Intrathoracic Displacement of Fractured Right Humeral Head: A Case Report.

Intrathoracic displacement of the humeral head is a very uncommon condition and can be life threatening due to lung or heart injuries. There is a report of this condition where intrathoracic bone fragment was missed. Because of rare incidence there is no guideline for approach and treatment of this condition. We hereby present a case of intrathoracic displacement of fractured humeral head in a man due to a car roll-over accident. This condition requires a concise team workup of trauma and orthopedic surgeons along with the physical therapists for the best possible decision making. Displaced fractured humoral head into the thorax is a rare condition that needs more punctuality for on time diagnosis and team approach.

Comparative effects of surgical and percutaneous repair on P-wave and atrioventricular conduction in patients with atrial septal defect--ostium secundum type.

Both surgical and percutaneous closures of atrial septal defects have been successful in reversal of atrial dilatation. We compared the effects of surgical and percutaneous transvenous device closure of atrial septal defect on post-operative changes of P-wave duration, PR segment, and PR interval. Electrocardiographic data were prospectively collected from 30 patients following either surgical (n equal to 16) or percutaneous (n equal to 16) repair of atrial septal defects between 2004 and 2010. A cardiologist blinded to the closure technique performed the electrocardiographic analyses. P-wave duration (98.5 plus or minus 15.4 to 86.4 plus or minus 13.2 milliseconds, p-value less than 0.05) and PR interval (162.9 plus or minus 18.5 to 140.6 plus or minus 15.2 milliseconds, p-value less than 0.05) were reduced after percutaneous transvenous device closure. P-wave duration (104.5 plus or minus 24.7 versus 83.2 plus or minus 13.3 milliseconds, p-value less than 0.05) and PR interval (173.2 plus or minus 38.7 versus 144.3 plus or minus 32.0 milliseconds, p-value less than 0.05) were also reduced after surgical closure. PR segment in the percutaneous group was significantly reduced (63.4 plus or minus 14.5 to 52.1 plus or minus 10.8 milliseconds, p-value less than 0.05), but not in the surgical group (68.6 plus or minus 18.7 versus 61.1 plus or minus 24.7 milliseconds). However, the difference in PR segment changes between the two groups was not significant (-11.3 plus or minus 15.0 versus -7.6 plus or minus 20.5 milliseconds, p-value equal to 0.18). Our analysis demonstrates that the changes between the two groups were not different and that both closure techniques reduce P-wave duration, PR segment, and PR interval within 6 months.

A short term follow up comparison of genu varum corrective surgery using open and closed wedge high tibial osteotomy.

INTRODUCTION: Knee deformity associated with osteoarthritis (OA) is one of the most common complications seen in patients referred to orthopaedic surgeons. High tibial osteotomy (HTO) is an accepted method for treatment of medial knee osteoarthritis with varus deformity. The aim of this study was to compare results of osteotomy methods in patients with genu varum (GV) deformity. METHODS: In this cohort study, the sample consisted of 32 patients with genu varum deformity (42 knees) who were divided into two groups and matched according to age and gender. The patients were treated with open or closed wedge osteotomy. After surgery, they were followed-up and compared for 6 months. RESULTS: The sample consisted of 25 women (87.2%) and 7 men (21.8%). Ten patients (31.2%) presented with bilateral deformity. The incidence of complications was the same for both procedures (12.5%); this included one peroneal nerve injury following closed wedge surgery. Overall, patient satisfaction was 87.5% and 75% for the open and closed wedge methods respectively. Operative time, days to full weight bearing, and days to return to routine activities were significantly shorter for patients treated with the open wedge method (p<0.001). CONCLUSION: Open wedged HTO is associated with shorter operating time, shorter recovery time, higher patient satisfaction, and probable lower risk of neurological injury. KEY WORDS: High Tibial Osteotomy, Open Wedge Osteotomy, Closed Wedge Osteotomy.

