scholarly journals CLINICAL STUDY OF MANAGEMENT OF FRACTURE OF SUPRACONDYLAR HUMERUS DISPLACED GARTLAND TYPE - III/ UNSTABLE GARTLAND TYPE - II IN CHILDREN’S BY CLOSED REDUCTION AND PERCUTANEOUS K - WIRE FIXATION

2015 ◽  
Vol 4 (65) ◽  
pp. 11281-11287
Author(s):  
Venkateswara Rao D ◽  
Moningi Kedar ◽  
Anvesh Sangepu
Keyword(s):  
Clinical Study ◽  
Closed Reduction ◽  
Type Ii ◽  
Type Iii ◽  
Wire Fixation

The Treatment of Mason Type II Radial Head Fractures using Closed Reduction and K-wire Fixation

2004 ◽  
Vol 17 (3) ◽  
pp. 277
Author(s):  
Byung Ki Kwon ◽  
Song Lee ◽  
Dong Ki Ahn ◽  
Joon Seong Park ◽  
Sang Kyu Cha
Keyword(s):  
Radial Head ◽  
Closed Reduction ◽  
Type Ii ◽  
Radial Head Fractures ◽  
Wire Fixation

scholarly journals Efficacy and complications after delayed fixation of femoral neck fractures in children

2019 ◽  
Vol 28 (1) ◽  
pp. 230949901988968 ◽  
Author(s):  
Chunxing Wu ◽  
Bo Ning ◽  
Ping Xu ◽  
Jun Song ◽  
Dahui Wang
Keyword(s):  
Femoral Neck ◽  
Closed Reduction ◽  
Open Reduction ◽  
Femoral Neck Fractures ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Fractures In Children ◽  
Reduction Group ◽  
Time From Injury

Objective: This study evaluated the efficacy of surgery for femoral neck fractures in children after a 24-h delay and the factors affecting the risk of complications. Methods: The study included 16 children who underwent surgery after the first 24 h for femoral neck fractures. According to Delbet’s classification, there were 2 type I, 11 type II, and 3 (four hips) type III cases. The mean time from injury to surgery was 85 h (range 27–240 h). According to Garden’s classification, there were 1 type II, 14 type III, and 1 type IV (two hips) cases. Initial surgery consisted of closed reduction and hematocele drainage with a 20-mL needle tube. If the procedure failed, open reduction was performed. Internal fixation (K-wire pinning, screw) was performed after closed ( n = 9) or open ( n = 8) reduction. The results were assessed using the Ratliff criteria after a mean follow-up of 23.2 months. Patient age, type of fracture, complications, treatment, and avascular necrosis (AVN) were evaluated. Results: The results were good in 15 hips (88.2%) and fair in 2 hips (11.8%, one type II case with closed reduction and one type I case with open reduction). The most frequent complication was AVN (4 of 17; 23.5%; three Ratliff good and one fair), which was significantly related to poor outcomes. AVN occurred in one hip in the closed reduction group (Delbet’s type II, 12.5%) and in three in the open reduction group (one Delbet’s type I, 50%; two Delbet’s type II, 66.7%). There were no significant differences in the time from injury to operation (27, 54, 64, and 116 h) and AVN incidence or Ratliff criteria. Conclusions: The efficacy of delayed reduction fixation of the femoral neck was better in the closed reduction group than in the open reduction group. Fracture location closer to the femoral head and older age affected the incidence of AVN.

scholarly journals Isolated Scaphoid Dislocation: A Case Report and Review of the Literature

2020 ◽  
Vol 09 (05) ◽  
pp. 431-439
Author(s):  
Asgeir Amundsen ◽  
Sarah N. Bishop ◽  
Steven L. Moran
Keyword(s):  
Literature Review ◽  
Closed Reduction ◽  
English Language ◽  
Motor Vehicle ◽  
Rare Event ◽  
Common Mechanism ◽  
Type Ii ◽  
Vehicle Accidents ◽  
Wire Fixation ◽  
Ligamentous Reconstruction

