Top PDF Comparative Study of Cross and Lateral Fixations on Supracondylar Humerus Fracture among Children

Comparative Study of Cross and Lateral Fixations on Supracondylar Humerus Fracture among Children

Comparative Study of Cross and Lateral Fixations on Supracondylar Humerus Fracture among Children

Subjects and Method: The study was a retros- pective study toward Gartland type III SCHF children in Dr. Soetomo Hospital, Surabaya, Indonesia from 2013–2016. The dependent vari- able is Supracondylar humerus fracture. Inde- pendent variables is type of fixation option, clini- cal functional test, degrees of satisfactory, and radiology evaluation. The radiology parameter used was Skaggs criteria. An observation was conducted for the occurrence of complication in the form of infection and peripheral nerves injury. All data were analyzed using Kolmogorov Smirnov and Fischer exact test.
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Percutaneous transolecranon pinning and lateral pinning Vs lateral pinning in displaced supracondylar fractures of humerus in children: an observative study

Percutaneous transolecranon pinning and lateral pinning Vs lateral pinning in displaced supracondylar fractures of humerus in children: an observative study

Background: Supracondylar fracture (humerus) is type of extra-articular fracture occurring in the distal metaphyseal site of humerus. It is almost exclusively a fracture of the immature skeleton, seen in children and young teenagers. Fractures around the elbow are a great challenge to orthopaedic surgeons. Clinical diagnosis may be difficult due to noncooperative patient and massive swelling around the elbow. Displaced type of supracondylar fractures poses problem not only in reduction but also in maintenance of reduced fracture and rapid inclusion of nerves and vessels.
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A comparative study of two percutaneous pinning techniques (lateral vs medial–lateral) for Gartland type III pediatric supracondylar fracture of the humerus

A comparative study of two percutaneous pinning techniques (lateral vs medial–lateral) for Gartland type III pediatric supracondylar fracture of the humerus

A total of 216 patients with supracondylar humerus fractures were admitted to the orthopedic wards either through the outpatient department or emergency services. Of the 216 patients, 140 were excluded from the present study as they did not fulfill the inclusion criteria. These included compound fractures (10 cases), aged [ 12 years (12 cases), were not fit for surgery/refused surgery (15 cases), were associated with ipsilateral forearm fractures (6 cases), or were being treated conservatively for Gart- land I and II fractures (46 cases). The remaining 76 patients were enrolled in the study. The method of patient selection for lateral entry or medial-lateral entry was random, using a computer-generated randomization table from http://www.randomization.com. The seed for the random number generator was obtained from the clock of the local computer and was printed at the bottom of the randomization plan. Fourteen patients were exclu- ded from the final analysis because of lost to follow-up. Our analysis included 62 patients who were followed up
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Three lateral divergent pinning for displaced supracondylar humerus fractures in children

Three lateral divergent pinning for displaced supracondylar humerus fractures in children

Introductions: Cross or two lateral pinnings are the most commonly done procedures for displaced supracondylar humerus fractures in children. A crossed pin is biomechanically stable than lateral pins, but associated with risk of iatrogenic ulnar nerve injury. Recent studies have shown stable fixation with three lateral pin construct. The purpose of this study was to evaluate the efficacy of three lateral divergent pinning for displaced supracondylar humerus fractures.

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Open reduction and percutaneous pinning via lateral approach without using C-arm in Gartland type III supracondylar humerus fractures in children

Open reduction and percutaneous pinning via lateral approach without using C-arm in Gartland type III supracondylar humerus fractures in children

A total of 44 patients with type III SCH fractures presented to the emergency room in our institution between June 2016 and January 2019. Three patients had skin blisters and two had compartment syndrome developed due to mismanagement by traditional bonesetters. One patient presented with pulseless cool hand and had brachial artery injury. Vascular repair together with fracture reduction was done via anterior approach. 2 cases had unacceptable reductions on post-operative radiographs and were re-operated in our main operation theatre under C- arm. All these 8 cases were excluded from the study. In this retrospective study we included 36 patients which were consecutively treated in our emergency operation theatre by ORPP via lateral approach. The patients consisted of 28 boys and 8 girls with a mean age of 7.5 years (range 3–14 years). Four cases in the study group had pink pulseless hand and were urgently fixed and observed for an average of five days postoperatively. Two cases were open type I fractures and were also included in the study. Two patients had sustained ipsilateral femoral shaft fracture and were managed by intramedullary elastic nails. One patient had ipsilateral distal radius fracture which was managed non- operatively.
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A two-stage retrospective analysis to determine the effect of entry point on higher exit of proximal pins in lateral pinning of supracondylar humerus fracture in children

