Closed Reduction Method Research Articles

Ultrasound-guided Reduction of Colle's fracture does not assist in Achieving Better Radiographic Indices - Results of a Randomised Controlled Trial.

Ultrasound-guided manipulation and reduction (M&R) of the distal radius fractures (DRF) is believed to improve radiographic indices due to real-time feedback of fracture alignment. The objective of this trial was to compare volar tilt, radial inclination, and radial height on radiographs between Ultrasound guided and conventional (landmark-guided) M&R. A total of 79 distal radius extraarticular fractures in adults were randomised to Ultrasound guided and conventional (landmark-guided) M&R. The radiograph parameters described above were compared before and after M&R in both groups. Except for volar tilt (P=0.05 difference in difference), there was no difference in both the groups on radiograph parameters i.e. radial inclination and radial height. We estimated a reduction in the incidence of malreduction by 49% (Risk ratio 0.51) and an absolute risk reduction of 22% through USG-guided reduction. We evaluated a number needed to treat 4 through USG-directed M&R of DRF to prevent one unacceptable reduction. There were 9 (22%) and 18 (46%) (P=0.70) unacceptable reductions in USG-guided and landmark-guided M&R. Adding USG guidance to conventional landmark-based closed reduction methods is not beneficial for the accuracy of fracture reduction in Colle's fracture. However, improved volar tilt in sonographic-directed M&R needs further studies to determine the clinical significance.

Close Reduction of Supracondylar fracture of humerus in children by Gravity Method

Objective: To evaluate the outcomes of employing a new technique, the gravity method, for the closed reduction of supracondylar humerus fractures (Gartland’s type II and III) in pediatric patients treated at the Trauma Center of Aziz Bhatti Shaheed Hospital Gujrat. Methodology: This descriptive cross-sectional study was conducted at Aziz Bhatti Shaheed Hospital's Trauma Center from August 2022 to April 2023. Children under 12 years old, presenting within 48 hours of injury with closed supracondylar humerus fractures (Gartland’s Extension type II and III), were included. All patients underwent closed reduction and percutaneous pinning. Data analysis was performed using SPSS, employing means and standard deviations for quantitative variables, and frequency and percentage for qualitative variables. Results: The mean age was 5.5 years (±1.5). Among 65 patients, there were 45 males and 20 females, with a male-to-female ratio of 1:0.4. The right humerus was affected in 28 patients (43%), while the left humerus was affected in 37 patients (57%). The gravity method successfully reduced 90% of fractures without the need for an assistant surgeon, resulting in a zero percent incidence of iatrogenic neurovascular injury. The average surgical duration was 20 minutes (ranging from 16 to 24 minutes), with an average of 7 images captured using the image intensifier. In cases where the gravity method failed, alternative closed reduction methods were employed for 10% of fractures; no open reduction was necessary. Conclusion: The gravity method demonstrates safety and efficacy by providing accurate traction for reducing displaced supracondylar fractures without causing damage to the overlying skin or neurovascular structures around the elbow. Its applicability is particularly noteworthy in settings with a shortage of trained medical personnel and limited expertise in managing neurovascular complications.

WITHDRAWN: Concurrent palmar lunate dislocation and posterior elbow dislocation with a distal radius fracture: A rare case report

We present an unusual case involving the simultaneous dislocation of the trans scapho retro lunate in the right wrist and a posterio-lateral dislocation in the right elbow joint in a 23-year-old male. These injuries occurred when he fell onto his outstretched right hand. The elbow dislocation was successfully treated using a closed reduction method. External manipulation was employed to reduce the transscaphoid perilunate dislocation, which was subsequently stabilized through percutaneous screw fixation of the scaphoid using a triquetrum-lunate pin. Additionally, a styloid pin was utilized to address and manage a distal radius fracture, followed by the implementation of a radiometacarpal external fixator. After one year and three months, the patient reported no pain in his elbow and minimal wrist discomfort during heavy lifting.

Comparative Evaluation of Open Reduction with Internal Fixation Against Closed Reduction Methods for Condylar Fracture Management: A Systematic Review and Meta- analysis.

