Treatment of displaced supracondylar humeral fractures in children by humero-ulnar external fixation.

PURPOSE: Humero-ulnar external fixation has been proposed to treat complex supracondylar humeral fractures in children. It facilitates fracture reduction and reduces the risk of ulnar nerve lesion, which can occur after cross pinning. METHODS: In a ten year period, 28 children have been operated on in our centre by humero-ulnar external fixation, for Lagrange-Rigault stages III and IV supracondylar humeral fractures. The data about fracture management and early follow-up were obtained from our medical database. The long-term evaluation was done at a minimum six months' follow-up. The range of motion and carrying angle measurements were classified according to Flynn. The final X-rays were evaluated for quality of reduction, presence of malunion, late infection signs, osteo-arthritis and myositis ossificans. The elbow function was evaluated by Mayo Elbow Performance Index (MEPI), Disabilities of the Arm, Shoulder and Hand (DASH) or modified DASH scores. RESULTS: The treatment was well tolerated by children and parents. There was no neurological complication related to the insertion of the pins, and no Volkmann syndrome. The median duration of external fixation was 33.5 days. Twelve patients were reviewed after a median follow-up duration of seven years (mean, 7.5 years; range, 3-21 years). One child had a refracture, three years after his original fracture, which was treated non-operatively. This case ended up in a cubitus varus deformity with a pronation deficit. All other patients had excellent clinical and radiological results. CONCLUSIONS: For the treatment of complex supracondylar humeral fractures in children, humero-ulnar external fixation is a good alternative to lateral or crossed pinning. The advantages are the ease to obtain the reduction, the absence of neurological risk to the ulnar nerve and the possibility to obtain good stabilisation of the fracture with moderate elbow flexion.

Retrospective study of metal contamination time trends in the French part of the Bay of Biscay.

Two cores were sampled in the Bay of Biscay: one a few miles off the Gironde estuary (pointe de la Coubre), the other near the Spanish border (Capbreton canyon) to study past variations in sediment contamination. Radiochronology (210Pb, 137Cs) and total metal determinations by ICP-MS allowed the study of time trends for metal concentrations in sediment. Off the Gironde, during the time interval recorded by the core (1958-1999), all metal concentrations remained less than OSPAR background values. Some variations occurred along the Cd and Zn profiles, which may correspond to a very attenuated signal from the Gironde outputs. This suggests that this area was not submitted to any significant anthropogenic input of metals between 1958 and 1999. In the canyon of Capbreton, the undisturbed part of the core recorded the influence of surface deposition between 1977 and 1999. From as early as 1977 high lead and mercury concentrations were noticed. Mercury concentrations increased until 1992, then decreased until 1999. This marks a drop of inputs in 1992, but the final concentration remained elevated. Lead had important concentrations (more than twice the OSPAR reference) all along the core and began to decrease only in the upper level of the unmixed layer. This shows a late (near 1998) drop of lead inputs. Other metals (Cd, Cu, Zn, Ni, Cr) stayed at a much lower level: less than the OSPAR reference for Cu, Cr and Ni or not far from the OSPAR reference for Cd and Zn.