Clinical significance of Baumann's angle in the percutaneous pinning fixation for supracondylar fractures of the humerus in children

To evaluate the clinical significance of Baumann’s angle in the closed reduction and percutaneous pinning fixation for supracondylar fractures of the humerus in children.Methods There were 97 children (male 59,female 38,mean age of 6.8 years) with displaced supracondylar fracrtures of the humerus were treated in this hospital.Under fluoroscopy guidance,three-dimensional displacement of fractures was corrected by closed reduction.The percutaneous Kirschner wire pinning was applied only if the radiographs demonstrated that Baumann’s angle was less than 4 degree compared to that on the normal side.All of them were followed up for 34.5 months (range,12 to 48 months).Results There was one case with ulnar nerve palsy associated with the pinning.There were no Volkmann’s contracture in this group.X-ray examinations revealed an average 73.7 degrees of Baumann angle on the injured and 72.8 on uninjured side.An average 7.6 degrees of the carrying angle on the injured and 9.7 on uninjured side were also demonstrated by radiography.Five patients developed slight cubitus varus deformity.The result according to Flynn criteria were excellent in 85 patients (87.6%),good in 12 patients (12.4%).Conclusion The satisfactory results can be gained in children with displaced supracondylar fractures of the humerus by restoration of the normal Baumann angle and percutaneous pinning fixation.18 refs,2 figs.

Fracture union in percutaneous Kirschner wire fixation in paediatric tibial shaft fractures

Purpose： To evaluate the efficacy of intramedullary Kirschner wires for the treatment of unstable tibial shaft fractures in children. Methods： This prospective study was conducted at the Department of Orthopaedic Surgery in Maharishi Markandeshwar Medical College from June 2005 to June 2010. Sixty-six children having closed fracture of the tibial shaft with a mean age of 7.7 years （range, 2-14 years） were recruited from emergency and outpatient department. They were treated with percutaneous intramedullary Kirschner wires. The clinical results of our study were rated on the basis of the criteria of union, nonunion, delayed union or malunion. All children were followed for one year. Results： Children achieved union in a mean time of 8 weeks （range, 6-10 weeks）. Postoperatively, three children （4.55%） had delayed union, one （1.52%） valgus deformity of lower leg, three （4.55%） post- operative knee pain and twelve （18.18%） skin irritation at pin site. Wires were removed after 8-22 weeks without any complications. No patient was lost to follow-up. The results were excellent in 95.45% and good in 4.55% children. Conclusion： This technique is cost-effective, simple, quick to perform, safe and reliable and avoids pro- longed hospitalization with good results.

An unusual Monteggia equivalent type 1 lesion： Diaphyseal ulna and radius fractures with a posterior elbow dislocation in a child

In this report, we describe an extremely unusual Monteggia equivalent type 1 lesion in a 10-year-old boy following a fall from a height of I m. On the plain radiographs, our patient had a particular Monteggia equivalent type 1 injury associating a posterior elbow dislocation with diaphyseal radius and ulna fractures. The patient was treated by closed reduction technique. At six months of follow-up, the frac- tures were consolidated and the elbow was stable. To our knowledge, only 8 adult cases and one pae- diatric observation with similar lesions had been reported through medical literature. Therefore, the aim of our case report is to remind this rare entity and also to provide a comprehensive review of the literature related to this uncommon lesion.