Mandibular fractures are frequent in facial trauma. Management of mandibular condylar fractures (MCF) remains an ongoing matter of controversy in maxillofacial injury. A number of techniques, from closed reduction (CR) to open reduction and internal fixation (ORIF), can be effectively used to manage these fractures. The best treatment strategy, that is, closed reduction or open reduction with internal fixation, remains controversial. The aim of this study is to systematically review the existing scientific literature to determine whether open reduction with internal fixation or closed reduction is a better treatment alternative for the patients with condylar fractures through a meta-analysis. A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases like PubMed, google scholar and Ebsco Host were searched from 2000 to December 2021 for studies reporting management of condylar fractures through open reduction with internal fixation against closed reduction and reporting the outcome in terms of mean and standard deviation (SD). Quality assessment of included case control and cohort studies was performed using Newcastle-Ottawa Scale, and randomized studies were evaluated using Cochrane risk-of-bias (ROB)-2 tool through its domains. The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The standardized mean difference (SDM) was used as summary statistic measure with random effect model and p value <0.05 as statistically significant. Seventeen studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only nine studies were suitable for meta-analysis. The pooled estimate through the Standardized Mean Difference (SMD) of 0.80, 0.36 and 0.42 for maximum inter incisal opening, laterotrusion and protrusion favours CR compared to ORIF for condylar fracture management. Also, most results of heterogeneity tests were poor and most of the funnel plots showed asymmetry, indicating the presence of possible publication bias. The results of our meta-analysis suggest that CR provides superior outcomes in terms of maximum inter incisal opening, laterotrusion and protrusion compared to ORIF in condylar fractures management. It is necessary to conduct more prospective randomized studies and properly control confounding factors to achieve effective results and gradually unify clinical guidelines.

A Countertraction Closed Reduction Technique in Minimally Invasive Fixation of Recent Type C Pelvic Ring Injuries.

Closed reduction of pelvic injuries is a prerequisite and critical step in minimally invasive treatment. Achieving non-invasive closed reduction of pelvic injuries is a challenging clinical problem. This study demonstrated a non-invasive traction technique for closed reduction called countertraction closed reduction technique (CCRT) and evaluated its effectiveness for type C pelvic ring injuries. The data of patients with unstable pelvic fractures treated with CCRT and minimally invasive fixation were retrospectively reviewed from January 2017 to February 2022. Sacroiliac screws were placed to fix the posterior pelvic ring, and internal or external fixation was used to fix the anterior pelvic ring. Operation time, intraoperative blood loss, duration of hospital stay, fracture union and postoperative complications were recorded. Fracture reduction quality was evaluated using the Matta scoring criteria. Functional recovery and general quality of life were evaluated using the Majeed functional scoring criteria. Thirteen patients (nine males and four females), with an average age of 49.6 years were treated with CCRT and followed up for a mean of 18.5 months. The average operation time was 137.2 minutes (range 92-195 minutes), the average intraoperative blood loss was 31.2 mL (range 10-120 mL) and the average duration of hospital stay was 14.3 days (range 4-32 days). All patients achieved bony union with an average union time of 11.9 weeks (range 10-16 weeks). According to the Matta radiographic criteria, the quality of fracture reduction was excellent in eight patients, good in four, and fair in one. The average Majeed functional score was 89.7 (range 78-100). The functional evaluation revealed that the outcomes were excellent in nine patients, and good in four patients. Complications included incision fat liquefaction in one patient, and heterotopic ossification in another patient. There were no surgical complications as a result of CCRT. CCRT is a non-invasive closed reduction method for minimally invasive fixation of fresh Tile C1 and C2 pelvic fractures. The advantages of CCRT combined with minimally invasive treatment include a small surgical incision, reduced intraoperative bleeding, satisfactory fracture reduction, bone healing and functional recovery.

