Outcome of open reduction and internal fixation in lateral condyle humeral fractures in pediatrics

Background: Lateral condyle fractures of the distal humerus are the second most common fractures at the elbow in the paediatric population usually between the ages of 6-10 years old making up 5-20% of fractures in children. The aim of the present study was to assess the early results of patients with a displaced lateral humeral condyle fracture treated with open reduction and internal fixation. Methods: Our clinical trial was conducted involving 12 patients treated with open reduction and internal fixation (ORIF). Preoperative stage included clinical evaluation, routine investigations and radiological evaluation. Fractures were classified using the Milch. Patients were followed up weekly until radiological union of the fracture was evident. Results: 83.3% of our patients were males, while 16.7% were females. According to mechanism of injury, falling down continues to play a major role in causing disability. At (3-5) weeks all cases were with soft callus remove K wire; at 8 weeks, all cases were with union fracture; but at 12 weeks, one case (8.3%) was with mild stiffness and the rest was with full range of motion. As regards the carrying angle in our study, only 16.7% were with abnormal carrying angle. 33.3% were complicated; one case with mild limitation of motion and valgus; one case with varus and two cases with superficial infection. Conclusions: The open reduction and internal fixation of lateral humeral condyle fracture is the ideal treatment and it has a rate of complications

Coronary artery bypass grafting on beating heart. does it provide superior myocardial preservation than conventional technique?

To compare myocardial injury caused by 3 commonly used methods for coronary artery bypass grafting [CABG]. A prospective randomized study conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. The study started in February 2003 and concluded in April 2004 after including 45 patients [15 patients in each of 3 sub-groups] who fulfilled the inclusion and exclusion criteria. The subgroups included coronary artery bypass surgery performed by: a] conventional technique, b] off-pump technique, and c] on-pump beating-heart techniques. All patients had similar operative risk profiles. Their ages were 70 years or less with an ejection fraction of 30-50%. The creatine kinase, myocardial band [CKMB] levels were determined 2 hours after arrival from the operating room then, at 4 hours, 6 hours, and 12 hours. The comparison of creatine phosphokinase and CKMB levels was carried out using analysis of variance with repeated measures. The p-values were used to evaluate the significance of differences. The pre-operative characteristics including age, gender, ethnic origin, diabetes mellitus, hypertension, and left ventricular function, were similar in the 3 groups. All groups had a median number of 3 bypass grafts. The stay in the intensive care unit and the duration of inotropes were shortest in the off-pump group, but the difference was not significant. There was a peak of CKMB levels at 6 hours in all groups. The trend of CKMB level showed significantly higher values in the conventional CABG group as compared with the other 2 groups. This study indicates that the off-pump technique provides better myocardial preservation than other methods

Routine care of normal deliveries as applied in Syrian maternity wards

routine practices during normal childbirth have not been studied in Syria. Our study was designed to describe the routines of normal childbirth as practiced in maternity wards in Syrian hospitals and to assess whether these routines are in accordance with the best evidence-based practices. a nationally representative sample of 57 hospitals was visited: 33 were government hospitals and 24 were private hospitals. The personnel in charge were interviewed using a specially designed questionnaire that covered both management and technical points. only 2 of the 57 hospitals had a written policy concerning childbirth, although 29 had a written breast-feeding policy. All except two hospitals reported the capability of doing a cesarean section at any time. Results on hospital routines are presented in the light of the available best-evidence guidelines. the study highlights the urgent necessity to formulate a national policy for care in normal birth. This policy needs to be designed bearing in mind the best evidence available and the nature of the national setting

Pregnancy outcomes among Palestinian refugee women with sickle cell trait in Damascus, Syria

The results on pregnancy outcomes of mothers afflicted with sickle cell trait are still contradictory. This study aimed to examine the fetal and maternal outcomes among a cohort of pregnant women. This is a prospective cohort study that examined the fetal and maternal outcomes among 98 women with sickle cell trait [HbAS] and 402 women with normal hemoglobin [HbAA]. The study was carried out in 4 health centers serving Palestinian Refugees in Damascus, during the period November 2000 to May 2002. Hemoglobin electrophoresis was carried out for all newly registered pregnancy women. Women were then followed up until 40 days after delivery. Data was collected from antenatal records and interviews with women. Outcomes of pregnancy were compared between women with HbAS and HbAA hemoglobin. There was no statistical difference in the rate of abortion, distribution of birth weight and perinatal mortality. Women with AS hemoglobin reported higher incidence of complications after delivery, namely, fever [risks ratio=4.05, 95% confidence interval=1.34-12.3]. In this study, pregnancies among women with sickle cell trait demonstrated high risk of complications after delivery. Watchful follow up of pregnancies among women with sickle cell trait is very necessary. Doctors and women must know that although the course of pregnancy among women with HbAS can be benign; it may well carry a high risk on women