Functional Outcome of Closed Reduction and Extension Casting in Forearm Fractures in Children.

Introduction Fractures in children are extremely common scenarios encountered by orthopedicians. Conservative treatment has been the most preferred choice for the management of diaphyseal forearm fractures. Traditionally, pediatric forearm fractures are treated by above elbow plaster cast with the elbow flexed to 90 degrees. The purpose of this study was to evaluate the functional and radiological outcomes of children treated with closed reduction and extension casting for forearm fractures. Patient and methods This is a prospective study evaluating the functional and radiological outcomes of 30 children of less than the age of 14 years and without pathological fractures, treated with closed reduction and extension casting for forearm fractures, either both radius and ulna or radius or ulna at middle third level, who reported to the Department of Orthopedics, Dr. D.Y. Patil Medical College, Hospital, and Research Center, Pune, India, between September 2019 and March 2022. Results The mean pre-operative angulation in radius (antero-posterior {AP}) was 22.7, radius (lateral {LAT}) was 24.2, ulna (AP) was 31.2, and ulna (LAT) was 29.2. The immediate post-operative angulation of radius (AP) was 0.7, radius (LAT) was 3.2, ulna (AP) was 0.6, and ulna (LAT) was 4.9. Cast status at two weeks, 83.3% had intact cast and 16.7% had loosened casts. Post removal, most patients had a good rotation of motion (ROM) at three and six weeks. Conclusion Casting with extended elbow is much better as compared to flexion casting in the hands of a trainee doctor. Furthermore, chances of loss of reduction are negligible in extension casting as compared to flexion casting.

Assessment of Surgical Outcome in Three- and Four-Part Proximal Humerus Fracture Treated With Proximal Humerus Internal Locking System (PHILOS) Plate Versus Neer's Prosthesis in Elderly Patients.

BACKGROUND: With an incidence of 50% of humerus fractures, proximal humerus fractures (PHFs) can significantly impact one's quality of life. Moreover, management of highly comminuted or displaced PHFs poses a significant challenge amongst elderly population due to poor bone quality. Prosthetic replacement of humeral head or its stabilization using external plates is a commonly employed intervention for treating three- and four-part PHFs. Thus, these two methods were compared in this study to identify a preferable intervention. METHODS: Patients were randomly divided into two groups to receive proximal humerus internal locking system (PHILOS®, Synthes, Switzerland) plating and Neer's hemiarthroplasty. The deltopectoral approach was deployed as the surgical method. Their surgical outcome was assessed from functional range of motion (ROM) and Constant-Murley scores at regular intervals of three, six, twelve, and twenty-four weeks. RESULTS: Twenty patients were divided into two groups who received PHILOS® plating and Neer's hemiarthroplasty, averaged 67.2 years and 72.8 years. The ROM pertaining to flexion, extension, abduction, internal rotation, and external rotation for individuals with PHILOS® plating was 20%, 12.5%, 14.7%, 11.5%, and 18.5% higher than those who received Neer's hemiarthroplasty. Moreover, the Murley score was also 8.7 units higher for individuals with PHILOS® plating. CONCLUSIONS: Prognosis following PHILOS® plate osteosynthesis had a better overall outcome than hemiarthroplasty with Neer's prosthesis. Although hemiarthroplasty yielded a consistent functional outcome, PHILOS® plate osteosynthesis tends to restore a greater ROM. Thus, PHILOS® plating is recommended as the suitable method to manage three- and four-part PHF for people above fifty-five years of age.

A Solitary Enchondroma of the Great Toe in an Adolescent Male: A Case Report.

Solitary enchondromas are benign and usually asymptomatic. Enchondromas are a form of cartilage tumor and have a higher chance of converting into chondrosarcoma. It is difficult to obtain a valid risk estimate, as this requires histopathology and MRI reports. A 17-year-old male presented with swelling over the left great toe since six months, which was insidious in onset, gradually progressive, and associated with intermittent dull aching type of pain. Physical examination revealed bony hard swelling of size 3 x 2.5cm over the left great toe. X-ray was suggestive of lytic lesions, scalloping of the cortex, and whorl of calcification. After confirming the diagnosis through MRI and histopathological examination, the decision was taken to remove whole of the proximal phalanx along with the tumor. Gap was filled up with fibular strut graft. Solitary enchondromas that are aggressively increasing in size should be treated surgically. Bone gap (between the first metatarsal and distal phalanx) caused after removing the tumor can be filled with bone graft or cement depending on the condition of the cortex.

Assessment of Functional and Radiological Outcomes of Comminuted Intra-Articular Distal Radius Fracture Treated With Locking Compression Plate.

Background Distal radial fractures (DRFs) are a prevalent form of skeletal injuries that hinder a person from performing daily living activities. Although several treatment modalities have been established to manage DRF, an optimal intervention has not been identified for comminuted fractures. The use of locking compression plates (LCPs) is gaining popularity for fractures that cannot be anatomically reduced because they offer better stability and early recovery. Thus, this study aims to investigate the surgical outcome of comminuted intra-articular DRFs treated with LCPs. Methodology We performed open reduction and internal fixation in 30 patients (18 males and 12 females) with DRF and were followed up at regular intervals following the surgery (at three, six, twelve, and twenty-four weeks). The surgical outcome was assessed both from functional and radiological standpoints. The influence of LCP on functional outcome was evaluated based on the modified Mayo wrist score and the quality of reduction based on the Lindstrom criteria by observing volar tilt and radial inclination. Results For radiological outcome, there was no variation in tilt/inclination of more than two degrees even after three months, which was a satisfactory result. Moreover, patients of all age groups showed early range of motion and functional benefit from LCP treatment. After six months of treatment, the patients experienced no pain and were able to return to their pre-injury jobs with little difficulty. Range of motion, work status, and grip strength after six months showed improvement of 15%, 7.8%, and 56%, respectively, compared to immediate postoperative assessments at three weeks. Although the end outcome with any treatment modality may yield similar results, when using LCPs, most patients experienced early functional improvement nearly six months after surgery. Conclusions By offering a lower risk of complications and early functional mobility, LCPs tend to restore the articular architecture of the fractured joint that results in the desired range of motion, grip strength, improved pain management, and functional status. Thus, LCPs appear to be a better alternative for distal end radial fractures than other treatment modalities.