Single-bone versus both-bone plating of unstable paediatric both-bone forearm fractures. A randomized controlled clinical trial

Abstract Purpose This clinical trial compares the functional and radiological outcomes of single-bone fixation to both-bone fixation of unstable paediatric both-bone forearm fractures. Methods This individually randomized two-group parallel clinical trial was performed following the Consolidated Standards of Reporting Trials (CONSORT) statement at a single academic tertiary medical centre with an established paediatric orthopaedics unit. All children aged between nine and 15 years who presented to the emergency department at Assiut university with unstable diaphyseal, both-bone forearm fractures requiring surgical intervention between November 1, 2018, and February 28, 2020, were screened for eligibility against the inclusion and exclusion criteria. Inclusion criteria were diaphyseal unstable fractures defined as shaft fractures between the distal and proximal metaphyses with an angulation of > 10°, and/or malrotation of > 30°, and/or displacement > 10 mm after attempted closed reduction. Exclusion criteria included open fractures, Galeazzi fractures, Monteggia fractures, radial head fractures, and associated neurovascular injuries. Patients who met the inclusion criteria were randomized to either the single-bone fixation group (intervention) or the both-bone fixation group (control). Primary outcomes were forearm range of motion and fracture union, while secondary outcomes were forearm function (price criteria), radius re-angulation, wrist and elbow range of motion, and surgical time Results A total of 50 children were included. Out of these 50 children, 25 were randomized to either arm of the study. All children in either group received the treatment assigned by randomization. Fifty (100%) children were available for final follow-up at six months post-operatively. The mean age of single-bone and both-bone fixation groups was 11.48 ± 1.93 and 13 ± 1.75 years, respectively, with a statistically significant difference (p = 0.006). There were no statistically significant differences in gender, laterality, affection of the dominant hand, or mode of trauma between single-bone and both-bone fixation groups. All patients in both groups achieved fracture union. There mean radius re-angulation of the single-bone fixation groups was 5.36 ± 4.39 (0–20) degrees, while there was no radius re-angulation in the both-bone fixation group, with a statistically significant difference (p < 0.001). The time to union in the single-bone group was 6.28 ± 1.51 weeks, while the time to union in the both-bone fixation group was 6.64 ± 1.75 weeks, with no statistically significant difference (p = 0.44). There were no infections or refractures in either group. In the single-bone fixation group, 24 (96%) patients have regained their full forearm ROM (loss of ROM < 15°), while only one (4%) patient lost between 15 and 30° of ROM. In the both-bone fixation group, 23 (92%) patients have regained their full forearm ROM (loss of ROM < 15°), while only two (8%) patients lost between 15 and 30° of ROM. There was no statistically significant difference between groups in loss of forearm ROM (p = 0.55). All patients in both groups regained full ROM of their elbow and wrist joints. On price grading, 24 (96%) and 23 (92%) patients who underwent single bone fixation and both-bone fixation scored excellent, respectively. Only one (4%) patient in the single-bone fixation group and two (8%) patients in the both-bone fixation group scored good, with no statistically significant difference in price score between groups (p = 0.49). The majority of the patients from both groups had no pain on the numerical pain scale; 22 (88%) patients in the single-bone fixation group and 21 (84%) patients in the both-bone fixation groups, with no statistically significant difference between groups (p = 0.38). The single-bone fixation group had a significantly shorter mean operative time in comparison to both-bones plating (43.60 ± 6.21 vs. 88.60 ± 10.56 (min); p < 0.001). Conclusion Single-bone ulna open reduction and plate fixation and casting are safe and had a significantly shorter operative time than both-bone fixation. However, single-bone ORIF had a higher risk radius re-angulation, alas clinically acceptable. Both groups had equally excellent functional outcomes, forearm ROM, and union rates with no complications or refractures. Long-term studies are required.

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Semi-Rigid Fixation Using a Sliding Plate for Treating Fractures of the Mandibular Condylar Process

Journal of Clinical Medicine ◽

10.3390/jcm10245782 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5782

Author(s):

Byung-Kyu So ◽

Kyeong-Soo Ko ◽

Dong-Hyuck Kim ◽

Hyon-Seok Jang ◽

Eui-Seok Lee ◽

...