Kirschner Wire Prying and Leverage Technique: a new closed reduction method in treatment of pediatric “Irreducible Supracondylar Humerus Fractures”

BackgroundThis study employs an innovative closed reduction approach to treat pediatric "Irreducible Supracondylar Humerus Fractures" with the goal of demonstrating its practical application compared to conventional methods.MethodsThis study sampled 146 surgically treated cases of "Irreducible Supracondylar Humerus Fractures" in our department. After applying inclusion and exclusion criteria, 120 children were selected and divided into two groups based on treatment methods. Group 1 underwent Closed Reduction and Percutaneous Pinning (CRPP), while Group 2 received treatment using the Kirschner Wire Prying and Leverage Technique alongside CRPP. The relevant data to the study were collected and assessed during the follow-up period.ResultsResults indicate that Group 2 demonstrated significantly shorter operative times and fewer instances of intraoperative fluoroscopy compared to Group 1. Furthermore, the percentage of cases requiring open reduction was notably higher in Group 1 than in Group 2. The analysis also identified age, BMI, time from injury to surgery, and the initial deviation of the distal fragment as independent risk factors associated with the failure of closed reduction.SummaryThe integration of CRPP with the Kirschner Wire Prying and Leverage Technique emerges as a safe and effective strategy for managing "Irreducible Supracondylar Humerus Fractures." This innovative approach not only reduces operative time and intraoperative fluoroscopy needs but also diminishes the reliance on open reduction without compromising safety.

Comparison of Neurosensory Recovery of the Inferior Alveolar Nerve After Open and Closed Reduction for Mandibular Fractures: A Prospective Study.

Traumatic mandibular fractures are the most common fractures of the facial region and are associated with loss of neurosensation in the inferior alveolar nerve (IAN). The present study aimed to compare IAN recovery after traumatic mandibular fractures between the open and closed reduction methods. The study included 90 patients with traumatic mandibular fractures of the body, angle, and symphysis, divided into two groups of 45 patients: group 1 was treated with closed reduction and fixation with rich arch-bar fixation under local anesthesia, and group 2 was treated with open reductionand rigid internal fixation with 2-mm titanium mini plates and monocortical screws (6 mm), and the plate was fixed to the fractured bony fragments. All patients underwent neurosensory testing using the Zuniga and Essick algorithm at baseline (preoperative), one week after surgery (postoperative), at three months, and at six months of follow-up. No statistically significant differences were observed in IAN recovery between the groups. The most common site of fracture was the body (44% in group 1 and 56% in group 2). The maximum recovery was observed in the younger age group (25-30 years). At baseline, functional nerve recovery was observed in 40 cases (88%) in group 1 and 38 cases (84%) in group 2, and the difference was not statistically significant. Levels A and B tests were affected by surgical management and improved after three months.The total recovery in group 1 ranged from 60% to 80%, and that in group 2 ranged from 56% to 72%. Based on the findings of the current study, both methods are recommended for surgical management of traumatic mandibular fractures with IAN recovery in 60-80% of cases six months postoperatively.

Comparison of outcomes of open reduction and internal fixation versus closed reduction and percutaneous pinning in Song type 4-5 pediatric lateral condyle fractures.

Lateral condyle fractures are the second most common peri-elbow fractures in children aged 6-10 years, following supracondylar fractures. In treating these fractures, either open or closed reduction fixation can be performed. However, it is not yet completely clear which type of fracture should be treated and how. The Song classification has been increasingly used by orthopedic surgeons for these fractures in recent years. A review of the literature reveals few studies comparing closed reduction and percutaneous pinning (CRPP) and open reduction and internal fixation (ORIF) in lateral condyle fractures (LCFs) with displacements of 2 mm or more. Based on this, we compared Song stage 4 and 5 fractures operated with open or closed reduction methods in our clinic in terms of radiological and clinical aspects. Patients who underwent surgery in our clinic for Song type 4 and 5 lateral condyle fractures between 2011 and 2016 were included in the study. After obtaining approval from our ethics committee (ID: 00171379117), we retrospectively evaluated the medical records of the patients. Between 2011 and 2016, 213 patients underwent surgery for LCF in our hospital, 24 patients were lost to follow-up, and 78 patients had other types of Song fractures. Our study evaluated 111 patients, who were divided into two groups: the CRPP group and the ORIF group. A total of 111 patients were included in our study, with 52 undergoing CRPP and 59 undergoing ORIF. There was no difference between the groups in terms of age, gender, side of injury, mechanism of trauma, and follow-up time (p=0.962, p=0.198, p=0.706, p=0.526, p=1.000, p=0.708, respectively). There was also no significant difference in the displacement amounts between the patients (p=0.233). In the postoperative radiological comparison, a lateral spur was observed in 12 patients (23%) in the CRPP group and 28 patients (47.5%) in the ORIF group. Hardacre's criteria were evaluated as excellent in 46 (88.4%) of the patients who underwent CRPP and 50 (84.7%) of the patients who underwent ORIF. No significant result was found between both groups (p=0.769). There was no difference in complications between the groups (p=1.000). This study demonstrates that in pediatric patients with lateral condyle fractures displaced by 2 mm or more, the choice between open or closed reduction has minimal impact on medium and long-term outcomes. Since there are not many studies on this subject in the literature, we believe that our results will provide valuable guidance for treatment decisions.

