Plaster Slab Research Articles

Management of Supracondylar Fractures of the Humerous in Children

Background: Supracondylar humeral fractures (SFH) are the most common fractures of the pediatric elbow, having a peak frequency between the ages of four and nine years. The majority of surgical therapy is percutaneous pinning and closed reduction. The present study aimed to determine the outcome of close reduction and percutaneous pinning in managing the supracondylar humeral fractures in children. Patients and Methods: A total of 64 children presented with supracondylar humeral fractures to the Orthopaedics Unit of Bacha Khan Medical Complex, Swabi during the period from 16th February 2022 to 15th November 2022. Children with supracondylar humerus fractures of completely displaced (Gartland Type III) were enrolled whereas neurovascular injury related to open or closed Gartland type-III fracture were excluded. Under general anesthesia, close reduction was accomplished, and the elbow was immobilized in extension by the implantation of two plaster slabs. The type of fracture, injury pattern, time from injury to final therapy, surgical treatment, and consequences were all recorded. Results: The overall mean age was 4.89±3.2 years. Of the total 64 SFH cases, there were 52 (81.3%) male and 12 (18.7%) females. Out of 52 (81.3%) children with pulseless hands, the incidence of Gartland type III and IV was 15.4% (N=8) and 84.6% (N=44) respectively. Out of 52 cases, there were 19 (36.5%) cold hands and 33 (53.5%) warm hands. The overall mean time between injury and presentation was 3.8±2.4 hours. The incidence of patients undergoing autologous interposition venous grafting, vascular reconstruction, and segmental resection and primary anastomosis was 25% (N=16), 59.4% (N=38), and 15.6% (N=10) respectively. There were no amputations, fasciotomies, re-explorations, or long-term ischemic sequelae. Conclusion: The present study found that close reduction and immobilization with two slabs is a safer and effective method for superior outcome of managing supracondylar humeral fractures in uncomplicated type III injuries as compared to flexion approach. Additionally, Rapid vascular exploration might effectively treat both cold and warm pulseless hands. Keywords: Supracondylar humeral fractures, Management, Children, Close reduction approach

Historical masonry wallets with plaster slabs strengthened by CrFRM and GFRP

Historical masonry wallets with plaster slabs strengthened by CrFRM and GFRP

Historical masonry wallets with plaster slabs strengthened by CrFRM and GFRP

Historical masonry wallets with plaster slabs strengthened by CrFRM and GFRP

Pure Obturator Dislocation of the Hip, a Rare Variety of Regular Dislocations, and Long-Term Clinical Outcomes

Introduction: Traumatic knee dislocation is considered an orthopedic emergency. Knee dislocations are relatively infrequent injuries. This injury frequently occurs from high-energy impact trauma. Neurovascular injuries can result in debilitating consequences if the diagnosis and treatment are delayed. Associated complications include degenerative arthritis, permanent neurovascular injury, and amputation. The poorest prognosis is seen in patients with knee dislocation longer than 6-8 hours before reduction. History: The 25-year-old male patient presented with a history of a road traffic accident to the emergency department. The patient presented with swelling, pain, and deformity of the left knee and leg. Examination: On examination, the patient had tense swelling and tenderness of the left knee joint and leg. Visible deformity of the left knee joint is seen. The posterior tibial artery and dorsalispedis artery were not palpable. Active ankle and toe movements were absent. Investigations: Plain radiograph was taken at the emergency department of the left knee and leg. X-rays showed anterior dislocation of the knee joint. Treatment: After valid written informed consent, the dislocated left knee joint was reduced under sedation in the operation theatre and immobilized in the above knee plaster slab. Reduction of the knee joint was done within 4 hours of injury. Then the distal pulses were re-assessed. The posterior tibial and dorsalispedis artery was absent. Hence, MR Angiography of the left lower limb was done. It showed popliteal artery transection. So, the artery was explored and end-to-end vascular anastomosis was done. A knee-spanning external fixator was applied to the left lower limb. Fasciotomy was done for the tense leg compartments. After a week, the fasciotomy wounds were infected for which extensive debridement of the wounds was done and antibiotic beads were placed. Knee was mobilized with a gradual range of motion exercises and non-weight bearing mobilization with a foot drop splint. Gradually full weight-bearing ambulation was allowed. Conclusion: Knee dislocation is rare, albeit a serious and potentially limb-threatening condition. The prognosis of knee dislocations is variable and is heavily dependent on the time interval between trauma and initiation of management. Immediate, timely, and proper management can salvage the limb, and amputation is not the only solution. Keywords: Dislocation, Posterior tibial artery, Fasciotomy

The Reinforced Ma-Griffith Method Combined with Minimally Invasive Small-Incision Suture for Acute Achilles Tendon Rupture.

