This study analyzed 393 displaced distal radial fractures in children treated with various methods including closed reduction and immobilization, cast immobilization alone, and Kirschner wire fixation. The results showed that closed reduction and immobilization can be considered the first choice of treatment, with 96.4% of fractures initially treated this way healing within normal remodeling limits and only 10% requiring secondary intervention. However, fractures that required repeated reduction maneuvers or had residual displacement after closed reduction showed a higher risk of redisplacement, indicating those cases may be better treated initially with Kirschner wire fixation to prevent loss of reduction. In conclusion, closed reduction and immobilization is generally sufficient but primary Kirschner wiring is recommended for fractures with difficult initial
‘Double X’ Cross Fixationin Paediatric Supracondylar Humerus Fractures: A 20-...clinicsoncology
Over the last 50 years, the developments emerged in the diagnosis and treatment of supracondylar humerus fractures (SHF) have significantly reduced the number of severe complications while certain complications with dreadful evolution, such as elbow stiffness or Volkmann’s syndrome, have completely vanished. During my residency, in 1982, on the suggestion of Prof. Pesamosca, I have performed a surgical intervention for a patient diagnosed with SHF
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
Background: Distal femur fractures make up 6 to 7% of all femur fractures. Various plating options for distal femur fracture are conventional buttress plates, fixed-angle devices, and locking plates. This study was planned to evaluate and explore locking compression plate fixation in distal end femur fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.
Methods: The study was conducted as prospective clinical study in 20 skeletally mature patients with x-ray evidence of distal femur fracture fulfilling inclusion and exclusion criteria, operated with distal femur LCP plating. Patients were assessed radiologically and classified according to distal femur fracture classification and outcome graded as excellent, good, fair and poor based on Lysholm Knee Score.
Results: Out of 15 excellent outcome cases, 3 cases were type A1 fracture, 1 case had type A3, 2 cases had type B1 and B2 each, 5 cases had type C2 and 2 cases had type C3 fracture. 1 case with good outcome was type C3. 1 case with fair outcome was type B2. While 3 cases with poor outcome were type A1, A2 and C3.
Conclusions: The DF-LCP is an ideal implant to use for fractures of the distal femur. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A and C, osteoporotic and periprosthetic fractures.
Keywords: Distal femur, DF-LCP, Lysholm score, Periprosthetic fracture
The value of dynamic MRI in cervical spondylotic myelopathy: About 24 cases.T...Michel Triffaux
Dynamic magnetic resonance imaging (MRI) of the cervical spine is extremely useful in assessing
pathological changes at the spinal cord, vertebrae, discs, ligaments and facet joints. we attempted to
document the radiological changes that the cervical spine undergoes during dynamic maneuvers and the
effects of Dynamic MRI in management of cervical myelopathy, emphasizing on the changes in treatment
protocol effected by the new findings discovered. Our work is based on 24 consecutive patients with
cervical spondylotic myelopathy had cervical MR imaging in neutral position, in flexion and extension of
the cervical spine between January 2021 and December 2021. The result found the mean age was 57.9
years (range 26-85 years). Among these 24 patients, there were 11 males and 13 females. Total number of
levels of compression were 47 and the additional levels of involvement were 17. Additional levels of
compression were noted in 12 patients, among these 17 new levels, 7 were in the posterior and 10 in the
anterior. The most affected level was C5C6 with 16 cases. All additional levels of compression were noted
in extension; Reduction of the cervical canal was observed in 20 patients only in extension. In the bending
sequences we have noticed an increase of the canal diameter in 3 patients. The location of the
compression is in 15 cases anterior, 2 cases posterior and 5 cases are mixed anterior and posterior
Surgery was considered in 17 patients. Anterior procedures were 11 (ACDF/ corpectomy and fusion) and
Posterior surgeries were 6 (laminoplasty/laminectomy), and. The rest of the patients did not require
surgery and was conservatively treated. A change of the signal was found in 3 patients during the
acquisition in extension position a. Most studies have shown a reduction of the root canal with an increase
of the compression level, which was the case in our study. MRI is a useful tool for diagnosis of CM, it does
not give an exact idea as to which is the offending level in a multilevel compression that requires surgery.
Even the approach and procedure cannot be decided on a static examination and hence are subject to
significant interpractitioner the role of extension MRI in determining cervical compression levels. Thus,
dynamic cervical spine MRI should be an important investigation before we decide to write off surgical
treatment in patients with cervical myelopathy and cord signal changes without definitive compression on
static MRI. Flexion and extension MRI is an important tool for decision making and planning appropriate
management in cervical compressive myelopathy.
Comparison Results between Patients with Developmental Hip Dysplasia Treated ...CrimsonPublishersOPROJ
Comparison Results between Patients with Developmental Hip Dysplasia Treated with Either Salter or Pemberton Osteotomy by Dello Russo Bibiana* in Orthopedic Research Online Journal
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: April CasesSean M. Fox
The document discusses 5 pediatric orthopedic imaging case studies of children presenting with tibia and fibula fractures, including Salter-Harris fractures. It provides imaging and details on each case, discussing factors like fracture classification and treatment approaches. The document also reviews topics like tibia fracture patterns, risks of compartment syndrome, and outcomes of different treatment methods for Salter-Harris II distal tibia fractures.
‘Double X’ Cross Fixationin Paediatric Supracondylar Humerus Fractures: A 20-...clinicsoncology
Over the last 50 years, the developments emerged in the diagnosis and treatment of supracondylar humerus fractures (SHF) have significantly reduced the number of severe complications while certain complications with dreadful evolution, such as elbow stiffness or Volkmann’s syndrome, have completely vanished. During my residency, in 1982, on the suggestion of Prof. Pesamosca, I have performed a surgical intervention for a patient diagnosed with SHF
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
Background: Distal femur fractures make up 6 to 7% of all femur fractures. Various plating options for distal femur fracture are conventional buttress plates, fixed-angle devices, and locking plates. This study was planned to evaluate and explore locking compression plate fixation in distal end femur fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.
Methods: The study was conducted as prospective clinical study in 20 skeletally mature patients with x-ray evidence of distal femur fracture fulfilling inclusion and exclusion criteria, operated with distal femur LCP plating. Patients were assessed radiologically and classified according to distal femur fracture classification and outcome graded as excellent, good, fair and poor based on Lysholm Knee Score.
Results: Out of 15 excellent outcome cases, 3 cases were type A1 fracture, 1 case had type A3, 2 cases had type B1 and B2 each, 5 cases had type C2 and 2 cases had type C3 fracture. 1 case with good outcome was type C3. 1 case with fair outcome was type B2. While 3 cases with poor outcome were type A1, A2 and C3.
