrence status, and brace compliance were recorded. Recurrent deformity was defined as any deformity recurrence requiring manipulation, recasting, or surgical treatment. Brace compliance was assessed per the parents' report. RESULTS: The median number of children in a family was 3 (range, 1-12). A total of 53 (58.2%) parents had up to 3 children, and 38 (41.8%) parents had more than 3 children. Of the patients, 22 (24.2%) had younger siblings and 25 (26.4%) had a family history of clubfoot. A total of 58 feet (44.6%) in 40 children (43.9%) developed recurrence. Brace non-compliance was the main risk factor for recurrence, increasing the recurrence rate 32-fold compared with that of compliant parents (odds ratio [OR], 32.67, 95% confidence interval [CI], 10.02-106.49; p=0.001). The rate of non-compliance with brace use was 51.6% (n=47). Brace non-compliance was significantly associated with having a younger sibling (OR, 3.9; 95% CI, 1.36-11.2; p=0.011) and having a complex deformity (OR, 11.62; 95% CI, 1.42-95.1; p=0.022) but was not associated with the total number of children (OR, 1.61; 95% CI, 0.7-3.73; p=0.265). CONCLUSION: Our study shows that having new siblings in the first years of the Ponseti treatment may increase the brace non-compliance by minimizing the attention paid to the children with clubfeet by their parents. Nonetheless, complex clubfoot deformity may promote brace compliance by increasing the parents' interest during the treatment process. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

The Effect of Hip Joint Mobilizations Using a Mobilization Belt on Hip Range of Motion and Functional Outcomes.

CONTEXT: Joint mobilizations have been studied extensively in the literature for the glenohumeral joint and talocrural joint (ankle). Consequently, joint mobilizations have been established as an effective means of improving range of motion (ROM) within these joints. However, there is a lack of extant research to suggest these effects may apply within another critical joint in the body, the hip. OBJECTIVE: To examine the immediate effects of hip joint mobilizations on hip ROM and functional outcomes. Secondarily, this study sought to examine the efficacy of a novel hip mobilization protocol. DESIGN: A prospective exploratory study. SETTING: Two research labs. PATIENTS OR OTHER PARTICIPANTS: The study included 19 active male (n = 8) and female (n = 11) college students (20.56 [1.5] y, 171.70 [8.6] cm, 72.23 [12.9] kg). INTERVENTIONS: Bilateral hip mobilizations were administered with the use of a mobilization belt. Each participant received hip joint mobilization treatments once during 3 weekly sessions followed immediately by preintervention and postintervention testing/measurements. Testing for each participant occurred once per week, at the same time of day, for 3 consecutive weeks. Hip ROM was the first week, followed by modified Star Excursion Balance Test the second week and agility T test during the third week. MAIN OUTCOMES MEASURES: Pretest and posttest measurements included hip ROM for hip flexion, extension, abduction, adduction, internal and external rotation, as well as scores on the modified Star Excursion Balance Test (anterior, posterolateral, and posteromedial directions) and agility T test. RESULTS: A significant effect for time was found for hip adduction, internal and external rotation ROM, as well as the posterolateral and posteromedial directions of the modified Star Excursion Balance Test. A separate main effect for both limbs was found for adduction and internal rotation ROM. CONCLUSION: Isolated immediate changes in ROM and functional outcomes were evident. Further evaluation is needed.

Can an acute high-grade acromioclavicular joint separation be reduced and stabilized without surgery? A surgeon's experience.

INTRODUCTION: While the management of Rockwood type III injuries is still a topic of debate, high-grade Rockwood type V injuries are mostly treated surgically, to anatomically reduce the acromioclavicular (AC) joint and to restore functionality. In this case report, we present a method for non-operative reduction and stabilization of a high-grade AC joint injury. CASE: A 31-year-old male orthopaedic resident sustained a Rockwood type V injury during a snowboarding accident. His AC joint was reduced and stabilized with an AC joint brace for six weeks. The brace provided active clavicle depression and humeral elevation. After removal of the brace the AC joint showed a nearly anatomic reduction. Six-month follow-up weighted X-ray views showed an AC joint which had healed in a Rockwood type II position and the patient returned to full pre-injury function with a satisfying cosmetic appearance. CONCLUSION: Non-operative reduction and stabilization of high-grade AC joint separations seems to be a valuable treatment option. A "closed reduction and external fixation" approach with the aid of a dedicated AC joint brace can reduce the AC joint and keep it in place until ligamentous consolidation occurs, thus improving AC joint stability and cosmetic appearance without surgical intervention.

