scholarly journals OPEN REDUCTION OF MEDIAL EPICONDYLE FRACTURES IN CHILDREN AND ADOLESCENTS: SUPINE VERSUS PRONE POSITION

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0010
Author(s):  
Soroush Baghdadi ◽  
Kathleen Harwood ◽  
Alexandre Arkader ◽  
John Todd Lawrence
Keyword(s):  
Prone Position ◽  
Supine Position ◽  
Surgical Procedure ◽  
Open Reduction ◽  
Medial Epicondyle ◽  
X Rays ◽  
Additional Time ◽  
Tourniquet Time ◽  
Fractures In Children ◽  
Ulnar Nerve Palsy

Background: Operative treatment of medial epicondyle (ME) fractures can be performed in either supine or prone position. In the supine position, visualization and fixation of the fracture is difficult. However, the prone position requires extensive patient repositioning but may improve visualization. Purpose: The purpose of this study was to compare the results of ORIF of ME fractures between supine and prone positions. Methods: In a retrospective review, patients <18 who underwent open reduction of an acute ME fracture from 2011-2019 were identified. Results and complications were compared between the supine and prone positions. Results: 204 patients were included, with a mean age of 11.7 years. 133(65.1%) were sports injuries, and 67(32.8%) had concomitant dislocation, with 17(8.3%) having an incarcerated fracture. 122(60%) patients were in the supine group, and 82(40%) in prone. The mean wheels in-wheels out time was 113 minutes in the supine group, and 141 minutes in the prone group (P<0.001). Mean tourniquet time was 53.1 and 55 minutes in supine and prone positions (P=0.4). C-arm usage was 27.9 and 26.9 seconds in the supine and prone groups, respectively (P=0.7). Displacement of the fracture on the first post-operative x-rays was 2.06 and 1.1 millimeters for the supine and prone groups (P<0.001). A total of 39(19%) patients had some ROM limitation at follow-up, with the majority (33 patients) having <10° loss of ROM. Five patients (2.5%) underwent 7 reoperations due to stiffness, 2 patients due to tardy ulnar nerve palsy, 2 due to non-union, and 53(26%) had a surgical hardware removal. Surgical position was not predictive of complications/reoperation. All of the nine surgeons (out of 16) who have operated at least one patient in the prone position have changed their preferred surgical position to prone. Conclusion: With the largest study population in the literature, the results of our study show that surgical stabilization of medial epicondyle fractures is safe, with minimal complications. While the prone position requires additional time in the operating room, presumably for positioning, the surgical procedure takes the same time and the prone position allows for a more accurate reduction. While the clinical significance of a 1mm difference in reduction quality is unknown, the observation that no surgeon that has tried the prone position had ever gone back to the supine position suggests that the surgical procedure is technically easier in this position.

OPTIMUM TREATMENT MODE APPLIED TO POST-OPERATIVE CERVICAL CANCER FOR 5F-IMRT PLAN BASED ON FOUR VARIABLES IN VARIAN ECLIPSE TPS

2016 ◽  
Vol 16 (07) ◽  
pp. 1650095
Author(s):  
JUN LI ◽  
XIAO-BIN TANG ◽  
XI-ZHI ZHANG ◽  
LONG-GANG GUI ◽  
YUN GE ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Prone Position ◽  
Supine Position ◽  
Maximum Dose ◽  
Target Volume ◽  
X Rays ◽  
Treatment Mode ◽  
Normal Tissues ◽  
Group A ◽  
Group B

