A retrospective study on manual reduction combined with Chinese Orthopaedic ankle external fixator in the treatment of trimalleolar fracture / 中国骨伤

OBJECTIVE@#To evaluate the needle puncture safety and clinical efficacy of manual reduction combined with external fixation of ankle frame in the treatment of trimalleolar fracture under the guidance of Chinese Osteosynthesis (CO) theory.@*METHODS@#The clinical data of 118 patients with trimalleolar fractures admitted from December 2010 to December 2021 were retrospectively analyzed. Fifty-three patients were treated with manual reduction combined with external fixation of ankle frame(observation group). Sixty-five patients were treated with open reduction and internal fixation with plate and screws(control group). The operation time, hospitalization days, non-weight-bearing time of the affected limb, clinical healing time of fracture, incidence of complications, visual analogue scale (VAS) before and 1 month after operation, and American Orthopedic Foot and Ankle Society(AOFAS) score of ankle joint before and 1 year after operation were compared between the two groups.@*RESULTS@#Patients in both groups were followed up for more than 1 year. All patients were followed up, and the duration ranged from 14 to 70 months, with an average of(35.28±14.66) months. There were statistically significant in operation time, hospitalization days, non-load-bearing time of affected limbs, clinical healing time of fractures and VAS score one month after operation between the two groups. One month after operation, the VAS score of the observation group was lower than that of the control group(t=3.343, P=0.001). The operation time of the observation group was significantly shorter than that of the control group(t=9.091, P=0.000). The hospitalization days in the observation group were significantly less than those in the control group(t=5.034, P=0.000). The non-load-bearing time of the affected limb in the observation group was significantly shorter than that in the control group(t=11.960, P=0.000). The clinical healing time of fracture in the observation group was significantly shorter than that in the control group(t=4.007, P=0.000). There was no significant difference in AOFAS score between the two groups one year after operation(t=0.417, P=0.678). In the observation group, there were 2 cases of pinhole infection and 3 cases of loss of reduction less than 2 mm. There were 3 cases of surgical incision infection in the control group. There was no significant difference in the incidence of complications between the two groups(χ2=0.446, P=0.504).@*CONCLUSION@#Manual reduction combined with external fixation is safe and effective in the treatment of trimalleolar fracture under the guidance of CO theory, and the function of ankle joint recovers well after operation. This therapy has good clinical value.

Clinical characteristics of patients with multi-canal benign paroxysmal positional vertigo / Características clínicas de pacientes com vertigem posicional paroxística benigna multicanal

Abstract Introduction Multi-canal benign paroxysmal positional vertigo is considered to be a rare and controversial type in the new diagnostic guidelines of Bárány because the nystagmus is more complicated or atypical, which is worthy of further study. Objective Based on the diagnostic criteria for multi-canal benign paroxysmal positional vertigo proposed by International Bárány Society, the study aimed to investigate the clinical characteristics, diagnosis and treatment of multi-canal benign paroxysmal positional vertigo. Methods A total of 41 patients with multi-canal benign paroxysmal positional vertigo were included and diagnosed by Roll, Dix-Hallpike and straight head hanging tests. Manual reduction was performed according to the involvement of semicircular canals. Results Among the 41 cases, 19 (46.3%) patients showed vertical up-beating nystagmus with or without torsional component and geotropic, apogeotropic horizontal nystagmus, and were diagnosed with posterior-horizontal canal. 11 (26.8%) patients showed vertical up-beating nystagmus with torsional component on one side and vertical down-beating nystagmus with or without torsional component on the other side during Dix-Hallpike test or straight head hanging test and were diagnosed with posterior-anterior canal benign paroxysmal positional vertigo 9 (26.8%) patients showed vertical down-beating nystagmus with or without torsional component and geotropic, apogeotropic horizontal nystagmus, and were diagnosed with anterior-horizontal canal 2 (4.9%) patients showed vertical geotropic torsional up-beating nystagmus on both sides and were diagnosed with bilateral posterior canal benign paroxysmal positional vertigo. High correlation between the sides with reduced vestibular function or hearing loss and the side affected by Multi-canal benign paroxysmal positional vertigo was revealed (contingency coefficient = 0.602, p = 0.010). During one-week follow up, nystagmus/vertigo has been significantly alleviated or disappeared in 87.8% (36/41) patients. Conclusion Posterior-horizontal canal benign paroxysmal positional vertigo was the most common type. Multi-canal benign paroxysmal positional vertigo involving anterior canal was also not uncommon. Caloric tests and pure tone audiometry may help in the determination of the affected side. Manual reduction was effective in most of Multi-canal benign paroxysmal positional vertigo patients.

