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

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

[Treatment of distal radius fracture with percutaneous pinning and pin-in plaster with patients older than 60 years]

Background: Distal radius fractures are the most common fractures of upper limbs in adults and their treatment in older patients is difficult. There are different therapeutic methods. In this study we aim to compare the therapeutic outcome of distal radius fractures treated with pin-in plaster and percutaneous pinning in older patients

Methods: In this randomized clinical trial, 60 old patients including 40 female and 20 male between 60-85 years old with distal radius fractures were evaluated in two groups of pin-in plaster [n=30] and percutaneous pinning [n=30] for treatment outcome, radiographic changes, functional outcome and pain during 6 month after surgery

Results: Pin-in plaster group compared to percutaneous pinning had significantly better radiologic findings at the end of 6 month. Excellent functional results after 6 weeks were observed in 30% and 23.3% of pin-in plaster and percutaneous pinning groups, respectively [p=0.84], six months after surgery, excellent functional outcome were significantly higher in pin-in plaster group [83.3% vs. 50%, p=0.006]. Being painless has no significant difference between groups after 6 weeks [43.3% vs. 56.7%, p=0.54], however it was significantly higher in pin-plaster group after 6 months [93.3% vs. 50%, p=0.002]

Conclusion: Pin-in plaster method compared to percutaneous pinning had acceptable radiologic and functional outcome in old patients over 60 years old. Using this method as a simple method with high efficacy in treatment of distal radius fractures is recommended

[Evaluation of calcitonin effects on the treatment of shoulder adhesive capsulitis]

Backgrounds and Objectives: Adhesive capsulitis, characterized by pain and progressive stiffness of the glenohumeral joint, is a common cause of shoulder pain in patients referred to the outpatient clinic. Calcitonin is a thyroid hormone that provides analgesic effects in painful conditions including complex regional pain syndrome, trauma, vertebral metastasis fractures and etc. Intranasal calcitonin would lead to significant improvement in the treatment of shoulder adhesive capsulitis

Materials and Methods: In a prospective, double blind, randomized, placebo controlled clinical trial study, 64 patients with adhesive capsulitis were divided into 2 groups. The active group received intranasal Calcitonin spray [200 u/day for 6 weeks] and placebo group received placebo spray. Patients of two groups were evaluated before and after intervention, with assessment of shoulder pain, shoulder range of motion and ability in performing daily activities

Results: At 6 weeks, there was greater improvement in shoulder pain, shoulder range of motion and ability in performing daily activities in the calcitonin group than placebo group. In intervention group, 22 [68%] patients experienced improvement while 10 [32%] patients did not experience improvement in their shoulder function. In placebo group, 9 [28%] and 23 [72%] of patients of the placebo group experienced and did not experience improvement of shoulder function

Conclusions: A 6 week course of 200 u/day intranasal calcitonin spray has a significant benefit in shoulder adhesive capsulitis. Considering the noninvasive nature and lack of any significant complications of this treatment, intranasal calcitonin spray associated with physiotherapy and anti-inflammation medicines are recommended for the treatment of shoulder adhesive capsulitis

Simultaneous dorsal base fracture and FDP avulsion of distal phalanx of the little finger

Avulsion injury of the flexor digitorum profundus [FDP] with concomitant fracture of the distal phalanx dorsal base is uncommon. Simultaneous avulsion fractures of the insertion of this tendon associated with rupture of the tendon from the bony fragment and combination with dorsal base fracture is very rare and also complicated. A 36- year- old man fell and injured his right little finger. FDP avulsion with simultaneous dorsal base fracture [containing extensor Tendon insertion] was detected. Our surgical repair by a single midlateral incision the avulsed fragment was replaced on the palmar base of the distal phalanx and successfully immobilized with 1.5 mm screw. After three months, patient had 20 degree range of motion in DIP joint. The digit was pain free and also relatively functional. It seems that FDP avulsion classification need to be extended and include this uncommon type as described in this case report for better management of these uncommon type

unusual cause of bilateral anterior shoulder dislocation

We present an unusual case of a traumatic bilateral simultaneous dislocation of shoulder in a healthy young male. Bilateral shoulder dislocation are rare and the reported cases, have been mostly associated with trauma or seizure. Only a few cases [about 4] have been reported in the literature so far and all of these are associated with trauma. The one we present is a bilateral anterior shoulder dislocation without traumatic history but associated with newly occurred seizures