comparison of delayed and early diagnosis of operative results gained through internal fixation of lateral humeral condyle fractures in children

Lateral humeral condyle fracture is one of the most common fractures during childhood. Delay in operation and internal fixation often associated with hopeless treatment results. The goal of this study is comparison of complications and operation outcomes between the patients that underwent early operation with the patients that undervent delay operation. This study was prospective and case series, performed on 60 patients from may 1998 to 2004. The patients were divided into two groups. The first group included 30 patients, treated during first week after lateral humeral condyle fracture, and the second group included 30 patients treated between 7 to 28 days after fracture. Method of operation was similar for the two group patients. All of the patients were studied for 12 to 30 months after treatment. In the first group, 16.66% were diagnosed to have Milch I and 83.34% Milch II fracture, As for displacement, 10% of the patients were in stage I, 40% stage II and 50% stage Ill, in the second groups 20% of fractures were diagnosed to have Milch I and 80% Milch II. As for displacement, 13.3% of patients were in stage I, 33.3% stage II and 53.4% were in stage III. Most of the patients in the first group were in excellent conditions considering the range of movement of elbow; however, in the second group they were mostly in moderate and poor conditions. The most common cause of delay in treatment was fracture handling by bonesetter. Delay exceeding 1 week in treatment of lateral condyle fracture will be followed by numerous complications. To prevent delay in operative treatment the public culture for early and true treatment must be reformed

[ study of factors and kinds of acute occupational injuries in Shohada Hospital]

Tools and instrument were developed with progress and development of societies. Whereas inattention to acquire of correct principles of job with these new tools may increased injuries in agriculturists and workers. Occupational hand injuries are one of the most common causes of time lost from work in agriculture and industry. The goal of this study was to investigate the prevalent causes bringing about acute hand injuries in accidents resulting from work in the above mentioned professions and also types and intensity of the injuries caused in the suffering workers and farmers and the time of absence from work. This is a discreptive prospective study. The population that was selected for this included 1130 case. Patients managed for acute occupational hand injuries during summer 1999- 2003 in Shohada hospital and patients assayed in view of kinds and factors of injuries. From 1130 patients, who admitted in Shohada hospital, 405 cases [35.8%] were related to agriculture injuries and 725 [64.2%] cases industrial injuries. The most common causes of agriculture injuries was lawn mower [38.3%] and the seconde cause was fall of heavy material [29.6%]. In industrial injuries the most common cause was fall of heavy material [38.3%], the seconde was press or turnery machins [31.7%]. The most victoms were in the first or seconde decade of life. Average time of hospitalization was 5 days [1-24 days], and average of follow-up time was 2 months [1 weak- 5 month]. We concluded that inadequate experience, training and protective devices incraese the possibility of occupational injuries

Effect of extradural Ketamine on onset time and sensory block in extradural bupivacaine-induced anesthesia

Epidural anesthesia is an appropriate approach for surgical operations on lower limbs, abdominal region and painless delivery. Since the application of epidural anesthesia is time-consuming and the onset of the effects of injected anesthetic drugs in epidural space is slow [about 20 minutes], therefore, the time of occupying the operating room is prolonged and this results in wasting of time of the surgeon and staff in the operating room. This study was conducted to assess the effect of bupivacaine while used with ketamine on shortening the onset time. This double blind study was done on 40 patients. All the patients were physically ASA I, II and they underwent orthopedic and urologic surgical operations. The patients were randomly divided into two groups of 20 individuals, receiving the drugs as follows: study group: bupivacaine 0.5% - 20 ml + ketamine 25mg [0.5ml] + adrnaline 1/200000, control group: bupivacaine 0.5%, 20ml + ketamine 25mg [0.5ml] + saline 0.9%, 0.5ml + adrenaline 1/200000. After injecting the drug in epidural space in L3-L4 or L4-L5 regions, blood pressure, heartbeat, onset of anesthesia and the level of anesthesia were evaluated in all patients. Patients in both groups were compared with regard to their height, weight, sex, age and systolic blood pressure before the injection of the drugs and no significant difference was noted among them. The systolic blood pressure and heartbeat of patients in both groups were checked in 2[nd], 5[th], 10[th], 15[th], 20[th], 25[th] and 30[th] minutes after drug injection and no significant differences were found in both groups compared to pre-anesthesia status. However, the onset and level of anesthesia was statistically significant in the two groups. The onset of anesthesia in study group was 3.5 to 4 minutes faster and the anesthesia level was two segments higher than that of the control group. Results of this study demonstrated that the addition of 25mg of ketamine to bupivacaine resulted in the acceleration of the onset as well as increase the level of anesthesia in extradural bupivacaine-induced anesthesia and this might be a useful approach in emergency surgical procedures