Resumo Introdução A vertigem posicional paroxística benigna multicanal é considerada um tipo raro e controverso nas novas diretrizes de diagnóstico da Bárány Society, porque o nistagmo é mais complicado ou atípico, o que é digno de mais estudos. Objetivo Com base nos critérios diagnósticos para a vertigem posicional paroxística benigna multicanal proposta pela International Bárány Society, o estudo teve como objetivo investigar as características clínicas, o diagnóstico e o tratamento da vertigem posicional paroxística benigna multicanal. Método Foram incluídos 41 pacientes com vertigem posicional paroxística benigna multicanal e diagnosticados pelo teste de Dix-Hallpike, roll test ou e teste straight head hanging A redução manual foi feita de acordo com o envolvimento dos canais semicirculares. Resultados Entre os 41 casos, 19 (46,3%) pacientes apresentaram nistagmo de batimento ascendente vertical com ou sem componente de torção e nistagmo horizontal apogeotrópico e geotrópico e foram diagnosticados com vertigem posicional paroxística benigna de canal horizontal-posterior. Onze (26,8%) pacientes apresentaram nistagmo vertical de batimento ascendente com componente de torção de um lado e nistagmo vertical de batimento descendente com ou sem componente de torção do outro lado durante o teste de Dix-Hallpike ou teste straight head hanging e foram diagnosticados com vertigem posicional paroxística benigna do canal posterior-anterior. Nove (26,8%) pacientes apresentaram nistagmo vertical com batimento descendente com ou sem componente de torção e nistagmo horizontal apogeotrópico e geotrópico e foram diagnosticados com vertigem posicional paroxística benigna de canal anterior-horizontal. Dois (4,9%) pacientes apresentaram nistagmo de torção geotrópico vertical de batimento ascendente em ambos os lados e foram diagnosticados com vertigem posicional paroxística benigna de canal posterior bilateral. Foi revelada alta correlação entre os lados com função vestibular reduzida ou perda auditiva e o lado afetado pela vertigem posicional paroxística benigna multicanal (coeficiente de contingência = 0,602, p = 0,010). Durante o seguimento de uma semana, o nistagmo/vertigem foi significativamente aliviado ou desapareceu em 87,8% (36/41) dos pacientes. Conclusões A vertigem posicional paroxística benigna de canal horizontal e posterior foi o tipo mais comum. A vertigem posicional paroxística benigna multicanal que envolveu canal anterior também não foi incomum. Testes calóricos e audiometria tonal pura podem ajudar na determinação do lado afetado. A redução manual foi eficaz na maioria dos pacientes com vertigem posicional paroxística benigna multicanal.

Manual reduction under general anesthesia and anterior cervical discectomy and fusion for treatment of cervical locked facet dislocation / 中华创伤骨科杂志

Objective:To investigate the clinical efficacy of manual reduction under general anesthesia combined with anterior cervical discectomy and fusion (ACDF) in the treatment of lower cervical locked facet dislocation.Methods:Retrospectively analyzed were the data of 53 patients with traumatic single segment dislocation of lower cervical spine combined with single/bilateral facet articular lock who had been admitted to Department of Orthopaedic Spine Surgery, Xiangya Hospital, Central South University from January 2019 to December 2020. There were 36 males and 17 females, aged from 18 to 64 years (average, 45.5 years). All the patients were treated with ACDF under neuroelectrophysiological monitoring. Clinical efficacy was assessed by observing complications and comparing American Spinal Injury Association (ASIA) grading, Modified Japanese Orthopaedic Association (mJOA) scores, neck disability index (NDI) and visual analogue scale (VAS) before and after surgery.Results:All patients were followed up for 16 to 30 months (mean, 24 months). All incisions healed by primary intention with no infection after operation. There were 2 cases of delirium, 9 cases of abdominal distension, 4 cases of lower extremity venous thrombosis, and one case of central diabetes insipidus. Postoperative imaging data showed that all patients achieved sequential reduction of the cervical spine, intervertebral bony fusion, and no internal fixation loosening. The last follow-up showed that the overall improvement rate of ASIA grading of spinal cord function was 84.9% (45/53) compared with the preoperation and that the VAS score (2.0±0.5), mJOA score (13.1±3.1) and NDI index (16.6±5.9) were significantly improved compared with the preoperative values (7.5±1.5, 6.9±3.5, and 37.8±7.8) ( P< 0.05). Conclusion:On the premise of fully assessing the patient's injury status, manual reduction under general anesthesia combined with ACDF is a safe and effective treatment of single-level lower cervical fracture combined with facet dislocation.

