ABSTRACT
BACKGROUND: Displaced lateral humeral condyle fractures in children are usually treated with open reduction and internal fixation. When treated operatively with Kirschner wires, the bent cut near side wire ends are either buried in the subcutaneous tissue or are left exposed. It is believed that burying the wires allows them to remain in longer and hence facilitate better union. Leaving them exposed seems to necessitate earlier removal, especially to reduce the risk of wire tract infection. There is not a clear consensus in published literature whether subcutaneous wire burial is better or not. PATIENTS AND METHODS: A systematic review of literature was performed using online database EMBASE, Pubmed, Medline, CINAHL and Cochrane database. The inclusion criteria comprised only those studies that compared lateral humeral condyle fracture fixation in children with wires buried subcutaneously versus those left exposed to skin. RESULTS: Of the four studies identified, three reported that it was safe to leave the wires exposed and that there was no statistically significant advantage of burying the wires with regards to risk of infection. However, our meta-analysis of the four studies demonstrated on forest plot charts that there is an increased risk of infection when the wires are left exposed (odds ratio 0.538 CI 0.437-0.639), but the overall complication rate was less in the group treated with exposed wires. Treatment with exposed wires was also cost effective when compared to treatment with buried wires. DISCUSSION: Our review concluded that despite a higher risk of superficial infections, exposed wires are safe and an economical option when fixing lateral humeral condyle fractures in children. LEVEL OF EVIDENCE: II, systematic review.
Subject(s)
Bone Wires , Fracture Fixation, Internal/methods , Humeral Fractures/surgery , Cost-Benefit Analysis , Humans , Surgical Wound Infection/etiologyABSTRACT
Accurate acetabular cup placement is a crucial step for a successful total hip replacement. Transverse acetabular ligament is an important and reliable landmark that helps in determining the version during the placement of acetabular cups. However, the visualization of transverse acetabular ligament may not be easy as the view may be blocked by the implants and the instruments. We have devised a simple technique to aid in achieving patient-specific ante-version during implantation of uncemented acetabular cups by using "channel lines."
ABSTRACT
Aim. To evaluate results of Aequalis humeral head resurfacing in patients with end-stage glenohumeral arthritis at a minimum followup of two years. Patients and Methods. Twenty-one consecutive patients underwent humeral head resurfacing hemiarthroplasty between 2007 and 2009. Three patients did not fulfill the inclusion criteria. 18 patients with mean age of 75.1 years (range 58-91 years) and a mean duration of preoperative symptoms of 33.6 months (range 6-120 months) were analyzed. Patients' self-reported Oxford shoulder score (OSS) was collected prospectively and was used as an assessment tool to measure final outcome. Results. The mean initial OSS was 15 (range 3-29). The score improved by an average of 19.5 points at a mean followup of 36.3 months (range 24-54 months) to reach a mean final OSS of 34.5 (range 6-47). The improvement of OSS was highly significant with a two-tailed P value less than 0.0001. The overall patient satisfaction was 94%. Conclusion. This study demonstrates Aequalis shoulder resurfacing hemiarthroplasty as a reliable procedure, away from its originating center, for improvement of shoulder function as shown by the patients' self-reported outcome score (OSS) in end-stage glenohumeral arthritis at a minimum followup of 2 years.
ABSTRACT
What is the relationship between the age or gender of the patient and the incidence of fracture-healing complications after internal fixation of intracapsular fractures? We aimed to determine the association between the age of the patient and fracture nonunion and also to establish if the gender of the patient had any influence on the occurrence of fracture nonunion. We prospectively studied 1133 patients with intracapsular fractures of the femoral neck treated by internal fixation. The overall incidence of nonunion was 19.3%. Fracture nonunion was less common for undisplaced fractures than for displaced fractures (48 of 565 [8.5%] versus 171 of 568 [30.1%]) and in men than in women (35 of 271 [12.9%] versus 184 of 862 [21.3%]). The incidence of nonunion progressively increased with age from one of 17 (5.9%) in patients younger than 40 years to 84 of 337 (24.9%) in patients in their 70s. For patients in their 80s, the incidence of nonunion began to decrease, but if patients who died within 1 year after injury were excluded, the incidence continued to increase. Our study showed an increased risk for intracapsular hip fractures developing nonunion with older age and in females.