Keyword(s):

Operative Time ◽

The Other ◽

Rigid Fixation ◽

Panoramic Radiographs ◽

Condylar Process ◽

Fixation Group ◽

Significant Difference ◽

Fracture Area ◽

Ramus Height ◽

Sliding Plate

Occlusal displacement often occurs after surgery for condylar process fractures because it is difficult to reduce these fractures precisely. However, performing semi-rigid fixation using a sliding plate may overcome this limitation. A retrospective clinical comparison between semi-rigid and rigid fixations was performed. Among 34 patients who had unilateral condylar process fractures, 17 were treated with rigid fixation and the remaining with semi-rigid fixation using a sliding plate. For all patients, panoramic radiographs were collected 1 day and 6 months after surgery. In these radiographs, ramus height and condylar process inclination were measured, and the differences between the fractured and normal sides were assessed. Additionally, the radiographic density of the fracture area was measured. Differences in surgical outcomes and operative times between the two groups and changes in postoperative deviations within each group were analyzed. There was no statistically significant difference in ramus height and condylar process inclination between the two groups at postoperative day 1 and 6 months. Radio-density was observed to be higher in the rigid fixation group, and it increased with time in both groups. The semi-rigid fixation group had a significantly shorter operative time than the other group did. Semi-rigid and rigid fixations showed no differences in terms of effectiveness and outcomes of surgery. In terms of operative time, semi-rigid fixation was superior to rigid fixation.

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Single-Bone Fixation of Both-Bone Forearm Fractures

Journal of Pediatric Orthopaedics ◽

10.1097/01241398-199609000-00020 ◽

1996 ◽

Vol 16 (5) ◽

pp. 655-659 ◽

Cited By ~ 72

Author(s):

John M. Flynn ◽

Peter M. Waters

Keyword(s):

Forearm Fractures ◽

Bone Fixation ◽

Single Bone

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The level of chorionic gonadotropin in postmenopausal women with CKD V stage treated with hemodialysis

Ukrainian Journal of Nephrology and Dialysis ◽

10.31450/ukrjnd.2(58).2018.02 ◽

2018 ◽

pp. 9-12

Author(s):

K. Abrahamovych ◽

I. Dudar ◽

V. Savchuk ◽

Y. Gonchar ◽

V. Krot ◽

...

Keyword(s):

Postmenopausal Women ◽

Chorionic Gonadotropin ◽

Functional Disorders ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Trophoblastic Diseases ◽

Menopausal Women ◽

Ckd Stage ◽

Significant Difference

The chorionic gonadotropin (CGT) test is used to diagnose and monitor the course ofpregnancy, including ectopic, to detect fetal abnormalities, trophoblastic diseases, preeclampsia, ovarian tumors, lungs, stomach, intestine, bladder, kidneys, prostate. The level of CGT is often elevated in postmenopausal women treated with hemodialysis (HD). Its significance is still not well understood, and therefore requires further study. The aim of our work was to investigate the level of CGT in postmenopausal women treated with HD. Methods. The determination of the level of CGT in 23 postmenopausal women treated with HD. The main inclusion criteria were as follows: oral informed consent of the patient to participate in the study, the presence of CKD stage VD and treatment of HD for at least 6 months. Exclusion criteria: severe functional disorders (liver, heart, respiratory failure), cancer processes, smoking, taking substitution hormonal therapy, lack of consent of the patient. The results were compared with the CGT levels in 20 healthy menopausal women (group II). Results. A statistically significant difference was found between the I group (postmenopausal women treated with HD) and II group (women without chronic kidney disease (CKD) (t = 3.62, p = 0.001). It was also found that CGT was increased in 9 (39%) of 23 women treated with HD. The norm of CGT in postmenopausal women is <14.0 IU/L, therefore the deviation of the index in the I group (13.63 ± 2.83 IU/L) is within the reference values. However, it does not explain the statistically significant difference between the CGT indices in the I group compared to the II group (p<0.01). Possibly, the presence of CKD contributes to the increase in HGT. Conclusions. Authentically higher rates of CGT in postmenopausal women treated with HD compared with women without CKD were detected. Thus, CKD can affect the serum level of CGT, probably due to disruption, but this issue has not been studied, and requires further investigation.

