RESUMO
BACKGROUND: The most widely accepted treatment for pediatric supracondylar humeral fracture is closed reduction and percutaneous pinning (CRPP). However, there is debate regarding the technique that is utilized, whether crossed or lateral pinning, and the number of pins used. AIM: To compare the functional and radiological outcomes of lateral and cross pinning in the management of humeral supracondylar fracture. METHODS: A retrospective analysis was performed on 101 patients who were surgically managed by either one of the CRPP techniques from 2015 to 2019. Several clinical parameters were taken into account, including pre- and post-intervention Baumann angle, as well as scores for pain, range of motion, function, and stability. Statistical analysis was performed to study the outcomes of the utilized techniques. RESULTS: Amongst our study sample, which included 63 males and 38 females with a mean age of 5.87 years, about one-third of the patients underwent crossed pinning fixation configuration and the remaining two-thirds were managed by lateral pinning configuration. Similar results were obtained in the two groups with no statistical difference regarding Mayo elbow performance scores (MEPS) and Baumann angle. The mean MEPS in the lateral and crossed pinning groups were 93.68 + 8.59 and 93.62 + 9.05, respectively. The mean Baumann angle was 72.5° + 6.46 in the lateral group and 72.3° + 4.70 in the crossed-pinning group (P = 0.878). CONCLUSION: Both lateral pinning and crossed pinning fixation configuration for displaced pediatric supracondylar humeral fractures provide similar functional and radiological outcomes.
RESUMO
BACKGROUND: Quadriceps or patellar tendon rupture incidence is relatively low, especially simultaneous bilateral rupture, which usually reported as a complication of chronic systemic disorders such as renal failure. OBJECTIVE: Herein, we report a case of bilateral knee extensor mechanism ruptured in a patient with chronic renal failure on long standing hemodialysis. CASE PRESENTATION: A 38-year-old white male, a known case of chronic renal failure on long term hemodialysis, presented to our clinic with clinical signs of bilateral simultaneous knee extensor tendons rupture. After proper workup simultaneous quadriceps and contralateral patellar tendons rupture diagnosis was made. The patient was managed with surgical repair of the tendons and within few days after the surgery he started physiotherapy and rehabilitation program, using walking crutches partial weight bearing mobilization was allowed, and a gradual increase of knee flexion within brace was applied. He used the knee braces and the walking crutches for two months, to ensure complete healing of the repaired tendon with a sufficient strength to allow full weight bearing. At four-year follow-up, complete bilateral knee extensor tendons healing and both knees functional outcome was satisfactory. CONCLUSION: A simultaneous rupture of quadriceps and contralateral patellar tendons is a rare event in patients with chronic renal failure undergoing long term hemodialysis. With early surgical intervention and good physiotherapy, the patient usually has good recovery of both knees function.