ObjectiveTo evaluate the treatment effects of the reinforced Ma‐Griffith method combined with a minimally invasive small incision(M‐G/MISI) in the treatment of acute Achilles tendon rupture.MethodsFrom January 2012 to January 2020, a retrospective study was carried out on thirty‐one patients with acute Achilles tendon ruptures that were treated using the M‐G/MISI. Patient with acute Achilles tendon rupture was operated on in the prone position. The M‐G/MISI begin with making a small incision to debride the stumps of ruptured tendon. Then M‐G/MISI was used to suture the distal and proximal Achilles tendons with the help of a epidural puncture needle and polydioxanone synthetic absorbable suture (PDS) Ⅱ line. Finally the stumps of ruptured tendon was reattached. After the surgery, the affected limb was fixed with either a plaster slab below the knee brace or a functional brace. Removal of plaster external fixation and partial weight‐bearing with crutches five weeks after the operation; Complete weight‐bearing nine weeks after the operation; jogging permitted 12 weeks after the operation; Patients were allowed to resume normal activities six months after the operation.ResultsAll 31 patients in this study were male. Nineteen of these patients had Achilles tendon rupture on the right lower extremity, while 12 had ruptures on the left lower extremity. The patients had a mean age of 33.35 ± 7.13 years (range, 18‐52 years). The mean operation time was 79.58 ± 22.67 minutes (range, 40‐167 minutes). The mean time from injury to operation was 4.19 ± 2.01 days (range, 1‐8 days), and the mean hospital stay was 9.87 ± 3.88 days (range, 5‐22 days). The new technique had a small incision with a mean length of 3.94 ± 1.82 cm (range, 2‐6 cm). The mean intraoperative blood loss was 16.77 ± 13.76 mL (range, 10‐50 mL) and the mean follow‐up time was 21.35 ± 10.18 months (range, 6‐50 months). No wound infection, fistula, skin necrosis, sural nerve damage, deep venous thrombosis or tendon re‐rupture was found. One year after the surgery, all patients reported 97.00 (range, 93‐100 points) AOFAS ankle‐hindfoot score points and the mean ATRS was 97.39 (range, 91‐100) points.ConclusionThe reinforced Ma‐Griffith method, combined with a minimally invasive small incision suture, is a simple, effective, minimally invasive technique and low‐cost surgical method for the treatment of acute Achilles tendon rupture.

English

BACKGROUND The various factors involved in Monteggia fractures treated by open reduction and internal fixation (ORIF) were studied in patients presenting to Government Medical College, Trichur. Its distribution based on age, gender, and nature of trauma, were observed in the patients. METHODS This study was a prospective descriptive study, conducted in Department of Orthopaedics, Medical College, Thrissur from 1, January, 2016 to 1, July, 2017. Patients were assessed according to age, sex, side of injury, co-morbidities and final functional assessment was made according to Broberg and Morrey score. A total of 37 patients were observed. The patients were assessed, deemed fit for the study, and subjected to operation. Radial head reduction, fixation if needed, then ulna fracture was opened, reduced, and fixed with plate and screws. Postoperative plaster slab was applied, then converted to full above elbow cast, and retained for as long as needed. Post-operative mobilization was by home physiotherapy only. RESULTS Our study showed that open reduction and internal fixation of ulna outcome in Monteggia fractures leads to good elbow function and minimal loss of physical capacity. Immobilization of more than 2 months have very high chances of elbow stiffness. Early active mobilization after surgery is necessary for good functional outcome. Other than mild stiffness and loss of range of motion in some cases, very few other complications were found in our series. CONCLUSIONS Rigid internal fixation of ulna and early active mobilization is the key to achieve a good functional outcome and minimal loss of physical capacity in Monteggia fractures. Very few of the complications that were described in the literature were seen in the study. Even with restricted resources and minimal facilities, almost no permanent or debilitating morbidity or complications were seen in our series. Early active mobilization after surgery was the most important deciding factor for good functional outcome. Prolonged immobilization of more than one month consistently produces poor results. KEYWORDS Monteggia, Broberg and Morrey, Bado Classification, Internal Fixation, Ulna Fracture

Establishing Safety Parameters for Orthopaedic Cast Saw Blade Usage.

