Modified supracondylar dome osteotomy: our experience in 11 children

Background: The present retrospective study was done with 11 children having cubitus varus following supracondylar fractures to access the stability of modified domeosteotomy and its fixation with k-wires in older children.Methods: 11 children, 7 males & 4 females were included in the study. The osteotomy was performed through posterior approach. The triangular wedge rotated inside the notch was inherently stable and also fixed with k-wires. Patients were followed at regular intervals. K wires were removed at 6 weeks and the physiotherapy started.Results: The correction obtained under vision was well maintained post operatively in 10 out of 11 cases. In only one case there was back out of k-wires and loss of correction. 5 cases had excellent result followed by 4 good and one fair result. Conclusions: Modified dome osteotomy performed through posterior approach and fixed with k-wires gives good results. Removal of the k-wires is simple. However, in children above 14 years plate fixation might be better to prevent loss of correction.

Download Full-text

Retrospective study of radial dome osteotomy with volar plate fixation versus K-wires in Madelung’s deformity: long-term follow-up

International Orthopaedics ◽

10.1007/s00264-021-05266-0 ◽

2021 ◽

Author(s):

Andrea Leti Acciaro ◽

Lorenzo Garagnani ◽

Mario Lando ◽

Giacomo Cataldo ◽

Roberto Adani

Keyword(s):

Retrospective Study ◽

Plate Fixation ◽

Volar Plate ◽

Dome Osteotomy ◽

Long Term Follow Up ◽

Volar Plate Fixation ◽

K Wires ◽

Madelung’S Deformity

Download Full-text

A Biomechanical Evaluation of Three Forms of Internal Fixation Used in Ankle Arthrodesis

Foot & Ankle International ◽

10.1177/107110079401500603 ◽

1994 ◽

Vol 15 (6) ◽

pp. 297-300 ◽

Cited By ~ 45

Author(s):

Michael P. Dohm ◽

James B. Benjamin ◽

Jeffrey Harrison ◽

John A. Szivek

Keyword(s):

Internal Fixation ◽

Plate Fixation ◽

Ankle Arthrodesis ◽

Biomechanical Study ◽

The Other ◽

Fixation Failure ◽

Plate Group ◽

Biomechanical Evaluation ◽

The Stability ◽

Fibular Strut

A biomechanical study was undertaken to evaluate the relative stability of three types of internal fixation used for ankle arthrodesis. Crossed screw fixation, RAF fibular strut fixation, and T-plate fixation were tested in 30 cadaver ankles using an MTS machine. T-plate fixation consistantly provided the stiffest construct when compared with the other types of fixation. Failure occurred by distraction of bony surfaces, posterior to the plane of fixation, in the crossed screw and RAF groups. In contrast, failure in the T-plate group occurred through compression of bone anterior to the midcoronal plane of the tibia. Although the stability of fixation is only one factor in determining the success or failure of ankle arthrodesis, the results of this study would support T-plate fixation over the other forms tested.

Download Full-text

Comparison of Outcome of Three Different Approaches for Supracondylar Humerus Fractures in Children

10.53350/pjmhs2115103482 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3482-3484

Author(s):

Syed Usman Shah ◽

Mohammad Younas ◽

Naseer Ullah Khattak ◽

Amina Gul Shehzar Khan ◽

Sultan Shah ◽

...

Keyword(s):