Clinical effect of manual reduction of humeroradial joint in the treatment of type Ⅰ-Ⅲ fresh Monteggia fracture in children / 中华创伤杂志(英文版)

PURPOSE@#To evaluate the efficacy of closed reduction on the humeroradial joint in the treatment of Bado type Ⅰ, Ⅱ and Ⅲ fresh Monteggia fractures in children and investigate the effect of clinical factors, including Bado classification, age and time of treatment on the success rate of closed reduction.@*METHODS@#We retrospectively studied the data of children ≤10 years old with fresh Monteggia fractures (injury within two weeks) treated by manual reduction with plaster immobilization from January 2014 to April 2019. All patients were followed up in the outpatient department every two weeks for 4-6 weeks until plaster removal and then 3, 6 and 12 months. Online or telephone interview was provided for some inconvenient patients after 6 months. Mackay criteria were used to evaluate the clinical effect. Radiographic data were collected and reviewed to assess the reduction of the humeroradial joint. Function of the elbow joint and forearm was evaluated and risk factors related to the failure of reduction were assessed. The successful manual reduction was analyzed from three aspects, respectively Bado fracture type (Ⅰ, Ⅱ, Ⅲ), patient age (6 years) and time interval from injury to treatment (group A, 3 days).@*RESULTS@#Altogether 88 patients were employed in this study, including 58 males (65.9%) and 30 females (34.1%) aged from 1 to 10 years. There were 29 cases (33.0%) of Bado type Ⅰ Monteggia fractures, 16 (18.2%) type Ⅱ and 43 (48.7%) type Ⅲ. Successful manual reduction was achieved in 79 children (89.8%) at the last follow-up. The failed 9 patients received open surgery. Mackay criteria showed 100% good-excellent rate for all the patients. The success rate of manual reduction was 89.7%, 87.5% and 90.7% in Bado type Ⅰ, Ⅱ and Ⅲ cases, respectively, revealing no significant differences among different Bado types (χ = 0.131, p = 0.937). Successful closed reduction was achieved in 13 toddlers (13/13, 100%), 38 preschool children (28/42, 90.5%) and 28 school-age children (28/33, 84.8%), suggesting no significant difference either (χ = 2.375, p = 0.305). However time interval from injury to treatment showed that patients treated within 3 days had a much higher rate of successful manual reduction: 67 cases (67/71, 94.4%) in group A, 10 cases (10/11, 90.9%) in group B, and 2 cases (2/6, 33.3%) in group C (χ = 22.464, p < 0.001). Fisher's test further showed significant differences between groups A and C (p = 0.001) and groups B and C (p = 0.028).@*CONCLUSION@#Closed reduction is a safe and effective method for treating fresh Monteggia fractures in children. The reduction should be conducted as soon as possible once the diagnosis has been made.

Manual reduction combined with percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures with intravertebral clefts / 中国骨伤