A two-stage retrospective analysis to determine the effect of entry point on higher exit of proximal pins in lateral pinning of supracondylar humerus fracture in children

The second stage of this study started from January 2017 and ended in December 2017. Based on the findings of the first stage (see the “Results” section), two of the sur- geons (EW and LS), after placing the lower/distal lateral pins, started to insert the proximal lateral pins from lateral (pins laid in the lateral third of the ONC or lateral to the ONC) and posterior (pins laid in the posterior third of the ONC or posterior to the ONC) in hyperflexed position under Jones radiographs (Fig. 3), and intentionally aimed at exiting in zone + 1. The location and configuration of the pins were confirmed by intra-operative radiographs. When the lateral pin fixation was found to be satisfactory and stable with no distal fragment rotation, removal and reinsertion of the pins for further proximal exit or inser- tion of another new pin was avoided. Patients were then immobilized in a long arm cast in 80 to 90° flexion for a period of 4 to 5 weeks depending on the age of the patient. This group of data was collected as the intended group, while the data of the other surgeons, who continued to fix the fractures according to the regular, standard pinning protocol, were categorized as the random group. Similar demographic data, fracture characteristics, and measure- ment data were also collected and recorded as in the first stage of the study.
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Outcome analysis of cross pinning versus lateral pinning in supracondylar fractures of humerus in children

Outcome analysis of cross pinning versus lateral pinning in supracondylar fractures of humerus in children

Various methods of skin traction and skeletal traction were used as treatment methods to maintain reduction which are of historic interest only. Treatment for a displaced fracture with severe swellingwas adviced by Blount et al 5 1951 by closed reduction aided by posterior periosteum and triceps. Secondary displacement occurred in plaster and cubitusvarus occurred - DAmbroisa 5 (1972). The problem of Mc Laughlin “ Supracondylar Dilemma” 5 was identified. That is the fracture gets reduced by flexion of elbow but the vascularity gets affected by flexion needing extension of elbow resulting in loss of reduction - Rang 5 (1974)
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Biomechanical analysis between Orthofix® external fixator and different K-wire configurations for pediatric supracondylar humerus fractures

Biomechanical analysis between Orthofix® external fixator and different K-wire configurations for pediatric supracondylar humerus fractures

Mechanical rotation stability of the different fixations in supracondylar humeral fracture is a major factor to avoid the development of cubitus varus. Cubitus varus has been considered as being just a cosmetic problem by many authors. The ulnar insertion of an anti-rotation wire into the distal fragment reinforces the stability if in- ternal rotation loading is applied and stabilizes the ulnar column of the distal humerus [17]. Wang et al. [18] re- ported that there was no statistical difference between the two medial pins and the two crossed-pin configura- tions ( P = 0.06 and 0.75, respectively) in internal and ex- ternal rotation testing, but they were significantly greater than two lateral pins ( P = 0.003 and 0.004; P = 0.001 and 0.02, respectively). In our study, the crossed K-wires provided more stability than two lateral K-wires ( P = 0.024; P = 0.032), which was similar with the previous study. Besides, the stiffness of two lateral K-wires (84 ± 15 Nmm/degree; 93 ± 14 Nmm/degree) Table 3 Construct stiffness data in internal rotation and external rotation loading direction for different K-wire configurations or external fixator
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Application of clinical pathway using electronic medical record system in pediatric patients with supracondylar fracture of the humerus: a before and after comparative study

Application of clinical pathway using electronic medical record system in pediatric patients with supracondylar fracture of the humerus: a before and after comparative study

