Is Percutaneous Fixation Necessary & Adequate For Displaced Supracondylar Fractures of Humerus in Children? - An Institutional Study

Supracondylar humerus fracture (SCHF) is frequently encountered in pediatric age group and nearly three fourth of all upper extremity fractures. Most commonly used technique for surgical treatment in the displaced SCHF in children is closed reduction and stabilization with percutaneous pins. Aim: This retrospective study was conducted to find out the outcome and safety of percutaneous pinning techniques which includes lateral pinning and cross pinning in terms of functional and radiological outcome in the management of displaced supracondylar humerus fractures in children and to see the associated complications with this method of fixation. Materials & Methods: This retrospective study comprising of 40 cases of displaced supracondylar humerus fracture, treated with lateral or cross pinning was carried out at Orthopedics Department, Gujarat Adani Institute of Medical Sciences and G.K General Hospital, Bhuj from July 2019 to june2020. The inclusion criteria were: a) Gartland extension type II, III, b) age below 12 years, c) presented to OPD/Emergency within 48 hours of injury, d) closed and gustilo grade I open fractures, Patients with: a) extension Type I of fractures, b) flexion type injuries, c) except Gustilo grade 1 open fracture d) age more than 12 year e) pervious history of fractures or nerve injury around the elbow, were excluded from the study. Results: Out of the 40 patients, 25 (62.5%) were male and 15(37.5%) were female. The children were aged 2 years to 12 years with a median age of 7.67 years. There were 19 left sided and 21 right-sided fractures. 29 children had an injury while playing and 11 had a fall from a height. functional results in our study were 67.5% of cases had excellent results, 25% had good results, 5% had a fair result and 2.5% had a poor result. 75% of cases had excellent cosmetic results were 17.5% of cases had good results, 5% had fair result and only one case had a poor result. Conclusion: In our study, we found that anatomical reduction and intra- operative stability will dictate the type of configuration to be used in SCHF

Management of Tibial Metaphyseal Fractures Using JESS Fixator

Introduction: The management of proximal and distal tibia fractures remains challenging due to associated soft tissue injuries. The use of wire fixators for the definitive treatment of such fractures entails a minimally invasive technique of insertion that gives good fracture reduction and stability combined with minimal postoperative complications. Aim: To assess the outcome of treatment of such fractures by the use of Joshi’s external stabilization system (JESS), which is a simple wire based, circular external fixator system. Materials and Methods: A prospective, uncontrolled study was done using JESS on 30 consecutive patients (20 patients of proximal tibial metaphyseal fractures and 10 of distal tibial metaphyseal fractures). Results: In our study, the most common mode of injury was road traffic accidents (21 cases), fall from height (6 cases) and slip injury (3 cases). The patients were operated at a mean interval of 3.2 days (range 1-6 days) due to associated poor soft tissue conditions. The patients were followed up for 24 weeks. Full weight bearing was allowed at 10 to 14 weeks. JESS frame was removed at mean duration of 13 weeks (range 12-16 weeks). According to knee society score (KSS), excellent result (score 80- 100) was seen in 12 patients (60%), good result (score 70-79) was seen in 4 patients (20%), fair result (score 60-69) in 3 patients (15%) and poor result (score <60) in 1 patient (5%) of proximal tibial metaphyseal fracture. According to Olerud and Molander score (OAMS), excellent result (score 91-100) was seen in 5 patients (50%), good result (score 61-90) in 3 patients (30%) and fair result (score 31-60) in 2 patients (20%) of distal tibial metaphyseal fracture. The complication seen was superficial pin tract infection in 4 patients, which was managed by regular pin tract dressing and oral antibiotics. Delayed union (mean at 15.3 weeks) was seen in 2 patients with Schatzker type VI fracture and 1 patient with severe comminuted distal metaphyseal fracture. Conclusion: JESS is a simple, light, effective and cheap method and can be used as a definitive procedure to treat these fractures even with soft tissue compromise.