Conclusions: The DF-LCP is an ideal implant to use for fractures of the distal femur. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A and C, osteoporotic and periprosthetic fractures.
Keywords: Distal femur, DF-LCP, Lysholm score, Periprosthetic fracture
The value of dynamic MRI in cervical spondylotic myelopathy: About 24 cases.T...Michel Triffaux
Dynamic magnetic resonance imaging (MRI) of the cervical spine is extremely useful in assessing
pathological changes at the spinal cord, vertebrae, discs, ligaments and facet joints. we attempted to
document the radiological changes that the cervical spine undergoes during dynamic maneuvers and the
effects of Dynamic MRI in management of cervical myelopathy, emphasizing on the changes in treatment
protocol effected by the new findings discovered. Our work is based on 24 consecutive patients with
cervical spondylotic myelopathy had cervical MR imaging in neutral position, in flexion and extension of
the cervical spine between January 2021 and December 2021. The result found the mean age was 57.9
years (range 26-85 years). Among these 24 patients, there were 11 males and 13 females. Total number of
levels of compression were 47 and the additional levels of involvement were 17. Additional levels of
compression were noted in 12 patients, among these 17 new levels, 7 were in the posterior and 10 in the
anterior. The most affected level was C5C6 with 16 cases. All additional levels of compression were noted
in extension; Reduction of the cervical canal was observed in 20 patients only in extension. In the bending
sequences we have noticed an increase of the canal diameter in 3 patients. The location of the
compression is in 15 cases anterior, 2 cases posterior and 5 cases are mixed anterior and posterior
Surgery was considered in 17 patients. Anterior procedures were 11 (ACDF/ corpectomy and fusion) and
Posterior surgeries were 6 (laminoplasty/laminectomy), and. The rest of the patients did not require
surgery and was conservatively treated. A change of the signal was found in 3 patients during the
acquisition in extension position a. Most studies have shown a reduction of the root canal with an increase
of the compression level, which was the case in our study. MRI is a useful tool for diagnosis of CM, it does
not give an exact idea as to which is the offending level in a multilevel compression that requires surgery.
Even the approach and procedure cannot be decided on a static examination and hence are subject to
significant interpractitioner the role of extension MRI in determining cervical compression levels. Thus,
dynamic cervical spine MRI should be an important investigation before we decide to write off surgical
treatment in patients with cervical myelopathy and cord signal changes without definitive compression on
static MRI. Flexion and extension MRI is an important tool for decision making and planning appropriate
management in cervical compressive myelopathy.
Comparison Results between Patients with Developmental Hip Dysplasia Treated ...CrimsonPublishersOPROJ
Comparison Results between Patients with Developmental Hip Dysplasia Treated with Either Salter or Pemberton Osteotomy by Dello Russo Bibiana* in Orthopedic Research Online Journal
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: April CasesSean M. Fox
The document discusses 5 pediatric orthopedic imaging case studies of children presenting with tibia and fibula fractures, including Salter-Harris fractures. It provides imaging and details on each case, discussing factors like fracture classification and treatment approaches. The document also reviews topics like tibia fracture patterns, risks of compartment syndrome, and outcomes of different treatment methods for Salter-Harris II distal tibia fractures.
This study compared outcomes of short versus long leg hip spica casts after closed reduction for developmental dysplasia of the hip (DDH) in 47 patients. The overall acute and long-term success rates were 83% and 66%, respectively. Acute success rates were 78.2% for short spica casts and 87.5% for long casts. Long-term success was higher for short casts at 73.9% versus 58.3% for long casts. Statistical analysis found no significant differences in outcomes between cast types for acute success, long-term success, residual dysplasia, or avascular necrosis. The study concluded that a short leg spica could be as effective an alternative to the traditional long spica
This case study examines the outcomes of a 9-year-old male who received applied functional science movement based therapy following a 12-week arm cast for a distal radius/ulna fracture. The patient received 6 weeks of therapy focused on restoring range of motion, strength, and function through a progressive 3-phase protocol. Evaluation measures showed significant improvements in range of motion, grip strength, muscle strength, and disability scores. While grip strength improved substantially, it did not fully return to normal levels. The functional movement based approach effectively reduced impairments and disability from immobilization.
Crimson Publishers-Herring Bone Stitch: Knitting to Secure Abdominal Wall Clo...CrimsonGastroenterology
Herring Bone Stitch: Knitting to Secure Abdominal Wall Closure for Emergency Midline Laparotomy by Dhananjaya Sharma in Gastroenterology Medicine & Research: Laparotomy
Introduction: 5-26% of patients develop incisional hernia (IH) after midline laparotomy. We hypothesized that a simple ‘herring bone’ stitch repair can provide secure abdominal wall closure and minimize the incidence of IH in patients undergoing emergency midline laparotomy.
Methods: This prospective observational study was done from March 2015 to December 2017 in a teaching hospital in Central India. Consecutive patients undergoing emergency midline laparotomy were included. Study group (patients undergoing single layer continuous herring bone closure of rectus sheath with Polypropylene no. 1 suture) was compared with control group (patients undergoing standard single layer continuous closure of rectus sheath with Polypropylene no. 1 suture). Patients were followed up till 1 year. Outcomes noted were surgical site infection (SSI), proline knot granuloma or sinus formation, superficial wound dehiscence, fascial dehiscence and IH.
Results: There were 112 patients in study group and 108 in control group with comparable demographics.Vector physics of Herring bone stitch showed that any tension on the suture line is preferentially distributed parallel to the wound. Incidence of SSI, proline knot granuloma and superficial wound dehiscence was comparable among the two groups. The incidence of fascial dehiscence (0.045) and IH was less (p = 0.009) in study group.
Discussion: The Herring bone stitch is technically easy, reproducible, safe and can be performed quickly. The present study shows superiority of ‘herring bone suture’ over conventional closure of rectus sheath in emergency midline laparotomy.
1) The document summarizes research on early orthodontic intervention for patients with tooth-size discrepancies. It focuses on using rapid maxillary expansion (RME) in the mixed dentition stage to correct crowding issues.
2) Long-term studies found that RME followed by fixed appliances resulted in clinically significant increases in maxillary and mandibular arch width even 5+ years post-treatment. RME also had benefits like improving nasal breathing.