What Is the Cost of a "Cast Holiday" in Treating Children With Early Onset Scoliosis (EOS) With Elongation Derotation Flexion (EDF, "Mehta") Casting?

INTRODUCTION: Serial casting of children with early onset scoliosis (EOS) is an established treatment option. A break from cast treatment often called a "cast holiday," (CH) is often allowed by some centers, particularly over the summer months. The impact of CHs on treatment duration or outcome has not been examined. METHODS: Institution review board approved retrospective review of children treated for EOS with elongation derotation flexion ("Mehta") casting at a children's hospital between 2001 and 2016 with a minimum of 2 years' follow-up. A CH was defined as a minimum of 4 weeks out of the cast, braced, or unbraced.The analysis was performed to determine the impact of a CH within the first 18 months of treatment. Separate analyses were performed for the entire cohort of children castedduring the study period, and then separately looking at idiopathic EOS in isolation. The impact of a CH was assessed in terms of the likelihood of achieving scoliosis <15 degrees at the final follow-up ("success"). Odds ratios were used to assess group differences between "success" ratios, and Student t tests assessed group differences for parametric data. RESULTS: Ninety children met inclusion and exclusion criteria, 31 of whom took a CH during the first 18 months of treatment (34%). This included 59 patients with idiopathic EOS (66%), 18 with syndromic EOS, 5 congenital, and 1 neuromuscular. There were no statistically significant differences between CH and no CH groups.Forty-four percent of the no CH group achieved scoliosis <15 degrees at final follow-up, as opposed to 13% of the CH group, an odds ratio of 5.3 for success without a CH. When limited to children with idiopathic EOS, 56% achieved success in the no CH, versus only 22% in the group that took a CH, an odds ratio of 4.4 for success with no CH. CONCLUSION: This study demonstrates that children treated for EOS with serial casting who take a CH within the first 18 months of treatment are less likely to achieve scoliosis <15 degrees than those who persist with treatment. LEVEL OF EVIDENCE: Level III.

Significance of Asymmetry of Groin and Thigh Skin Creases in Developmental Dysplasia of the Hip Revisited: Results of a Comparative Study.

BACKGROUND: No high level of scientific evidence exists about the use of asymmetry of skin creases (ASC) on the groin and thigh regions in diagnosing developmental dysplasia of the hip. The aim of this comparative study was to revisit whether or not ASC was a significant clinical finding in developmental dysplasia of the hip. METHODS: This was retrospective analysis of a prospectively collected data. Control group was composed of 1000 consecutive healthy infants (mean age, 46.7 d) whose both hips were considered Graf type I (normal). Study group (SG) was composed of 246 consecutive patients (mean age, 96.5 d) whose treatments by abduction bracing were initiated due to unilateral or bilateral Graf type IIa(-) and worse hips. RESULTS: SG included 178 patients with bilateral or unilateral dysplastic hips [Graf type IIa(-), IIb, IIc] and 68 patients with at least 1 decentered hip (Graf type D, III, IV). ASC was seen in 63 of 101 patients (63%) having positive clinical finding(s). The rates of both ASC alone (P<0.001; odds ratio, 3.46) and ASC total (ASC with and without additional findings) (P<0.0001; odds ratio, 7.48) were significantly higher in SG than in control group. ASC was the only clinical finding in 31 patients and 24 of these 31 patients (77%) had unilateral or bilateral dysplastic hips. Sensitivity and specificity of ASC alone were 12.60% and 96.00%, respectively. ASC was accompanied by other clinical findings (mostly Galeazzi sign and limitation of abduction) in 32 patients and 23 of these 32 patients (72%) had at least 1 decentered hip. Sensitivity and specificity of ASC total were 25.61% and 95.60%, respectively. CONCLUSIONS: ASC is a significant finding, as there is considerable increased risk of having dysplastic or decentered hips in infants having such a finding alone or associated with other findings. ASC alone is more commonly seen in patients with dysplastic hip(s) whereas ASC is mostly accompanied with other clinical finding(s) in patients with decentered hip(s). This study shows that, ASC can be introduced as a risk factor in selected newborn hip screening programs. LEVEL OF EVIDENCE: Level II-diagnostic study.