OBJECTIVE@#To explore the therapeutic efficacy of manual reduction combined with percutaneous vertebroplasty in treating osteoporotic vertebral compression fractures(OVCFs) with intravertebral clefts.@*METHODS@#The clinical data of 94 patients with osteoporotic vertebral compression fractures with intravertebral clefts treated from January 2014 to January 2017 were retrospectively analyzed. The patients were divided into group A and group B according to different operative methods. In group A, 45 patients were treated with unilateral approach PVP, including 17 males and 28 females, aged (75.35±11.82) years old, with a bone density T-value of (-4.28±0.65) g/cm³; in group B, 49 patients treated with manual reduction combined with unilateral approach PVP, including 19 males and 30 females, aged (76.79±9.64) years old, with a bone density T-value of (-4.33±0.72) g/cm³. The operation time, bone cement injection volume and postoperative complications of two groups were recorded. The VAS and ODI scores of two groups were analyzed respectively at 1, 12, 18 months after operation. Vertebral height and kyphosis Cobb angle of two groups were compared immediately after surgery and 12, 18 months after operation. The distribution of bone cement in the vertebral body was observed and its distribution excellent rate was calculated.@*RESULTS@#There was no significant difference in operation time between two groups. The amount of bone cement injection was(8.42±1.24) ml in group A and(9.19±1.09) ml in group B, and the difference between two groups was statistically significant(0.05), but group A was higher than group B at 12 and 18 months after operation (<0.05). The vertebral height and Cobb angle before surgery, immediately after surgery, and 12, 18 months after surgery in group A were(59.17±1.42)%, (85.95±2.19)%, (75.27±3.45)%, (68.34±2.24)% and(23.83±3.37)°, (15.26±2.61)°, (17.63±2.16)°, (19.46±2.54)°, and in group B were(59.31±1.87)%, (89.19±2.53)%, (88.62±2.51)%, (88.59±2.62)% and(24.72±3.78)°, (14.91±2.28)°, (15.48±2.55)°, (15.86±2.81)°. Vertebral height Immediately after surgery was greater in group B than in group A and Cobb angle in group B was smaller than in group A (<0.05). During follow-up, there was no significant change in vertebral height in group B, while vertebral body recollapse in group A(<0.05).@*CONCLUSIONS@#In the treatment of osteoporotic vertebral compression fractures with intravertebral clefts, the manual reduction combined with PVP is more effective than single PVP, which can effectively prevent vertebral body recollapse and improve the long-term efficacy of patients.

Surgical treatment of chronic prolonged mandibular dislocation: case report and literature review / 口腔疾病防治

Objective@#To investigate the treatment methods of chronic prolonged mandibular dislocation.@*Methods@#Surgical reduction was performed in a case of temporomandibular joint dislocation over 6 months after manual reduction failure. The flap was removed under general anesthesia, and the bone of the condyle were removed. The articular disc was aligned and incision was sutured, and the procedure was combined with intermaxillary fixation for a correct occlusion and traction. After the operation, the surgical efficacy was observed, and the related literature was reviewed. @*Results@#The patient recovered well after the operation; the mouth opening was 3 cm, and the occlusion was normal. No recurrence was observed after 10 months of follow-up. The literature shows that surgery is a common treatment for temporomandibular joint dislocation after the failure of manual reduction, and postoperative patient education can reduce recurrence and complications. @*Conclusion @#Surgery combined with intermaxillary traction can effectively treat chronic prolonged mandibular dislocation.

Finite Element Analysis on Manual Reduction with Inverse Shift for Pronation-Extorsion Trimalleolar Fracture / 医用生物力学

Objective To investigate the feasibility of manual reduction with inverse shift for pronation-extorsion trimalleolar fracture by applying the finite element method combined with clinical experience. Methods Based on CT images and anatomical features of bone, ligaments and other tissues as well as material parameters, a normal ankle model with completed muscles and bones for a Chinese young male was established. According to the related characteristics of the pronation-extorsion trimalleolar fractures, fracture was simulated in the proper position to make osteotomy model. The finite element model of pronation-extorsion trimalleolar fractures was thus established and then applied with mechanical loading to simulate manual reduction with inverse shift. Results The established finite element model of pronation-extorsion trimalleolar fractures was effectively restored by the displacement loading. Conclusions The finite element analysis on pronation-extorsion trimalleolar fractures by inverse shift maneuver could further prove the feasibility, effectiveness and scientificity of manual reduction with inverse shift based on clinical experience.