3) For patients with mild-moderate crowding, RME combined with other approaches like Schwarz appliances in early treatment resulted in increased arch widths that were maintained long-term. RME was found to be an effective option for treating mixed dentition patients
This document summarizes a study evaluating outcomes of closed reduction versus open reduction and internal fixation for treating different types of condyle and subcondylar fractures. The study included 45 patients with 51 fractures that were classified into different classes based on displacement and dislocation. Class I non-displaced fractures were treated with closed reduction, while displaced and dislocated fractures in Classes II and IV underwent open reduction and internal fixation. The results found that Class I fractures healed well with closed reduction, while Classes II and IV achieved good function and range of motion when treated with open reduction and internal fixation. Complications for both groups were minor and resolved within a year.
This document summarizes the treatment of intertrochanteric hip fractures, which occur between the greater and lesser trochanters. It discusses the demographics, mechanisms of injury, surgical and non-surgical treatment options including sliding hip screws, intramedullary nails, and hemiarthroplasty. It also outlines complications rates between different implant choices and emphasizes the importance of anatomic reduction and tip-apex distance when using implants.
This study retrospectively analyzed outcomes of 27 patients who underwent surgery for chondrosarcomas originating in the sacrum between 1992-2014. It found that en bloc resection was associated with longer hospital stays than intralesional surgery. En bloc resection also resulted in greater loss of motor, bowel and bladder function compared to intralesional surgery, though the results were not statistically significant. The 5-year and 10-year overall survival rates for the entire group were 53% and 37.8% respectively, with a higher rate seen for unilateral nerve root resection versus bilateral resection. The study aims to help assess functional outcomes and quality of life for patients with this rare type of cancer.
The document discusses the classification and treatment of supracondylar humerus fractures in children, including closed reduction and K-wire fixation being the standard treatment, with debate around whether lateral entry pinning or cross pinning provides better stability and outcomes while avoiding risks of iatrogenic ulnar nerve injury. Lateral entry pinning has gained acceptance as it avoids medial pinning risks and studies have found no increase in loss of reduction compared to cross pinning.
This document discusses optimal timing for Twin-block therapy to correct Class II malocclusions. It describes two groups treated at different skeletal maturity stages - an early-treated group before pubertal growth peak, and a late-treated group during/after peak. Evidence shows functional appliances work best when treatment includes the pubertal growth spurt. The document aims to evaluate skeletal and dental changes produced by Twin-block in these groups to define optimal treatment timing.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 31st publication IJAR 1st name
This document summarizes a presentation on early treatment for Class III malocclusion patients. It discusses what has been learned about treating Class III patients with maxillary expansion and facemask therapy. Specifically, it notes that successful treatment can be achieved in these patients to correct the overjet within 6-9 months. However, long-term stability is only achieved in 50-60% of patients after pubertal growth due to variability in mandibular growth. The document also reviews several methods that have been proposed to predict mandibular growth and the likelihood of treatment success or failure, but notes accuracy has been limited to around 70%. Factors like overbite, growth pattern, and remaining growth are discussed as indicators for treatment.
This study evaluated the intermediate and long-term results of femoral neck lengthening (Morscher osteotomy) in 18 patients (20 hips) with a median follow-up of 7 years. Postoperatively, the Trendelenburg test was negative in most patients and the median Harris Hip Score improved significantly. Radiographic examination found progression of osteoarthritis in 3 patients, while one operation failed and required total hip replacement after 4 years and two others required it at 10 years. The procedure successfully reduced leg length discrepancy in most patients. The study concluded that Morscher osteotomy can effectively treat patients with short femoral neck and overgrown greater trochanter with a positive Trendelenburg test and mild leg length
This document summarizes research on the stability and predictability of orthognathic surgery procedures. It finds that superior repositioning of the maxilla and mandibular advancement of less than 10mm are the most stable procedures. Mandibular setback, downward movement of the maxilla, and maxillary expansion are the least stable and have a high risk of significant postoperative change. Condylar remodeling often occurs after surgery and can be evaluated using cone-beam computed tomography scans. Long-term stability depends on the specific procedure and factors like rigid internal fixation.
This study examined 406 microsurgical tissue transfer cases in the head and neck region over a 13-year period. The overall flap survival rate was approximately 92%. Primary reconstructions had a significantly higher success rate than secondary reconstructions. Defect location also significantly impacted survival, with more caudal locations associated with better outcomes. Neither anticoagulation regimen nor recipient vessel system choice influenced survival rates. Microsurgical tissue transfer is a reliable reconstruction method for maxillofacial defects when aware of success factors.
This document discusses a study on the management of intra-articular fractures of the calcaneus (heel bone) using a combined percutaneous and minimal internal fixation technique. 22 patients with this fracture were treated with minimal incision and fixation using a single cancellous screw and 2 K-wires. At follow-up of 26 months on average, all fractures had healed without complications. Patients were evaluated using the Modified Rowe Score and outcomes were rated as excellent for 10 patients, good for 10 patients, and satisfactory for 2 patients, with an average score of 80. The technique aims to minimize complications by using minimal soft tissue dissection and implants.
Study of current pattern of Cervical Spondylotic Myelopathy and to evaluate t...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
1) Arthroscopic stabilization of anterior shoulder instability has advantages over open surgery such as better cosmesis, less morbidity, and possibly less loss of external rotation. However, past studies reporting on arthroscopic stabilization have been limited by small sample sizes and variable surgical techniques and patient characteristics.
2) Several arthroscopic techniques have been developed and studied, including stapling, transglenoid suturing, suture anchors, and biodegradable tacks. Recurrence rates vary significantly between studies and depend on patient factors like age and activity level. Improper patient selection and surgical technique also contribute to failed stabilization.
3) Recent studies directly comparing suture anchor and transglenoid fixation techniques found lower recurrence
The document discusses the stability of open bite treatment. It finds that:
1) Relatively few scientific studies have evaluated the stability of open bite treatment. The studies that do exist show that 35-60% of non-surgically treated patients experience a relapse of their open bite.
2) Various therapies have been proposed to improve stability, such as crib therapy and myofunctional therapy, but no long-term studies conclusively prove their effectiveness.
3) While early treatment is generally indicated for open bites depending on severity, age, etc., stability remains a clinical problem as about 20-40% of patients, both surgically and non-surgically treated, will experience a relapse.