Conjoined twins presenting with foot deformities: insights to management and challenges.

Conjoined twins are a rare outcome of conception associated with numerous anomalies involving multiple organ systems. Musculoskeletal abnormalities like vertebral anomalies, sacral agenesis, foot deformities and hip dysplasia have been described in literature. We describe two cases of pyopagus twins with congenital talipes equinovarus and congenital vertical talus deformity which have not been described previously in this type of conjoined twins. The orthopaedist should look actively for such deformities in this patient population and be wary of the difficulties associated with their management.

Outcomes Following Dynamic Compression Bracing for Pectus Carinatum.

Introduction: Children with pectus carinatum (PC) are particularly vulnerable to psychosocial effects of poor body image, even though they may not experience physical symptoms. Nonoperative treatment with orthotic bracing is effective in PC correction. We describe our experience with dynamic compression bracing (DCB) for PC patients and their satisfaction with bracing. Materials and Methods: Prospective institutional data of patients undergoing DCB from July 2011 to June 2018 were reviewed and analyzed for those who entered the retainer mode after correction, defined by a correction pressure of <1 psi. A telephone survey was conducted regarding their bracing experience and satisfaction with the outcome on a scale of 1-10. Results: Of 460 PC patients, 144 reached the retainer mode. Median time to retainer mode was 5.5 months. There was no statistically significant relationship between initial correction pressure or carinatum height and time to retainer mode (P = .08 and P = .10, respectively). Fifty-seven percent were compliant with brace use, and median time to retainer mode in this subset was significantly shorter than noncompliant patients (3.5 months versus 10 months, P < .001). Fifty-three percent responded to the survey 13 months [interquartile ratios 3, 33] after the last clinic visit. The main barrier to compliance with wearing the brace was discomfort (37%), while the main motivation for compliance was appearance (58%). All endorsed bracing as worthwhile, with 94% reporting a satisfaction rating of 8 or greater for the correction outcome. Conclusion: DCB is effective in achieving correction of PC in compliant patients. Regardless of time to retainer mode, patients reported high satisfaction with bracing.

Ten cold clubfeet.

Background and purpose - Idiopathic clubfeet are commonly treated with serial manipulation and casting, known as the Ponseti method. The use of Plaster of Paris as casting material causes both exothermic and endothermic reactions. The resulting temperature changes can create discomfort for patients. Patients and methods - In 10 patients, we used a digital thermometer with a data logger to measure below-cast temperatures to create a thermal profile of the treatment process. Results - After the anticipated temperature peak, a surprisingly large dip was observed (Tmin = 26 °C) that lasted 12 hours. Interpretation - Evaporation of excess water from a cast might be a cause for discomfort for clubfoot patients and subsequently, their caregivers.

Mobilization with movement and kinesio taping in knee arthritis-evaluation and outcomes.

INTRODUCTION: The aim of this study was to investigate the acute effects of Mulligan mobilization with movement (MwM) and taping on function and pain intensity in patients with osteoarthritis (OA). MATERIALS AND METHODS: Female patients aged between 40 and 70 years with knee OA participated in the study. The patients were divided into three groups and each group received different interventions. Group 1 received MwM and taping according to Mulligan's concept. Group 2 received MwM and placebo taping with no recovery effect and group 3 received placebo taping. Functional tests including lifting, picking up, sit and stand-up, socket tests in addition to climbing up and down stairs, ten metres walk, and timed up and go (TUG) tests were performed before and after intervention. Pain during the test performances were assessed by a visual analog scale. RESULTS: Performance in all tests improved significantly in the MwM + taping group, while only sit and stand-up, ten metres walk, and TUG test performances improved in the MwM + placebo taping group (p < 0.05). Pain intensity during the tests was also significantly better after intervention in those two groups (p < 0.05). Comparison between the groups showed that the pain intensity during all tests was less and functional test scores were better in sit and stand-up, ten metres walk, and walking down stairs in the MwM + taping group than the MwM + placebo taping group. CONCLUSIONS: MwM accompanied by taping improves pain during functional activities as well as the performance. MwM without taping may also improve pain intensity; however, it may be inadequate in increasing the performance.