Purpose: This study aimed to determine the dosimetric effect on the target volume, organs at risk (OARs) and normal tissues based on the different choice for four types of mechanical variables, i.e., treatment position, dose calculation algorithm, mulitleaf collimator (MLC) motion mode and X-ray energy; and to investigate the optimum treatment mode applied to post-operative cervical cancer for 5-field intensity-modulated radiation therapy (5F-IMRT) technique. Methods: The dosimetric difference on the target volume and OARs under the influence of four types of variables were initially compared by changing one variable at a time. Then, based on the above compared results, we compared the dosimetric difference on planning target volume (PTV) and OARs between group A composed of the superior four variables and group B composed of the relatively inferior four variables. The dosimetric parameters included dose distribution of the target volume, OARs and normal tissues, conformal index (CI), homogeneity index (HI), monitor units (MU) and beam-on time ([Formula: see text]. The independent and paired t-tests were used for statistical analysis, and the threshold for statistical significance was [Formula: see text]. Results: Compared with the supine position, the maximum dose of PTV ([Formula: see text]), the maximum dose of small intestine ([Formula: see text]) and [Formula: see text] of bladder ([Formula: see text] were all lower in prone position. In contrast with the pencil beam convolution (PBC), CI of PTV (CI[Formula: see text]) was larger while HI of PTV (HI[Formula: see text]) was lower, both [Formula: see text] and the maximum dose of rectum ([Formula: see text]) were lower using anisotropic analytical algorithm (AAA). Moreover, the same results were obtained using sliding window (SW) compared with multiple static segments (MSS). The mean dose of PTV ([Formula: see text] and CI[Formula: see text] was larger while the maximum dose of the spinal cord ([Formula: see text]), [Formula: see text] and the maximum dose of femoral heads were lower with 15 MV X-rays compared with 6 MV X-rays. In comparison with group B comprising the supine position, PBC, MSS and 6 MV X-rays, [Formula: see text] and HI[Formula: see text] decreased 1.4% and 53.4% respectively, CI[Formula: see text] increased 5.8% medially, while [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text] all decreased in group A comprising of prone position, AAA, SW and 15 MV X-rays. Conclusion: The treatment mode composed of prone position, AAA algorithm, SW and 15 MV X-rays is chosen for the post-operative cervical cancer of 5F-IMRT technique, which is more capable of meeting the target volume constraints and maximal protection of OARs.

scholarly journals Cast immobilisation in situ versus open reduction and internal fixation of displaced medial epicondyle fractures in children between 7 and 16 years old. A study protocol for a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044627
Author(s):  
Tero Hämäläinen ◽  
Matti Ahonen ◽  
Ilkka Helenius ◽  
Jenni Jalkanen ◽  
Markus Lastikka ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Ulnar Nerve ◽  
Operative Treatment ◽  
Open Reduction ◽  
Nonoperative Treatment ◽  
Medial Epicondyle ◽  
University Hospital ◽  
Fractures In Children ◽  
Patient Reported ◽  
Nerve Dysfunction

IntroductionMedial epicondyle fracture of the humerus is a common injury in childhood. There is uniform agreement that minimally displaced fractures (dislocation ≤2 mm) can be treated nonoperatively with immobilisation. Open fractures, fractures with joint incarceration or ulnar nerve dysfunction require surgery. There is no common consensus in treatment of closed medial epicondyle fractures with >2 mm dislocation without joint incarceration or ulnar nerve dysfunction. We hypothesise that there is no difference in treatment outcomes between nonoperative and operative treatment.Methods and analysisThis is a multicentre, controlled, prospective, randomised noninferiority study comparing operative treatment to non-operative treatment of >2 mm dislocated paediatric medial epicondyle fractures without joint incarceration or ulnar nerve dysfunction. A total of 120 patients will be randomised in 1:1 ratio to either operative or nonoperative treatment. The study will have a parallel nonrandomised patient preference arm. Operative treatment will be open reduction and internal fixation. Nonoperative treatment will be upper limb immobilisation in long arm cast for 4 weeks. Data will be collected at baseline and at each follow-up up to 2 years. Quick-DASH is used as primary outcome measure. Secondary outcomes are patient-reported pain, differences in range of motion, Pediatric Quality of Life Inventory, cosmetic visual analogue scale and Mayo Elbow Performance Score.Ethics and disseminationEthical approval has been obtained from Helsinki University Hospital (HUS) ethical board HUS/1443/2019. Each study centre has obtained their own permission for the study. A written authorisation from legal guardian will be acquired and the child will be informed about the trial. Results of the trial will be disseminated as published articles in peer-reviewed journals.Trial registrationThe trial has been registered at clinicaltrials.gov with registration number NCT04531085.

scholarly journals OUTCOME OF OPEN REDUCTION AND INTERNAL FIXATION OF DISPLACED MEDIAL EPICONDYLE HUMERUS FRACTURES IN CHILDREN

1969 ◽  
Vol 5 (1) ◽  
pp. 630-634
Author(s):  
WAQAR ALAM ◽  
DILAWAR KHAN ◽  
MUHAMMAD IDREES ◽  
FAIZ ALI SHAH ◽  
SHAMS UR REHMAN ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Teaching Hospital ◽  
Open Reduction ◽  
Kirschner Wire ◽  
Medial Epicondyle ◽  
Elbow Fracture ◽  
Fractures In Children ◽  
Humerus Fractures