The incidence of injuries from cast saws during cast removal ranges from 0.12% to 4.3%. With 1 second or less of exposure time, a temperature of 65°C can cause partial thickness burns. Despite numerous studies that recommend avoiding the use of a dull blade, there is no objective measure of what defines dullness. Plaster and fiberglass casts were collected and measured after removal from patients in the clinic. A series of slabs were constructed based on these measurements. To simulate our emergency department setting, a Stryker 940 cast saw without an attached vacuum was used to split plaster slabs. A thermocouple was used to directly measure the 940-23 ion-nitride saw blade temperature after each use. To simulate our orthopaedic clinic setting, a Stryker 940 cast saw with an attached vacuum was used to split fiberglass and plaster slabs. Three blades were tested in each setting, bivalving 50 slabs each. For the plaster slabs split without a vacuum, average blade temperature of the 3 blades reached 65°C on the 42nd cast. However, the individual blades exceeded 65°C on the 33rd, 31st, and 38th casts, respectively. For the fiberglass and plaster slabs split with a vacuum, average blade temperature reached a maximum of 57.5°C in the first 50 trials. Extrapolating from this data, the blade is predicted to exceed 65°C on the 104th cast. When a Stryker 940 cast saw without vacuum is used to cut plaster casts, the ion-nitride blade should be changed frequently, at minimum after 60 casts have been split, or 30 casts have been bivalved. When a Stryker 940 cast saw with vacuum is used to remove fiberglass and plaster casts, the ion-nitride blade should be changed after removing 103 casts. A cast saw with an attached vacuum should be used whenever possible to minimize the risk of burning patients. Determine how often a cast saw blade should be changed to minimize risk of burning patients.

Study of outcome of knee joint in patients with fracture distal femur versus fracture ipsilateral femur and tibia

The posture on the two wheeler at the speed we travel, makes knee the vulnerable joint of all in any of the mishaps. We as orthopedic surgeons see the fractures around the knee joint as one of the most studied concept in the subject. This is a prospective study conducted, over 2 years, in Krishna Institute of Medical Sciences, Deemed to be University, Karad. In this study, 20 cases of fracture distal femur and 20 cases of ipsilateral fracture femur and tibia were studied to evaluate outcome of knee joint and post surgical stabilization of fractures. The fractured limb was stabilized with splinting the limb in Thomas splint or plaster slab. The type of fracture, type of fracture fixation, duration of hospital stay, time of union and time to start weight bearing are evaluated. According to Neer’s score, Good outcome was found in both Fracture Distal femur and Ipsilateral Fracture Femur and tibia. The functional outcome was found to be better in diaphyseal fractures femur and tibia treated with intramedullary interlock nailing which allowed early mobilization and weight bearing than in intra-articular fractures treated with plating. Bony union occurred early in closed, diaphyseal and simple transverse or oblique fractures and delayed in open, intraarticular and comminuted fractures.

Perception of medical interns towards the skills they acquired.

. The undergraduate medical course in India is for five-and-a-half years. Every medical student has to undergo compulsory rotating residential internship for 12 months. During this period, interns acquire skills under supervision. The literature shows they have limited experience and confidence in performing basic and emergency procedures. We assessed interns' perception of their experience and competence. . We did a questionnaire-based cross-sectional study among medical students after they had completed their internship to reflect on their experience and competence in various procedural skills. A questionnaire (25 questions) based on knowledge and skills was piloted by 15 interns and was reliable (Cronbach alpha 0.9). The Likert scale ranged from never observed to performed independently under supervision. . Seventy-eight of 80 interns responded; 51 were females (65.3%). Three-quarters of interns felt they could independently carry out venous blood sample collection, arterial blood gas interpretation, Pap smear specimen collection and digital rectal examination, but only half felt that they could do a lumbar puncture, cervical dilatation and collection of throat swab. Parenteral drug administration, catheterization, nasogastric tube insertion and cardiopulmonary resuscitation were done confidently by over 90%, but vaginal delivery and application of a plaster slab required assistance. The majority said that they had observed drainage of abscess, excision of sebaceous cyst and endotracheal tube intubation. . Most interns felt that they were competent in performing simple surgical tasks independently. However, conducting a vaginal delivery and endotracheal tube intubation were tasks that needed more support.

