scholarly journals Repair of an open forearm fracture and extensive bony loss (case report)

2021 ◽  
Vol 27 (1) ◽  
pp. 87-91
Author(s):  
Sh.M. Davirov ◽  
◽  
P.U. Urinboev ◽  
Keyword(s):  
High Risk ◽  
Intramedullary Nailing ◽  
Forearm Fracture ◽  
Complete Recovery ◽  
Bony Defect ◽  
Fibular Graft ◽  
Comminuted Fracture ◽  
Soft Tissue Necrosis ◽  
Ilizarov Frame ◽  
Forearm Bones

Introduction Repair of a double open comminuted fracture of forearm bones with extensive bony loss is challenging due to a high risk of infection and the need to address a significant bony defect. Neither internal fixation nor open reduction could be considered due to substantial bone loss and severely impaired circulation with a high risk of soft tissue necrosis and infection. We report staged management of forearm fracture using avascular autologous graft to repair the defect and maintain the forearm length. Objective Demonstrate the successful management of the double open comminuted fracture of forearm bones with extensive bony loss using Ilizarov external fixation, classical autologous grafting harvested from fibula and intramedullary (IM) nailing. Results and discussion The limb was temporarily fixed with Ilizarov frame in an extra-focal manner. An autogenous fibular graft of 11 cm was used to fill in the gap. Intramedullary nailing of the radius and ulna was produced and ulnar defect was repaired with autogenous fibular graft. IM nails were removed once the bones consolidated. The limb function was completely regained, anatomical length of the segment maintained and metal constructs removed. Conclusion Combination of different bone fixation modalities, classical autografting technique and intramedullary nailing provided complete recovery of the broken limb maintaining the function and bringing down the risk of complications to ensure a good clinical result.

scholarly journals Elastic stable intramedullary nailing in pediatric diaphyseal forearm bone fracture

2017 ◽  
Vol 3 (2) ◽  
pp. 190
Author(s):  
Poojan Kumar Rokaya ◽  
Mangal Rawal ◽  
Javed Ahmad Khan ◽  
Praveen Kumar Giri
Keyword(s):  
Intramedullary Nailing ◽  
Bone Fracture ◽  
Closed Reduction ◽  
Forearm Fracture ◽  
Minimal Invasive ◽  
Elastic Stable Intramedullary Nailing ◽  
Forearm Bones ◽  
Average Loss ◽  
Forearm Bone ◽  
Elastic Intramedullary Nailing

<p class="abstract"><strong>Background:</strong> Pediatric forearm bone fracture present significant challenges where most of them are managed with closed reduction and casting. Irreducible, unstable and open fracture usually requires operative stabilization. Intramedullary nailing is considered minimal invasive however it is not free of complication. The aim of this study is to analyze the outcome and complications after elastic stable intramedullary nailing in pediatric diaphyseal forearm fracture<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> A descriptive observational study was carried out for four years (2013-2016) in diaphyseal pediatric forearm fracture stabilized with titanium elastic stable intramedullary nailing. Final range of motion, complications and outcome were assessed using Clavien-Dindo classification modification appropriate for orthopedic surgery.<strong></strong></p><p class="abstract"><strong>Results:</strong> We report the outcome of 36 patients with complete medical records. Closed reduction and nailing was successful in 25 patients (69.4%) whereas eleven patients (30.6%) required open reduction (both radius and ulna in 6 patients 16.7%, ulna in 3 patients 8.3% and radius in 2 patients 5.6%). Radiological union was achieved at an average of 7.75±1.5 weeks (range 6 to 16 weeks). Forearm rotation was limited in 7 patients with average loss of 16° pronation and 18° supination. The overall rate of complication was 22.2%. According to Clavien-Dindo classification excellent results were noted in 29 patients (80.6%), good in 3 patients (8.3%) and fair in 4 patients (11.1%)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Elastic intramedullary nailing in pediatric diaphyseal forearm bones fracture is minimally invasive with low rate of complication and the outcomes are fair to excellent<span lang="EN-IN">.</span></p>

Elastic intramedullary nail treatment of adolescent perihardware radius and ulna refracture

2021 ◽  
Vol 14 (1) ◽  
pp. e236098
Author(s):  
Carah M Griffin ◽  
Jeremy S Somerson
Keyword(s):  
Intramedullary Nailing ◽  
Intramedullary Nail ◽  
Plate Fixation ◽  
Forearm Fracture ◽  
Entire Length ◽  
Hardware Removal ◽  
Intramedullary Nails ◽  
Flexible Intramedullary Nailing ◽  
Additional Protection ◽  
Forearm Bones