BACKGROUND: Medical epicondyle fracture is one of the commonest elbow fracture in children.Various treatment options exist inadequate treatment leads to elbow deformity. Our study will highlightone treatment option with open reduction and fixation with k-wires or one screw and one k-wire.OBJECTIVE: To determine the functional outcome of open reduction and internal fixation ofdisplaced medial epicondyle humerus fractures in children.MATERIAL AND METHODS: This Descriptive cross sectional study was conducted simultaneouslyat five orthopaedic units: Orthopaedic Unit District Headquarter Hospital Timergara Lower Dir,Orthopaedic Unit, Saidu Teaching Hospital Swat, Department of Orthopaedics and Trauma Khalifa GulNawaz Teaching Hospital Bannu, Orthopaedics and Traumatology Unit “ A” Lady Reading HospitalPeshawar and Department of Orthopaedics and Trauma, Pak International Medical College Peshawarfrom January 2012 to September 2014. Twenty one children meeting the inclusion criteria were operatedunder general anaesthesia and tourniquet control and fracture was stabilized with either two kirschnerwires or a screw and single kirschner wire. All patients were discharged on first or second postoperativeday and advised active movements of fingers. Patients were called for follow up visit after two, six andtwelve weeks and elbow functions and deformity was evaluated in each visit using modified criteria ofHardacre et al (25).RESULTS: Twenty one patients including 14 males and 7 females with mean age 12.3 years (range 6 to15 years) had displaced fracture of medial epicondyle and were operated. Two of our patients were lostin follow up and they were excluded from the final results. After evaluating our results according tomodified Hardacre et al criteria, five patients (26.32%) had excellent results, eleven (57.89%) patientshad good results and three (15.78%) patients had poor results.CONCLUSION: Early surgical stabilization of displace medial epicondyle humerus fractures inchildren results in excellent and good functional outcome in majority of patients.KEY WORDS: Medial epicondyle humerus, Open reduction and internal fixation, Kirschner wire.

Influence of submaximal isometric contractions of the hamstrings on electromyography activity and force while functioning as hip extensors

2020 ◽  
pp. 1-8
Author(s):  
Dasom Oh ◽  
Wootaek Lim
Keyword(s):  
Prone Position ◽  
Supine Position ◽  
Isometric Contraction ◽  
Muscle Length ◽  
Biceps Femoris ◽  
Emg Activity ◽  
Isometric Contractions ◽  
Significant Difference ◽  
Extension Force ◽  
Long Head

BACKGROUND: Although the medial and lateral hamstrings are clearly distinct anatomically and have different functions in the transverse plane, they are often considered as one muscle during rehabilitation. OBJECTIVE: The purpose of the study was to compare the electromyographic (EMG) activity between the prone position and the supine position during maximal isometric contraction and to additionally confirm the effect of submaximal isometric contractions on EMG activity of medial and lateral hamstrings, and force. METHODS: In the prone position, EMG activities of the long head of biceps femoris (BFLH) and semitendinosus (ST) were measured during the maximal isometric contraction. In the supine position, hip extension force with EMG activity were measured during the maximal and the submaximal isometric contractions. RESULTS: EMG activity in the prone position was significantly decreased in the supine position. In the supine position, there was a significant difference between the BFLH and ST during the maximal isometric contraction, but not during the submaximal isometric contractions. CONCLUSIONS: The dependence on the hamstrings could be relatively lower during hip extensions. When the medial and lateral hamstrings are considered separately, the lateral hamstrings may show a more active response, with increased muscle length, in clinical practice.

scholarly journals A Neglected Markedly Displaced Medial Epicondyle Fracture with Simultaneous Ulnar Nerve Palsy in an Adolescent

2017 ◽  
Vol 9 (4) ◽  
pp. 542 ◽  
Author(s):  
Tamer Ahmed EL-Sobky ◽  
John Fathy Haleem ◽  
Hossam Moussa Sakr ◽  
Ahmad Saeed Aly
Keyword(s):  
Ulnar Nerve ◽  
Nerve Palsy ◽  
Medial Epicondyle ◽  
Ulnar Nerve Palsy ◽  
Medial Epicondyle Fracture

Open Reduction and Internal Fixation of Intra-articular Calcaneal Fractures in Children