Abstract Background Isolated scaphoid dislocation is an exceedingly rare event with only 55 cases described. Closed reduction followed by operative intervention with Kirschner's wires (K-wire) fixation and ligamentous reconstruction are the mainstays of treatment. Case Description We describe a patient with a solitary scaphoid dislocation treated with initial closed reduction and urgent open reduction with K-wire stabilization and ligamentous repair. The patient was immobilized for 6 weeks and on 24-month follow-up, the patient was doing well with no limitations in his daily living, no pain, and acceptable range of motion. Literature Review A literature review was performed on the 55 cases described in the English language. The majority of the patients were males, aged between 18 and 79 years, and presented with motor vehicle accidents as the most common mechanism. Historically, isolated scaphoid dislocations were treated with closed reduction. However, K-wire fixation and, now, K-wire fixation coupled with ligamentous injury repair remain the current treatments of choice. Avascular necrosis of the scaphoid remains a rare event with only one documented case. Overall, patients do well with only minor pain and limited wrist movements. Notably, only eight cases were associated with type-II lunates. Type-II lunates appear to be protective for carpal injury. Clinical Relevance Although isolated scaphoid dislocations remain a rare event, understanding the anatomy and the current ability to restore carpal anatomy is important. Type-II lunates appear to confer protection from carpal injuries.

scholarly journals Displaced supracondylar humeral fractures in children: Comparison of three treatment approaches

2016 ◽  
Vol 144 (1-2) ◽  
pp. 46-51 ◽  
Author(s):  
Sinisa Ducic ◽  
Marko Bumbasirevic ◽  
Vladimir Radlovic ◽  
Petar Nikic ◽  
Zoran Bukumiric ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Type Ii ◽  
Percutaneous Pinning ◽  
Cast Immobilisation ◽  
Fractures In Children ◽  
Supracondylar Humerus Fractures ◽  
Wire Fixation ◽  
Supracondylar Humeral Fractures ◽  
Humerus Fractures

Introduction. Closed reduction and percutaneous pinning are the most widely used treatment options for displaced supracondylar humerus fractures in children, but there is still no consensus concerning the most preferred technique in injuries of the extension type. Objective. The aim of this study was to compare three common orthopaedic procedures in the treatment of displaced extension type supracondylar humerus fractures in children. Methods. Total of 93 consecutive patients (66 boys and 27 girls) referred to our hospital with Gartland type II or III extension supracondylar humeral fractures were prospectively included in the study over a six-year period. At initial presentation 48 patients were classified as Gartland type II and 45 as Gartland type III fractures. The patients were subdivided into three groups based on the following treatment modality: closed reduction with percutaneous pinning, open reduction with Kirschner wires (K-wires) fixation, and closed reduction with cast immobilisation. The treatment outcome and clinical characteristics were compared among groups, as well as evaluated using Flynn?s criteria. Results. Excellent clinical outcome was reported in 70.3% of patients treated with closed reduction with percutaneous pinning and in 64.7% of patients treated with open reduction with K-wire fixation. The outcome was significantly worse in children treated with closed reduction and cast immobilisation alone, as excellent outcome is achieved in just 36.4% of cases (p=0.011). Conclusion. Closed reduction with percutaneous pinning is the method of choice in the treatment of displaced pediatric supracondylar humeral fracture, while open reduction with K-wire fixation is as a good alternative in cases with clear indications.

scholarly journals Type II D Phalangeal Neck Fractures in Children: A Series of 20 Cases Treated According to a Preset Stepwise Algorithm

2020 ◽  
Author(s):  
Mohammad M. Al-Qattan ◽  
Saad A. Almohrij ◽  
Batool Alaskar ◽  
Turki S. Alhassan
Keyword(s):  
Closed Reduction ◽  
Demographic Data ◽  
P Value ◽  
Type Ii ◽  
Fracture Fragment ◽  
Fractures In Children ◽  
Wire Fixation ◽  
The Mean ◽  
Distal Fracture