Comparative study on clinical effects of therapeutic methods on child distal fracture of radius / 医疗卫生装备

Objective To explore the clinical effects of therapeutic methods on child distal fracture of radius.Methods Totally 180 children with distal 212 fractures of radius from January 2012 to December 2015 in some hospital were enrolled into three treatment groups and a control group,of whom,there were 58 ones in a treatment group with external fixation support (external fixation group),58 ones in a treatment group with T-shaped plate internal support (T-shaped plate group),56 ones in a treatment group with Kirschner wire internal fixation (Kirschner wire group) as well as 40 ones in the control group with manual reduction and plaster external fixation.The clinical effects in the four groups were observed,and function scoring was carried out according to Dienst standard.Results The excellent rates in the external fixation group,T-shaped plate group,Kirschner wire group and control group were 72.41％,53.57％,82.76％ and 45％ respectively.The external fixation group had the excellent rate with no significant difference with that in T-shaped plate group (P＞0.05),while obviously higher than that in Kirschner wire group (P＜0.05),and Kirschner wire group had the excellent rate statisticallyhigher than that in the control group (P＜0.05).The external fixation group,T-shaped plate group and Kirschner wire group had the satisfaction significantly higher than that in the control group (P＜0.05).Conclusion Compared with the traditional reduction and Kirschner wire fixation,the external fixation and T-shaped plate fixation have better clinical effects.The treatment of child distal fracture of radius should be planed according to the type of fracture,stability,age,economic condition and substance of the bones of the patient.

Vertical locking of the metacarpophalangeal joint of the little finger: A case report / 中华创伤杂志(英文版)

Locking of the metacarpophalangeal (MCP) joint is commonly caused by hyperextension of the thumb or moderate flexion of the index or middle finger. We report a rare case of vertical locking of the MCP joint of the little finger in a 16-year old female after blunt trauma to the little finger. The MCP joint was locked when positioned at approximately 90-degree-flexion and could not extend actively or passively. A manual reduction was easily achieved and no immobilization was applied. Vertical locking of the MCP joint can be easily reduced, and immobilization is unnecessary after reduction. Correct diagnosis prior to reduction and differentiation from other types of locking are essential to prevent overtreatment.

Clinical Study on Osteoporotic Thoracolumbar Compression Fractures Treated by Manual Reduction with Percutaneous Vertebroplasty / 中国中医药信息杂志

Objective To observe clinical efficacy of osteoporotic thoracolumbar compression fractures treated by manual reduction with percutaneous vertebroplasty. Methods Totally 82 patients with osteoporotic thoracolumbar compression fractures were randomly divided into treatment group (43 cases) and control group (39 cases). The treatment group received the manual reduction combined with percutaneous vertebral plasty, while the control group only received percutaneous vertebral plasty. Lumbar back pain VAS scores, vertebral anterior height and spine after convex Cobb angle before and after operation in the two groups were compared. Results There was statistical significance among VAS pain score, spine after convex Cobb angle and anterior flange height in the two groups (P0.05), while there was statistical significance in spine after convex Cobb angle and anterior flange height in the two groups (P<0.05);There was statistical significance among VAS pain score, spine after convex Cobb angle and anterior flange height in the two groups in the 3rd month after operation (P<0.05). Conclusion Manual reduction combined with percutaneous vertebral plasty can improve the lower back pain, restore vertebral body height and correct spine after contex Cobb angle of osteoporotic thoracolumbar compression fractures, which is better than pure percutaneous vertebral plasty.

Manual reduction combined with percutaneous kyphoplasty for fresh osteoporotic vertebral compression fractures in elderly patients / 医学研究生学报

