Experience with supracondylar humeral osteotomy [SCHO] for correction of late cubitus varus deformity [CVD] clinical and practical consideration

Seventeen corrective supracondylar humeral osteotomy [S.C.H.O] was performed for post traumatic late cubitus varus deformity [CVD] in 16 patients. The average age at injury was 4.5 years [range 3-10 years] and at S.C.H.O was 8 years [range 4-16 years] and the average follow up period was 2.5 years [range 6 months-5 years].The main indication for operation was the unsightly deformity caused by malunion. Early correction is advisable because deformity will not going to be corrected by remodelling and to provide prophylaxis against late ulnar nerve palsy S.C.H.O was a difficult operation and had significant incidence of complications and operative risk. Difficulty was encountered in maintainence of the correction [14 cases had K. wire fixation and 3 had only external plaster immobilisation]. The average varus deformity was 20 degrees [range 10-40 degrees]. Refinement of the technique was necessary simple wedge corrective osteotomy was carried out with no attempt for correction of mild rotational deformity. The average correction was 30 degrees. Relative higher success rate [47% excellent result] was attributed to equal limb osteotomy, varus correction alone, preservation of intact medial hinge, preoperative wedge tracing and accurate pin placing the operation is deceptively simple but it had a significant complication rate [47%] including: recurrence [255], neuropraxia [18%], sepsis [18%], bad scarring [11%] but no case had non union. Post operative well filled back elbow slab in extension was important and highly recommended to achieve good hold of the fragments and higher satisfactory result. Cosmetic result could have been improved by operative medial shift of the distal fragment. The result of the study stress on the prevention or C.V.D. to avoid unnecessary secondary difficult operation

Betadine R "Povidone-Iodine" skin protection of orthopaedic patients during cast immobilisation and intravenous cannulation

A clinical evaluation of Betadine R ointment in protecting the skin of orthopaedic patients encased in plaster of Paris casts for traumatic conditions and elective operations as well as in protecting the skin of cannulated orthopaedic patients, was performed with clinical assessment of the results. The two groups in the three studies did not differ appreciably in the distribution of diagnostic criteria. Comparative study with the controlled group showed that the cast -Betadine traumatic group [63 cases] gave significantly better satisfactory result [79%] with protection-benefit up to 93% of the cases. This was in comparison with 14% satisfactory result for the control group [63 cases] with similar injury. The skin of intravenous cannulated Betadine premedicated group of patients [60 cases] showed similarly high percentage of satisfactory skin protection without thrombophlebitis in 87% of the cases as compared with 50% satisfactory result for the control group [60 patients]. Also, the skin protection after Betadine premedication yielded 94% satisfactory result in patients underwent for elective ankle and foot surgery [33 patients] as compared with 76% satisfactory result for the controlled group [33 cases] underwent for similar operation. It seems therefore that the broad spectrum bactericidal and fungicidal effect of Betadine R are of considerable practical benefit when used as a topical germicide for prophylaxis-protection of the skin against infections as well as for protecting the skin encased in plaster of Paris casts restoring its normal appearance and also for protection-prophylaxis when it is used before intravenous cannulation.The therapeutic and prophyalctic efficiacy of Betadine R ointment has been proved in this study by superior satisfactory result with regard to all parameters assessed by the pateints and by the study. The result was found to be significantly better in statistical terms. The tolerability was good and unwanted effects was not observed. Consequently this paper recommend the use of topical Betadine R ointment in similar conditions

Sprain wrist: the concealed osseo-ligamentous injury: a clinico-roentogenographic study

A consecutive series or 83 cases of wrist injury have been reviewed to determine the incidence of concealed osseo-ligamentous injury including fissure fractures, ligamentous injury joint malalignment, minor joint subluxation and instability. A clenshed fist radiographs was used in addition to the routine scaphoid views. Of 26 patients [36%] had persistent wrist symptom, 6 patients [23%] had scapho-lunar dissociation instability and rotary subluxation of the scaphoid. 5 cases [19%] had inferior radioulnar subluxation, four cases [15.4%] had fracture waist of the scafoid, 3 cases had carpal instability after distal radial fracture [11.5%], two cases had fracture proximal pole scaphoid, 2 cases had chip fracture capitate and one case had perilunar subluxation. Another case had radio carpal malalignment, third case had ulno-carpal malalignment and fourth case had flake fracture or the triquetrum. Injuries producing significant ligamentous damage and carpal instability maybe as common as scaphoid fractures and should be awared with. They require special consideration in the diagnosis and management. Localisation or the pathology or painful wrist was most helpful by palpation.Special roentogenic projections arthrographic views, bone scans, thermography tomography and motion view may aid in the final diagnosis to establish proper line of treatment preventing grip weakness continued aching disability and alarming bony displacement. Proper understanding or the most complicated joints of the body together with adequate diagnosis establish the proper program of treatment. Increased awareness of these injuries will clarify the natural history of the potentially serious ligamentous disruption nariants