Emergency Management of Symphysis and Right Angle of Mandible Fracture with Laceration Wound at Buccal and Submental Region: A Case Report

Introduction: Fracture of the mandible is a case that is quite commonly found in the ER of The Oral and Maxillofacial Surgery Department at Dr. Hasan Sadikin General Hospital Bandung, fractures of the mandible rank second to fractures of the facial area because it is a prominent bone that is located at the edge and position in the lower third of the face. Emergency management aims to take any appropriate action, prevent complications, and consult other departments involved. Objective: To explain the emergency management of symphysis and right angle of mandible fracture with laceration wound at buccal and submental region. Case report: A manage 21 year came with bleeding from the mouth due to a motorcycle accident approximately 24 hours before admission to the hospital. Physical examination showed asymmetrical face, edema at right cheek region, laceration wound at right cheek and chin region, and multiple abrasive wound at facial region. There were steps, crepitus on symphysis, and right angle of mandible region. Intraoral examination showed laceration wounds on the gingiva. Case management: The laceration area is then sutured both intraoral and extraoral followed by the application of closed reduction in the mandible with interdental wiring at the lower jaw aiming to prevent infection and malunion. The management of soft tissue and hard tissue injury is by reduction, fixation, and immobilization of fractures, management of pain, and administration of antibiotics. Conclusion: The emergency management of symphysis and right angle of mandible fracture with laceration wound at the buccal and submental region is promptly and rapidly carried out with minimal intervention by using closed reduction method gave good results in stability and function before definitive treatment.

A RARE CASE OF FEMORAL COLUMN FRACTURE IN CHILDREN WITH CLOSED REDUCTION AND SPICA CAST: A CASE REPORT

Background: Femoral column fracture is a rare case fracture in children. This is usually caused by high-energy trauma, such as falling from a height, or, in some cases, can also occur due to pathological fractures or repetitive trauma, such as running or jumping. Femoral column fractures can occure several complications, such as avascular necrosis (AVN), coxa vara, malunion, and osteonecrosis. Therefore, appropriate treatment is needed to reduce the risk of complications that may occur. Case Presentation: A 15 year old boy came to the emergency room with complaints of pain in base of his right thigh after falling while jumping over a tennis net with focus on his right leg. On examination, vital signs were normal, pain in the right groin had limited range of motion (ROM), and no other injuries or pain were found in his parts of the body. Then treatment was carried out using the closed reduction method and the installation of a spica cast without internal fixation. Conclusion: Although there is still a lot of controversy regarding the best time and method for administering therapy, determining the Delbet classification is very helpful as a consideration in choosing treatment and patient prognosis. In this case, treatment was given using close reduction and spica cast techniques with the consideration that anatomical reduction could be achieved.