A 13-year-old girl presented to the clinic with a midshaft refracture of both forearm bones adjacent to the site of a prior forearm fracture that had been treated with plating. She was treated with hardware removal and placement of elastic intramedullary nails. Flexible intramedullary nailing can be successful for a skeletally mature adolescent in treatment of refracture surrounding plate fixation of a midshaft forearm fracture. This technique allows for additional protection of the entire length of the affected bones, while avoiding the extensive dissection needed for extended plating.

scholarly journals Intracranial Hemorrhage in Egyptian Children with Primary Immune Thrombocytopenia (ITP): Report of 24 Cases in 20 Years

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 1080-1080
Author(s):  
Mohsen Saleh Elalfy ◽  
Mohamed Ahmed Badr ◽  
Ahmed Mansour ◽  
Tamer Hassan ◽  
Mohamed Meabed ◽  
...  
Keyword(s):  
High Risk ◽  
Head Trauma ◽  
Intracranial Hemorrhage ◽  
Immune Thrombocytopenia ◽  
Conflicts Of Interest ◽  
Complete Recovery ◽  
Published Data ◽  
Severe Thrombocytopenia ◽  
Egyptian Children ◽  
Neurosurgical Intervention

Background: 35 million children < 18 years; approximately 1800 new cases of ITP were diagnosed annually in Egypt. Intracranial hemorrhage (ICH) is a rare devastating complication of childhood immune thrombocytopenia (ITP). Incidence of ICH among children with ITP varies markedly in different studies from 0.2 up to 1.0 %. Intracranial hemorrhage after head trauma in children with ITP leads to significant morbidity and mortality. We published data during 1997 - 2007 (10 ICH) in children with primary ITP; risk factors and outcome. Aim & Methodology: A follow-up study to assess any change in outcome of ICH from last decade; whether new therapies might change the landscape of ICH. Centers treating > 25 child with prim ITP /year and offered a complete data of >150 children with ITP over 2 decades were enrolled. We compared 2008 - 2018 with the decade before it; variation of ICH reporting from center to center and outcome in relation to therapy. All children with ITP and ICH during study period had been treated, within < 24 hours and referred to neurosurgical hospital complex facility for consultation and intervention. Time elapsed till receiving platelet enhancing therapy and neurosurgical intervention was assessed, Outcome whether a complete recovery, permanent sequalae or death was reported. Results: Four thousand, three-hundred and forty primary ITP were evaluated, ( 380 were excluded due to incomplete data ) Twenty-four (0.6%) ICH were reported over 2 decades (14 in this decade with 20% increase incidence) and 48 matched ITP control subjects were evaluated. Platelet counts were less than 10 x 10(9)/L in 90% of children with ICH. Four (16.2%) children developed ICH within 14 days of diagnosis of ITP; one of these, was the presenting feature of ITP. four were from 3-12 months and sixteen (66.6%) of children had chronic ITP. Centers treating > 50 case/year had a higher frequency of reporting 0.8 % compared to 0.2 % in centers < 50 cases/year. Outcome is better on early intervention as well as aggressive platelet enhancing therapy with 70% complete recovery compared with 30% complete recovery on delayed intervention. Head trauma and hematuria and PC < 10 were the mostly associated with ICH, identified in 33%, 25% and 90% respectively of the patients with ICH and in 1, none and 50% of the controls (P < .001). Bleeding beyond petechiae and ecchymoses was also linked to ICH. Mortality was 25%; a further 25% had neurologic sequelae. Neurosurgical intervention was done in 25% of cases with good outcome. Reporting was more in this decade with better outcome in bigger centers. Conclusion: A rise in the incidence of ICH in Children with severe thrombocytopenia over last decade; high risk for ICH among those with PC< 10,000 plus head trauma and/or hematuria. Platelet enhancing agents whether HDMP or IVIG or TPO-RAs could not prevent ICH. However they had a good impact on survival and lessen sequalae if used in combination. Strategies by which high-risk children could be identified and well managed in small centers. Disclosures No relevant conflicts of interest to declare.

scholarly journals Bisphosphonate-Related Osteonecrosis of the Jaws. A Severe Side Effect of Bisphosphonate Therapy

2012 ◽  
Vol 55 (3) ◽  
pp. 111-115 ◽  
Author(s):  
Zuzana Janovská
Keyword(s):  
High Risk ◽  
Bone Resorption ◽  
Secondary Infection ◽  
Complete Recovery ◽  
Bisphosphonate Therapy ◽  
Severe Side Effect ◽  
Main Role ◽  
Osteonecrosis Of The Jaws ◽  
Oncologic Patients ◽  
High Doses