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Middle calyx access in complete supine percutaneous nephrolithotomy

Canadian Urological Association Journal ◽

10.5489/cuaj.1246 ◽

2013 ◽

Vol 7 (5-6) ◽

pp. 306 ◽

Cited By ~ 6

Author(s):

Siavash Falahatkar ◽

Ehsan Kazemnezhad ◽

Keivan Gholamjani Moghaddam ◽

Majid Kazemzadeh ◽

Ahmad Asadollahzade ◽

...

Keyword(s):

Operative Time ◽

P Value ◽

Inclusion Criteria ◽

Renal Anomalies ◽

Safety And Efficacy ◽

Stone Free Rate ◽

Significant Difference ◽

Hemoglobin Drop ◽

Free Rate ◽

Staghorn Stones

Background: Middle calyx access has been underused in percutaneousnephrolithotomy (PCNL), especially in the supine position.We compared the safety and efficacy outcomes between middlecalyx and lower calyx accesses in the complete supine PCNL in anon-randomized single-surgeon clinical study.Methods: Between February 2008 and October 2011, 170 patientsunderwent posterior subcostal single tract complete supine PCNLwith one-shot dilation and middle calyx (n = 48) and lower calyx(n = 122) accesses. Stone location and surgeon decision determinedtarget calyx for access. Inclusion criteria were pelvis stones,staghorn stones and multiple location stones. Exclusion criteriawere renal anomalies, only upper calyx stones, only middle calyxstones and only lower calyx stones. Important parameters werecompared between the two groups. A p value of <0.05 was consideredsignificant.Results: Two groups were similar in important patient- and stonerelatedparameters. Mean operative time (60.7 minutes), meanpostoperative hospital stay (1.84 days) and mean hemoglobin drop(0.67 g/dL) in the middle calyx group were significantly lesser thanin the lower calyx group (80.1 minutes, 2.19 days, 1.36 g/dL). Themiddle calyx group (89.6%; 79.6%) had a higher stone-free rate(p = 0.054) and efficiency quotient than the lower calyx group(76.2%; 61.6%). In the middle calyx group (10.4%; 2.1%), complicationand transfusion rates were lesser (p > 0.05) than lowercalyx group (14.8%; 7.4%). No significant difference (p = 0.40)was seen between two groups using the modified Clavien classificationof complications.Interpretation: Middle calyx can be an optimal access in PCNLwith the complete supine position for many of upper urinary tractstones due to its superior outcomes.

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Efficacy of fructooligosaccharide versus placebo for treatment of acute diarrhea in children: A double-blind randomized clinical trial

Paediatrica Indonesiana ◽

10.14238/pi45.2.2005.65-8 ◽

2016 ◽

Vol 45 (2) ◽

pp. 65

Author(s):

Reni Suryanty ◽

Supriatmo Supriatmo ◽

Berlian Hasibuan ◽

Atan Baas Sinuhaji

Keyword(s):

Clinical Trial ◽

Body Weight ◽

Placebo Group ◽

Randomized Clinical Trial ◽

Outpatient Clinic ◽

Acute Diarrhea ◽

Pediatric Patients ◽

Inclusion Criteria ◽

Double Blind ◽

Significant Difference

Objective To compare the efficacy of fructooligosaccharide (FOS)versus placebo in pediatric patients with acute diarrhea with re-gard to duration and frequency of diarrhea and the volume andconsistency of the stools.Methods This double-blind randomized clinical trial was carriedout from July to November 2003 in the pediatric intensive careunit, outpatient clinic, and pediatric ward of Adam Malik Hospitaland Pirngadi Hospital, Medan. Subjects were children and infantsaged 4 to 24 months suffering from acute diarrhea without dehy-dration or with mild to moderate dehydration whose parents gaveconsent. Children included in this trial received tablets of either600 mg FOS or 761 mg fructulin as placebo. Patients with mild tomoderate dehydration were initially rehydrated according to theWHO protocol. Afterwards, 10 tablets of FOS or placebo were givento each subject to be taken twice daily. In subjects without dehy-dration, the tablets were given by their parents. Daily follow-upwas performed, in which body weight, temperature, duration andfrequency of diarrhea, and the volume and consistency of stoolswere recorded. For outpatients, home visits were made.Results Out of 142 children who met inclusion criteria, 135 com-pleted the study. These consisted of 68 children in the FOS groupand 67 in the placebo group. Subjects were mostly <12 months ofage (57.0%), male (57.8%), and moderately malnourished (34.1%).There was no statistically significant difference between both groupsin the duration and frequency of diarrhea and the volume and con-sistency of stools (P>0.05).Conclusion There is no effect of the administration of FOS assupplemental therapy on the duration and frequency of diarrheaand on the volume and consistency of stools in children with acutediarrhea