Comparison of short-term effects of mobilization with movement and Kinesiotaping on pain, function and balance in patellofemoral pain.

OBJECTIVE: The aim of this study was to compare the short-term effects of Mobilization with movement (MWM) and Kinesiotaping (KT) on patients with patellofemoral pain (PFP) respect to pain, function and balance. METHODS: Thirty-five female patients diagnosed with unilateral PFP were assigned into 2 groups. The first group (n = 18) received two techniques of MWM intervention (Straight Leg-Raise with Traction and Tibial Gliding) while KT was applied to the other group (n = 17). Both groups received 4 sessions of treatment twice a week for a period of 2 weeks with a 6-week-home exercise program. Pain severity, knee range of motion, hamstring flexibility, and physical performance (10-step stair climbing test, timed up and go test), Kujala Patellofemoral Pain Scoring and Y-Balance test were assessed. These outcomes were evaluated before the treatment, 45 min after the initial treatment, at the end of the 4-session-treatment during 2-week period and 6 weeks later in both groups. RESULTS: Both treatment groups had statistically significant improvements on pain, function and balance (p < 0.05). Pain at rest (p = 0.008) and the hamstring muscle flexibility (p = 0.027) were demonstrated significant improvements in favor of MWM group. CONCLUSIONS: Our results demonstrated similar results for both treatment techniques in terms of pain, function and balance. The MWM technique with exercise had a short-term favorable effect on pain at rest and hamstring muscle flexibility than the KT technique with exercise in patients with PFP. LEVEL OF EVIDENCE: Level I, therapeutic study.

Effect of a modified dynamic accordion hinge Denis Browne brace on the success rate of the Ponseti method in idiopathic clubfoot: a preliminary study.

After the success of Dr Ponseti's method for the treatment of idiopathic clubfoot deformity, the number of patients who need soft tissue release has decreased, but the use of foot abduction orthosis is crucial for maintaining correction after this method. The lack of adherence to the orthosis regimen is reported to be a major factor for recurrence. Noncompliance with brace may be because of skin ulceration and blistering or irritability of children because of restrictiveness of the leg motion in the brace. The aim of this article is to introduce a new design of Denis Browne brace (accordion Hinge DB brace) and evaluate the results. We treated a total of 90 patients with idiopathic clubfoot (145 clubfeet) by Dr Ponseti's method and then prescribed a new design accordion to a hinge DB brace after correction of the deformity. We retrospectively reviewed the rate of complications, noncompliance, results, and effectiveness of this newly designed brace. The mean follow-up duration was 36 months (range 14-50 months). All 145 (100%) clubfeet showed complete correction after applying Dr Ponseti's method before brace prescription. Then, the accordion hinge DB brace was applied after removal of the last cast, 23 h a day for 3 months, followed by nightly use subsequently for up to 4 years. Noncompliance was encountered for 15 (10.3%) clubfeet and in 11 (7.5%) clubfeet, relapse was observed. The mean time to relapse was 14 months. Among 15 noncompliant patients, 13 were older than 2 years of age and only one relapse occurred in a patient younger than 2 years old. We did not encounter any case with skin ulceration. On the basis of the results, and compared with our previous study with a classic DB brace, a considerable reduction in noncompliance and relapse was observed. We did not encounter any case with skin ulceration. This accordion hinge DB brace reduces the rate of the complications of classic DB brace, and we strongly recommend the accordion hinge DB brace after the Ponseti method and serial casting. LEVEL OF EVIDENCE: 4.

Leverage application on Gartland type IV supracondylar humeral fracture in children.