The CP for pediatric patients with supracondylar frac- ture of the humerus was implemented using an EMR system, in June 2011. When the indication for surgery was established, the preoperative evaluation, including blood analysis (complete blood count, electrolyte, liver function tests and coagulation studies), electrocardiog- raphy, chest x-ray and urinalysis, were performed at the emergency room or the out-patient clinic. If patients had medical history, which showed a risk for general anesthesia, consultation was performed preoperatively. There are two ways to implement CP in EMR system. One is that application of CP was decided at out-patient clinic and ‘ Applying the CP’ button was clicked before admission. For this case, application of CP was recon- firmed in EMR system after admission. The other is that ‘ Applying the CP’ button was clicked on the ward after patients were admitted to the hospital. Then, the path- way for closed pinning in children with supracondylar fracture of the humerus was selected among various pathways and the implementation of CP was initiated. If it is impossible to execute CP workflow for variation of standard treatment process, the pathway can be discontinued by click the ‘drop-out’ button. Patients and their guardians were informed by the orthopedic resi- dent concerning the perioperative schedules, involving the preoperative evaluation, surgical method, postopera- tive care, and planned postoperative hospital stay. Lat- eral pinning technique, using 2 pins, which was found to be more beneficial than the medial and lateral crossed pinning technique on the basis of current evidences [16], were used for the fixation of supracondylar fracture of the humerus. Following the surgery, all patients were immobilized in a long arm cast at least for 3 weeks, according to the radiographic findings. After that period, 2 pins were removed at the out-patients clinic and
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Management of gartland type III supracondylar fracture of humerus in children by open reduction and internal fixation using crossed K-wires: A Short term follow up study

Management of gartland type III supracondylar fracture of humerus in children by open reduction and internal fixation using crossed K-wires: A Short term follow up study

Open reduction is indicated in displaced supracondylar fractures where irreducibility results from proximal fragment being buttonholed 16 through soft tissue or interposition of biceps or neurovascular structures. Approaches for open reduction are anterior, posterior, medial and lateral. Posterior approach through triceps muscle and tendon has been used with excellent results. Posterior approach 23,24,25 is easier when comparing with other approaches. K wires 1.5mm to 2mm are used in crossed pin technique. After reducing the fracture visually lateral pin is inserted first and second pin is placed medially. Both the pins should have a purchase on the opposite cortex. Elbow is immobilised in flexion with forearm in neutral position using above elbow posterior slab.
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A prospective randomised, controlled clinical trial comparing medial and lateral entry pinning with lateral entry pinning for percutaneous fixation of displaced extension type supracondylar fractures of the humerus in children

A prospective randomised, controlled clinical trial comparing medial and lateral entry pinning with lateral entry pinning for percutaneous fixation of displaced extension type supracondylar fractures of the humerus in children

All the children attending in the Accident and Emergency Department or, in the Outpatient Department of Ortho- paedics and Traumatology in our institution between October 2007 and September 2010 with supracondylar fractures of the humerus were enrolled in the present study if they had the following inclusion criterias: (i) age between two and twelve years (ii) Unilateral fracture (iii) Extension type (iv) Displaced Gartland [4] type II and type III (v) presenting within seventy two hours after the injury (vi) no other associated injury in the same limb (vii) no previous fracture in the same limb.
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Original Article Comparison of Kirschner wires and Orthofix external fixator for displaced supracondylar humerus fractures in children

Original Article Comparison of Kirschner wires and Orthofix external fixator for displaced supracondylar humerus fractures in children

One medial combined two or three K-wires could provide more stability than classical cro- ssed, two or three lateral divergent of K-wires in complex supracondylar humeral fractures in children [13]. Silva et al. [18] reported two lat- eral adding a medial K-wires increased tor- sional stiffness and bending stiffness. Zionts et al. [19] demonstrated that two crossed K-wir- es fixation could provide more stable torsional fixation than three lateral K-wires, which was similar to the result in Lee et al. study [20]. In our study, the configuration of K-wires also provided the stability of supracondylar hume- ral fractures. Compared with fixation of K-wir- es, the reduction of fracture can be facilitat- ed by direct manipulation of external fixing frame. If the reduction is not optimal with resi- dual extend displacement, external fixing could reduce the fracture easily in vertical plane. Slongo et al. [16] reported external fixator as a safe alternative for supracondylar fractures of humerus, and the manipulation of external fix- ator could reduce the unattainable fracture. The external fixator facilitated a satisfactory reduction of fracture by an indirect approach and provided the rigid stability of fracture to allow early movement of elbow without addi- tional plaster immobilization [21].
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Functional Outcomes In Fracture Of Supracondylar Humerus In Children Treated With Percutaneous Pinning With Cross KWiresLaxmi Narayan Meena, D.R Galfat