This document discusses the use of trochanteric buttress plates (TBPs) to augment proximal femoral nailing for pertrochanteric hip fractures with an incompetent lateral wall. It found that for 21 patients treated with a proximal femoral nail and TBP: 1) 17 had a preoperative lateral wall fracture and 4 developed one during surgery; 2) the average lateral wall thickness was 12.2 mm; 3) none developed varus malunion; and 4) fractures united on average in 12.6 weeks without complications. The study concludes TBP augmentation should be considered for AO type 31A2 pertrochanteric fractures with a lateral wall fracture to help maintain integrity and achieve good outcomes when treated with
Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
The History of NZ 1870-1900.
Making of a Nation.
From the NZ Wars to Liberals,
Richard Seddon, George Grey,
Social Laboratory, New Zealand,
Confiscations, Kotahitanga, Kingitanga, Parliament, Suffrage, Repudiation, Economic Change, Agriculture, Gold Mining, Timber, Flax, Sheep, Dairying,
This study compared outcomes of short versus long leg hip spica casts after closed reduction for developmental dysplasia of the hip (DDH) in 47 patients. The overall acute and long-term success rates were 83% and 66%, respectively. Acute success rates were 78.2% for short spica casts and 87.5% for long casts. Long-term success was higher for short casts at 73.9% versus 58.3% for long casts. Statistical analysis found no significant differences in outcomes between cast types for acute success, long-term success, residual dysplasia, or avascular necrosis. The study concluded that a short leg spica could be as effective an alternative to the traditional long spica
This case study examines the outcomes of a 9-year-old male who received applied functional science movement based therapy following a 12-week arm cast for a distal radius/ulna fracture. The patient received 6 weeks of therapy focused on restoring range of motion, strength, and function through a progressive 3-phase protocol. Evaluation measures showed significant improvements in range of motion, grip strength, muscle strength, and disability scores. While grip strength improved substantially, it did not fully return to normal levels. The functional movement based approach effectively reduced impairments and disability from immobilization.
Crimson Publishers-Herring Bone Stitch: Knitting to Secure Abdominal Wall Clo...CrimsonGastroenterology
Herring Bone Stitch: Knitting to Secure Abdominal Wall Closure for Emergency Midline Laparotomy by Dhananjaya Sharma in Gastroenterology Medicine & Research: Laparotomy
Introduction: 5-26% of patients develop incisional hernia (IH) after midline laparotomy. We hypothesized that a simple ‘herring bone’ stitch repair can provide secure abdominal wall closure and minimize the incidence of IH in patients undergoing emergency midline laparotomy.
Methods: This prospective observational study was done from March 2015 to December 2017 in a teaching hospital in Central India. Consecutive patients undergoing emergency midline laparotomy were included. Study group (patients undergoing single layer continuous herring bone closure of rectus sheath with Polypropylene no. 1 suture) was compared with control group (patients undergoing standard single layer continuous closure of rectus sheath with Polypropylene no. 1 suture). Patients were followed up till 1 year. Outcomes noted were surgical site infection (SSI), proline knot granuloma or sinus formation, superficial wound dehiscence, fascial dehiscence and IH.
Results: There were 112 patients in study group and 108 in control group with comparable demographics.Vector physics of Herring bone stitch showed that any tension on the suture line is preferentially distributed parallel to the wound. Incidence of SSI, proline knot granuloma and superficial wound dehiscence was comparable among the two groups. The incidence of fascial dehiscence (0.045) and IH was less (p = 0.009) in study group.
Discussion: The Herring bone stitch is technically easy, reproducible, safe and can be performed quickly. The present study shows superiority of ‘herring bone suture’ over conventional closure of rectus sheath in emergency midline laparotomy.
1) The document summarizes research on early orthodontic intervention for patients with tooth-size discrepancies. It focuses on using rapid maxillary expansion (RME) in the mixed dentition stage to correct crowding issues.
2) Long-term studies found that RME followed by fixed appliances resulted in clinically significant increases in maxillary and mandibular arch width even 5+ years post-treatment. RME also had benefits like improving nasal breathing.
3) For patients with mild-moderate crowding, RME combined with other approaches like Schwarz appliances in early treatment resulted in increased arch widths that were maintained long-term. RME was found to be an effective option for treating mixed dentition patients
This document summarizes a study evaluating outcomes of closed reduction versus open reduction and internal fixation for treating different types of condyle and subcondylar fractures. The study included 45 patients with 51 fractures that were classified into different classes based on displacement and dislocation. Class I non-displaced fractures were treated with closed reduction, while displaced and dislocated fractures in Classes II and IV underwent open reduction and internal fixation. The results found that Class I fractures healed well with closed reduction, while Classes II and IV achieved good function and range of motion when treated with open reduction and internal fixation. Complications for both groups were minor and resolved within a year.
This document summarizes the treatment of intertrochanteric hip fractures, which occur between the greater and lesser trochanters. It discusses the demographics, mechanisms of injury, surgical and non-surgical treatment options including sliding hip screws, intramedullary nails, and hemiarthroplasty. It also outlines complications rates between different implant choices and emphasizes the importance of anatomic reduction and tip-apex distance when using implants.
This study retrospectively analyzed outcomes of 27 patients who underwent surgery for chondrosarcomas originating in the sacrum between 1992-2014. It found that en bloc resection was associated with longer hospital stays than intralesional surgery. En bloc resection also resulted in greater loss of motor, bowel and bladder function compared to intralesional surgery, though the results were not statistically significant. The 5-year and 10-year overall survival rates for the entire group were 53% and 37.8% respectively, with a higher rate seen for unilateral nerve root resection versus bilateral resection. The study aims to help assess functional outcomes and quality of life for patients with this rare type of cancer.
The document discusses the classification and treatment of supracondylar humerus fractures in children, including closed reduction and K-wire fixation being the standard treatment, with debate around whether lateral entry pinning or cross pinning provides better stability and outcomes while avoiding risks of iatrogenic ulnar nerve injury. Lateral entry pinning has gained acceptance as it avoids medial pinning risks and studies have found no increase in loss of reduction compared to cross pinning.
This document discusses optimal timing for Twin-block therapy to correct Class II malocclusions. It describes two groups treated at different skeletal maturity stages - an early-treated group before pubertal growth peak, and a late-treated group during/after peak. Evidence shows functional appliances work best when treatment includes the pubertal growth spurt. The document aims to evaluate skeletal and dental changes produced by Twin-block in these groups to define optimal treatment timing.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 31st publication IJAR 1st name
This document summarizes a presentation on early treatment for Class III malocclusion patients. It discusses what has been learned about treating Class III patients with maxillary expansion and facemask therapy. Specifically, it notes that successful treatment can be achieved in these patients to correct the overjet within 6-9 months. However, long-term stability is only achieved in 50-60% of patients after pubertal growth due to variability in mandibular growth. The document also reviews several methods that have been proposed to predict mandibular growth and the likelihood of treatment success or failure, but notes accuracy has been limited to around 70%. Factors like overbite, growth pattern, and remaining growth are discussed as indicators for treatment.