PURPOSE: Although the most complex management of Gartland type IV supracondylar humeral fracture (SCHF) due to instability, the gold standard of initial treatment remains closed reduction and percutaneous pinning. However, open reduction was inevitable in most published studies. This study reports the outcome of treatment by leverage-assisted closed reduction. METHOD: Twenty-seven patients were diagnosed as Gartland type IV SCHF during surgery in 214 preoperative Gartland type III fractures. Leverage-assisted reduction with percutaneous lateral pinning was done in these patients after failure of close reduction. Evaluations were performed with radiographic examination, clinical assessment and Flynn's criteria by interview and physical examination. RESULT: All 27 patients obtained acceptable reduction by leverage-assisted close reduction and percutaneous pinning. The average follow-up was 23.6 (18-30 months). There was no neurovascular complication, infection, nonunion, myositis ossificans or Volkmann's contracture. Evaluation of Baumann's angle was towards varus (74-74.2°). There was no significant difference (p = 0.1876). Flynn's criteria were excellent in 22 (81.5 %) patients, good in four (14.8 %) and fair in one (3.7 %). The rate of excellent and good outcome was 96.3 % and of satisfactory 100 %. CONCLUSION: We recommend leverage-assisted closed reduction as an option before open reduction in type IV SCHF, not only for gold standard management but also because of satisfactory outcomes and the low incidence of major complications.

Tibia Shaft Fractures in Adolescents: How and When Can They be Managed Successfully With Cast Treatment?

Despite the increasing popularity of operative treatment in adolescent tibia fractures, casting remains a viable first-line treatment. Because the selection bias in published reports does not allow direct comparison between casting and flexible nail treatment of closed pediatric tibia fractures, it is unclear whether flexible nailing offers any advantages over casting. This overview discusses parameters of acceptable alignment, indications, techniques for successful reduction and casting, subsequent inpatient and outpatient management including wedging of casted tibia fractures, expected outcomes, and comparison of casting with flexible nailing. As with any orthopaedic procedure, careful attention to patient selection, indications, and detail facilitates successful cast treatment in this older pediatric population.

Does Clubfoot Treatment Need to Begin As Soon As Possible?

INTRODUCTION: Parents of an infant with an idiopathic clubfoot deformity are often urged by their primary care physician to seek treatment as soon as possible. This advice frequently appears in many general pediatric and pediatric orthopaedic textbooks and monographs on the subject. This recommendation has not changed since the wide acceptance of the minimally invasive Ponseti method to treat clubfoot. We determined the correlations among patient-related variables, early treatment variables, and the age at which the patient was first seen to begin treatment. METHODS: Infants with moderate to very severe idiopathic clubfoot deformity were invited to participate. Age at which the patient presented to begin treatment was correlated against early treatment-related variables, including number of casts required, cast slippage, cast-related skin problems, brace-related skin problems, early noncompliance with brace wearing, and relapse before 1 year. Patient-related variables were also correlated against age at first visit. RESULTS: Over 7 years, 176 infants met the inclusion criteria. There were no significant differences in the aspects of the early management as a function of age at first visit, with the exception of cast slippage (P=0.05). CONCLUSIONS: The age at first visit influenced the incidence of cast slippage, but otherwise did not affect the early treatment of clubfoot. CLINICAL RELEVANCE: The treatment of idiopathic clubfoot deformity should not be considered an orthopaedic emergency, and parents whose infants are born with this deformity should be counseled accordingly.

Treatment of Clubfoot With Ponseti Method Using Semirigid Synthetic Softcast.

Randomized controlled clinical trial.The main purpose of the present study was to comparatively analyze the effectiveness, advantages, and the complications of using semirigid synthetic softcast with respect to plaster of Paris (POP) during the treatment of clubfoot deformity.The study group consisted of 196 babies (249 feet). A total of 133 feet treated by an orthopedic referral center using semirigid synthetic softcast were included in group A whereas the other 116 feet treated by another orthopedic clinic using POP cast were included in group B. The Pirani scores, number of cast applications, time period until Achilles tenotomy, any skin problems due to the cast itself, and/or cast removal were recorded. A final parent satisfaction score was also obtained.The mean Pirani sores were significantly improved from the first administration to the time before Achilles tenotomy in both groups. There was no significant difference according to the number of casts applied until tenotomy. The slippage of the cast and skin lesions was significantly more common in group B. Higher parent satisfaction levels were detected in group A.Semirigid softcast has been found as superior to POP in the aspects of parent satisfaction and cast-related complication rates.