Objective Minimally invasive treatment of orthopedic diseases is the general direction of future development of medicine.This study was designed to observe the effect of manual reduction combined with percutaneous kyphoplasty (MR+PKP) in the treatment of fresh osteoporotic vertebral compression fractures ( OVCF) in elderly patients. Methods Sixty OVCF patients aged 60-86 ( mean 72.3) years were randomly assigned to 2 groups of e-qual number to be treated by MR+PKP and PKP alone, respectively. Comparisons were made between the two groups of patients in the op-eration time, volumeand permeability of the bone cement injected,changes of the Cobb angle,restoration of the anterior height of the compressed vertebral bodies,pre-and post-operative Visual Analogue Scale ( VAS) pain scores, OswestryDisability Indexes ( ODIs) , and other differences observed before and aftersurgery. Results Op-erations were performed successfully in all the 60 cases.In the MR+PKP group, the mean operation time was 61 min, the mean volume of bone cement injected was 5.1mL with qualified distribution, and bone cement leakage occurred in 1 case without adverse reaction. Statistically significant differences were found in the pre-and post-operativeanterior height of the compressed vertebral bodies, Cobb an-gle, VAS scores, and ODIs (P<0.05).Compared with the PKP control, MR+PKP achieved a significant increase at 3 days and 3 months after surgery in the anterior height of the compressed vertebral bodies ([22.4±1.4] vs [26.8±8.1] mm and [21.4±4.2] vs [26.5±7.2]mm, P<0.05), and a decrease in the Cobb angle ([8.6±2.7] vs [8.1±2.1]°and [9.0±2.3] vs [8.3±1.8]°, P<0.05) as well as remarkably reduced VAS scores (4.1±2.2vs 3.1±2.0, P<0.05)and ODIs (23.0±3.1vs25.6±3.3, P<0.05) at 3 d postopera-tively. Conclusion MR+PKP, with its advantages of effective pain-relief, improvement of the height of compressed vertebral bodies, and reduction of bone cement leakage,is better than PKP alone for the treatment of OVCF in elderly patients.

The comparison of the effect of open reduction and internal fixation in the treatment of fractures of the proxi-mal humerus manipulative reduction and splint external fixation / 中国基层医药

Objective To compare the clinical efficacy of manipulative reduction and splint external fixation and open reduction and internal fixation in the treatment of fractures of the proximal humerus .Methods 62 patients with proximal humeral fractures were randomly divided into the two groups .31 cases in the manipulation group re-ceived manual reduction and splint external fixation;31 patients in the open reduction and internal fixation group were treated by open reduction and internal fixation .The clinical efficacy was compared between the two groups .Results The average healing time of the manual reduction group was (98.34 ±0.42) d,which was shorter than (121.53 ± 0.45)d of open reduction and internal fixation group (t=209.76,P<0.05).The incidence rate of pain in the manu-al reduction group was 22.58%,which was lower than 48.39% in the open reduction and internal fixation group (χ2 =4.51,P<0.05).The excellent and good rate of the manual reduction group was 96.77%,which was higher than 80.65%of the open reduction and internal fixation group (χ2 =4.03,P<0.05).Conclusion The clinical curative effect of manual reduction and splint external fixation in the treatment of proximal humerus fractures is better than open reduction and internal fixation ,it is a reliable choice for treatment of fractures of the proximal humerus .

Case-control Study on Small Splint and Plaster External Fixation after Closed Manipulative Reduction in the Treatment of Elderly Type C Colles Fractures / 中国中医药信息杂志

Objective To compare the clinical effects of small splint fixation after closed manipulative reduction with plaster external fixation in the treatment of elderly type C Colles fractures.Methods Totally 96 elderly patients with type C Colles fractures were randomly divided into two groups, 48 patients in each group. Both groups were treated with closed manipulative reduction. The fractures were externally fixed with splint in the treatment group, and those were externally fixed with pipe plaster in the control group. The figure of radius length, palmar tilt and ulnar deviation were detected respectively in pre-reduction, the same day with reduction, and the day when external fixation was removed (6th week), in order to evaluated the drop of anatomical position. The therapeutic effects were evaluated according to Gartland-Werley wrist score when external fixation was taken off after 6 months.Results In both groups, figures of radius length, palmar tilt and ulnar deviation evidently increased in the day after reduction and the day of external fixation removal, compared with pre-reduction (P<0.05). Compared with the day after reduction, the radius length, palmar tilt and ulnar deviation of the day of external fixation removal all dropped in both groups (P<0.05). But the drop degree in control group was significantly higher than treatment group (P<0.05). For the joint function, 9 cases for excellent, 26 for good, 6 for fair, and 4 for bad in the therapy group. The excellent and good rate was 77.8% (35/45). In the control group, 4 cases for excellent, 22 for good, 10 for fair and 9 for bad. The excellent and good rate was 57.8% (26/45). The curative effect of treatment group was remarkably superior to control group (P<0.05).Conclusion Closed manipulative reduction combined with splint external fixation is more effective than pipe plaster in treatment of elderly type C Colles fractures.