PROSPECTIVE STUDY OF FUNCTIONAL OUTCOME OF DISTAL FEMUR FRACTURE TREATED WITH MINIMAL INVASIVE PERCUTANEOUS PLATE OSTEOSYNTHESIS (MIPPO)

Background: Study of functional outcome of distal femur fractures treated with minimal invasive percutaneous plate osteosynthesis (MIPPO) Methods: Hospital based Prospective intervantional study conducted on 30 Patients in the department of Orthopedics in hospitals attached to S.M.S Medical College and hospital. Results: In our study, 43.33% patients had excellent scoring and 26.67% patients had good results and 30.00% patients had fair result Conclusion: We concluded that three fourth patients functional outcome was excellent/ good. Keywords: Functional outcome, MI-PPO, Femur

Talo-calcaneal smile osteotomy as a treatment of rigid residual equinus deformity

Foot deformities are usually complex. Equinus deformity can be a residual foot deformity element or isolated. A rigid type is the most difficult for treatment. The aim of work is the treatment of rigid equinus deformity by a minimally invasive technique using Ilizarov fixator to restore plantigrade foot and to prevent further recurrence. 17 feet in 14 patients with stiff ankles and rigid equinus after failed surgical correction of club feet, with mean age 6.6 years (4 to 10 years), all treated by smile talocalcaneal osteotomy and Ilizarov ring fixator with a mean follow up 20.9 months (5 to 30 months). 5 feet (29.9%) had excellent results, 8 (47.1%) had good results, 1(5.9%) had a fair result and 3 feet (17.6%) had poor results and underwent revision surgery. In conclusion, our technique Talo-calcaneal smile osteotomy based on distraction osteogenesis method appears to provide similar or better results compared to other literature results without discrimination of foot size, provide some range of motion and plantigrade foot. Keywords: Clubfoot- equinus- rigid -deformity, Ilizarov- Smile osteotomy.

12. Interpretation

This chapter examines approaches to contract interpretation. Interpretation is the exercise by which the meaning of the contract is ascertained. Under the so-called traditional approach to interpretation, where the contractual language chosen was clear and unambiguous, that language was simply given effect. By contrast, under the ‘modern’ approach to interpretation, a much broader range of factors can be taken into account, and courts now appear able to depart from the ‘plain meaning’ of a written document. The modern approach takes into account the ‘matrix of fact’ in which the contract is concluded, including the purpose of the contract. The modern approach has been praised for allowing judges greater flexibility in order to reach a fair result, but criticised for undermining commercial certainty, potentially prejudicing third parties, and intruding into the domain traditionally occupied by the doctrine of rectification.

Assessment of the outcome of fracture proximal humerus transdeltoid versus deltopectoral approach with PHILOS

<p><strong>Introduction: </strong>Fracture proximal humerus accounts for 4 percent of all fractures. Out of all the humerus fractures, proximal fractures accounts for 26%. According to the Neer’s classification, 2, 3- and 4-part fracture are difficult to achieve stable fixation. In this study, we want to assess whether the different surgical approach, deltopectoral and transdeltoid approach, used for the stabilization of the fracture proximal humerus effects on the outcome of the surgery.</p><p><strong>Method: </strong>A total of 30 patients with fracture proximal humerus 2, 3 and 4-part were included in this study and were divided into 2 groups. In group 1, 15 patients were taken and were operated by deltopectoral approach, while in group 2, 15 patients were taken and operated by transdeltoid approach. All the fixation was done by PHILOS.</p><p><strong>Result: </strong>In group 1, out of 3 patients having 2-part fracture, 2 had excellent result and 1 had fair result. Out of 4 patients having 3-part fracture, 3 had good outcome and 1 had fair result. Out of 6 patients having 4-part fracture, 1 had good outcome. In group 2, out of the 3 patients having 2-part fracture, 1 had excellent outcome and 2 had good outcome. Out of the 4 patients having 3-part fracture, 1 had excellent outcome, 3 had good outcome. Out of the 6 patients having 4-part fracture, 3 had good result.<strong></strong></p><p><strong>Conclusions: </strong>Deltopectoral approach is recommended for calcar reconstruction that provides better visibility of medial calcar reduction while transdeltoid approach is recommended for greater tuberosity reduction that provides better visibility of greater tuberosity.</p>

Assessment of dental arch relationships in 5-year-old children with unilateral cleft lip and palate after neonatal cleft lip repair