Open and closed reduction methods for intramedullary nailing of femoral shaft fractures: A systematic review and meta-analysis of comparative studies

IntroductionClosed reduction and intramedullary nailing is the preferred surgical intervention for femoral shaft fractures. Open reduction involves opening the fracture site and is performed in various circumstances. Comparative studies of the approaches have conflicting results. We sought to compare the outcomes and complications of open and closed reduction for intramedullary nailing of femoral shaft fractures. Materials and methodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a systematic review of comparative studies included the databases and registers PubMed (Medline), Embase, Scopus, and Cochrane Central (PROSPERO registration ID: CRD42022325382). Additional studies were identified through hand and citation searching. Two reviewers independently extracted data. The standardized mean difference and 95% confidence intervals were determined for continuous variables, whereas odds ratios and 95% confidence intervals were assessed for dichotomous variables. ResultsClosed reduction had a higher pooled union rate (93.93%, 92.02%), an increased odds ratio for union (OR = 1.624 [95% CI: 1.004, 2.624]; p = .048), and a faster time to union (SMD = −0.292 [95% CI: −0.549, −0.0.035]; p = .026). There were no differences in operative time (SMD = 0.128 [95% CI: −0.700, 0.956] p = .762) or overall complication rate (OR = 1.314 [95% CI: 0.966, 1.787] p = .082). ConclusionsClosed reduction has the advantage of higher union rates, quicker time to union, and lower overall infection compared to open reduction for intramedullary nailing of femoral shaft fractures. Open reduction remains a reasonable alternative with acceptable union rates when closed reduction is not feasible.

Closed reduction of chronic protracted bilateral TMJ dislocation using a reduction forcep: case report in a 60-year old woman

Chronic protracted TMJ dislocation refers to a condition in which the joint is displaced from its articulations and fixated in that position (open-locked) without reduction. The Hippocratic maneuver is usually unsuccessful with a high failure rate making treatment of this condition very challenging. This article reported a case of TMJ dislocation not amenable to the traditional closed reduction method but which was successfully treated using the direct application of reduction forceps on the angle of the mandible. The technical aspects of the procedure and post-operative management were also highlighted.

Closed reduction and drainage incision for the treatment of neglected and infected mandibular fractures

Background: Jaw fracture is the most common facial fracture in oral and maxillofacial bone and is usually caused by trauma. The fracture itself could lead to infection due to bone and tissue damage, which is the port of entry for microorganisms. Fracture-related infection (FRI) in the patient discussed in this study manifested as a submandibular abscess. The goals of fracture treatment were achieving the anatomic reduction of the fracture line and regaining acceptable occlusion. There are two methods for treating mandibular fractures: the closed method, also called conservative treatment, and the open method, which requires advanced surgery. Closed method treatment uses a maxillomandibular fixation (MMF) device in order to reduce and immobilize fracture fragments. Treatment of FRI should use a multidisciplinary approach to achieve an outstanding result, such as wound debridement, antimicrobial therapy, and implant retention. Purpose: The purpose of this article is to report a case of neglected mandibular fracture with a submandibular abscess, which was treated with a combination of the closed reduction method and incision drainage. Case: A 25-year-old female visited Nala Husada Hospital because of a submandibular abscess on the neglected mandibular fracture of the right parasymphysis and left corpus. Case management: The case was managed using an arch bar in the mandible and an eyelet in the maxilla while continuing with MMF and an extra oral drainage incision. Conclusion: Combination therapy (MMF and incision drainage) was needed to treat this case because of the occurrence of a submandibular abscess due to a neglected mandibular fracture.

Transoropharyngeal closed reduction for traumatic atlantoaxial dislocation: a novel technique for fast and precise reduction

PurposeThe aim of this study is to introduce a new technique for the rapid and accurate reduction of traumatic atlantoaxial dislocation (TAAD) and to investigate its radiological and clinical outcomes.MethodsThe clinical outcomes of 18 patients who were diagnosed with acute TAAD and underwent rapid transoropharyngeal closed reduction in our hospital were retrospectively analyzed from January 2015 to December 2020. Following general anaesthesia, all patients were immediately treated with oropharyngeal reduction under somatosensory evoked potential monitoring. The Japanese Orthopedic Association score, neck disability index and visual analog scale score for neck pain were used to evaluate clinical efficacy. Atlantodental distance, posterior atlantodental interval, and the clivus-canal angle were used to assess reduction and spinal cord compression.ResultsThe mean follow-up time was 23.3 months, with a range of 13–38 months. No neurovascular injury occurred during the operations. For all patients, the closed reduction method through the oropharynx under general anaesthesia was successful, and the success rate of reduction was 100%. All patients recovered uneventfully with marked improvement in clinical outcomes and imaging parameters (P < 0.01). Two patients developed mild postoperative dysphagia. One patient developed postoperative fever and pulmonary infection.ConclusionRapid trans-oropharyngeal closed reduction can safely, effectively, and rapidly reduce acute TAAD. This method provides a new strategy for treatment of the condition.

