A Neglected Markedly Displaced Medial Epicondyle Fracture with Simultaneous Ulnar Nerve Palsy in an Adolescent

Humeral medial epicondyle fractures constitute around 15% of pediatric elbow fractures. Up to 60% occur in association with elbow dislocations. Knowledge of potential imaging pitfalls when examining acute elbow fractures in children contributes significantly to accurate diagnosis. Nevertheless, management of missed pediatric medial epicondyle fractures has rarely been reported. We present an 11-year-old boy with a neglected and severely displaced medial epicondyle fracture with concurrent ulnar nerve palsy. We performed neural decompression, fragment excision, and muscular and capsuloligamentous reconstruction of the medial elbow. This study demonstrates that the surgical outcome of a late presenting fracture can be satisfactory in terms of function and neural recovery. It also underscores the importance of careful interpretation of elbow imaging including normal anatomic variants.

Detection of occult HBV infection by nested PCR assay among chronic hepatitis C patients with and without hepatocellular carcinoma

Occult hepatitis B virus infection [OBI] has been reported among patients with chronic hepatitis C virus [HCV] infection and hepatocellular carcinoma [HCC]. This study aimed to evaluate the prevalence of OBI in chronic hepatitis C patients with and without hepatocellular carcinoma. A total of 40 chronic hepatitis C patients who were negative for HBsAg, were enrolled into the study. They were classified into two groups: Group I which included 20 patients with chronic hepatitis C only whereas Group II included 20 patients with chronic hepatitis C and HCC. Detection of HBV DNA was done by nested-PCR using two sets of primers specific for surface and X viral genomes in serum and liver tissue of patients. Genotyping system based on PCR using type-specific primers was done for HBV-DNA positive intrahepatic samples. OBI was detected in the liver tissue in 23/40 [57.5%] of chronic HCV infected patients, 18 [78.3%] of whom belonged to group II, conferring a 90% prevalence of this group. In serum, HBV-DNA was detected in 9/40 patients [22.5%], 7 [77.8%] of whom belonged to group II. Among the 23 positive intrahepatic HBV-DNA samples studied, HBV-genotype D [34.8%] and B [26.1%] were more predominant, whereas HBV-genotype C [13.1%] and A [8.7%] infections were the least observed, respectively; mixed genotypes were detected in 17.4% [n = 4], 3 of them were with HBV-genotype D and B, and 1 was with HBV-genotype C and A. In conclusion OBI is a fact in our community; it was detected in liver tissue of chronic HCV-infected patients, especially in cases of chronic HCC. In addition, OBI might be related to severity of necroinflammatory activity and fibrosis. Large studies are needed to confirm that co-infection could determine a worse progress of chronic liver disease in this population. Also, detection of intrahepatic HBV-DNA is more useful in diagnosis of OBI

Management of wrist drop in children with Erb's palsy

There are two main types of obstetric brachial plexus palsy [OBPP]: Erb's and total palsies. Children with total involvement of the brachial plexus [C5-Tl] have poor hand function and are not candidates for limb reconstruction. In children with Erb's type of palsy restoration of active wrist extension is important as an effective hand grip is only possible with the wrist extended. The aim of this study is to evaluate the results of flexor carpi ulnaris [FCU] to extensor carpi radialis brevis [ECRB] transfer to restore active wrist extension and consequently establish an effective hand grip in patients with C5-7 pattern of Erb's palsy. Fifteen children with OBPP and wrist drop [C5-7 pattern of involvement] underwent FCU to ECRB transfer. The wrist drop was reconstructed in all patients who were consequently able to perform an effective hand grip. This study confirms that FCU to ECRB transfer in patients with OBPP and wrist drop is a simple and effective technique provided the selection criteria are respected

Ain Shams experience with total inter-vertebral DISC prosthesis with 30 months follow up

Degeneration of the intervertebral disc is the most common cause of low back pain. Continuous researches for an alternative option to surgical fusion have been successfully run over the last two decades. That resulted in total intervertebral disc prosthesis for treatment of disc degeneration with motion segment preservation. The aim of this study is evaluation of the short term results of lumbar intervertebral disc prosthesis in treatment of degenerative lumbar disc disease in selected cases. This prospective study was carried out at Ain Shams University hospital in the period between August 2000 and March 2005.on 16 patients with disabling low back pain due to degenerative disc disease. Seven of them have also sciatica. The patients were selected according to 1- the age between 22 -48 years 2-chronic disc disease presented by severe low back pain with or without sciatica 3- good bone quality 4-all had moderate to severe degrees of disability according to the modified Stauffer and Coventry Scoring system which have not improved by medical treatment and physiotherapy. All patients have been treated by total disc replacement [SB Charite] after complete clinical, radiological investigation that included stress X-ray films and MRI study. One level replacement was done in 12 patients and double levels replacement were done in four patients'.The total number of the disc prostheses used in this study were twenty prostheses. The operation was done through an anterior retroperitoneal approach in 15 cases and through transperitoneal approach in 1 case. The patients were followed up for an average period of 30 months [range 7-60 months]. The results were evaluated according to modified Stauffer and Coventerey. The patients were satisfied with the results. All have resumed the pre-disease activities and duties although two patients had low back pain that needs mild anti-inflammatory medications in low doses. Two patients have a displaced prosthesis [off-position from the mid-line in antero-posterior view only while the saggital view position was perfect in these patients like others]. No major complications were recorded in relation to the surgical approach or to the prosthesis during surgery or immediately after; also no complications were reported in relation to the position of the prosthesis or its integrity and stability, and no ossification in the surgical bed, were detected in the follow up period up to 60 months in the early inserted prosthesis. Although the number of cases in this study is limited and the follow up period is short, the maximum follow up period is five years the results are satisfactory to the surgeons and to the patients. Comparing this results in relation to the activities and duties before surgery and in relation to the results and complications after spinal fusion surgery with its passive effect on the discs above and blow the fused segment. So the articulating disc prosthesis can be a successful solution for treatment of degenerative and prolapsed disc in well selected patients

Modified Hoffer procedure for children with Erb's palsy

The Hoffer technique in which the tendons of the latissimus dorsi and teres major are transferred to the rotataor cuff-posterior to the long head of the triceps - has been reported to result in significant improvement in both external rotation and abduction of the shoulder. During an 18-month period, 13 children with obstetric brachial plexus palsy [C5-C6 pattern of involvement] underwent a stimultaneous subscrapularis recession and transfer of the tendons of the latissimus dorsi and teres major muscles to the rotator cuff through a single posterior incision. The age at time of surgery ranged from 4-8 [average 5.5] years. Follow up ranged from 13-31 [average 18] months. All patients improved following surgery. The average gain in external rotation was 51.5° and in abduction was 61.6°. This study further emphasizes the results of previous authors regarding improvement of shoulder external rotation and abduction following the Hoffer procedure. A modification of the original procedure is described allowing correction of the internal rotation contracture and tendon transfer through a single incision