Do It Yourself (DIY) Radiolucent Drill Guide Using a 10 ml Syringe for Freehand Distal Interlocking in Intra-medullary Nailing: A Surgical Technique.

Distal interlocking during intramedullary femoral, tibial, and humeral nailing is frequently challenging. In the traditional image intensifier (II) 'bull's eye' technique, the implant's interlocking screw hole can be obscured by the radio-opaque chuck, necessitating multi-planar checks by tilting the drill bit before drilling. This manoeuvre can adversely alter the drill trajectory, compromise fixation, or damage the implant. We introduce a surgical technique that uses a 10 ml syringe to overcome this difficulty.

Selective Kirschner wiring for displaced distal radial fractures in children.

OBJECTIVES: This study was designed to evaluate our departmental policy of plaster immobilization and selective Kirschner (K) wiring for the management of displaced distal radius fractures in children. METHODS: On a retrospective basis, we evaluated a consecutive series of 112 childhood displaced distal radius fractures (108 patients; 77 boys, 31 girls; mean age 10.5+/-2.6 years; range 5 to 16 years) presenting with clinical deformity during a two-year period. There were 97 incompletely displaced (86.6%), and 15 completely displaced (13.4%) fractures. All the fractures were managed with manipulation under general anesthesia and plaster immobilization. Additionally, K-wire fixation was performed following manipulation in seven (46.7%) of the completely displaced fractures. The mean follow-up period was 1.1 years (range 10 weeks to 2 years). RESULTS: The mean angulation of fractures prior to manipulation was 21.5+/-10.1 degrees, it decreased to 2.4+/-4.8 degrees following manipulation. Remanipulation was required in 11 fractures (9.8%) based on clinical and radiographic findings of redisplacement. Of these, eight fractures (8.3%) were incompletely displaced, and three fractures (20%) were completely displaced. All completely displaced fractures that required remanipulation had been additionally treated with K-wire fixation. Fractures requiring further treatment had a mean angulation of 17.1+/-5.8 degrees prior to remanipulation, and a mean residual angulation of 4.7+/-6.0 degrees at final radiographic assessment. A perfect fracture reduction was achieved in all the patients with a Salter-Harris II injury (n=22), and none of these patients required remanipulation. However, the quality of initial reduction was not associated with the development of redisplacement. There was no significant difference between isolated distal radius fractures (n=58) and combined radius and ulna fractures (n=32) with respect to remanipulation rate and final angulation (p>0.05). Final radiographs showed a significantly greater angulation in fractures which were initially completely displaced in comparison with those that were incompletely displaced (8.2+/-7.1 degrees vs. 4.2+/-5.7 degrees; p=0.024), but this was not of clinical significance. None of the patients had radial shortening and no K-wire related complications were encountered. CONCLUSION: Our data suggest that there should be other factors involved in the development of redisplacement and the need for remanipulation other than the degree of fracture displacement and the quality of initial reduction. Selective K-wire fixation in displaced fractures does not seem to decrease redisplacement and remanipulation rates.

Minimally invasive osteosynthesis of distal tibial fractures using locking plates.

The management of distal tibia fractures can be challenging because of the scarcity of soft tissue, their subcutaneous nature, and poor vascularity. Classic open reduction and internal plate fixation require extensive soft tissue dissection and periosteal stripping, with high rates of complications. Minimally invasive plating techniques reduce iatrogenic soft tissue injury and damage to bone vascularity and preserve the osteogenic fracture hematoma. Locking plates (LPs) have the biomechanical properties of internal and external fixators, with superior holding power because of fixed angular stability through the head of locking screws, independent of friction fit. In this review, the rationale for the use of LPs and a description of the technique of minimally invasive LP osteosynthesis of distal tibia fractures are presented.

Sports injuries in children.

INTRODUCTION: Sports injuries in children affect both growing bone and soft tissues, and can result in damage of growth mechanisms with subsequent lifelong, growth disturbance. This clinical review unfolds the incidence and distribution, physiology, injury characteristics and the prevention modalities. METHODS: A comprehensive in Medline literature search was performed, and the reference lists of sports injuries related journals and text books was consulted. RESULTS: During growth, there are significant changes in the biomechanical properties of bone. In young athletes, as bone stiffness increases and resistance to impact diminishes, sudden overload may cause bones to bow or buckle. Fractures that are initially united with some deformity can completely remodel, and the bone may appear totally normal in later life. DISCUSSION/CONCLUSION: Most injuries caused in children's sports are minor and self-limiting, suggesting that children and youth sports are safe. The training programmes should take into account their physical and psychological immaturity, so that growing athletes can adjust to the changes in their bodies.

[Southwick osteotomy in stable slipped capital femoral epiphysis: a long-term outcome study]. / Stabil femur basi epifiz kaymasinda Southwick osteotomisi: Uzun dönem sonuçlar.

OBJECTIVES: Moderate to severe chronic stable slipped capital femoral epiphysis (SCFE) produce permanent irregularities in the femoral head and acetabulum. We report a single centre long-term outcome study of Southwick's procedure for the management of moderate or severe stable chronic SCFE with irregularity of the femoral head. METHODS: In the period from January 1978 to January 1990, 20 patients (16 girls, 4 boys; mean age 13 years; range 11 to 15 years) underwent 22 Southwick osteotomies for chronic stable SCFE with closure or partial closure of the growth plate and a slip between 30 degrees and 70 degrees . All osteotomies were performed by the same surgeon. Patients were followed-up for an average of 22 years (range 16 to 28 years). RESULTS: External rotation deformity was corrected, and the Trendelenburg sign was hardly observable in any of the patients from six months of surgery. Radiographically, all patients showed full consolidation of the osteotomy within two months of surgery. There was no further epiphyseal slipping. We did not encounter any infection or avascular necrosis. Only one patient developed chondrolysis, which resolved fully in eight months. At the latest follow-up, no limb length discrepancy was seen in 18 patients, while two patients had a mean of 0.8 cm shortening. Eight patients (36.4%) showed radiographic evidence for degenerative joint disease, but none were symptomatic. CONCLUSION: The management of chronic stable (moderate to severe) SCFE by Southwick's osteotomy is safe, but technically demanding. It affords good predictable outcome with a low complication rate.

Traumatic quadriceps rupture in a patient with patellectomy: a case report.

INTRODUCTION: Acute traumatic, unilateral, quadriceps rupture after patellectomy is rare. CASE PRESENTATION: We present a 42-year old male who experienced a unilateral left quadriceps tendon rupture following assault by four people. Twenty-seven years before this injury, the patient had suffered ipsilateral femur and comminuted patellar fractures, which were managed by intramedullary nailing and patellectomy respectively. We performed primary end to end repair of the torn tendon. Postoperatively, histology revealed findings consistent with pre-existent degenerative changes. The patient made good recovery, and returned to his former occupation which was reliant on his ability to drive. CONCLUSION: Degenerative changes of the tendon of the extensor mechanism of knee following patellectomy may predispose the quadriceps tendon to traumatic rupture. Early operative intervention and protracted rehabilitation are required to obtain the best functional results.