A Retrospective Observational Study of Paediatric Mandibular Fractures: Demographics, Pattern and Challenges of Management in a Nigerian Population

Abstract Background: Paediatric mandibular fractures unlike adult mandibular fractures are said to be rare. When not recognised early, they may be associated with significant problems such abnormal mandibular growth. Materials and Methods: This was a retrospective observational study of paediatric patients with mandibular fractures presenting to a university teaching hospital from August 1999 to December 2019. Information sourced from patient’s case notes and operating records included age, sex, aetiology, investigation, concomitant injuries, treatment and complications. The retrieved data were recorded in a personal computer, analysed with appropriate statistical tool and presented in tables and figures. Results: A total of 550 patients who presented with mandibular fractures within the period of the study constituted the study population. Of these, 84 (15.3%) occurred in the paediatric age group. The ages of the patients ranged from 1 to 17 years with a mean age of 10.3 ± 5.0 years and there was a gender ratio (male: female) of 1.9:1. Road traffic accident accounted for most mandibular fractures. The imaging modality used in assessing mandibular fractures was mainly plain radiography and treatment was administered in 60 (71.4%) patients, with closed reduction method (n = 45; 75.0%) being the most frequent technique used. The period of hospital stay ranged from 3 to 90 days with a mean of 16.8 days. Conclusion: Mandibular fractures in paediatric population were noted to be more common in males and the main aetiology was pedestrian-related road traffic accidents. There is a need for continual review of injury prevention strategies in the paediatric group.

Prefabricated Acrylic Cap Splint: A Minimally Invasive and Conservative Intervention for Paediatric Mandibular Fractures: A Case Report

Dental traumatic injuries in paediatric patients result in a painful experience for both the parents and the child. Although children may exhibit similar fracture patterns as seen in adult traumatic injuries, there are various factors to consider when treating fractures in paediatric patients, which pose challenges for paediatric dentists. There are numerous treatment options available for managing maxillofacial fractures, such as open reduction, closed reduction, immobilisation with open or closed cap splint, with or without circummandibular wiring, and the use of mini plates, among others. In this present case report, a five-year-old child presented with multiple step deformities in the mandible. Since the patient had deciduous dentition, the main concerns were the high possibility of disruption to the periosteal envelope, which could affect the growth of the mandibular processes, and damage to developing permanent tooth buds. These were key considerations when planning the appropriate treatment. Taking into account these potential complications associated with other invasive procedures, a minimally invasive conservative management approach was chosen for the child, which proved to be highly successful and cost-effective. Undisplaced fractures in paediatric patients should always be treated or stabilised using the closed reduction method.

Open versus closed treatment for extracapsular fracture of the mandibular condyle.

Selection of treatment methods for mandibular condylar fractures remains controversial. In this study, we investigated treatment methods for condylar fractures to determine the indications for open or closed reduction. Patients and. Patients >12 years of age treated for mandibular condylar fractures with a follow-up period of ≥3 months were included in this study. The medical records of enrolled patients were reviewed for sex, age, fracture site, treatment method (open or closed reconstruction), postoperative intermaxillary fixation period, operation time, and complications. Radiological analysis of fracture fragment displacement and changes in ramal height difference was performed using computed tomography and panoramic radiography. A total of 198 patients was investigated, 48.0% (n=95) of whom underwent closed reduction and 52.0% (n=103) underwent open reduction. There was no significant correlation between reduction method and patient sex, age, or follow-up period. No statistically significant difference between the incidence of complications and treatment method was observed. None of the patients underwent open reduction of condylar head fracture. Binary logistic regression analysis showed that open reduction was significantly more frequent in patients with subcondylar fracture compared to in those with a fracture in the condylar head area. There was no statistically significant correlation between the groups and fracture fragment displacement. However, there was a significant difference between the treatment groups in amount of change in ramal height difference between the fractured and the nonfractured sides during treatment. No significant clinical differences were found between the open and closed reduction methods in patients with mandibular condylar fractures. According to fracture site, closed reduction was preferred for condyle head fractures. There was no significant relationship between fracture fragment displacement and treatment method.