Functional Outcomes In Fracture Of Supracondylar Humerus In Children Treated With Percutaneous Pinning With Cross KWiresLaxmi Narayan Meena, D.R Galfat

This study included 30 cases of fracture of supracondylar humerus treated with percutaneous pinning with two cross k-wire. The mean age at the time of injury was 7 years (Fig. 4). In this study, 23 patients had injury on the left side and 7 cases had injury on right side. 24 patients suffered injury due to fall while the remaining patients suffered injury in road accident. 23 patients came next day after the injury and 7 patient reported 2 days after injury. The post-reduction metaphyseal-diaphyseal angle was in the range of 83-85 degree in 5 cases, 85-88 degree in 21 cases, 89- 92 degree in 3 cases. 16 patients had carrying angle range from 13- 15 degree,13 patients had carrying angle range from 10-13 degree and 1 patient had carrying angle change 8 degree. The Final functional results were excellent in 26(86.66%) cases, good in 3(10%) case, and unsatisfactory or poor in 1 (3.33%) patient (Fig. 5). At final follow-up, 2 (6%) cases had full range of motion, 24(80%) cases had limitation of range of flexion 0-10 degree, 3 (10%) case had limitation of range of flexion 10- 20 degree and 1 (3.33%) case had limitation of range of flexion more than 20 degree.
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CROSSED PINNING VERSUS TWO LATERAL WIRES IN THE MANAGEMENT OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN

CROSSED PINNING VERSUS TWO LATERAL WIRES IN THE MANAGEMENT OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN

series of 375 patients by Lyons JP et al., they observed that 6% of the patients had an iatrogenic ulnar nerve palsy postoperatively [18]. They also stated that these are usually neuropraxia which resolves almost completely in majority of the situations. There were 25 cases in Group B in the present study, who had ulnar nerve neuropraxia postoperatively and who recovered completely within three weeks of surgery. The incidence of neuropraxia can be reduced by keeping the elbow in 45-50 degrees of flexion rather than the usual hyperflexed position used while inserting the lateral pin. No pin removal was required in the present study for the neuropraxia. In all the patients where cross pinning was executed, a mini- open approach was used, the ulnar nerve was palpated and the K-wire was introduced with the elbow in semi- extended position.
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A comparative study between conservative and operative management in displaced proximal Humerus fracture

A comparative study between conservative and operative management in displaced proximal Humerus fracture

Proximal humeral fractures, defined as fractures occurring at or proximal to the surgical neck of the humerus. Nowadays proximal humeral fractures account for almost 7% of all fractures and make up In patients above the age of 65 years proximal humeral fractures are the second most frequent upper extremity fracture, and the third most common non-vertebral radius fractures. The treatment of this lesion age, degree of fracture displacement, the amount of last systematic diseases; fractured bone resulted of pathology, degree of ges and experience of surgeon. It might be chosen from surgical or nonsurgical treatment. Although series of conservative treatment suggest that reasonable functional results can be achieved th surgical management, even in more complex fracture types. With this background we have chosen this topic as a comperative study to evaluate the results of conservative and operative study in displaced proximal humerus fracture.
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Comparative study of motor development among Indian and Iranian students a cross sectional study

Comparative study of motor development among Indian and Iranian students a cross sectional study

15 and 16years were not better than 18 year male student. In Iranian male student paired mean difference of 18 and 13 year and 18 and 16 year of age were found significant, these indicated that 18 year were better than 13year male students and 16 year was better than 18 year male student in speed. But in cases of no significant differences were found in cases of 18 and 14 year, 18 and 15year and 18 and 17 year. These indicated that 18 year male students were not quicker than 14, 15and 17 year male student. Motor development is the process of change in motor behavior that is related to the age of the individual. The main significant focus on the relationship between age and motor behavior makes the study of motor development unique from other viewpoints. Motor development includes age-related vagaries in both posture and movement, the two main component of motor behavior. Development processes Occur throughout the human life span. (Jan Stephen Tecklin 1998). For the purpose of this study the term was understood to mean motor ability through the performance in selected motor fitness components that underlie gross motor skills.
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Infant and Young Child Feeding Practices among the Mothers in Urban Slums of Dibrugarh Town: A Cross Sectional Study

