Using calcaneal plates in fixation of comminuted posterior wall acetabular fractures with cranial or posterior extension: a prospective case series and novel technique.

BACKGROUND: This study aims to evaluate the outcomes of using calcaneal plate in fixation of comminuted posterior wall (PW) acetabular fractures especially that have cranial (dome) or posterior extension (posterior column edge), and to evaluate its safety. To our knowledge, this is the first study that utilizes this off label implant technique in fixation of such fracture. METHODS: Twenty-two patients enrolled in the study with a minimum follow up of one year. After reducing the PW fragments sequentially, calcaneal plate was applied, fixing its distal part at ischial tuberosity upper ends using 3 screws in a triangular fashion, while its proximal part and radial wings were firmly fixed along the acetabular rim together with the classic longitudinal anchorage. Any fixation failure or head subluxation was recorded. RESULTS: Radiological outcome showed 18 cases scored as excellent, 2 were good, and 2 were poor. The functional outcome revealed 2 patients were excellent, 6 were very good and 14 were good. There was no loss of reduction or fixation failures throughout the follow up period. CONCLUSION: Calcaneal plate may offer an alternative method of fixation of comminuted PW fractures with acceptable radiological and functional results. Our study result may encourage the comprehensibility and replicability of this practice, however randomized multicentered studies should be conducted to validate this assumption. This method provides valuable trick strategy, stable and soft-tissue-friendly fracture fixation where modern implantations may be unavailable or of high cost. Calcaneal plates show some fascinating features that allow using them outside their field being flexible with large footprint area for fracture buttressing beside numerous hole choices with diverse paths providing suitable fixation, articular stability and wide zone of coverage in PW comminuted fracture patterns with cranial or posterior extensions. The plate proximal triangular configuration together with distal triangular screw fixation gives a stiff rigid anchorage and buttressing similar to a metal mesh covering and fixing any fragment numbers up to dome level.

Open versus closed reduction and internal fixation in children with femoral neck fractures. Systematic review and meta-analysis of the literature.

Background: Femoral neck fractures in children are uncommon, making up little more than 1% of all paediatric fractures. It's not apparent which type of internal fixation-closed or open-is preferable in these situations when it comes to therapeutic options. When treating children with displaced femoral neck fractures, serious problems can arise. Methods: Five databases were examined: Medline Plus, PubMed, Scopus, Science Direct, and Web of Science. The outcomes that were relevant for the meta-analysis were non-union, coxa vara, and avascular necrosis. Using the RevMan file, we extracted the data and carried out the analysis (Review Manager Version 5.3). Results: 294 patients had ORIF procedures and 266 patients had CRIF procedures in the included trials. Regarding the outcome of avascular necrosis, we discovered that there was no statistically significant difference between the two groups (RR = 0.84, [95% confidence range (CI) = 0.60, 1.18], P = 0.32). There was homogeneity in the data (P = 0.22, I2 = 27%). When it came to coxa vara, there was no statistically significant difference between the two groups (RR = 0.69, [95% CI = 0.30, 1.58], P = 0.38). There was homogeneity in the data (P = 0.22, I2 = 27%). Regarding non-union, the similar outcome was seen (RR = 0.45, [95% CI = 0.16, 1.14], P = 0.12). There was homogeneity in the data (P = 0.49, I2 = 0%). Conclusion: Regarding reducing the risk of non-union, coxa vara, and avascular necrosis, we did not find any difference between CRIF and ORIF. To validate this outcome, however, additional research on the various variables (fracture type, age, displacement, fixation technique, and duration of surgery) is required. Sorting patients based on the kind of fracture will ensure that the right approach is used for each type.

Technique for facilitating closed reduction of difficult flexion type supracondylar humeral fracture in children.

The displaced flexion type supracondylar humeral fractures (SCHF) are inherently unstable and there is great intraoperative difficulty in obtaining and maintaining the fracture reduction by closed means. We introduced a technique for closed reduction and K-wires pinning of displaced flexion type SCHF. Fourteen patients with flexion-type SCHF (9 boys and 5 girls) underwent a reduction technique using a construct of three K-wires. The proximal wire was used for rotational control of the proximal fragment and the two distal wires were used for correction of the flexion and rotational deformity of the distal fragment. The patient's mean age was 7 (6-11) years. Results were evaluated by the anterior humeral line, Baumann's angle, carrying angle radiographically and Flynn's criteria clinically. The mean time for the union was 4.8 (4-6) weeks. The anterior humeral line passed through the middle one-third of the capitulum in 12 patients and the anterior third in two patients. The mean Baumann's angle was 19.60 ± 3.8 and the mean carrying angle was 14.21 ± 3.04. We reported no cases of failed closed reduction. The median operation time in this study was 30 (25-40) min. The mean number of C-arm images was 33.5 ± 5.23. According to Flynn's criteria; 10 cases (71.4%) were excellent and 4 (28.6%) were good. This technique can achieve the accurate reduction of flexion type SCHF and avoid the complications of both repeated closed reduction trials and open reduction. Level of Evidence: Level IV, case series.

Using Skin of the Cleft as Bipedicle flap for Release of the First Web Space in Congenital Central Deficiency.

We are describing a new technique to utilize the skin of the cleft as a bipedicle flap to reconstruct and to widen the narrow first web space in congenital central deficiency. The skin of the cleft maintains its attachments on the dorsal and palmar aspects of the hand and the index finger is passed (tunneled) underneath it so that the skin of the cleft comes to occupy the first web space. This technique ensures maintenance of good blood supply of the skin of the cleft and a rounded edge of the first web without scars across it.

A new anchoring technique for tibialis anterior tendon transfer.

Tibialis anterior tendon transfer was described as an effective method in the management of dynamic supination as well as prevention of clubfoot relapse in children. Different successful methods were described for anchoring the transferred tibialis anterior tendon; however, each of which has its own complications that were avoided by using this novel technique. This study included 26 feet in 18 patients, who underwent tibialis anterior tendon transfer as a part of management of their congenital clubfoot. The mean age was 3.6 years (ranging from 2.5 to 5 years), all patients were followed up for 6 to 30 months (mean = 14 months). The transferred tibialis anterior tendon was anchored in the third cuneiform using transfixing K wires. This novel technique resulted in successful and stable anchoring of the transferred tibialis anterior tendon. The transferred tendon was well palpated in all patients with active dorsiflexion, with no associated tendon rupture, anchoring problems, or wound complication. Our technique is secure, reliable, and economic with no special equipment needed. It could successfully avoid the plantar skin complications associated with pullout sutures and neurovascular injury.