Operative Management of Late Presented Displaced Lateral Condyle Fracture of Humerus in Children.

INTRODUCTION: Management of late presented displaced fracture of lateral condyle of humerus in children is controversial, many recommend conservative management due to fear of complications like avascular necrosis but recently many are advocating for operative management with good results hence we studied the outcome of operative management in late presented displaced lateral condyle fracture of humerus in children. METHODS: We studied 22 children aged between 4 to 11 years, presenting 3 to 16 weeks from injury. All underwent open reduction and internal fixation with Kirschner wires with or without additional screw and followed up for average 18.05 months. Elbow range of motion, angular or local deformity, premature fusion of physis, avascular necrosis and fracture union were noted and analyzed using modified Aggarwal et al criteria. RESULTS: We had 9 (40.91%) excellent, 5 (22.73%) good, 5 (22.73%) fair, 3 (13.63%) poor result. Overall satisfactory results were seen in 19 (86.37%); 3 (13.63%) had poor result , one due to AVN, two due to premature fusion of physis and visible local deformity. All poor result were seen among delay of operation 6 weeks or later. There was significant improvement of elbow range of motion and all fracture united. CONCLUSIONS: Outcome of operation without bone grafting on lateral condyle fracture of humerus in children who presents late up to 5 weeks are excellent; whereas outcome of delayed operation up to 16 weeks also gives good functional recovery and union.

Outcome of Needle Fenestration, Subacromial Steroid and Diclofenac Phonophoresis in Acute Calcific Tendinitis of Shoulder.

INTRODUCTION: Acute calcific tendinitis of shoulder is very painful and disturbing condition. There are many modalities with variable outcome to address the condition. We studied needling technique with multiple fenestration, subacromial steroid and diclofenac phonophoresis and evaluated the outcome in term of pain relief and improvement of shoulder function at a simple outpatient clinical set up without image or ultrasound guidance. METHODS: We studied cases of acute calcific tendinitis presenting within one week from onset of symptoms and X-ray showing calcific deposit. All underwent needle fenestration at maximum tender site with lignocaine loaded syringe, subsequent injection of 40 mg subacromial methylprednisolone and diclofenac phonophoresis done by qualified physiotherapist for five days. Visual Analogue Scale was used to measure pain, Simple shoulder Test applied to evaluate shoulder function and size of calcific deposit was measured at maximum length. RESULTS: Pain subsided dramatically and there was substantial improvement of shoulder function within a week. CONCLUSIONS: Needle fenestration and subacromial methylprednisolone along with diclofenac phonophoresis without image guidance gives excellent pain reduction and improves shoulder function which can be done at simple outpatient clinic.