Evaluation of Functional Outcome of Elbows after Resection Arthroplasty of Failed Total Elbow Replacement.

Background:Recovery of elbow function is a challenging problem following resection arthroplasty after failure of total elbow prosthesis. The objective of this study is to evaluate long term functional outcome in a series of such patients.Materials and Methods:Nineteen patients with twenty elbows who had failed total elbow arthroplasty (TEA) following the use of Baksi total elbow prosthesis needed removal of prosthesis during the period from 1978 to 2003. As two patients were lost to followup, 17 patients with 18 elbows (bilateral in one) were included in this study with a mean age of 44.3 years. Nine cases had uncontrolled infection, seven cases of aseptic loosening including one occurred after TEA for bilateral postburns ankylosis, and two had broken humeral stems. After removal of the prosthesis and its adjacent surrounding bone cement, the cut ends of humerus and ulna were approximated with number 5 Ethibond suture. Postoperatively, the elbow was immobilized in a plaster slab in 110° elbow flexion for 6 weeks followed by physiotherapy. The patients were evaluated for 15–19.4 (mean 16.3) years where functional results were compared at 10 years and 15 years following resection arthroplasty.Results:The resected elbow initially remained flail but gradually regained stability, especially in the sagittal plane. Both the groups showed overall improvement from preoperative Mayo Elbow Performance Score (MEPS) 26.5 to postoperative mean MEPS at 10 years (69.6) and at 15 years (70) (P = 0.001). Postoperative mean DASH score was 36.62 at 10 years’ and 36.38 at 15 years’ followup, suggesting persistence of function of resected elbow in the passage of time. The results were good in 9 (50%), fair in 7 (38.8%), and poor in 2 (11.1%) patients. None had recurrence of infection. Transient ulnar nerve palsy was seen in three patients. Postoperatively, power of Biceps recovered up to Medical Research Council grade 4 and Triceps 2–3.Conclusion:Resection arthroplasty of elbow provided acceptable functional recovery in our series of patients with failed elbow prosthesis.

Results of bridging LCP along with corticocancellous autogenous bone graft and calcium hydroxyapatite blocks in gap nonunion of long bones

<p class="abstract"><strong>Background:</strong> High-energy trauma is an important cause of compound fractures of long bones that in turn results into bone gap due to bone loss or high communition with resultant displacement of minute fracture fragments and hence non-union. Bone resorption or surgical excision for infection or tumour also leads to gap non-unions.</p><p class="abstract"><strong>Methods:</strong> Forty-one patients having fracture of long bones of extremities with a bone gap of upto 2 inches were enrolled and were treated with autogenous bone grafting and calcium hydroxyapatite (CHA) blocks along with fixation by a locked compression plate (LCP) and plaster slab. The average follow-up period was ten months. One patient was excluded from the study due to drop out from follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> In 23 (57.5%) patient’s radiological union occurred by 24-26 weeks. In 16 (40%) patients, radiological union was seen between 26-28 weeks, while in one (2.5%) patient union was seen at 30 weeks. Also, it was seen that smaller the length of gap, the faster was the union. Excellent results were seen in the majority of 25 patients (62.5%), good results in 11 patients (27.5%), fair results in 3 patients (7.5%) and poor outcome in 1 patient (2.5%). Also, it was seen that smaller the gap size, better was the outcome.</p><p class="abstract"><strong>Conclusions:</strong> The technique of bridge plating using internal fixator i.e. LCP along with autogenous corticocancellous bone graft and CHA blocks is a fairly good technique to treat gap non unions. It has its own advantages of avoiding complications associated with large external frame constructs. However, larger gap size limits the usefulness of this technique.</p>

Non-union of paediatric carpal fractures: A case report and current concepts review

