Closed reduction and percutaneous fixation with crossed k-wires in displaced supracondylar fractures of humerus

To evaluate the out-come of closed reduction under image intensifier and percutaneous cross k-wire fixation in Gartland Type II and III supracondylar fractures of humerus in children. Case series . Combined Military Hospital Rawalpindi and Combined Military Hospital Malir, from Jun 2006 to Jan 2012. Patients 3-10 years of age, of both genders were included in the study by convenience sampling. Patients who had closed Gartland Type II and III fractures and reported within 24 hours of injury were included in the study. Standardized percutaneous cross. K wiring [medial and lateral] was performed in all the patients, followed by casting, by an orthoropedic surgeon. K wires were removed after four weeks. Patients were followed for upto 06 months and all the early and late post-operative complications were recorded on the given proforma. Evaluation of the results was done on the basis of Flynn's criteria by measuring loss of elbow motion and carrying angle. A total of 30 patients completed the study. The mean age was 6.1 years with a gender distribution of 23 males and 7 females. The involved elbow was right in 17[56.6%] patients and 13[43.3%] patients had left sided injury. There were 18[60%] Gartland type II fractures and 12[40%] Gartland III fractures. All of the fractures were extension type. Three patients [10%] had pin tract infections, whereas none had osteomyelitis, neurovascular damage or compartment syndrome. Twenty four patients [80%] had excellent results according to Flynn's criteria whereas four patients [13.3%] had poor results. Closed reduction under image intensifier and percutaneous K wiring through medial and lateral approach in selected Gartland Type II and III fractures in children is a safe procedure and provides adequate stabilization with satisfactory results

Reconstruction of hind foot defects; a simplified workable solution

Reconstruction of traumatic as well as non-traumatic hind foot defects is always a challenging task. We share here a simple and practical protocol [working solution] to select the most suitable method for soft tissue coverage of hind foot defects, customizable for every patient. We carried out this study, in our department on 75 cases from March 2009 to May 2012. All cases with wound/defect in hind foot area were included. Majority of cases were traumatic rest included cases of malignancy, Trophic ulcers, infection. Patient's data including age, sex, site of injury, mode of injury, extent of injury [isolated or combined], if combined structures involved, type of wound, management of wound, wound healing time and complications were noted. Once optimal wound conditions were achieved the best possible reconstructive option was selected. The various reconstructive options include VAC therapy, Skin graft, local transposition flap, perforator based flapspedicled faciocutaneous/ muscle flaps, intrinsic foot muscles, Medial plantar artery flap and distant flaps like cross leg flap and micro vascular free flaps. All patients had satisfactory and stable reconstruction. They were ambulating freely by 4-6 weeks post operatively. There were few complications like patchy graft loss, peripheral flap necrosis, flap congestion, but none was serious and did not require repeat surgery. The simplified protocol followed by us is a practical customizable solution for difficult task of hind foot reconstruction. The choice of one or multiple techniques will vary from time to time from one surgeon to another depending upon his or her experience and liking

Comparison of shoulder function, radial nerve palsy and infection after nailing versus plating in humeral shaft fractures

To compare shoulder function, radial nerve palsy and infection after interlocking nailing with plating of fractures of shaft of humerus during 30 weeks of follow-up. Experimental study. Orthopaedic Wards of Combined Military Hospital, Rawalpindi, from November 2006 to November 2008. Two groups of 30 patients each were inducted. Group A [n=30] was treated with intramedullary interlocking nailing while Group B [n=30] underwent plating with dynamic compression plate [DCP]. Shoulder function using ASES score, radial nerve palsy and infection were observed for 30 weeks. In group A, 11 patients had severe or moderate shoulder dysfunction [ASES score below 39], out of whom 8 [72%] were above 50 years. This age related disability was significant [p=0.003]. Transient palsy was observed in 3 patients [10%] and mild wound infection in 2 [6%], which was not associated with age or open fracture. In group B, only 1 patient had severe shoulder dysfunction, the difference was statistically significant between the two groups [p=0.001], especially in patients above 50 years of age. There was no statistical difference in infection and palsy rates between the two groups. Although nailing and plating are effective treatments for fractures of shaft of humerus, ante-grade nailing may not be suitable in elderly patients, as it can cause significant shoulder dysfunction