This study evaluated the intermediate and long-term results of femoral neck lengthening (Morscher osteotomy) in 18 patients (20 hips) with a median follow-up of 7 years. Postoperatively, the Trendelenburg test was negative in most patients and the median Harris Hip Score improved significantly. Radiographic examination found progression of osteoarthritis in 3 patients, while one operation failed and required total hip replacement after 4 years and two others required it at 10 years. The procedure successfully reduced leg length discrepancy in most patients. The study concluded that Morscher osteotomy can effectively treat patients with short femoral neck and overgrown greater trochanter with a positive Trendelenburg test and mild leg length
This document summarizes research on the stability and predictability of orthognathic surgery procedures. It finds that superior repositioning of the maxilla and mandibular advancement of less than 10mm are the most stable procedures. Mandibular setback, downward movement of the maxilla, and maxillary expansion are the least stable and have a high risk of significant postoperative change. Condylar remodeling often occurs after surgery and can be evaluated using cone-beam computed tomography scans. Long-term stability depends on the specific procedure and factors like rigid internal fixation.
This study examined 406 microsurgical tissue transfer cases in the head and neck region over a 13-year period. The overall flap survival rate was approximately 92%. Primary reconstructions had a significantly higher success rate than secondary reconstructions. Defect location also significantly impacted survival, with more caudal locations associated with better outcomes. Neither anticoagulation regimen nor recipient vessel system choice influenced survival rates. Microsurgical tissue transfer is a reliable reconstruction method for maxillofacial defects when aware of success factors.
This document discusses a study on the management of intra-articular fractures of the calcaneus (heel bone) using a combined percutaneous and minimal internal fixation technique. 22 patients with this fracture were treated with minimal incision and fixation using a single cancellous screw and 2 K-wires. At follow-up of 26 months on average, all fractures had healed without complications. Patients were evaluated using the Modified Rowe Score and outcomes were rated as excellent for 10 patients, good for 10 patients, and satisfactory for 2 patients, with an average score of 80. The technique aims to minimize complications by using minimal soft tissue dissection and implants.
Study of current pattern of Cervical Spondylotic Myelopathy and to evaluate t...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
1) Arthroscopic stabilization of anterior shoulder instability has advantages over open surgery such as better cosmesis, less morbidity, and possibly less loss of external rotation. However, past studies reporting on arthroscopic stabilization have been limited by small sample sizes and variable surgical techniques and patient characteristics.
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The document discusses the stability of open bite treatment. It finds that:
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2) Various therapies have been proposed to improve stability, such as crib therapy and myofunctional therapy, but no long-term studies conclusively prove their effectiveness.
3) While early treatment is generally indicated for open bites depending on severity, age, etc., stability remains a clinical problem as about 20-40% of patients, both surgically and non-surgically treated, will experience a relapse.
This document discusses the use of trochanteric buttress plates (TBPs) to augment proximal femoral nailing for pertrochanteric hip fractures with an incompetent lateral wall. It found that for 21 patients treated with a proximal femoral nail and TBP: 1) 17 had a preoperative lateral wall fracture and 4 developed one during surgery; 2) the average lateral wall thickness was 12.2 mm; 3) none developed varus malunion; and 4) fractures united on average in 12.6 weeks without complications. The study concludes TBP augmentation should be considered for AO type 31A2 pertrochanteric fractures with a lateral wall fracture to help maintain integrity and achieve good outcomes when treated with
Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
The History of NZ 1870-1900.
Making of a Nation.
From the NZ Wars to Liberals,
Richard Seddon, George Grey,
Social Laboratory, New Zealand,
Confiscations, Kotahitanga, Kingitanga, Parliament, Suffrage, Repudiation, Economic Change, Agriculture, Gold Mining, Timber, Flax, Sheep, Dairying,
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
This presentation was provided by Racquel Jemison, Ph.D., Christina MacLaughlin, Ph.D., and Paulomi Majumder. Ph.D., all of the American Chemical Society, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
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LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
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𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
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This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
2. 422 D. S. Wendling-Keim et al.
1 3
15–17]. However, no agreement regarding a gold standard
has been found to date.
Therefore, the aim of our study was to investigate the
rate of redisplacement after closed reduction and cast
immobilization on a large-scale analyzing 393 cases of dis-
placed distal forearm fractures and hereby to determine if
this regimen still can be accepted as the method of choice
for this type of fracture in children. Furthermore, our goal
was to identify factors that increase the risk of the compli-
cation of redisplacement and therefore determine the indi-
cation of initial Kirschner wire fixation instead of only cast
immobilization after closed reduction.
Materials and methods
The Study was carried out retrospectively. Patients with
displaced radial fractures aged 0–18 years with epiphyseal
plates who were treated in the pediatric surgery clinic at
the Dr. von Haunersches Kinderspital from 2005 through
2011 were selected from the hospital’s electronic radio-
logic archive. Patients with Salter/Harris 3 and Salter/
Harrys 4 fractures as well as stress fractures, pathological
fractures, refractures, any known bone disease or pubertas
praecox and tarda were excluded from the study. Fracture
treatment and outcome were analyzed considering angula-
tion and translation as well as involvement of the epiphysis,
concomitant fractures and volar or dorsal displacement and
therefore the use of fracture classification systems was not
incorporated in this study.
Fractures were treated with cast immobilization alone or
closed reduction and cast immobilization or Kirschner wire
fixation or, although very rarely, with ESIN (elastic stable
intramedullary nailing) according to the degree of displace-
ment, the stability after reduction and the decision of the
surgeon on call. Closed reduction was performed under
general anesthesia with one exception due to cystic fibrosis.
A C-arm was used to control the position of the fragments.
Immobilization was achieved by the fitting of long-arm
plaster- or fiberglass splints.
All radiographs and patient records including operation
reports were analyzed. Optimal reduction was defined as
angulation of less than 5° and translation of less than cor-
ticalis width. Redisplacement of any degree, number of
interventions and complications were registered as well as
demographic data. Any increase in angulation or translation
after the initial treatment was registered as redisplacement
and further analyzed.
Limits of remodeling were considered ≤30° angulation
and ≤shaft width translation for children under 12 years of
age and ≤15° angulation and ≤1/2 shaft width translation
for children aged 12 years or older, respectively.