Abstract Introduction Type II phalangeal neck fractures are defined as displaced fractures with bone-to-bone contact at the fracture site. In the type II D subtype, the distal fracture fragment is thin. A review of the literature did not reveal any study investigating the outcome of management of these fractures. Patients and Methods This is a retrospective study of 20 consecutive children with type II D phalangeal neck fractures treated over the past 4 years. Demographic data were reviewed. All cases were managed according to the preset stepwise algorithm. The outcome of management at final follow-up was documented using Al-Qattan’s grading system. Results The mean age was 30 months (range 12–80 months). There were 12 males and 8 females. The mean follow-up was 2 years (range 7 months to 3 years). The largest two categories within the management algorithm were patients with minimally displaced fractures treated conservatively (n = 8) and those with displaced fractures treated with closed reduction and percutaneous K-wire fixation (n = 9). Fischer exact test was used to compare the outcome in these two groups and the p value was significant (p = 0.015), indicating a significantly better outcome in the former group. Conclusion Several conclusions were made from the study. Type II D of phalangeal neck fractures tend to occur in young children and the majority involve the middle phalanx. The thinness of the distal fracture fragment makes standard techniques of closed reduction more difficult. However, flexion of the proximal and distal joints appears to be effective in reducing dorsally displaced type II D fractures by closed means. Finally, a more conservative approach to minimally displaced type II D fractures results in a better outcome compared with closed reduction and percutaneous K-wire fixation.

scholarly journals Ipsilateral Supracondylar Fracture and Forearm Bone Injury in Children: A Retrospective Review of Thirty one Cases

2012 ◽  
Vol 9 (2) ◽  
pp. 11-16 ◽  
Author(s):  
D Dhoju ◽  
D Shrestha ◽  
N Parajuli ◽  
G Dhakal ◽  
R Shrestha
Keyword(s):  
Bone Fracture ◽  
Closed Reduction ◽  
Supracondylar Fracture ◽  
Radius Fracture ◽  
Type I ◽  
Type Iii ◽  
Bone Injury ◽  
Wire Fixation ◽  
Forearm Bone ◽  
Floating Elbow

Background Supracondylar fracture and forearm bone fracture in isolation is common musculoskeletal injury in pediatric age group But combined supracondylar fracture with ipsilateral forearm bone fracture, also known as floating elbow is not common injury. The incidence of this association varies between 3% and 13%. Since the injury is rare and only limited literatures are available, choosing best management options for floating elbow is challenging. Method In retrospective review of 759 consecutive supracondylar fracture managed in between July 2005 to June 2011, children with combined supracondylar fracture with forearm bone injuries were identified and their demographic profiles, mode of injury, fracture types, treatment procedures, outcome and complications were analyzed. Result Thirty one patients (mean age 8.91 yrs, range 2-14 yrs; male 26; left side 18) had combined supracondylar fracture and ipsilateral forearm bone injury including four open fractures. There were 20 (64.51%) Gartland type III (13 type IIIA and 7 type III B), seven (22.58 %) type II, three (9.67 %) type I and one (3.22 %) flexion type supracondylar fracture. Nine patients had distal radius fracture, six had distal third both bone fracture, three had distal ulna fracture, two had mid shaft both bone injury and one with segmental ulna with distal radius fracture. There were Monteggia fracture dislocation, proximal ulna fracture, olecranon process fracture, undisplaced radial head fracture of one each and two undisplaced coronoid process fracture. Type I supracondylar fracture with undisplaced forearm were treated with closed reduction and long arm back slab or long arm cast. Displaced forearm fracture required closed reduction and fixation with Kirschner wires or intramedullary nailing. Nineteen patients with Gartland type III fracture underwent operative intervention. Among them nine had closed reduction and K wire fixation for both supracondylar fracture and forearm bone injury. One patient with closed reduction and long arm cast application for both type III supracondylar fracture and distal third radius fracture developed impending compartment syndrome and required splitting of cast, remanipulation and Kirschner wire fixation. There were three radial nerve, one ulnar nerve and one median nerve injury and two postoperative ulnar nerve palsy. Three patients had pin tract related complications. Among type III, 16 (80%) patients had good to excellent, two had fair and one gad poor result in terms of Flynn’s criteria in three months follow up ConclusionDisplaced supracondylar fracture with ipsilateral displaced forearm bone injuries need early operative management in the form of closed reduction and percutaneous pinning which provides not only stable fixation but also allows close observation for early sign and symptom of development of any compartment syndrome.DOI: http://dx.doi.org/10.3126/kumj.v9i2.6280 Kathmandu Univ Med J 2011;9(2):11-16 