Giving a second thought to brisement force - a case report.

Fractures of temporomandibular joint (TMJ) may be caused by indirect trauma where force of trauma is transmitted to the mandibular condyle from a blow elsewhere or in other situations may also result from direct trauma. TMJ trauma in children is usually accompanied with pain, swelling, limited jaw movement and other additional findings. This report highlights a case of post traumatic trismus successfully managed with Brisement force - gradual tractional forces applied to the temporomandibular joint.

PBNR: Percutaneous Blunt Needle Reduction of Bony Mallet Injuries.

Mallet finger injuries are common; treatment goals include achieving joint stability, preventing extensor lag, and subsequent swan-neck deformity. We describe a simple technique for improving intraoperative bony mallet reduction, which may avoid the requirement for closed Ishiguro extension blocking wires or open fixation, and present a prospective case series (n=12). Intraoperative percutaneous blunt needle reduction (PBNR) is achieved under image intensifier guidance. Using artery forceps, a blunt fill needle tip is manipulated onto the proximal avulsed fragment; this is then guided into a reduced position and maintained using a well-formed Zimmer splint across the distal interphalangeal joint in 15- to 30-degree extension. There were 5 injuries involving >1/3 of the articular surface (Doyle's classification IVb) and 7 injuries involving >1/2 of the articular surface (Doyle's classification IVc). Mean hand therapy follow-up was 10.6±1.0 weeks, extensor lag was 4.6±1.7 degrees, and all patients achieved full functional recovery with return to normal daily activity. No complications were reported. Closed techniques, for example, Ishiguro extension blocking wires, may reduce the risks associated with open reduction, but do not avoid further articular surface damage. PBNR offers the surgeon a useful adjunct to the treatment options for bony mallet injuries, without excluding progression to surgical fixation if required. PBNR represents a less-invasive management option for bony mallet injures where surgical fixation may also be indicated.

A new patient-controlled technique for shoulder relocation in emergency departments.

BACKGROUND: The glenohumeral joint is the most mobile joint in the human body due to the shallowness of the glenoid socket. This unique anatomy also makes it the most dislocated joint in humans. All the techniques described so far for relocation require operator control and prescription drugs. We describe a technique that is unique, easy, and patient-controlled. CASE REPORT: A 29-year-old male patient presented to the Emergency Department after falling from scaffolding at work. He had left shoulder dislocation confirmed by clinical and radiological examination. The patient lay face down on the trolley with trolley being raised with electronic controls. The shoulder was reduced with ease and the patient was discharged home after radiologic confirmation of reduction. CONCLUSIONS: A new patient-controlled technique for reduction of the glenohumeral joint following dislocation is described. It is simple, safe, and effective to perform in Emergency Departments.

Manipulation and brace fixing for the treatment of congenital clubfoot in newborns and infants.

BACKGROUND: As one of the most common congenital deformities in children, clubfoot has long been a challenge for orthopedic surgeons. This paper describes the experience of our team with manipulation and above-the-knee brace fixation without percutaneous Achilles tenotomy for the treatment of clubfoot in newborns and infants. METHODS: In the orthopedic department of our hospital, 32 infants and newborns (56 feet) with congenital clubfoot underwent manipulation and above-the-knee brace fixation between 2008 and 2012. External rotation brace was used for 1-4 years during the night after deformity correction. Prospective follow-up for a mean duration of 29 months (range, 12-48 months) was carried out. The efficacy of the treatment was assessed by Pirani's scoring system before and after treatment. RESULTS: Fifty-two feet achieved a normal appearance within 3 to 6 months (average, 4.2 months) after treatment. Two patients had skin pressure sores due to improper brace care, but these healed with no scarring after timely treatment. The mean Pirani score 1 year after treatment was 0.21 ± 0.09, whereas it was 4.93 ± 1.02 before treatment (p=0.0078). No patient required treatment with percutaneous Achilles tenotomy. CONCLUSION: The manipulation and brace fixation used in this study offer an effective method for correcting clubfoot deformity in newborns and infants. This treatment can be an alternative choice to percutaneous Achilles tenotomy.