Closed reduction and percutaneous pinning of displaced supracondylar fractures of humerus in children with delayed presentation

Objective： Supracondylar fractures of the humerus account for 60% of all the fractures around the pediatric elbow and even in developed countries 18% of patients undergo surgery 48 hours or longer following presentation in the hospital. Management guidelines are not clear yet for these patients who present late. The aim of this prospective study was to evaluate the clinical, radiological and functional outcome following closed reduction and percutaneous pinning of widely displaced supracondylar fractures of the humerus presenting 12 hours or more after injury.Methods： We reviewed the functional and radiological results of closed reduction and percutaneous pinning using crossed K-wires in 40 patients with displaced extension type supracondylar fracture of the humerus （Gartland type Ⅲ） with a delay of more than 12 hours in presentation. The average age of patients was 4.5 years and the mean delay in presentation was 17.55 hours.Results： Closed reduction and percutaneous pinning was successful in 90% of patients. The mean follow up period was 15 months. The Baumann＇s angle was restored within 4 degrees of the unaffected side in all patients. Use of a small medial incision in patients with severe swelling helped us avoid ulnar nerve injury. Using Flynn＇s criteria,38 patients （95%） had an excellent result. Two patients had mild myositis and both had a poor result. None of the patients developed cubitus varus.Conclusion： Closed reduction and crossed pinning of displaced supracondylar fractures of humerus in children is a safe and effective method even with delayed presentation.

Ipsilateral proximal and shaft femoral fractures

Purpose： To study the management and evaluate anatomical and functional outcomes of patients with ipsilateral proximal and shaft femoral fractures. Methods： A retrospective, descriptive and analytic study lasted for ten years and a half ranging from January 1, 2005 to June 30, 2015. The following parameters were studied： epidemiology, fracture char- acteristics, therapeutic, anatomical and functional outcomes. The correlation between different param- eters was analyzed with Fischer test. The significant threshold was defined for p value 〈0.05. Results： Ten medical files were registered. There were 7 men and 3 women, with a sex ratio of 2.33. The average age was 46 years （range： 29-62 years）. It was about traffic road accidents in all cases. Motorcycle -motorcycle and motorcycle-car collision were most frequent. Average admission delay was 7 h （range： 1.5-24 h）. Left side was most reached in 8 cases. According to Garden classification, there was type Ⅲ cervical fracture in 2 cases, type Ⅱ in 1 case and type Ⅳ in 1 case. According to Ender classification, there was type I trochanteric fracture in 3 cases, type Ⅵ in 2 cases and type Ⅶ in 1 case. According to AO classification, there was type A shaft fracture in 6 cases （A2 in 4 cases and A3 in 2 cases）, type B in 2 cases （BI in 1 case and B2 in 1 case） and type C in 2 cases （CI in 1 case and C2 in 1 case）. Average surgical delay was 28.7 days （range： 11-61 days）. For proximal femoral fracture, Moore prosthesis was used in 1 case, blade plate 130° in 2 cases, long Gamma nail in 4 cases, double screwing in 2 cases and dynamic hip screw in 1 case. For shaft femoral fracture, blade plate 95° was used in 3 cases, low compressive plate in 2 cases. Osseous contention was achieved in 4 cases with long Gamma nail and in 1 case with long blade plate 130°. Nonunion of cervical fracture was achieved in 2 cases. The average osseous healing delay was 5.14 months （range： 3-12 months） for proximal femoral fracture and 5 months （range： 3-8 months） for shaft femoral fractures. According to Friedman and Wyman criteria, functional results were good in 4 cases, average in 4 cases and bad in 2 cases. Regarding implants, healing delay showed no statistic difference between one-implant group and two-implant group （p = 0.52）, and among the patients with different functional outcomes （p = 0.52）. Functional outcomes showed no statistic difference between one-implant group and two-implant group （p = 0.46）. Conclusion： Ipsilateral proximal and shaft femoral fractures are relatively uncommon in our daily ac- tivities. It is difficult to recognize proximal femoral fractures which are unnoticed. Results are generally good if the doctors take the two fractures into account in the management.

Clinical Research on Zishengukang Pill(滋肾骨康丸)Used to Treat Delayed Union of Fracture

Objective:To observe the curative effect of Zishengukang Pill(滋肾骨康丸) on delayed union of fracture.Methods:Sixty-four patients with delayed union of fracture were randomly divided into a control group of 32 cases treated with Western medicine and a treatment group of 32 cases treated with Western medicine and Zishengukang Pill.After 3 courses of treatment with 30 days as a course,the curative effects in the two groups were evaluated and their clinical symptoms,union rate and union time of fracture were compared.Results:The treatment resulted in cure in 25 cases,improvement in 6 cases and ineffectiveness in 1 case with the effective rate at 96.8% in the treatment group,higher than 81.3% in the control group(P<0.05).The union rate of fracture in the treatment group was higher than that in the control group(34.3% vs.12.5%,P<0.05).The union time of fracture in the treatment group was shorter than that in the control group((4.0±1.7) months vs.(5.0±1.4) months,P<0.05).Conclusion:Zishengukang Pill with obvious curative effect in the treatment of delayed union of fracture is worth popularizing.

Delayed cementless total hip arthroplasty for neglected dislocation of hip combined with complex acetabular fracture and deficient bone stock

Total hip arthroplasty （THA） for an un- treated acetabular fracture is technically challenging and the long-term result is not so favorable. A 45-year-old fe- male patient with untreated column and comminuted poste- rior wall fracture of the acetabulum was treated in our insti- tution by reconstruction of the posterior wall using iliac strut autograft and plate stabilization of the posterior col- umn with cancellous grafting and cementless THA in a single stage. At 3 years＇ follow-up, the patient was independently mobile without limb length discrepancy. Radiological evalu-ation showed well integrated components and bone grafts. No evidence of aseptic loosening or osteolysis was found. This report aims to emphasize that bony acetabular recon- struction allows the use of primary hip components, which improves prosthesis longevity and preserves bone stock for a future revision.

T-condylar fracture delayed for 10 days in a 5-year-old boy： a case report and review of the literature

T-condylar fracture is rare in paediatric age group, especially in skeletally immature children less than 9 years old. with very few cases reported in available literature. We present such a case in a 5 year old child that was initially managed as a supracondylar fracture at another centre before referral to us, 10 days after the injury. The child was diagnosed as having a displaced T-condylar fracture on plain radiograph. Open reduction and internal fixation with K-wires was performed. At 2 years follow-up, the child had good range of motion at elbow with 5°of cubitus varus. With this background we discuss the pertinent principles of management ofT-condylar fractures in skeletally immature children.