Long-term outcome of nonunion of the lateral humeral condyle fracture in children: a multicentre retrospective study.

PURPOSE: Lateral humeral condyle nonunion in children is a rare condition. The treatment protocol for nonunion of lateral humeral condyle remains controversial due to the potential complication. This study reports long-term functional outcomes of the nonunion of the lateral humeral condyle fracture. In addition, we identified the prognostic factors for nonunion of the lateral humeral condyle fracture. METHODS: We conducted a multicentre retrospective cohort study of nonunion of lateral humeral condyle between January 1995 and December 2022. The patient's preoperative demographic information was reviewed. Potential risk factors of poor functional outcome, such as age, duration from initial injury, and fracture displacement, were retrieved. Functional outcomes at the latest follow-up visit were evaluated using the Mayo Elbow Performance Score (MEPS). Multivariable linear regression was deployed to evaluate the association of potential risk factors with the functional outcome. RESULTS: A total of 63 patients from eight medical centers were included, of which 60 were surgically treated. Patients' average age was 7.3 years old, with a mean follow-up duration of seven years. All nonunion cases were successfully treated, resulting in a normalized humeroulnar angle. The rate of AVN was 16.7%. All patients reported excellent range of motion and MEPS at the latest follow-up. Multivariable linear regression demonstrated that Fracture displacement (ß = -0.88, 95% CI -1.55 to -0.22, p = 0.010) and duration from initial injury (ß = -0.09, 95% CI -0.17 to -0.02, p = 0.010) were statistically significant factors influencing functional outcome of lateral humeral condyle nonunion. CONCLUSIONS: Initial fracture displacement and duration from the initial injury are statistically significantly associated with elbow function in lateral humeral condyle nonunion. However, the effect size for these factors is relatively small and does not reach clinical significance. Despite this, the functional outcome is excellent in all patients, with an average follow-up duration of seven years.

Neurological Recovery Determined by C-Reactive Protein, Erythrocyte Sedimentation Rate and Two Different Posterior Decompressive Surgical Procedures: A Retrospective Clinical Study of Patients with Spinal Tuberculosis.

BACKGROUND: C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) not only are useful in the diagnosis but also are reliable parameters in evaluating the response to treatment and prognosis of tuberculous spondylodiscitis. OBJECTIVE: To analyze the correlation between neurological recovery and declination of CRP or ESR after two different posterior spinal procedures. MATERIAL AND METHOD: The patients who had neurological deficit due to spinal tuberculosis and undergone spinal surgery between January 2009 and June 2013 were analyzed retrospectively. Posterior transforaminal decompression and interbody fusion were done in group I, whereas posterior transpedicular decompression and posterolateralfusion were performed on group II. Both groups were stabilized with pedicle screw instrumentation. Rapid recovery represented by improvement of at least one Frankel grade within 6 weeks after operation, otherwise it was slow recovery. Inflammatory markers were evaluated at initial diagnosis and at 6-week, 3-month, 6-month, and 1-year post-operation. RESULTS: There were 31 patients. Group I included 14 cases and group II consisted of 17 cases. The median CRP and ESR at diagnosis were 80.4 mg/L and 78.0 mm/hour respectively. Rapid neurological recovery significantly related to the earlier declination of CRP within the first 6 weeks (p < 0.001). Considering the type of spinal procedures especially at thoracic and thoracolumbar level, neurological recovery in group I was significantly faster than in group II (p = 0.02; relative risk, 2.67; 95% confidence interval, 1.02 to 6.91). CONCLUSION: Earlier declination of CRP within six weeks post-operation could determine rapid neurological recovery. Posterior transforaminal decompression and interbody fusion with instrumentation may be a suitable optionfor thoracic and thoracolumbar lesions.

Effectiveness of Mom-made Pavlik harness for maintaining reduction of the hip in DDH.

BACKGROUND: Co-operation of the parent is a major factor for successful treatment of developmental dysplasia of the hip (DDH). The commercial Pavlik harness is too expensive and the parent may not understand or refuse its use. Regarding the function of the Pavlik harness and awareness of complications, a Mom-made Pavlik harness was developed. OBJECTIVE: To evaluate the effectiveness of Mom-made Pavlik harness in maintaining the reduction ofDDH MATERIAL AND METHOD: Infants with Ortolani positive DDH, ages up to five months, treated at Maharat Nakhon Ratchasima Hospital between October 2003 and September 2012, were analyzed, retrospectively. Irreducible DDH, neuromuscular DDH and hyperlaxity syndrome were excluded. A Mom-made Pavlik harness was used to maintain reduction after the initial two weeks of a hip spica cast. The success of treatment was evaluated by ultrasound of the hip. The center edge (CE) angle was measured from AP film at age one and four years. RESULTS: There were 24 infants, 35 hips with 11 bilateral, seven left and six right sides DDH. Thirty-two hips were successfully reduced (91.4%). Three hips had recurrent dislocation. Two of these were further managed by adductor tenotomy and closed reduction under general anesthesia and hip spica cast, followed by hip abduction brace. Another was treated by open reduction and Salter's innominate osteotomy. The average CE angle at age one and four years was 16.5 and 25.9 degree, respectively. CONCLUSION: Treatment of the infants with DDH requires a long period of care not only in hospital but also at home. Therefore, it needs the diligence, intention and regularity by their parents to achieve a successful outcome. The Mom-made Pavlik harness represents the spirit of this resolution.