Infant and Young Child Feeding Practices among the Mothers in Urban Slums of Dibrugarh Town: A Cross Sectional Study

In the open technique, knee joint was entered through the standard midline incision and medial parapataller capsular incision. All Intra-articular fracture fragments were anatomically reduced and fixed with screws in anterior and posterior segments of condyles, allowing adequate space to place the nail centrally in the intramedullary canal. Entry point was made in intracondylar notch just anterior to the origin of the posterior cruciate ligament. Entry into the intercondylar notch was made with a curved awl. Entry point should be centralized with the condyles in anatomic alignment to ensure that the alignment will not deviate into a varus or valgus position. The entry point was reamed 1.0 mm larger than the selected diameter nail to avoid displacing condyles when the nail is inserted.
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A multi center, randomized, clinical study to compare the effect and safety of autologous cultured osteoblast(Ossron™) injection to treat fractures

A multi center, randomized, clinical study to compare the effect and safety of autologous cultured osteoblast(Ossron™) injection to treat fractures

With regard to the time required for osteoblast injection, although it varies depending on the patient for cases with- out osteogenesis, even two months after bone fracture injury when the overall bone union rate was evaluated, the callus formation was relatively slow; in addition, this is the time period during which the osteogenesis activity after fracture decreases[11]. Based on the assumption that irregardless of the type of procedure, if the activity within a fracture could be increased, the effect of the continuous callus formation could be maintained and the optimal time for osteoblast transplant would be approximately two months after the initial treatment. Following trans- plant, rapid callus formation could be detected in some of
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Experimental analysis of mechanical response of stabilized occipitocervical junction by 3D mark tracking technique

Experimental analysis of mechanical response of stabilized occipitocervical junction by 3D mark tracking technique

Displacement has to be measured during the mechanical loading on the full surface of the posterior skull but also on the fixations and on the rods. Furthermore displacement of the metallic vertebra has also to be measure to know the imposed moment value. So a field measurement method has to be employed and according to the morphology of the specimens and also the geometry of the setup, this method has to be able to measure 3D displacements without contact. For that, only an optical method can be used and as the displacement has to be measured in different points of the setup (skull, fixations, rods, resin), 3D mark tracking technique has been chosen. This method enables to measure 3D displacements of marks (natural or artificial) deposed on surfaces. The observation is based on a stereoscopic vision to obtain evolution of mark positions in the space. Two CCD cameras (noted 1 and 2) are employed (Figure 3). To determine 3D position of each mark, the first step consists in computing the position of each one (X i , i=1,2) in each bench mark associated to
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Original Article Surgical techniques and clinical efficacy of micro locking plate in the treatment of capitellar fractures

Original Article Surgical techniques and clinical efficacy of micro locking plate in the treatment of capitellar fractures

For Dubberley III fracture, i.e., fracture with pos- terior condylar comminution, it is difficult to apply the anteroposterior fixation with the K-wire or mini-screw, therefore, a stable bone bed is required to reduce the fractured articular surface. We reduced the fracture utilizing the anatomical relationship of the anterior articular surface as the criterion: 1.0 mm K-wire or 2.0 mm screw during the fixation applied at the dis- tal humeral joint in a lateral to medial manner and then the T-type micro locking plate (3-5 holes at the proximal and 2-3 holes at the dis- tal) was perfectly fit to the humeral lateral con- dyle for the support and fixation. If the fixation was not firm, another similar plate was perfect- ly fit onto the capitellar articular surface for the non-slip fixation in the same aforementioned position. The supporting plate should be placed lateral to the humeral lateral condyle. Excellent fracture reduction and appropriate screw length were intraoperatively confirmed in all the patients with the C-arm X-ray apparatus (Figure 1). The wounds were rinsed with normal saline and the elbow flexion and extension functions were examined for the obstruction caused by the protrusion of internal fixation. Unstable elbow valgus stress indicated ulnar collateral ligament injury, which required further inspec- tion or repair as per necessity. Drainage should be adequate to prevent the heterotopic ossifi- cation induced by intra-articular hematocele. The wounds were sutured layer by layer and bandaged while the elbow adjustable brace was adopted to fixate the lesioned limb at a flexion position of 90°.
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