The pearson’s χ2
test was applied. Statistical analysis
was performed using IBM SPSS Statistics 20.0. Statistical
significance was set at an alpha level of P = 0.05.
Results
383 patients with displaced distal radial fractures were
detected during the study period from 2005 through 2011
yielding 393 cases since in ten patients two fractures of the
distal radius occurred either at the same time in different
arms or at different points of time in the same arm but at
different locations within the distal radius.
The mean age was 9.8 years, 72.5 % of patients were
male and 27.5 % female. The age distribution is shown in
Fig. 1. Of all cases 82.1 % extension fractures and 17.9 %
flexion fractures were noted.
Of all displaced distal radial fractures secondary dis-
placement was found in 143 cases, respectively, 36.4 %.
However, any displacement after the initial therapy was reg-
istered in this study to avoid any bias and only 56 of these
absolutely redisplaced fractures needed further treatment.
Redisplacement resulting from a new trauma or from a
defect cast was excluded. Analysis of the age pattern showed
56
202
135
age distribuon of paents with displaced distal
radial fractures n=393
1-5J
6-11J
12-18J
Fig. 1 The age distribution demonstrates the majority of patients in
the study were between 6 and 11 years of age
Table 1 Frequency within the different age groups
Age group (years) Redisplacement
rate (%)
1–5 45.3
6–11 40.5
12–18 31.8
3. 423
Closed reduction and immobilization of radial fractures
1 3
that redisplacement was more frequent in younger patients
pointing to the fact that the choice of treatment seems to
be strongly influenced by the growth-dependent correction
potential (Table 1). Furthermore, redisplacement was mainly
detected one week after trauma or reduction (Table 2).
Furthermore, the differentiation of fracture types
revealed a tendency of increased redisplacement rate
in radial fractures with concomitant ulnar fractures
(P = 0.051) as compared to isolated radial fractures
whereas involvement of the ulnar styloid processus did
not have any effect. Also, Salter/Harris 1 and 2 fractures
displayed a significantly lower redisplacement frequency
compared to fractures that were more located further proxi-
mal which is related to the increased instability in the more
proximal fractures (P = 0.005). Additionally, fractures
with dorsal displacement redisplaced more often than volar
fractures (P = 0.003),Of the analyzed 393 displaced distal
radial fractures 263 cases were treated by closed reduction
and immobilization while 104 fractures were only immo-
bilized according to the expected growth-related correc-
tion potential depending on the age of the patient. Only 25
fractures, respectively, 6.3 % were primarily fixated with
Kirschner wires and due to individual decision ESIN was
performed in one exceptional case (Fig. 2).
The majority of displaced distal radial fractures count-
ing 263 cases, respectively, 66.9 % were treated by closed
reduction and immobilization. Above-elbow casts were
applied. Angulation in these fractures ranged from 7° to
54° and translation from corticalis thickness to more than
shaft width. Most patients were between 6 and 11 years of
age (Fig. 3).
Of these patients who were treated with closed reduction
223 fractures, respectively, 84.8 % did not need any further
intervention, since 78.0 % of redisplacements were meas-
ured to be less than 10° and 96.4 % of fractures displayed
only slight residual displacements ranging within the limits
of remodeling after closed reduction.
Table 2 Redisplacement detected mainly within the first week after
primary treatment
Time of detection of redisplacement Occurrence Rate (%)
1 day 2 1.4
1 week 82 57.3
2 weeks 13 9.1
3 weeks 14 9.8
4 weeks 21 14.7
5 weeks 3 2.1
6 weeks 7 4.9
Unknown due to treatment in external
hospital
1 0.7
Total 143 100
263
104
25
1
distribuon of treatment n=393
closed reducon
and cast
immobilisaon
cast
immobilizaon
inial Kirschner
wire fixaon
ESIN
Fig. 2 It shows that most patients studied were treated with closed
reduction and cast immobilization
30
128
105
age distribuon of paents with primary closed reducon
and immobilizaon
n=263
1-5J
6-11J
12-18J
Fig. 3 Primary closed reduction and immobilization was applied for
all age groups, however, the majority of patients was aged 6–11 years
0
2
4
6
8
10
12
14
16
18
1-5years 6-11 years 12-18 years
age distribuon of secondary treatment aer closed
reducon and immobilizaon
secondary Kirschner wire
fixaon
repeated closed reducon
Fig. 4 The age distribution of patients needing secondary interven-
tion after primary reduction demonstrates the dependence of fre-
quency and type of secondary treatment on the remodeling potential
according to the patient’s age
4. 424 D. S. Wendling-Keim et al.
1 3
However, 38 fractures needed further treatment after
closed reduction. 28 patients were treated with repeated
closed reduction. Angulation and translation before
repeated reduction were measured between 11° and 44°
and 1/4 and 1/2 shaft width, respectively.
Furthermore, after primary closed reduction ten redis-
placed fractures were secondarily fixated with Kirschner
wires. Redisplacement angulation of 27°–30° and transla-
tion of 1/3 shaft width or more were noted in these cases.
Two more patients needed secondary Kirschner wires as
well, however, these two cases were excluded from the
analysis since their cast had been accidentally broken.
Interestingly, 80 % of patients with secondary Kirschner
wire fixations were between 12 and 18 years of age and
the remainining 20 % were 6–11 years while no patient
under 6 years received secondary Kirschner wires. Accord-
ingly, patients aged 6–11 years with redisplacement after
closed reduction was mainly treated with repeated reduc-
tion (Fig. 4).
To investigate the cause of spontaneous redisplacement
after primary reduction in these 38 fractures we analyzed
the operative reports. Operation reports of 35 cases were
available since three fractures were not initially treated at
our hospital. Interestingly, in 48.6 % of these cases, we
detected explicitly described problems during primary
reduction consisting of necessary repetition of reduction
and residual angulation of more than 5° or translation of
more than corticalis width after reduction. Furthermore,
investigation of 216 of the 223 fractures without second-
ary intervention was performed, since seven were not
treated initially at our hospital. The reports revealed that
fractures that redisplaced after reduction, although within
the limits of remodeling, had raised the above-mentioned
problems significantly more often (P = 0.00029) than
fractures that did not redisplace. While 18.5 % of frac-
tures without difficulties during reduction showed sec-
ondary displacement, 43.8 % of cases with problems dur-
ing primary reduction displaced again during follow-up
(Fig. 5). We therefore, consider repeated reduction and
residual angulation and translation (5° or more and cor-
ticalis width or more, respectively) risk factors for redis-
placement and therefore indication of primary Kirschner
wire fixation. Regarding the outcome, 96.4 % of 223
cases that were treated by primary closed reduction and
immobilization alone were found to range within the lim-
its of remodeling and 78.0 % displayed an angulation of
less than 10°. Furthermore, 89.3 % of cases that needed
secondary reduction and 100 % of fractures with second-
ary Kirschner wire fixation after primary closed reduction
were measured within the limits of remodeling while 64.3
and 91.7 %, respectively, showed a residual angulation of
10° or less.