Orthopedics ◽  
2012 ◽  
Vol 35 (6) ◽  
pp. e874-e879 ◽  
Author(s):  
Guang-rong Yu ◽  
Hong-mou Zhao ◽  
Yun-feng Yang ◽  
Jia-qian Zhou ◽  
Hai-feng Li
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Calcaneal Fractures ◽  
Fractures In Children

Translunate, Transmetacarpal, Scapho-Radial Fracture with Perilunate Dislocation A Case Report

1985 ◽  
Vol 10 (3) ◽  
pp. 382-384
Author(s):  
P. TOFT ◽  
K. BERTHEUSSEN ◽  
S. OTKJAER
Keyword(s):  
Case Report ◽  
Avascular Necrosis ◽  
Closed Reduction ◽  
Open Reduction ◽  
X Rays ◽  
Radial Fracture ◽  
Perilunate Dislocation ◽  
Carpal Fracture ◽  
Fracture Dislocations

A case translunate, transmetacarpal, scapho-radial fracture with perilunate dislocation occurred as a young man drove his motorcycle into the side of a car. Closed reduction was performed initially. Open reduction was performed with a screw in the lunate. Eighteen months later the screw was removed and after two and a half years x-rays revealed no signs of avascular necrosis or arthrosis. The patient fully recovered. This case stresses the necessity of open reduction in cases of complicated carpal fracture dislocations.

scholarly journals High-Flow Nasal Cannula and Prone Positioning in Awake Patients with COVID-19 Related Respiratory Failure: An Observational Study.

2021 ◽  
Author(s):  
Fekri Abroug ◽  
Zeineb Hammouda ◽  
Manel Lahmar ◽  
Wiem Nouira ◽  
Syrine Maatouk ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Observational Study ◽  
Prone Position ◽  
Supine Position ◽  
Early Response ◽  
High Flow ◽  
Nasal Cannula ◽  
Youden Index ◽  
Prone Positioning ◽  
High Flow Nasal Cannula

Abstract Background: We report an observational study on the use of High-flow nasal cannula (HFNC) and awake prone position in patients with Covid-19 related severe ARF.Methods: chart analysis of consecutive patients with confirmed Covid-19 and severe ARF (PaO2/FiO2 ratio <150) who received HFNC. Patients were systematically encouraged to lie in the prone position if tolerated. We calculated initial ROX index (the ratio of SpO2/FIO2 to respiratory rate) while in supine position and at the end of the first HFNC session whether in prone or supine position, and their difference (delta ROX). The success/failure of HFNC (need for intubation) was recorded. Predictors of HFNC failure were identified using ROC curve and logistic regression.Results: HFNC was administered to 213 out of 360 patients with COVID-19 related severe ARF (71% male, median age:59 years (IQR:50-68), median PaO2/FIO2: 104(73-143). At the start of HFNC, median ROX index was 4(3.4-5). Among included patients, 178 (83.5%) could tolerate prone position and had a median of 4.4(2-6) prone sessions during a median of 10(4-16) hours/day each, for a median of 4(2-7) days. Overall, HFNC failure occurred in 61 patients (28.1%) with similar proportions in patients who had HFNC in prone position and in patients who did not tolerate prone position (29% and 26%, respectively; relative risk:1.14. 95%CI:0.62-2.1). In the prediction of HFNC outcome, AUC was highest for delta ROX (AUC=0.83); AUC for baseline ROX (0.71), PaO2/FiO2 (0.73), and SpO2 (0.67), were significantly lower. The delta ROX cut-off ≤1.8 had the best Youden index indicating the best combination of sensitivity (0.89) and specificity (0.61) with a PLR (2.33) and a NLR (0.17) to predict HFNC failure. Logistic regression disclosed the following predictors of HFNC failure: delta ROX: RR=0.44, 95%CI=0.32-0.62; p-0.0001); baseline ROX index: RR=0.58, 95% CI:0.39-0.85, p=0.005); SOFA score (RR=1.6 for each point; 95%CI: 1.1-2.2, p=0.007); and PaO2/FiO2 at admission: RR=0.96, 95%CI=0.94-0.99). Prone position was not related to HFNC success.CONCLUSION: Awake HFNC in prone position is feasible in most patients with severe hypoxemic COVID-19. Indicators of ARF severity and the early response to HFNC, rather than prone position are independently associated with HFNC outcome.

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