scholarly journals CLOSED REDUCTION IN THE TREATMENT OF DISPLACED TIBIAL SPINE FRACTURES: REVISITING A LOST ART

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0026
Author(s):  
Henry Ellis ◽  
Morgan Adkins ◽  
Marilyn Elliott ◽  
Sharon G. Huang ◽  
Charles W. Wyatt ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Closed Reduction ◽  
Pediatric Patients ◽  
Treatment Success ◽  
Spine Fractures ◽  
Type Ii ◽  
Tibial Spine ◽  
Type Iii ◽  
Meniscal Pathology ◽  
Pediatric Orthopedic

Background: There is renewed interest in optimal treatment, and development of algorithmic care for pediatric tibial spine fractures. While recent publications have most often investigated operative treatment, closed reduction of selected tibial spine fractures may result in good outcomes without invasive surgical procedures. Purpose: To evaluate an institutional series of displaced tibial spine factures treated with closed reduction for factors associated with treatment success. Methods: An IRB-approved, retrospective review of consecutive pediatric patients treated by a tertiary pediatric orthopedic group for displaced tibial spine fractures with closed reduction (2000 - 2017) was performed (Figure 1). Those with inadequate imaging or follow up were excluded. Demographics, injury data, exam findings, and reduction variables were recorded. Radiographic measures of fracture displacement pre and post-reduction, and at union were noted. Statistical comparison of variables associated with definitive closed reduction vs conversion to operative treatment was performed. Results: Of the 35 patients (mean age= 10.9 years [6-16 years]; 24 males) who underwent closed reduction of a tibial spine fracture, 19 (54.2%) had Type II Meyers and McKeever fractures, with the remainder Type III. Mean time to treatment was 6 days (2 hrs-46 days). Hemarthrosis aspiration with anesthetic injection was performed in 20 (57.1%) patients and 9 (25.7%) had general anesthesia or procedural sedation. Short-duration immobilization (typically 3 weeks) of long-leg casting (32, 91.4%) or bracing was utilized. The average reduction (Δ) in superior displacement of the tibial spine fragment was 4.6mm (0-16.4 mm) with 12 fractures improving > 5 mm following reduction maneuver. Eight patients (22.8%) failed closed reduction and were converted to operative fixation to treat residual displacement. Although no differences where noted in demographics, injury mechanism, classification (II vs III), or type of reduction; failures of closed reduction were noted to have more superior displacement (12.93 vs. 8.17 mm; p=0.023). Conclusion: Closed reduction of both Type II and Type III tibial spine fractures can result in acceptable reduction in in pediatric patients. Further prospective study of closed reduction of tibial spine fractures in selected patients presenting early, without critical meniscal pathology is warranted. [Figure: see text]

scholarly journals Treatment Result Following Fluoroscopic Guided Close Reduction and Internal Fixation by Per-Cutaneous Crossed K-Wires of Extension Type Gartland Type-II and Type-III Supracondylar Fracture of Humerus in Children

2021 ◽  
Vol 20 (2) ◽  
pp. 32-36
Author(s):  
Tafhim Ehsan Kabir ◽  
ANM Humayun Kabir ◽  
Alak Kanti Biswas ◽  
Rahma Binte Anwar ◽  
Touhidul Islam ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Supracondylar Fracture ◽  
Treatment Result ◽  
Type Ii ◽  
Supracondylar Fractures ◽  
Female Ratio ◽  
Type Iii ◽  
K Wires ◽  
Tract Infections