Treatment of pediatric open femoral fractures with external fixator versus flexible intramedullary nails.

BACKGROUND: In children, inappropriate treatment of open femoral fractures may induce several complications. A few studies have compared the external fixator with flexible intramedullary nails in high-grade open femoral fractures of children. The present study aims at comparing results of these two treatment methods in open femoral fractures. METHODS: In this descriptive analytical study, 27 patients with open femoral fractures, who were treated using either the external fixator (n=14) or TEN nails (n=13) method from 2006-2011, were studied. Some patients were treated with a combination method of TEN and pin. The results were evaluated considering infection, union, malunion, and refracture and the patients were followed up for two years. RESULTSS: Mean time required for fracture union was 3.89 (range: 2-5.8) and 3.61 (range: 2-5.6) months for the external fixator and TEN groups, respectively. The difference was not statistically significant and there was not any significant difference between the two groups considering infection of the fractured area. Osteomyelitis was not observed in any group. There was an infection surrounding the external fixator pin in 4 cases (28.5%) and so this required changing the location of the pin. In the TEN group, one case (7.6%) of painful bursitis was observed at the entry point of TEN and so the pin was removed earlier than usual. There were two cases (14.2%) of femoral refracture in the external fixator group. Malunion requiring correction was not observed in any of the groups. There were no complications observed in five patients treated with a combined method of pin and flexible intramedullary nails. CONCLUSION: Both external fixator and intramedullary nail methods are effective ways in treating high grade open femoral fractures in children and final treatment results are similar. Combining pins and flexible intramedullary nails is effective in developing more stability and is not associated with more complications.

Treatment of open pediatric tibial fractures by external fixation versus flexible intramedullary nailing: a comparative study.

BACKGROUND: Tibial fractures are the third most common pediatric long-bone fracture after forearm and femoral fractures. Approximately 50% of pediatric tibial fractures occur in the distal third of the tibia. This is followed by midshaft tibial fractures (39%), and least commonly, the proximal third of the tibia is involved. Tibial fractures in the skeletally immature patient can usually be treated without surgery but tibial fractures resulting from high energy traumas are of special importance considering type of the selected treatment method affecting the children future. Manipulation and casting are regarded as definite treatments for children tibial fractures. They are used following compartment syndrome in poly-trauma, neurovascular damages, open fractures, and fasciotomy cases. OBJECTIVES: In children, most open fractures occur due to high energy traumas and inappropriate treatment of the fractures may result in several complications. Flexible intramedullary nailing is one of the popular options as an effective method of treating long-bone fractures in children. The external fixator is used in cases with severe injuries and open fractures. The present study aims at comparing results of these two treatment methods in the open pediatric tibial fractures. MATERIALS AND METHODS: In this descriptive analytical study, 32 patients with open tibial fractures were treated with either fixator (n = 18) or TEN nails (n=14) during 2006-2011. Some patients were treated with a combination method of TEN and pin. The results were evaluated considering infection, union, mal-union, and re-fracture and the patients were followed up for two years. RESULTS: Mean time required for fracture union was 12.5 (11-14) and 11.8 (10-12) weeks for the external fixator and TEN groups, respectively. There was no statistical difference in time of union between the two methods. The main complications in external fixation were infection around the pin 4 (22.2%), leg-length discrepancy 2 (11.1%) and re-fracture 4 (22.2%). In the TEN group, 2 cases (14.2%) of painful bursitis were observed at the entry point of TEN and the pin was removed earlier. There was not any report of mal-union requiring correction in the groups. No complication was seen in 6 patients treated with a combined method of pin and flexible intramedullary nails. CONCLUSIONS: Although external fixation in open pediatric fractures and severe injuries is recommended, intramedullary nailing is also an effective method with low complications. Combining pins and flexible intramedullary nails is effective in developing more stability and is not associated with more complications.

Comparison study of therapeutic results of closed tibial shaft fracture with intramedullary nails inserted with and without reaming.