Introduction Paediatric carpal bone fractures are rare, and usually secondary to significant direct trauma. Diagnosis can commonly be missed or the significance of the injury not completely recognised on presentation. During development, the ossification centre of each individual carpal bone is surrounded by a spherical growth plate. This acts as a protective barrier against injury. As the child reaches adolescence the critical bone-to-cartilage ratio is reached, and so, carpal bone fractures start to become more common. Case description A 12 year-old boy presented to the emergency department with right wrist pain following a fall from his bicycle while travelling at speed. The impact was sustained directly on to an outstretched hand, resulting in a closed injury. Radiographs demonstrated a dorsally displaced Salter-Harris III fracture of the distal radius with associated displaced fractures of the ulna styloid and lunate. The patient reported reduced sensation and tingling in the thumb, index and radial aspect of middle finger consistent with the distribution of the median nerve. Motor supply was intact. The fracture was initially mobilised with a dorsal plaster slab. The patient was taken to theatre the following morning for manipulation under anaesthetic and plaster immobilisation. Satisfactory reduction of the distal radius fracture was achieved with the lunate and ulnar styloid fractures not addressed. Median nerve symptoms improved somewhat following the procedure but did not completely resolve. At 10 days post-operatively check radiographs demonstrated the distal radius fracture reduction to be maintained and the plaster cast was changed to a lightweight below elbow full cast which remained in situ for 6 weeks. Radiographs at 6 weeks demonstrated union of the distal radius fracture but no signs of healing of the ulnar styloid or lunate fractures. Median nerve sensory symptoms had improved. The cast was removed and range of motion exercises begun. An MRI was performed showing a non-united fracture of the lunate without signs of avascular necrosis. The patient is now 6 months post-op and currently asymptomatic with a full painless range of motion. He has returned to his pre-morbid level of function being actively involved in physical education at school and reports no pain in the wrist or functional deficit. Radiographs continue to demonstrate a lunate non-union. Results and Conclusions Paediatric lunate fractures are very rare, and as a result there is very little published literature available. Previous case reports have demonstrated good long-term results from both conservative and operative management of paediatric carpal fractures. A case report by Bhatnagar et al. highlighted a good clinical outcome with non-operative treatment of an active 11-year old boy with multiple carpal fractures. They demonstrated asymptomatic full range of motion of the wrist at 3 years follow-up, despite CT at this stage showing non-union of a hamate fracture. Similarly, there have been good clinical outcomes with operative management. Kamano et al. showed effective results in a child with multiple carpal fractures treated with wire fixation followed to twenty-nine months. In 2009, Foley et al. also demonstrated similar outcomes in a 10-year old boy treated with Kirschner wires. In this patient, bone union was achieved and there was pain free full range of movement of the wrist at 1 year follow-up. In our case, we pursued a conservative approach to management based solely on the patient’s symptoms. The questions that however remain are: – whether this lunate fracture may progress to a delayed union and should we thus follow up the patient until this occurs? – if union does not occur will this result in long term detriment to wrist function or chronic pain? – should a delayed ORIF with bone grafting be performed simply to achieve union or should it be performed only in the presence of symptoms? – should lunate fixation have been performed at the primary operation? Take home message • Paediatric carpal fractures are rare and are commonly missed and possible underestimated. • No evidence exists on the specific management of paediatric lunate fractures and asymptomatic non-union in these patients. • No long term studies provide the possible sequelae of carpal fracture non-union in children. • We present a conservative management approach based on the patient’s symptoms which appears successful in the short to mid-term, however we are unable to comment on the long term prognosis.

English

Objectives: To determine the outcome of close reduction and conservativemanagement in closed humeral diaphyseal fracture in terms of normal union and delayedunion. Study design: Descriptive case series. Setting: Orthopedic Department of Allied andDHQ Hospital Faisalabad. Duration of study: 15th December 2012 to 15th December 2014.Material & Methods: 170 patients with mean age of 36.68 ± 14.16 including 98 (57.6%)males and 72 (42.4%) females falling in inclusion criteria were managed conservatively withthe technique i.e. application of u-shaped plaster slab initially for 3 weeks then replaced byhumeral brace (Sarmiento) uptil 12 weeks. Results: 170 patients with mean age of 36.68 ±14.16 including 98 (57.6%) males and 72 (42.4%) female patient. Simple transverse fractureswere 103 (66.47%), spiral fractures 31 (18.23%) and oblique fractures 36 (15.30%). Unionwas achieved in 158 patients (92.94%), 12 patients (7.05%) progress to delayed union. Meanhealing time was 10 weeks ± 1.81 with a range of 7 to 15 weeks. Conclusion: When choosingconservative methods close reduction and conservative management initially with u-slab ofplaster of paris later replaced by humeral brace (Sarmiento) is the treatment of choice becauseof low complication but very high success rates.