Posterior Approach ◽

Lateral Approach ◽

Supracondylar Fractures ◽

Medial Approach ◽

Fractures In Children ◽

Supracondylar Humerus Fractures ◽

Significant Difference ◽

Group A ◽

Humerus Fractures ◽

Group B

Objective: The aim of this study is compare the outcomes among three different approaches (lateral approach, medial approach and posterior approach) for supracondylar humerus fractures in children. Study Design: Retrospective cohort study Place and Duration: The study was conducted at Orthopedics department of Ayub Teaching Hospital, Abbottabad for duration of one year from January 2020 to December 2020. Methods: There were one hundred and thirty five children had supracondylar humerus fracture were presented. Patients were aged between 3-12 years. Informed written consent was taken from authorities for detailed demographics age, sex, cause of fracture and side of fracture. Patients were categorized into three equal groups, group A had 45 patients and received lateral approach, group B had 45 patients and received medial approach and group C received posterior approach with 45 cases. Shaft Condylar Angle (SCA) and Baumann angle were used to analyze the radiological result. All children were assessed using Flynn's criteria for functional outcomes, and the results were divided into Excellent, Good, Fair and Poor. Post-operative outcomes among all the three groups were calculated and compared. SPSS 23.0 version was used to analyze complete data. Results: There were 90 (66.7%) males (30 in each group and 45 (33.3%) females (15 in each group). In group A mean age was 6.88±5.45 years, mean age in group B was 7.11±5.33 years and in group C mean age was 7.17±5.66 years. Sports 85 (62.9%) was the most common cause of fracture followed by traffic accidents 30 (22.2%) and the rest were 20 (14.8%) fall from the height. According to radiological outcomes, Mean shaft condylar Angle in group A was 41.5±6.3, in group B was 41.8±1.9 and in group C was 40.1±3.8 respectively (P>0.05). Mean Bauman angle in group A was 18.8±6.11, group B was 19.4±7.5 and in group C 20.4±5.3 with (P>0.05). According to Flynn’s criteria, excellent outcomes were observed in 33 (73.3%) in LA group, 24 (53.3%) in MA group and 22 (48.9%) in PA group, good results were observed in 11(24.4%), 19 (42.2%) and 21 (46.7%), fair outcomes in 1 (2.2%), 2 (4.4%) and 2 (4.4%). Conclusion: As a result of this research, we have concluded that the lateral technique for supracondylar fractures is superior to the medial or posterior approaches in terms of radiological and functional results. However, there was no statistically significant difference between the three groups. Keywords: Supracondylar fractures, Flynn’s criteria, Functional outcome, Open reduction

Download Full-text

Surgical Outcomes of Pediatric Humeral Supracondylar Fractures Treated By Posterior Approach and Triceps Splitting

Journal of Trauma & Treatment ◽

10.4172/2167-1222.s4-007 ◽

2013 ◽

Vol s4 ◽

Author(s):

Omidi Kashani F

Keyword(s):

Surgical Outcomes ◽

Posterior Approach ◽

Supracondylar Fractures

Download Full-text

Tuber-to-Anterior Process Angle (TAPA): A Cadaveric Study and Surgical Technique for Placing Axial Calcaneal Screws

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00413 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0041

Author(s):

Kristen L. Stupay ◽

Jorge Briceno ◽

Brian Velasco ◽

John Y. Kwon

Keyword(s):

Surgical Technique ◽

Guide Wire ◽

Articular Surface ◽

Plate Fixation ◽

Operative Management ◽

Screw Placement ◽

Anterior Process ◽

Starting Point ◽

K Wires ◽

Average Angle

Category: Ankle, Hindfoot Introduction/Purpose: Operative management of displaced intra-articular calcaneus fractures frequently involves placement of P: A screws in order to maintain calcaneal length and axial alignment. While plate fixation may still be more commonly utilized, screw-only fixation for the treatment of these fractures has been demonstrated by several authors to be safe and effective. Directing fixation from the tuber into the anterior process can be challenging. Understanding the calcaneal long-axis as it relates to the long-axis of the foot, a measurement we call the Tuber-to-Anterior Process Angle (TAPA), can facilitate the ease and accuracy of guide-wire and cannulated screw placement. The goals of this study are to define the TAPA, and to report a surgical technique which uses this angle to facilitate axial screw placement. Methods: Eight cadaver feet were utilized. A longitudinal pin was placed from the center of the posterior calcaneal tuber to the 2nd metatarsal heads. Next, the calcaneocuboid joint was exposed, and a wedge of cuboid was removed. A calcaneal pin was then placed, exiting at the center of the anterior process. The tips of two small K-wires were impacted into the medial and lateral-most aspects of the articular surface. A true axial view of each specimen was obtained. On these images, a digital line was drawn from the posterior tuber starting point and the central calcaneal pin, representing the calcaneal long-axis. The angle subtended by this line and the long-axis of the foot represents the TAPA. Digital lines were drawn between the posterior tuber starting point and the medial and lateral K-wires, and the range between their subtending angles represents the axial plane tolerance for screw placement within the anterior process. Results: The average TAPA measured 10.9 ± 1.3 degrees (range: 8.4-13.0). The average angle, as measured to the medial extent of the anterior calcaneus, measured 2.8 ± 1.3 degrees (range: 0.4-4.3). The average angle, as measured to the lateral extent of the anterior calcaneus, measured 19.0 ± 2.7 degrees (range: 15.7-22.7). Conclusion: Knowledge of the Tuber-to-Anterior Process Angle (TAPA), found to be 10.9 degrees (± 1.8 degrees) laterally deviated from the long-axis of the foot, simplifies placement of posterior-to-anterior screws in the calcaneus. Understanding this relationship reduces reliance on intraoperative axial fluoroscopy and increases operative efficiency. Furthermore, this knowledge can be applied during other procedures in which axial screw placement is performed, such as with corrective calcaneal osteotomy.

