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A prospective study of closed reduction percutaneous pin fixation and early early passive range of motion exercise of the acute acromioclavicular jonit separation was done in Srinakarind hospital, Khon Kaen, Thailand during July 1991 to December 1992 , 14 male patients were included, average age was 33.79 years, 6 were left side and 8 were right side, traffic accidents were the major cause of injury, only one was by sport injury and the other one was by sport injury and the other one was hit by an elephant, 11 cases were type III dislocation and 3 cases were type IV, average preoperative coracoclavicular gap was 1.74 centimeters. Average time of pin removal was 58 days postoperatively, 3 cases (21.42%) of the patient had free motion of the shoulder at 2 weeks postoperatively and 13 cases (92.88%) had pain free motion at 4 weeks, 12 cases (85.71%) had normal range of motion of the shoulder at 8 weeks. 4 cases (28.57%) had retrograde pin migration and one had pin tract infection.
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Background: There are two principles of operative technique for the treatment of acromioclavicular dislocation. One is transarticular of the acromioclavicular fixation of the acromioclavicular joint and the other is coracoclavicular fixation. Both two techniques may or may not include ligamentous repaired. However, both techniques have many complications. Objective: To present a new operative technique which based on extensive studying of anatomy of this particular area. This technique is open reduction and transfixation the lateral end of clavicle to the base of acromion process with single malleolar screw and washer. Study Design: Case report. Setting: Orthopedics department, Faculty of Medicine, Khon Kaen University.Results: The reliability technique was presented by using the aiming device for directing the drill from the clavicle to scapular spine. This technique was done in one patient. This technique provides the ritid and stable fixation of the joint, therefore, the patient can move his shoulder immediately after operation. Conclusion: The new operative technique for acromioclavicular joint dislocation has been presented.
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Background: Clavicular fracture is a common fracture of the upper extremity. Normally, non-operative treatment is recommended, however, the mal position and shortening of this fracture might affect the shoulder functions. Therefore, many authors recommend operative treatment.Objectives: To evaluate the satisfaction and range of motion on the ipsilateral shoulder of the patients with malunited fracture of the clavicle who were treated at Srinagarind Hospital.Design: This was a retrospective study.Setting: Srinagarind HospitalResults: There were 30 patients, regarded to the range of motion of the shoulder that had an ipsilateral malunion of clavicle. There were 23 men and 7 women. The mean age of the patients was 29.93 year (range 14-56 years). The mean duration between finished treatment and the last follow up was 41.80 weeks (range 5-108 weeks). The right clavicle was fractured in 20 patients (66.67%) and the left clavicle was in 10 pateints (33.33%). The most common site of fractures was the middle third (27 patients, 90%). The rest was the distal third. The most common cause of fractures was traffic accident (26 patients, 86.67%). The figure of eight casts were applied 28 patients (93.33%) and donut splint for the rest 2 patients. The mean time for immobilization was 4.9 weeks (range 2-12 weeks). The mean length of clavicle was 16.03 + 1.44 centimeters (range 13.5-18.5 centimeters). The mean shortening of the malunited clavicle was 0.83 + 0.58 centimeters (range 0-2 centimeters). Twenty-one patients (70%) had equally range of motion of the shoulder bilaterally, nine patients had a difference from the normal shoulder. In the latter group, 8/9 patient had good function status only 1 patient had moderate function status.Conculusion: Regarding the function of shoulder there were 28 patients (93.33%) had good function and the cosmetic results have a median value of 4 (2-5). Seventy percent of the patients had normal range of motion compared with the normal sides.Key words: (1) Clavicle (2) Malunion (3) Shoulder (4) Motion
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Background : Plaster of Paris is a material, used for immobilization when the patients have fractures or muscle injuries or dislocation of the joints. Cast removal will be done after finished treatment. The common tool for removing the plaster of Paris cast is an electrical saw. However, the noise and dust produced during the process of cutting are undesirable and most of the patients are scared of the noise and the moving saw blade of the electrical saw. Moreover, the electrical saw is an expensive tool. New methods to conserve energy and to reduce pollution in the office are proposed. Objective to evaluate the efficacy of a new device, twisted wire, compared with the electrical saw for removing the plaster of Paris cast.Study design : Non randomized experimental study.Setting : The outpatient clinic number I at Srinagarind hospital.Subjects : Sixty patients with fracture and ligamentous injuries of the extremities were included in this study; fifty-three males and seven females. The mean age was 26 years old (15-43 years). The four groups of fifteen patients each consisted of those with; short arm casts, long arm casts, short leg and PTB casts, and long leg and cylindrical casts.Result : The mean standard deviation of duration for cutting the short arm cast using the electrical saw and twisted wire 10.02 2.15 seconds and 3.00 1.80 seconds respectively (p \<.005). The mean and standard deviation of duration for\ cutting the long arm cast by using the electrical of duration for cutting the long arm cast by using the electrical saw and twisted wire 17.00 4.35 seconds and 6.10 1.38 seconds respectively (p \< .005). The mean standard deviation for cutting the short leg and PTB casts using the electrical saw and the twisted wire were 15.12 2.56 seconds and 5.01 1.65 seconds respectively (p\<.005). The mean and standard deviation for cutting the long leg cast using the electrical saw and twisted wire were 58.23 9.86 seconds and 15.35 2.69 seconds respectively (p\<.05). The mean and standard deviation to the overall satisfaction of the patients with the electrical saw and twisted wire were 52.25 27.15 and 83.75 9.57 respectively (p\<.05).Conclusion : The twisted wire cutting cast is a new and effective for removing a plaster of Paris cast which is easy to produce and use, safe, cheapness, and noiseless.