HUMERAL DIAPHYSEAL FRACTURE;

Objectives: To determine the outcome of close reduction and conservativemanagement in closed humeral diaphyseal fracture in terms of normal union and delayedunion. Study design: Descriptive case series. Setting: Orthopedic Department of Allied andDHQ Hospital Faisalabad. Duration of study: 15th December 2012 to 15th December 2014.Material & Methods: 170 patients with mean age of 36.68 ± 14.16 including 98 (57.6%)males and 72 (42.4%) females falling in inclusion criteria were managed conservatively withthe technique i.e. application of u-shaped plaster slab initially for 3 weeks then replaced byhumeral brace (Sarmiento) uptil 12 weeks. Results: 170 patients with mean age of 36.68 ±14.16 including 98 (57.6%) males and 72 (42.4%) female patient. Simple transverse fractureswere 103 (66.47%), spiral fractures 31 (18.23%) and oblique fractures 36 (15.30%). Unionwas achieved in 158 patients (92.94%), 12 patients (7.05%) progress to delayed union. Meanhealing time was 10 weeks ± 1.81 with a range of 7 to 15 weeks. Conclusion: When choosingconservative methods close reduction and conservative management initially with u-slab ofplaster of paris later replaced by humeral brace (Sarmiento) is the treatment of choice becauseof low complication but very high success rates.

Bone stress stimulation to promote bone formation and scaffold degradation in rabbit tibial defects

Objective To explore if postoperative rapping by a bone stress stimulator can accelerate bone formation and degradation of deproteinization bone (DPB) scaffolds in rabbit tibial defects. Methods A segmental bone defect of 5 mm long was created in the middle of the right tibial shaft in 30 New Zealand rabbits which were randomly divided into 3 groups. The defects were stabilized with a plate and screws. In group A (n=12), the bone defect was filled with a DPB matrix scaffold and stimulated by rapping by a bone stress stimulator. In group B (n=12), the defect was just filled with a DPB scaffold. In group C (n=6), the defect was left untreated. The right lower limbs of all the rabbits were fixated with a plaster slab after operation. Lane-Sandhu X-ray evaluation system was used to evaluate the bone healing process by X-ray ex-aminations at 2, 4, 8 and 12 weeks. The osteogenesis and biodegradation speed of the scaffold were evaluated using histological quantitative analysis at 4 and 12 weeks. Results The mean Lane-Sandhu X-ray scores in group A were significantly higher than in groups B and C at all the time points (P< 0.05). At 12 weeks, the bone defects in group C were not repaired, showing successful modeling of bone defects. HE staining showed that at 4 and 12 weeks postoperation the rates of new bone formation area in group A (25.4±4.2% and 38.6%±6.3%) were significantly greater than in group B (7.6%±2.2% and 20.4%±4.2%) (P< 0.05), and the rates of residual DPB area in group A (15.1%±3.7% and 1.3%±0.9%) were signifi-cantly lower than in group B (27.5%±2.4% and 19.7%±4.2%) (P < 0.05). Conclusion Rapping by a bone stress stimulator is effective on promoting callus formation and DPB degradation in the rabbit tibial defects. Key words: Animal experimentation; Osteogenesis; Physical stimulation; Stress, mechani-cal; Scaffolds

Pediatric forearm fractures with tens: freedom of movements

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; A prospective analysis of a case series of diaphyseal forearm fractures in children treated with titanium elastic nails is presented. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Between 2012 and 2014, 30 children aged 5-15 years with displaced diaphyseal forearm fractures underwent titanium elastic nailing. Both bones were fractured in 25 patients, four fractured only the radius, and one experienced ulna fracture. Eleven candidates had unstable irreducible fractures, 13 had loss of reduction, and six had open fractures. Titanium elastic nails were used to stabilize the fractures. All fractures were immobilized postoperatively with an above-elbow plaster slab for 2 weeks till the swelling is completely resolved followed by encouraging range of motion exercises.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Closed reduction and TENS was successful in 20 cases, including 15 double-bone fractures and five single-bone fractures. Open reduction was completed in four fractures of both bones, and in six single-bone open fractures. Bone union was achieved in all patients at an average of 7 weeks. The ROM of the forearms was evaluated using the Daruwalla grading criteria. Excellent results were reported in 96% without significant complications after a mean follow-up of 20 months.&lt;/p&gt;&lt;p class="Default"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Titanium elastic nails fixation of pediatric forearm fractures revealed several advantages, a small incision for insertion, a low rate of complications, unhindered bone healing, and good clinical and radiological results thus achieving maximum range of motion at the earliest.&lt;/p&gt;