Download Full-text

Comparison of cross pinning versus lateral three pins in type three supracondylar fracture of distal humerus in children.

Asian Journal of Medical Sciences ◽

10.3126/ajms.v10i2.22034 ◽

2019 ◽

Vol 10 (2) ◽

pp. 58-61

Author(s):

Krishna Sapkota ◽

Krishna Wahegaonkar ◽

Niraj Ranjeet ◽

Pabin Thapa ◽

Upendra Jung Thapa ◽

...

Keyword(s):

Nerve Injury ◽

Ulnar Nerve ◽

Distal Humerus ◽

Supracondylar Fracture ◽

Good Stability ◽

Lateral Side ◽

Supracondylar Fractures ◽

Wire Fixation ◽

Ulnar Nerve Injury ◽

K Wires

Background: Supracondylar fracture of distal humerus is the most common paediatric fracture. Type III supracondylar fractures should be treated with anatomical reduction and stable Kirschner wire (K- wire, pin) fixation to prevent the cosmetic deformity. The configuration of wires is debatable. Although two crossed K-wires are bio-mechanically stable, there is a risk of iatrogenic ulnar nerve injury. Lateral 3 K-wires is a good alternative. This study was done to compare the outcome of cross K- wire and lateral 3 K-wires in terms of stability. Materials and Methods: This is a prospective study done in Manipal Teaching Hospital. All the Gartland type 3 supracondylar fractures of the distal humerus were treated with closed reduction and stabilized with K wires. In Group I, fractures were stabilized with cross K wire fixation and in group II they were stabilized with 3 lateral K-wires. The patients were followed up at 4-5 weeks for wire removal and at 3 months and 6 months after surgery. Baumann's angle, a functional outcome as per Flynn's criteria, and range of motion were recorded in each visit. Outcomes were compared in term of displacement of fracture. Result: Seventeen children in each group were taken up for the study. There were no significant differences in term of patients and fracture character. No patients had significant loss of reduction at final follow up. There is no statistically significant difference seen in mean changes of Bauman's angle. According to Flynn's criteria good result was seen in more than 95% of cases in both groups. Conclusion: Both cross K-wires and Lateral 3 K-wires provide good stability. Fixation of supracondylar fracture from lateral side had an advantage of no risk of iatrogenic Ulnar nerve injury. Addition of third K-wire from lateral side provides good stability as that of cross K- wire fixation.

Download Full-text

Anterior versus posterior surgical approach for lumbosacral tuberculosis

Journal of International Medical Research ◽

10.1177/0300060518764933 ◽

2018 ◽

Vol 46 (7) ◽

pp. 2569-2577 ◽

Cited By ~ 3

Author(s):

Bolong Zheng ◽

Dingjun Hao ◽

Hua Guo ◽

Baorong He

Keyword(s):

Cobb Angle ◽

Anterior Approach ◽

Posterior Approach ◽

Operation Time ◽

Analog Scale ◽

Loss Of Correction ◽

Pain Scores ◽

Angle Correction ◽

Before And After

Objective To compare two different approaches for the treatment of lumbosacral tuberculosis. Patients and Methods In total, 115 patients who were surgically treated in our department from July 2010 to July 2014 were included in this retrospective study. They were divided into the anterior and posterior approach groups. Intraoperative hemorrhage; the surgery time; the Cobb angle preoperatively, postoperatively, and at the follow-up visit (2 years postoperatively); visual analog scale (VAS) pain scores before and after surgery; and Oswestry Disability Index (ODI) scores before and after surgery were compared between the two groups. Results The Cobb angle and VAS and ODI scores were significantly improved in both groups after surgery. Significant differences were found in the operation time, intraoperative hemorrhage, Cobb angle correction, and loss of correction at the last follow-up. No significant differences were found in the VAS and ODI scores between the groups. Conclusions The posterior approach is superior to the anterior approach with respect to the surgery time, intraoperative hemorrhage, and Cobb angle postoperatively and at the last follow-up. When both approaches can be carried out for a patient with lumbosacral tuberculosis, the posterior approach should be favored over the anterior approach.

Download Full-text