Treatment of chronic prolonged mandibular dislocations / 实用口腔医学杂志

5 patients with chronic prolonged mandibular dislocations(CPMD)were examined by CT scan.The patients were treated by manual reduction under general anaesthesia and muscle relaxants.Traction was performed with ligaturing steel wires on fixation titanium screws intermaxillaryly and wrapping up the skull-jaw bone with elastic bandages for 3 weeks.After 1 month,a maximal mouth opening of o-ver 30 mm was noted and no episode of redislocation occurred in 3 -34 month follow-up.

Manual Reduction of Incarcerated Inguinal Hernia in Children.

Introduction: Incarceration of an indirect inguinal hernia in children is an acute emergency and one of the common complications that may occur before herniotomy. Inguinal hernias rarely go away, and therefore, virtually all should be repaired at any age of presentation. Incarcerated inguinal hernia can be reduced successfully by manual reduction if performed by experienced hands on time. The objective of this study was to assess the safety and efficacy of manual reduction of incarcerated indirect inguinal hernia. Materials and Methods: Thirty six patients who attended Emergency Department of Kanti Children’s Hospital over 30 months period from January 2009 to July 2011 were studied prospectively. All patients were diagnosed case of inguinal hernia and waiting for elective herniotomy. Results: There were 30(83.33%) males and 6(16.66%) females, with male-to-female ratio of 5:1. Right sided inguinal hernia was 20(55.5%) and left 16(44.44%). The ages ranged from 1.5 months to 28 months with mean age of 15 months. Time of incarceration ranged from 3 hours to 30 hours. Manual reduction was successful in 30(83.33%). Remaining six had to undergo emergency surgery. Four patients with edematous but viable hernial contents had successful surgical reduction. Two patients with gangrenous small bowel loops had bowel resection and anastomosis. Conclusion: Manual reduction is safe and effective when performed timely. Herniotomy should be done without delay once diagnosed to avoid unnecessary complications.

Clinical Study on the Treatment of Humeral Supracondylar Fracture in Children with Manual Reduction Combined with Oral Medicinal Herbs and Fumigation / 国际中医中药杂志

Objective To observe the clinical effect of treating humeral supracondylar fracture in children with manual reduction combined with oral medicinal herbs and fumigation.Methods 80 children with humeral supracondylar fracture were involved in clinical observation.Patients with Gartland Type Ⅰ and Type Ⅱ were selected and treated with manual reduction and plaster external fixation.Gartland Type Ⅲ cases were selected and treated with Kirschner-wire transfixion.All of patients were treated with oral medicinal herbs and fumigation.Results All children with humeral supracondylar fracture recovered.Based on the clinical function test,39(48.75%)cases had excellent effects,39(48.75%)cases had good effects,and 2(2.50%)cases had fair effects.No Volkmann contracture or cubitus varus deformity occurred.Conclusion The treatment of humeral supracondylar fracture in children with manual reduction combined with oral medicinal herbs and fumigation has a good effect.

Pushing scapula reset anterior dislocation of shoulder with fracture of surgical neck of humerus / 临床外科杂志

Objective To seek a new closed reduction for anterior dislocation of shoulder with fracture of surgical neck of humerus.Method 6 cases in present study were well followed up.There were 4 males and 2 females.The average age was 42.5 years old;the average time of injury to reduction was 3.5 hours.After local anesthesia,on prone position,one hand carried on the head of humerus, another pushed the scapula.All cases were treated successfully.Result According to the Neer criterion, 4 cases were excellent,2 cases were satisfactory.Conclusion Anterior dislocation of shoulder with fracture of surgical neck of humerus can be succeeded in manual reduction.

Reduction Method of Anterior Shoulder Dislocation: A New Method / 대한정형외과학회잡지

There have been many methods of manual reduction of shoulder dislocation. But each method has its unique complications such as fracture of'humeral neck or shaft as well as vascular and nerve injuries around the shoulder due to excessive pulling and rotation during the maneuver. The present authors devised a method in which the backrest of a chair is used as a fulcrum during manupulative reduction. The dislocated shoulder can be abducted by the backrest rim, when the armpit is placed over the top of the backrest. In this abducted position of the shoulder, minimal adduction force on distal humerus and gentle backward pressure on humeral head are very effective in reducing the anterioly disocated shoulder.