Background Non-syndromic cleft lip and palate (CLP) is one of the most common craniofacial malformations. The purpose of this study was to assess the dental arch relationships in 5-year-old children with non-syndromic unilateral cleft lip and palate (UCLP) and to compare the results with the data published by other cleft centers. Methods The models of forty-six patients with unilateral cleft lip and palate taken at the age of five were scored. Neonatal cleft lip repair and one-stage palatal closure at the age from 6 to 13 months were performed in all patients by the same surgeon according to the same protocol. The outcomes of the dental arch relationships were assessed and categorized by three orthodontists experienced in cleft care; for scoring the 5 Year Olds´ index was used. Results The mean score of the 5 Year Olds´ index was 2.42. Of all the patients, 57% belonged to groups 1 and 2 (good result), 24% to group 3 (fair result), and 19% to groups 4 and 5 (poor result). These results were compared with the data published by other cleft centers. The outcomes of our method were comparable to the results achieved by other cleft centers which followed different surgical protocols. Conclusions The results of our study showed that neonatal cleft lip repair and one-stage palatal closure lead to satisfactory maxillary growth and interdental relationships.

Functional outcome of tibial plateau fracture managed conservatively

<p class="abstract"><strong>Background:</strong> Tibial plateau fractures involve the articular surface of the proximal tibia. They account for approximately 1% of adult fractures. A number of articles have been published regarding tibial plateau fracture management. Interestingly excellent results have been published concluding not all fractures of the tibial plateau require surgery and not all displaced intra-articular fractures need to be reduced surgically. In this method we used conservative method to restore normal joint anatomy, joint stability, and functional motion and avoid complications.</p><p class="abstract"><strong>Methods:</strong> This study design is prospective study including forty randomly selected cases of diagnosed tibial plateau fracture presented in Orthopaedic department of tertiary referral centre over 18 months period and treated with conservative method. The patients then were followed up and evaluation of outcome was analyzed as per modified Rasmussen clinical criteria and radiological criteria at six months.<strong></strong></p><p class="abstract"><strong>Results:</strong> In this study, tibial plateau fracture was seen more in patients of age group 31-40 (35%). Mean age being 41.25 years. There were 28 (70%) male and 12 (30%) female. Road traffic accident comprises the majority of cases (75%). Regarding radiological outcome, 41.5% had excellent result, 34.3% had good result, 8.5% had fair result and 15.7% had poor result. 84% had acceptable outcome. The Rasmussen’s functional outcome at final follow up was 46% patients had excellent result, 30% had good result, 12% had fair result and 12% had poor result. 88% had acceptable clinical outcome.</p><p class="abstract"><strong>Conclusions:</strong> Conservative management of tibial plateau is still a reliable, inexpensive and alternative treatment option with favourable functional outcome.</p>

1. Introduction to Equity

All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing able students with a stand-alone resource. This chapter discusses the concept of Equity and defines it as the body of law that has been made and developed by judges in the Chancery courts to modify the rigid application of the common law. It is grounded on rules, principles, and doctrines that are strictly interpreted, but their application and the remedies awarded can be tempered by the exercise of judicial discretion to ensure a just and fair result. It plays an important role in many contemporary aspects of the law, including commercial and corporate law. A distinction between property rights and personal rights lie at the heart of Equity, and there exists no substantive fusion between Common Law and Equity as bodies of rules — even if their administration has been conjoined into a single procedural system. The chapter also discusses a variety of equitable maxims that are useful generalizations of complex law.

Procrastination in Relationship to Mental Health

Procrastination is an act wherein one postpones activities or schedules or, worse, does not perform the tasks. The descriptive-correlational study aimed to determine the causes, mechanisms, consequences, and the correlation between procrastination and mental health among the senior high school students of Mahayag National High School. There were 280 respondents in this particular study. The first questionnaire measures one's procrastinating tendency, while the second measures one's mental health. The researcher underwent the Research Ethics Committee review procedures to ensure that the "do no harm" policy was duly observed and secured proper permission and consent. The results revealed that the respondents have a moderate level of procrastinating tendency. Regarding their mental health, mental health's positive affect cupped a good result, while the negative affect yielded a fair result. The researcher concluded that the respondents' most common procrastinating tendency is the ningas cogon or maňana habit, running out of time and doing things intended to do days before. It is done in academic and household settings, manifested through watching television, going through social media accounts, and sleeping resulting in educational, psychological, and physiological consequences.