Tibia fractures are the most common type of long bone fractures in US. This study aimed at comparing the therapeutic results of closed tibial shaft fracture with intramedullary nails inserted with and without reaming. In this randomized clinical trial study, 60 patients with a fracture of the tibia were examined. The patients were randomly divided into two groups. Thirty patients treated through inserting intramedullary nail with reaming technique (group A). The other 30 patients treated through inserting intramedullary nail without reaming technique (group B). After operation physical examination and control radiography were taken up to 6 month and results were compared. Sixty patients suffering from closed tibial diaphysis fractures were studied. Mean age of the group A and B were 40.24 +/- 12.32 and 38.42 +/- 14.28, respectively. Group A consisted of 24 (80%) males and 6 (20%) females while group B consisted of 24% females and 76% males. Considering fracture based on OTA criteria (p = 0.4) and severity of soft tissue damage based on Tscherne classification (p = 0.6), there was no statistically meaningful difference between groups A and B. The study demonstrated that degree of horizontal displacement, mean time of surgery, post-operation infection, organ shortness at the end of the follow-up period, organ deviation in patients of the group A was significantly more than that of the group B. Time required for callus formation (mean time of union), mean time of full weight bearing time and mean time of return to normal activities in group B was significantly more than that of the group A.

Manipulation with Schanz screws for closed reduction of femoral shaft fractures during intramedullary nailing.

OBJECTIVE: To use Schanz screws as a simple and effective method for closed reduction of femoral shaft fractures. METHODS: In the present cohort study, which was carried out in Shohada Orthopedic Center, Tabriz, Iran between January 2004 and February 2005, 30 adult patients, with a mean age of 29 (18-65 years) with femoral shaft fractures underwent closed reduction with Schanz pins. The patients were followed up for 12 months. RESULTS: Reduction was satisfactory in 93.3% of patients. The average time for reduction was significantly shorter if treated in the first 48 hours, and if the amount of pre-operative traction approached 15% of the body weight. Reduction time was also shorter in Winquist-Hansen type III and IV fractures than in type I and II fractures (5.9 +/- 0.2 minutes versus 15.7 +/- 0.4 minutes). There was 13% valgus deformity (5-10 degrees), 33% external mal-rotation (5-15 degrees) and 37% shortening (up to 1-3 cm). We encountered no need for blood transfusion or bone grafting. CONCLUSION: Schanz screws provide a very effective method for closed reduction of femoral shaft fractures, and complications are similar to or less than other methods, especially if carried out in the first 48 hours after the trauma and if the weight for pre-operative traction approaches 15% of body weight.

The effects of zinc supplementation on serum zinc, alkaline phosphatase activity and fracture healing of bones.

OBJECTIVE: To determine the effect of zinc supplementation on callus formation, serum zinc and alkaline phosphatase activity in humans. METHODS: This randomized, double-blind, placebo controlled clinical trial was conducted on 60 patients with traumatic bone fracture referred to Shohada Hospital of Tabriz, Iran from August to December 2007. Subjects were randomly divided into 2 groups: cases (n=30), receiving one capsule of zinc sulfate consists of 50 mg zinc each day and the controls (n=30), receiving placebo for 60 days. Individual and clinical information was determined by a questionnaire: nutritional intake by 3 days food records at the beginning and the end of trial. Serum zinc and alkaline phosphatase was measured by atomic absorption spectroscopy, and by enzymatic method. Callus formation during fracture healing was evaluated by radiography of the bone. RESULTS: There was no significant difference in physical activity, gender, age, type of fractures, and nutrient intake, between the 2 groups. The administration of zinc caused a significant elevation of serum zinc and alkaline phosphatase activity. Assessment of bone x- rays showed a significant progress in callus formation in cases compared to the controls. CONCLUSION: This study shows that zinc supplementation can stimulate fracture healing, however, it needs further study.