No further intervenon
n=223
No difficules
during primary
reducon
n=168
Difficules
during primary
reducon
n=48
Redisplacement
n=31 (18.5%)
Redisplacement
n=22 (43.8%)
Secondary intervenon
n=38
Repeated
reducon
n=28
Secondary
Kirschner wire
fixaon
n=10
Difficules
during primary
reducon
n=12
Difficules
during primary
reducon
n=5
In 48.6% of cases with necessary
secondary intervenon
explicitly depicted difficules during
primary reducon of fracture
Primary closed reducon
and immobilizaon
n=263
No operave reports
available due to
reduconn in
different hospital
n=7
No operave
reports available
due to reducon
in different
hospital
n=3
Influence of difficules during primary intervenon on redisplacement rate
Fig. 5 Factors influencing redisplacement are shown here for patients primarily treated with closed reduction and immobilization
5. 425
Closed reduction and immobilization of radial fractures
1 3
Taken together, 14.4 % of patients treated primar-
ily with closed reduction and immobilization required
further treatment, e.g., either secondary reduction in 28
cases or Kirschner wire fixation in ten cases. Eleven frac-
tures displayed residual displacement beyond the limits of
remodeling, however, limits were set very strictly. Maxi-
mal residual angulation was 40° in the group of patients
aged 1–5 years, 35° in the group of 6–11 years and 26° in
patients from 12 to 18 years in the last follow up examina-
tion after 4–6 weeks.
Next, we investigated application of immobilization
without closed reduction as initial treatment and found
104 fractures with a primary displacement degree rang-
ing from 7° to 48°. However, minor angulation was com-
bined with severe translation. Children aged 8 years or
younger received above-elbow casts while older patients
were treated with underarm-casts. Only 14.4 % of patients
were older than 11 years in this treatment group (Fig. 6).
Although in 51 fractures secondary displacement was
detected (and additionally, ten fractures revealed an
increase in displacement after another trauma or after acci-
dentally breaking the cast and therefore, were excluded),
only 18 of these needed secondary closed reduction and no
fracture was fixated with Kirschner wires (Fig. 7). Three
fractures were secondarily placed in Schede position. All
other cases maintained their status or were expected to cor-
rect their displacement spontaneously due to remodeling.
Taken together, 78 of 94 fractures (83.0 %) did not need
any further treatment after cast immobilization and 86.2 %
were noted to be within limits of remodeling at the last fol-
low-up examination after 4–6 weeks.
Summing up the cases of secondary reduction, 46 cases
were registered, namely 18 times after primary immo-
bilization alone and 28 times after primary closed reduc-
tion. Interestingly, of these secondary reductions only six
fractures were unsuccessful due to consolidation within 1,
2 and 7 weeks. However, all other cases were effectively
reduced secondarily.
Primary Kirschner wire fixation was performed in 25
patients corresponding to 6.11 % of all studied cases. 80 %
of the patients treated with primary Kirschner wire fixation
were older than 5 years (Fig. 8). Indication for this proce-
dure was instability after closed reduction or necessity of
open reduction intraoperatively. In the last follow-up exam-
ination, 92 % of these fractures displayed a residual angu-
lation of less than 10° and no translation. Only one fracture
redisplaced revealing an angulation of 15°. One patient, as
an exception, however, displayed an increased angulation
21
68
15
age distribuon of paents with primary
immobilizaon n=104
1-5J
6-11J
12-18J
Fig. 6 The age pattern of patients primarily treated with immobiliza-
tion is depicted here
0
2
4
6
8
10
12
14
16
18
1-5years 6-11 years 12-18 years
age distribuon of repeated reducon aer primary
immobilizaon
Fig. 7 Secondary intervention after primary cast immobilization
alone consisted of secondary reduction only. Due to their remodeling
potential, most patients were between 6 and 11 years of age
5
6
14
age distribuon of paents with Kirschner wire
fixaon n=25
1-5J
6-11J
12-18J
Fig. 8 More than half of patients treated with Kirschner wire fixation
were older than 11 years of age
6. 426 D. S. Wendling-Keim et al.
1 3
even in comparison to the initial X-ray and needed plat-
ing which is applied in children only very rarely and under
special circumstances. Apart from this case complications
were uncommon as one patient developed wound infection
and one suffered from maceration of the skin in the area of
the wire tip.
Of the studied fractures some had special features. Eight
were open fractures, however, seven of them were rated
Gustilo grade I and one Gustilo grade II. Furthermore
78 Salter-Harrys-II and 4 Salter-Harrys I fractures were
counted as well as 14 green stick fractures and three plu-
rifragmentary fractures. Interestingly, no significant dif-
ference regarding the redisplacement rate was detected in
comparison to the fractures without special characteristics
except for the fractures with involvement of the growth
plate (Table 3).
Interestingly, involvement of the epiphyseal plate was
found to be a factor influencing the rate of redisplacement.
Of 87 cases with fractured epiphyseal plates a redisplace-
ment rate of only 25.3 % was detected as opposed to 42 %
in 288 patients with fractures located away from the phy-
sis yielding a significant P value of 0.005. The total of 375
fractures here is explained by redisplacement due to a new
trauma or a defect cast. Another influencing factor is the
direction of initial displacement as 42.8 % of dorsally dis-
placed fractures revealed redisplacement while only 20.6 %
of fractures with volar angulation did.
Furthermore, 49.1 % of patients in our study presented
with an intact ulna and 33.2 % of these displaced second-
arily and only 44.2 % needed further treatment. However,
42.5 % of complete fractures showed secondary displace-
ment so that we cannot confirm other studies that consider
an intact ulna a risk factor for redisplacement.
Discussion
The aim of our study was to investigate on a large-scale
if closed reduction and immobilization of displaced distal
radial fractures provide a sufficient treatment for children
and to establish parameters that reveal an increased risk for
redisplacement and indicate for Kirschner wire fixation.