Transpharyngeal closed reduction displacement of the first cervical vertebra in children

BACKGROUND: Currently, the treatment of children with atlantoaxial rotational block has no standard protocol. The proposed conservative methods are difficult and require long-term hospitalization, whereas surgical treatment is associated with a risk of complications.&#x0D; AIM: This study aimed to develop and evaluate the effectiveness of the transpharyngeal closed reduction method for first cervical vertebral displacement in children.&#x0D; MATERIALS AND METHODS: The study presents the analysis results of clinical cases of 46 children with atlantoaxial rotational fixation with types III subluxations by Fielding and Hawkins the CI transpharyngeal closed reduction method. The average age of the patients was 4.5 2.6 years. The time of admission of patients after the disease onset varied from 1 to 30 days. The reduction technique consisted of the following elements: 1. A bracket is installed for traction behind the skull along the axis; 2. The surgeon pulls the bracket along the axis, while using the index finger of the other hand in the oropharynx fixes the anterior arch of the atlas, creating a fulcrum; 3. Rotational displacement of the atlas is eliminated by rotational movements with simultaneous traction along the axis; and 4. The anatomical position of the atlas and axis is controlled by an X-ray image intensifier.&#x0D; RESULTS: Only in one case of recurrent dislocation was noted after 4 days. The efficiency of primary reduction was 97.8%. Pain syndrome on the visual analog scale was reduced by 62.3%. Neurological deficit recurrence was not noted. The average bed-day was 2.5 1.3 days.&#x0D; CONCLUSION: Transpharyngeal closed reduction method for first cervical vertebral displacement in children of the younger age group is effective for atlantoaxial rotational fixation treatment in early admitted patients, which determines the prospects for its wider application in the practice of specialized hospitals.

Outcome of open reduction and Kirschner wire fixation in pediatric radial neck fracture.

BackgroundRadial neck fracture in children is rare. This study attempted to evaluate the outcome of surgically treated patients and any associated complications.MethodsThis study evaluated 23 children under 15 years of age with radial neck fracture who were treated with open reduction between 2006 and 2016 to determine their range of motion, postoperative complications, and radiographic outcomes. The results were assessed clinically using the Mayo clinic elbow performance score.ResultsThe mean follow-up duration for patients was 34.6 months. The average postoperative angulation was 3.6º. Hypoesthesia was reported in only 9% of patients, and none of the patients complained of postoperative pain. The postoperative X-ray results were excellent in 60% and good in 40%. No radiographic complications were identified. The elbow score was excellent in 87% and good in 13% (mean score, 96.74). There was a statistical relationship between range of motion limitations and age, degree of fracture, initial displacement, and surgical pin removal time.ConclusionsAlthough most patients accept the closed reduction method as a primary treatment, the present study suggests that an open-reduction approach has been associated with optimal therapeutic outcomes for patients in whom closed reduction was not satisfactory or indicated.

Open Reduction With Internal Fixation in Locked Pubic Symphysis: A Case Presentation

Regarding the fact that lateral compression is usually not the underlying mechanism of fracture, Locked pubic symphysis is a very rare injury. At most times it can be managed with closed reduction method; however, open reduction with or without internal fixation may sometimes be required. In rare cases, osteotomy is the only choice. Urethral or bladder damage can occasionally be found. In this study, we presented a case of locked pubic symphysis with failed closed reduction who underwent successful open reduction with internal fixation.