Proximal carpal row carpectomy

Resection of the proximal carpal row, termed proximal row carpectomy (PRC), is performed in order to treat pathologies of the proximal carpal row or radiocarpal joint between the scaphoid and scaphoid facet. It entails the articulation of the capitate and the lunate facet. Lunate necrosis, carpal collapse, joint infection with concomitant intercarpal ligament lesions. Severe cartilage lesions of the lunate facet and the capitate, wrist capsule laxity, rheumatoid arthritis, neuromuscular dysbalance of the wrist-covering soft tissue structures. Dorsal approach to the wrist, incision of the third and fourth extensor compartments, resection and coagulation of the dorsal interosseous nerve, usage of aligament-sparing capsule incision, identification of the proximal carpal row and inspection of cartilage of the lunate facet and capitate, mobilization and excision of the lunate, scaphoid and triquetrum, articulation of lunate facet and capitate is controlled clinically and fluoroscopically, wound closure, application of plaster slabs. Immobilization of the wrist on plaster slabs for 2weeks, removal of sutures after 14days. PRC is asurgical procedure with few complications. Satisfactory range of motion and grip strength could be preserved without limiting function of the upper extremity. Postoperative osteoarthritis of capitate and lunate facet did not correlate with the good clinical outcome.

Adherence behavior in an acute pediatric hand trauma population: A pilot study of parental report of adherence levels and influencing factors

IntroductionDescriptive and cross-sectional study. Purpose of the StudyThe hand is a common site of injury in children; however, little is known regarding adherence to hand trauma management in this population. PurposeThis pilot study aimed to describe adherence to plaster slab immobilization, advice regarding return to sport, appointment attendance, and the factors influencing nonadherence. MethodForty-seven parents of children with hand trauma completed an online questionnaire reporting their child's adherence to the initial medical management. ResultsParents reported that 34% (16 of 47) of children were adherent to all aspects of management. Nonadherence with plaster slab immobilization was reported by 38% (18 of 47), and 45% (21 of 47) reported nonadherence with advice regarding return to sport. Hygiene, discomfort, and restriction were the most common reasons for plaster removal. Belief that sport would not cause harm and social factors influenced return to sport against medical advice. ConclusionNonadherence behavior is commonly reported in children with acute hand trauma. Level of evidence4.

The Rubber Stopper: A Simple and Inexpensive Technique to Prevent Pin Tract Infection following Kirschner Wiring of Supracondylar Fractures of Humerus in Children.

Percutaneous pinning after closed reduction is commonly used to treat supracondylar fractures of the humerus in children. Minor pin tract infections frequently occur. The aim of this study was to prevent pin tract infections using a rubber stopper to reduce irritation of the skin against the Kirschner (K) wire following percutaneous pinning. Between July 2011 and June 2012, seventeen children with closed supracondylar fracture of the humerus of Gartland types 2 and 3 were treated with this technique. All patients were treated with closed reduction and percutaneous pinning and followed up prospectively. Only one patient, who was a hyperactive child, developed pin tract infection due to softening of the plaster slab. We found using the rubber stopper to be a simple and inexpensive method to reduce pin tract infections following percutaneous pinning.

Treatment of Paediadric Forearm Fractures with Titanium Elastic Nails

Background: A prospective analysis of a case series of diaphyseal forearm fractures in children treated with titanium elastic nails is presented. Methods: Between 2012 and 2014, 45 children aged 5-15 years with displaced diaphyseal forearm fractures underwent titanium elastic nailing. Both bones were fractured in 32 patients, ten fractured only the radius, and three experienced ulna fracture. Eighteen children had unstable irreducible fractures, twenty had loss of reduction, and seven had open fractures. Titanium elastic nails were used to stabilize the fractures. All fractures were immobilized postoperatively with an above-elbow plaster slab for 2 weeks till the swelling is completely resolved followed by encouraging range of motion exercises. Results: Closed reduction and TENS was successful in 33 cases, including 25 double-bone fractures and eight single-bone fractures. Open reduction was unavoidable in seven fractures of both bones, and in five single-bone open fractures. Bone union was achieved in all patients at an average of 7 weeks. Conclusion:Titanium elastic nails fixation of pediatric forearm fractures revealed several advantages, a small incision for insertion, a low rate of complications, unhindered bone healing, and good clinical and radiological results. Key words: Diaphyseal; Radius and ulna; Pediatric; Forearm fractures; Fracture fixation; TENS