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Background : The diagnosis of acromioclavicular (AC) joint injury depends upon primary physical and radiological examinations. Simultaneous views of both AC joints are obtained and measurements compared between injured and uninjured sides. Most commonly, the severity of injury is determined by the relative differences between the widths of the AC joint space, the coracoclavicular (CC) distance, and degree of elevation of the clavicle above the acromion. These parameters are usually used to decide on surgical or conservative treatments. The measurement’s variation can change the treatment options.Objectives : To evaluate the reliability of the current method for measuring the CC distance and introducing the new method of measuring the width of CC distance by using a Mose’s template.Design : Descriptive studySetting : Department of Orthopedic, faculty of medicine, Khon Kaen University.Subjects : The anteroposterior radiograph of both acromioclavicular joints with Zanza technique were used in this study. Twenty radiographs were selected based on the quality of the radiograph. There were 15 male and female patients. The average age of the patients was 25±6 years old (range 20-48). Thirteen patients had right and seven had left AC joint injuries. Two observers were included in this study to evaluate the reliability of the current and new methods.Results : There were thirty-two of 40 pairs (32/40, 80 %, 95% confidence interval 67.61%-92.39%) of measurement by two observers (interobserver reliability) using Mose’s template had the same results. However, the current technique used by two observers had the same results only three of 40 pairs (3/40, 7.5%,95% confidence interval 7.2%-7.8%) of measurements. The intraobserver reliability, for the Mose’s template of the observer I and II, there were 8 of 10 (8/10, 80%, 95% confidence interval 30%-90%) and 6 of 10 pairs (6/10, 60%, 95% confidence interval 30%-90%) of measurements had the same results respectively. For the current technique, however, there were only two of 10 pairs(2/10,20%,95% confidence interval 0-45%) and one of 10 pairs (1/10, 10%,95% confidence interval 1%-29%) of measurements of the observer I and II had the same results respectively.Conclusion : The Mose template technique is a more reliable method of measurement the CC distance in the AC joint injury.
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Background: A child who has an acutely irritable hip can pose a diagnostic challenge. The purposes of this study were to determine the diagnostic value of presenting variables for differentiating between septic arthritis and primary psoas abscesses in children who present with hip pain.Purpose: This study was to determine the diagnostic value of the clinical presentations in children for differentiating between septic arthritis of the hip joint and psoas abscess.\ Methods:\ The cases of children evaluated for an acutely irritable hip at a university hospital between 1984 and 2001 were reviewed retrospectively.\ Diagnoses of septic arthritis of the hip joint and psoas abscess were defined by the presence of pus in the hip joint or in the psoas muscles, results of cultures of the joint fluid, blood and pus, and the clinical course.\ The clinical presentations were used to differentiate between septic arthritis and psoas abscesses;\ univariate and multiple logistic regression analyses were used to assess their statistical significance.Study design: Case-control studySetting: Department of Orthopedics, Faculty of Medicine, Khon Kaen UniversityResults:\ Thirty-seven patients, 13 girls and 24 boys, had septic arthritis of the hip joint and ten, 4 girls and 6 boys, had a psoas abscess. The mean age of the septic hip and psoas abscess groups were 9.7 3.6 years (range, 4 to14 years) and 8.34.2 years (range, 5 months to 14 years) respectively. The left hip joint was affected in 21 cases, the left psoas muscle in 7.\ Staphylococcus aureus was the causative pathogen in 25 cases of the septic hip group and 6 of the psoas abscess group. Most of the psoas abscess group (90 percent, 9/10 cases) presented with a lower abdominal mass whereas none were found in the septic hip group (p\<. 001). All of patients in the psoas abscess group experienced abdominal pain, while none in the septic hip group did (p\<. 001). None of the patients in the septic hip group was able to walk but all of the psoas abscess group was able to do so (p\<. 001). All cases in both groups presented with fever and hip flexion contracture except one in the septic hip group. Results of other laboratory investigations were similar for both groups, except that ultrasound of abdomen revealed abscesses inside affected psoas muscles.\ The mean duration of symptoms was 9.5 8.8 days and 31.635.2 days in the septic hip and psoas abscess groups, respectively (p\<. 001). The multiple logistic regression indicated that lower abdominal mass and pain, and ability to bear weight were significant variables only in the psoas abscess group.Conclusions:\ Pyogenic psoas abscess is the most likely diagnosis in children who present with fever, hip pain and flexion contracture of the hip joint, but can bear weight, and have clinical findings that include lower abdominal masses and pain.