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Twin Pregnancies, Crown-rump Length and Birthweight Discordancy: The Influence of Chorionicity

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0040-1712128 ◽

2020 ◽

Vol 42 (09) ◽

pp. 529-534

Author(s):

Joana Sousa Nunes ◽

Mário Sousa ◽

Nuno Montenegro ◽

Alexandra Matias

Keyword(s):

Twin Pregnancy ◽

Regression Line ◽

Multiple Pregnancy ◽

Multiple Pregnancies ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Crown Rump Length ◽

Biometric Parameters ◽

Significant Difference ◽

Twin Pregnancies

Abstract Objective The purpose of the present study was to analyze the influence of chorionicity in the biometric parameters crown-rump length (CRL), birthweight (BW), crown-rump length discordancy (CRLD) and birthweight discordancy (BWD), determine the correlation between these latter two in cases of intertwin discordancy, and to analyze the influence of chronicity in the presence of these discordancies with clinical relevance (> 10% and > 15%, respectively). Methods The present study was a retrospective study based on the twin pregnancy database of the Centro Hospitalar S. João (2010–2015), including 486 fetuses among 66 monochorionic (MC) and 177 dichorionic gestations (DC). The inclusion criteria were multiple pregnancies with 2 fetuses and healthy twin gestations. The exclusion criteria were trichorionic gestations and pregnancies with inconclusive chorionicity, multiple pregnancy with ≥ 3 fetuses and pathological twin gestations. Results No statistically significant difference was found in BW (p = 0.09) and in its discordancy (p = 0.06) nor in CRL (p = 0.48) and its discordancy (p = 0.74) between MCs and DCs. Crown-rump length discordancy and birthweight discordancy were correlated by the regression line “BWD = 0.8864 x CRLD + 0.0743,” with r2 = 0.1599. Crown-rump length discordancy > 10% was found in 7.58% of monochorionic and in 13.56% of dichorionic twins. Birthweight discordancy > 15% was detected in 16.67% of monochorionic and in 31.64% of dichorionic twins. Conclusion No statistically significant influence of chorionicity was identified in both birthweight and birthweight discordancy, as in crown-rump length and crown-rump length discordancy. Birthweight discordancy was correlated to crown-rump length discordancy in 20% of cases.

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Dopamine and Drip Lasix in Pediatrics with Oliguria: A Clinical Trial Study

Nephro-Urology Monthly ◽

10.5812/numonthly.111895 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Maryam Ghaderi Dehkordi ◽

Parsa Yousefichaijan ◽

Yazdan Ghandi ◽

Fatemeh Dorreh ◽

Saeed Alinejad ◽

...

Keyword(s):

Clinical Trial ◽

Urine Volume ◽

Female Gender ◽

Study Group ◽

Inclusion Criteria ◽

Significant Difference ◽

The Mean

Background: Urine volume less than 1 mL/kg/h is called oliguria. The treatment of these patients is very important. Objectives: This study aimed to compare dopamine and drip Lasix in children with oliguria. Methods: This study was performed as a clinical trial in the NICU, PICU, neonatal and pediatric wards of Amirkabir hospital in Arak. Children with oliguria with less than 1 mL/kg/h during treatment were considered the study group. Sixty children who met the inclusion criteria were selected and randomly divided into two groups, including 30 children in the dopamine group and 30 children in the Lasix group. In the dopamine group, the drug was administered at a dose of 3 µg/kg/min, in the second group, drip Lasix was administered at a dose of 0.05 mg/kg/h. Results: In this evaluation, after evaluating the patients in both groups, it was observed that mean ± SD of age was 2.76 ± 1.85 years, and 51.7% of children have female gender (P = 0.438). The mean ± SD of creatinine in children after receiving dopamine and drip Lasix was 0.87 ± 0.2 mg/dl (P = 0.0001) and 0.84 ± 0.17 mg/dl (P = 0.000), respectively. Conclusions: Both drip Lasix and dopamine improved the condition of patients with oliguria. In addition, there was no statistically significant difference between these two drugs, so both drugs could improve the condition of patients.

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