Of 393 fractures that we investigated, 263 cases were
indicated to be reduced and immobilized because they did
not apply for mere immobilization due to their displace-
ment beyond the limits of remodeling. To avoid any bias,
we registered any change in angulation or translation after
reduction in our study. Since only 14.4 % of these fractures
needed further treatment because of redisplacement and
the outcome was good, we conclude that closed reduction
and immobilization is an appropriate method to treat these
fractures in children. In comparison to hospitals that gen-
erally treat fractures that display angulation or translation
beyond the known limits of remodeling with Kirschner
wire fixation to avoid the risk of loss of reduction, in our
study 85.6 % of patients were spared general anesthesia as
well as hospitalization for hardware removal and the risk of
wound infection.
Due to the absence of consent about the remodeling
capacity [18–22] very strict limits of remodeling were cho-
sen as described in the methods section. Limits of remod-
eling were considered ≤30° angulation and ≤shaft width
translation for children under 12 years of age and ≤15°
angulation and ≤1/2 shaft width translation for children
aged 12 years or older, respectively. Nevertheless, most
fractures were found to be within these strict limits after
closed reduction and immobilization which underlines the
usefulness of closed reduction and immobilization as the
standard treatment for distal radial fractures in children.
However, to optimize treatment of the cases that needed
secondary therapy, we analyzed operation reports and
intraoperative X-rays amongst other factors increasing the
chance of redisplacement. Interestingly, in nearly half of
these cases, reports and X-rays revealed that fractures were
not optimally reduced since residual angulation of more
than 5° or/and translation of more than corticalis width was
accepted during the intervention or more than one attempt
of reduction was needed. As it is well-known that opera-
tive reports not always contain every detail during a pro-
cedure it is even possible that these problems evolve in a
greater percentage of cases leading to loss of reduction
in need of further treatment. In our study, these above-
explained difficulties were noted in 17 cases of which five
needed secondary Kirschner wire fixation and 12 required
Table 3 Rate of redisplacement
of the different fracture types
Type of displaced fracture Number of fractures Redisplacement rate (%)
Distal radial fracture without special features 286 37.8
Open fracture Gustilo grade I/II 8 26.7
Aitken fracture I 78 26.3
Aitken fracture 0 4 –
Green stick fracture 14 24.9
Plurifragmentary fracture 3 –
Total 393
7. 427
Closed reduction and immobilization of radial fractures
1 3
secondary reduction. Furthermore, in 48 more cases, prob-
lems during reduction were logged, and 43.8 % of these
redisplaced, however, measurements were within the limits
of remodeling and patients did not need secondary therapy.
Although only 26.2 % of fractures with explicitly reported
problems during reduction were reduced again or fixated
with Kirschner wires, 58.6 % of fractures with difficulties
during reduction revealed loss of reduction. Therefore, we
consider the mentioned reported difficulties a risk factor
for redisplacement and recommend primary Kirschner wire
fixation for these cases to reduce the fraction of 14.4 % of
fractures that needed secondary treatment.
Furthermore, our results regarding residual displace-
ment as a risk factor for redisplacement are in agreement
with earlier studies [6, 10, 13, 23–26]. Strikingly, repeated
attempts of reduction have not been described in this
context so far. On the other hand, another finding under-
lines our statement, since only 6.9 % of fractures without
any reported problems or without residual displacement
needed further treatment and this number does not take
into account when repeated attempts of reduction were not
noted in the reports possibly due to lack of detailed descrip-
tion of a routine procedure.
Additionally, fractures with involvement of the epiphy-
seal plate were more resistant to redisplacement pointing
to a higher stability of distal fractures. However, we can-
not confirm results from some studies that hypothesize that
an intact ulna increases the rate of secondary displacement
[11, 15, 24, 27, 28] as opposed to others that found no influ-
ence of an intact ulna on the rate of redisplacement [15, 28]
since our study found a tendency of increased redisplace-
ment risk that is associated with a fractured ulna. Notably,
when using the term “intact ulna” we did not include ulnar
buckle fractures or ulnar styloid fractures in this term as
opposed to other groups [24].
Only 25 patients in our study were treated with primary
Kirschner wire fixation. Indication for this operation was
instability during reduction or need of open reduction.
The outcome was highly satisfying since only one patient
needed further treatment and complication rate was also
low since we detected only one case of wound infection and
one patient with skin maceration due to Kirschner wires.
However, as mentioned above, further hospitalization and
anesthesia was necessary for hardware removal so that we
confirm our recommendation to keep this method back for
the explained selected cases. Furthermore, a recent study
has shown that there is no long-term benefit of Kirschner
wire fixation regarding the outcome of these fractures in
children [29].
Limitations of this study are the short follow-up time
of mostly 4–6 weeks so that we can not draw any conclu-
sions on the long-term outcome of the fractures. However,
the remodeling potential and long term outcomes after
radial fractures in children have been investigated in pre-
vious studies [18–22] whereas our goal was to investigate
the redisplacement rate after closed reduction without
osteosynthesis of fractures in children and its risk factors to
avoid this complication and to evaluate this method of treat-
ment. Nevertheless, a follow-up study addressing the group
of patients with residual deformities has been planned.
Another point to consider is, of course, the retrospective
design of the study. However, performing a prospective
study with children regarding treatment in an emergency
setting will raise ethical concerns and recruitment might be
severely prolonged due to the anxiety of the parents. Fur-
thermore, limitating, this has been a single-center study,
collecting data from various centers might be a task for the
future. Additionally, 7 different attendings and 14 different
residents have performed the analyzed reductions, but the
large number of cases should compensate for this inhomo-
geneity. Also, we investigated different fracture types, how-
ever, this was considered in the analysis. A further interest-
ing follow-up trial might be an analysis in our institution
regarding the impact of the recommended change in the
management of the mentioned distal radial fractures on the
rate of secondary displacements.
This study presents a large series of distal displaced
radial fractures in children. In conclusion, 85.4 % of cases
with primary closed reduction and immobilization did not
need any further intervention while 10.7 % of reduced frac-
tures needed secondary reduction and 3.8 % of reduced
cases were treated with secondary Kirschner wire fixa-
tion. Due to our analysis of operative reports, we consider
repeated reductions and residual displacement of angula-
tion of 5° or more and translation of corticalis thickness
or more a major risk factor for redisplacement and suggest
primary Kirschner wire fixation in these cases.
Conflict of interest Danielle Wendling-Keim, Hans-Georg Dietz
and Barbara Wieser declare that they have no conflict of interest.
Compliance with ethical requirements The study was performed
according to the ethical requirements; this article does not contain any
experiments with human or animal subjects performed by any of the
authors.
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