Can the reduction quality of distal humeral transphyseal fractures be determined using reference measurements on conventional radiography?

OBJECTIVE: Our objective was to compare the radiological outcomes of transphyseal fractures treated using closed reduction and percutaneous fixation, without arthrography, with those of supracondylar humerus fractures treated using the same method within a similar age group. Additionally, we aimed to assess the efficacy of the reference points in the lateral and anteroposterior radiographs utilized for the evaluation of reduction. PATIENTS AND METHODS: The study included patients aged 0-3 years who underwent surgery for supracondylar and transphyseal fractures between 2013 and 2022. All the patients were diagnosed using anteroposterior (AP) and lateral elbow X-rays. No arthrographic intervention was used either in the diagnosis or treatment phase. On the AP X-rays, we assessed the alignment between the humeral shaft line and the ulnar long axis line to determine the positioning of the distal humeral physis segment in relation to the humerus. Additionally, we evaluated the relationship between the anterior cortex line of the humerus and the coronoid process on lateral radiographs. At the final follow-up visit, Flynn criteria were used for functional assessment. RESULTS: The study comprised 24 patients with supracondylar humerus fractures and 24 patients with transphyseal fractures. In the early post-operative radiographs, the humero-ulnar angle measured 6.43° (-7° - 16.6°) in the supracondylar group and 9.8° (-4.3° - 25.3°) in the transphyseal group (p = 0.087). The distance between the coronoid and the anterior humeral line was 9.19 mm (4.27 - 16.08) for the supracondylar fracture group and 8.05 mm (3.29 - 14.85) for the transphyseal fracture group (p = 0.513). CONCLUSIONS: The current study's findings suggest that both the humero-ulnar angle and the distance between the coronoid and the anterior humeral line are valuable indicators for assessing the quality of reduction in transphyseal distal humerus fractures.

Comparison of Different Fixation Confi gurations in Different Types of High Pediatric Supracondylar Humerus Fractures: a Finite Element Analysis.

PURPOSE OF THE STUDY: The purpose of this study is to compare the stability of different fi xation methods in high pediatric supracondylar humerus fractures with a fi nite element analysis method. MATERIAL AND METHODS Transverse, lateral oblique, and medial oblique fracture models were created in a ten years old boy's distal humerus. Eight different fi xation methods were applied to each fracture model. Displacement of the fracture models was measured under the translational and torsional forces. RESULTS In the transverse fracture model; the 6th method provided the best stability in internal rotation, external rotation, and extension loading. In varus 7th method, valgus 8th, and fl exion the 5th and 2nd methods had the best stability. In the lateral oblique fracture model; the 7th method had the best stability in all loading directions except fl exion and the 6th method had the best stability in fl exion and had acceptable values in all other directions except valgus and external rotation. In the medial oblique fracture model; the 6th method had the best stability in all directions except varus. 3rd method was the best fi xation type against varus and the second stable fi xation type in all other directions. CONCLUSIONS Combining lateral antegrade with lateral retrograde wire and lateral condylomedullary wire provides strong stability in the lateral oblique fracture. Two condylomedullary Kirchner wires and one antegrade lateral wire results in a strong stability in the medial oblique fracture. Medial-lateral condylomedullary and lateral antegrade wires provided the best stability against varus in transverse and lateral oblique fractures. KEY WORDS: high pediatric supracondylar humerus fracture, percutaneous fi xation method, metaphyseal-diaphyseal junction, fi nite element analysis.

Does high fat diet effect the bone-implant connection?

OBJECTIVE: Obesity induced by a high fat diet is associated with chronic up-regulation of inflammatory cytokines which stimulate osteoclast activity and bone resorption. However, the role of high-fat diet on bone-implant connectivity has not been studied in detail. In this study, we investigated whether a high-fat diet (HFD) affects bone implant connection (BIC) in periimplant bone. METHODS: Twenty female Sprague Dawley rats were divided in two groups: 1) Control rats were fed with normal chow and titanium implants were integrated into tibial bones at the end of 3rd month and no treatment was applied 2) HFD group; rats were fed a high-fat diet (42 % of calories as fat), then the titanium implants were integrated into tibial bones at the end 3rd month. Following surgical integration of the implants, the rats were fed with control and HFD diets for 3 months. After the 6 months experimental period all rats were sacrificed and the implants and surrounded bone tissues were collected and the BIC was assessed histomorphometrically after the non-decalcifiing histological methods. Bone implant connection was detected with the ratio of the implant surface directly connected with the peri-implant bone tissues to the total implant surface length. RESULTS: Histologic analysis showed that HFD was not impaired BIC (p>0.05). CONCLUSION: In conclusion, within the limitation of this research, HFD did not effect the BIC rat tibias (Tab. 2, Fig. 2, Ref. 26). Text in PDF www.elis.sk.