Bisphosphonates (BP) are potent inhibitors of bone resorption used mainly in the treatment of metastatic bone disease and osteoporosis. By inhibiting bone resorption, they prevent complications as pathological fracture, pain, tumor-induced hypercalcemia. Even though patient’s benefit of BP therapy is huge, various side effects may develop. Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is among the most serious ones. Oncologic patients receiving high doses of BP intravenously are at high risk of BRONJ development. BPs impair bone turnover leading to compromised bone healing which may result in the exposure of necrotic bone in the oral cavity frequently following tooth extraction or trauma of the oral mucosa. Frank bone exposure may be complicated by secondary infection leading to osteomyelitis development with various symptoms and radiological findings. In the management of BRONJ, conservative therapy aiming to reduce the symptoms plays the main role. In patients with extensive bone involvement resective surgery may lead to complete recovery, provided that the procedure is correctly indicated. Since the treatment of BRONJ is difficult, prevention is the main goal. Therefore in high risk patients dental preventive measures should be taken prior to bisphosphonate administration. This requires adequate communication between the prescribing physician, the patient and the dentist.

scholarly journals The outcome of chemotherapeutic regimen by high-risk pre-B-cell protocol in ALL children

2021 ◽  
Vol 31 (3) ◽  
pp. 330-333
Author(s):  
Afshin Fathi ◽  
Mehrdad Mirzarahimi ◽  
Homa Farajkhah
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
B Cell ◽  
Risk Group ◽  
Survival Rates ◽  
Complete Recovery ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Chemotherapeutic Regimen ◽  
First Remission

Objective: The aim of this study was to investigate the outcome of chemotherapeutic regimen by high-risk pre-B-cell potocol in ALL children. Methods: The cross-sectional study was conducted on 55 children who were treated with the Children Oncology Group (COG) protocol from September 2010 to February 2015 to evaluate the chemotherapeutic regimen results. Results: There was a complete recovery rate of 76.4% during the first week after treatment. Three-year overall survival was 85.5% and five-year overall survival was 81%. Relapse rate after first remission was 20% and death after relapse was 50%. Thirty percent of total deaths were at the induction period. All of the deceased cases died due to sepsis. Conclusion: Results showed that the survival rate increased. By choosing the COG protocol and by controlling infection in patients without considering the risk group we can improve survival rates.

scholarly journals A study on patients treated with interlock nailing in the forearm fracture bones

2016 ◽  
Vol 2 (4) ◽  
pp. 229
Author(s):  
Shivakumar G. V. ◽  
Naveen P. R. ◽  
Manjunatha M. L.
Keyword(s):  
Standard Procedure ◽  
Forearm Fracture ◽  
High Rate ◽  
Surgical Approaches ◽  
Rigid Fixation ◽  
Surgical Time ◽  
Major Mode ◽  
Significant Difference ◽  
Forearm Bones ◽  
Closed Fractures

<p class="abstract"><strong>Background:</strong> Fractures involving the bones of the forearm present unique problems not encountered with fractures of other long bones and may significantly affect the function of the upper limb. The purpose of the present study was to evaluate the functional outcome of patients treated with interlock nailing in the fracture forearm bones<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Thirty two patients included after their <span lang="EN-IN">consent. </span>With the patient supine on a radiolucent table, and under general or regional anesthesia the extremity was prepared and the surgery was performed using a standard procedure. If secure rigid fixation is achieved forearm POP splint is applied and kept in place for 2 weeks, thereafter a removable sugar-tong orthosis is worn until bridging callus is present, and the orthosis is removed frequently for exercise.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The average age of the patients was 38.90 years. The major mode of injury was RTA (59.09%) followed by assault (36.36%). 41% of patients were operated within week of injury, only three patients were operated after a week and one patient after 3 weeks. More than half of patients had closed fractures and rest was open fractures, of which Gustilo Anderson type II were in majority. In 3/5 of patients locking at nondriving end was not done cause of stable fixation. There was statistically significant difference in the surgical time (P &lt;0.05) and duration of postoperative immobilization differed statistically significantly (P &lt;0.001) between the group of patients in whom locking was done and not done. </span></p><p class="abstract"><strong>Conclusions:</strong> Advantages of Interlocking nail are high rate of bony consolidation along with minimized surgical approaches, cosmetically better suited and little risk of refracture after removal of the implant<span lang="EN-IN">.</span></p>

Closed Intramedullary Nailing of Diaphyseal Forearm Fracture in Adolescence

1995 ◽  
Vol 30 (5) ◽  
pp. 1416
Author(s):  
Yung Khee Chung ◽  
Jung Han Yoo ◽  
Baek Yong Song ◽  
Yong Wook Park ◽  
Sang Cheol Baik
Keyword(s):  
Intramedullary Nailing ◽  
Forearm Fracture ◽  
Closed Intramedullary Nailing
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