Background : Supracondylar fractures of the humerus is one of the most common fractures in children. Failure to treat properly leads to malunion of the fracture site. For that, closed reduction and percutaneous pinning is considered to be the golden choice for treatment. There are many methods in which percutaneous k-wire fixation can be done. The aim of this study is to report the advantages of percutaneous fixation using cross pinning from both medial and lateral sides. Materials and methods : A total number of seventy pediatric patients with Gartland type II and type III supracondylar fracture of the humerus were recruited from the outpatient department of two different hospitals between January 2018 and September 2020. All of them were treated using closed reduction and internal fixation using percutaneous crossed k-wires. The treatment outcomes were evaluated using Flynn’s criteria and were compared with other similar studies. Results : The mean age of study subjects was 8.14 ± 2.8 and the male to female ratio was 1.6:1. In 27(38.6%) cases the left arm was involved while in 43(61.4%) cases the right arm was involved. Preoperative complications included 1(1.4%) case with radial nerve palsy and 4(5.7%) cases with pulseless pink hand. When evaluating cosmetic outcome using Flynn’s criteria, there were 57(81.4%) excellent, 10(14.3%) good and 3(4.3%) fair outcomes. On evaluating outcome according to range of motion deficit outcomes were excellent in 35(50%), good in 22(31.4%), fair in 5(7.2%) and poor in 8(11.4%) children. Post-operative complications were 1(1.4%) ulnar nerve neuropraxia and 5(7.2%) superficial pin tract infections. Conclusion : Closed reduction and internal fixation using percutaneous crossed kwires placed from the medial and lateral side gives satisfactory cosmetic and functional outcomes in majority of the patients with Gartland type II and III supracondylar fractures of the humerus. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 32-36

scholarly journals Classification of unilateral cervical locked facet with or without lateral mass-facet fractures and a retrospective observational study of 55 cases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chao Tang ◽  
Yuan He Fan ◽  
Ye Hui Liao ◽  
Qiang Tang ◽  
Fei Ma ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Closed Reduction ◽  
Injury Mechanism ◽  
Neurological Deficits ◽  
Type I ◽  
Type Ii ◽  
Lateral Mass ◽  
Fracture Type ◽  
Type Iii ◽  
Articular Process

AbstractThis study describes a morphology-based unilateral cervical facet interlocking classification in an attempt to clarify the injury mechanism, instability, neurological deficits, radiological features, and determine optimum management strategies for these injuries. A total of 55 patients with unilateral cervical locked facet (UCLF) involving C3 to C7 were identified between January 1, 2012 and December 1, 2019. The injuries were classified into three types, and they were further divided into six subtypes using three-dimensional computed tomography. The injury mechanism, clinical features, neurological deficits, and imaging characteristics were analyzed, and the appropriate treatment strategies for UCLF were discussed. UCLFs were divided into the following six subtypes: UCLF without lateral mass-facet fracture (type I) in nine cases, with superior articular process fracture (type II A) in 22, with inferior articular process fracture (type II B) in seven, both superior and inferior articular process fractures (type II C) in four, with lateral mass splitting fracture (type III A) in three, and with lateral mass comminution fractures (type III B) in ten. A total of 22 (40.0%) of the 55 patients presented with radiculopathy, and 23 patients (41.8%) had spinal cord injuries. The subtype analyses showed high rates of radiculopathy in types II A (68.2%) and II C (75.0%), as well as significant spinal cord injury in types I (77.8%) and III (61.5%). Destruction of the facet capsule was observed in all patients, but the injury of disc, ligamentous complex, and vertebra had a significant difference among the types or subtypes. The instability parameters of the axial rotation angle, segmental kyphosis, and sagittal displacement showed significant differences in various types of UCLF. Closed reduction by preoperative and intraoperative general anesthesia traction was achieved in 27 patients (49.1%), and successful rate of closed reduction in type I (22.2%) was significantly lower than that in type II (51.5%) and type III (61.5%). A total of 35 of 55 patients underwent a single anterior fixation and fusion, 10 patients were treated with posterior pedicle and (or) lateral mass fixation, and combined surgery was performed in ten patients. Ten patients (18.2%) with a poor outcome were observed after first surgery. Among them, 3 patients treated with a single anterior surgery had persistent or aggravated radiculopathy and posterior approach surgery with ipsilateral facet resection, foramen enlargement, and pedicle and (or) lateral mass screw fixation was performed immediately, 5 patients treated with a short-segment posterior surgery showed mild late kyphosis deformity, and 2 patients with vertebral malalignment were encountered after anterior single-level fusion during the follow-up. This retrospective study indicated that UCLF is a rotationally unstable cervical spine injury. The classification proposed in this study will contribute to understanding the injury mechanism, radiological characteristics, and neurological deficits in various types of UCLF, which will help the surgeons to evaluate the preoperative closed reduction and guide the selection of surgical approach and fusion segment.

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