Risk Analysis of Re-displacement After Conservative Treatment of Pediatric Unstable Fractures of Middle and Distal Forearm

Background: Fractures of the middle and distal diaphysis of the forearm are common in children. Conservative treatment is effective in this regard. Some studies have discussed the risk factors and predictive indicators of re-displacement; however, the objects of the study are all fixed with tubular plaster or double sugar splint. Objectives: This study was performed to determine the risk factors of re-displacement after closed reduction and double splint plaster fixation of unstable pediatric fractures of the middle and distal diaphysis of the forearm. Methods: This retrospective study was conducted on 57 patients undergoing closed reduction and plaster fixation after unstable diaphyseal fractures of the middle and distal forearm in Wuxi Children's Hospital of Nanjing Medical University within May 2014 to May 2020. A total of 35 male and 22 female subjects aged 6 - 9 years (average: 7.3 years) participated in this study. They were followed up for more than 6 weeks after fracture healing. According to whether experiencing a secondary displacement within 2 weeks after the fracture, the subjects were divided into two groups, namely displacement, and non-displacement. Gender, age, double fracture, reduction quality, and plaster fixation type were analyzed as relevant, effective factors. Results: All 57 patients were followed up, and all fractures reached clinical healing standards at the last follow-up. Moreover, 20 and 37 cases were in the shift and non-shift groups, respectively. No statistically significant difference was reported in gender (c2 = 0.168; P = 0.780), age (t = 1.003; P = 0.217), double fracture (c2 = 0.021; P = 1), and plaster fixation type (c2 = 0.416; P = 0.699) between the two groups. The reduction quality (c2 = 7.480; P = 0.025) showed a statistically significant difference. Binary logistic regression analysis showed that reduction quality was a risk factor for fracture relocation providing a predictive value. Conclusions: Good reduction quality can reduce the risk of fracture displacement.

More invisible and vulnerable: the impact of COVID-19 on older persons in displacement in Durumi IDP camp Abuja, Nigeria

Purpose The novel coronavirus disease (COVID-19) pandemic has further intensified the vulnerability of older persons in displacement and rendered them more unseen. This study aims at exploring the impact of COVID-19 on older people in displacement. Design/methodology/approach Data were obtained using semi-structured interviews from 12 older persons at Durumi IDP camp Abuja, while observing strict infection control measures. The data were inductively coded with Nvivo and analysed thematically. Findings Findings revealed that the economic and psychosocial fallout of the COVID-19 pandemic has increased older persons in displacement poverty, psychological stress and placed them at risk of ageism, social isolation and may subsequently lead to secondary displacement, thereby losing all progress, development and resilience built after initial displacement. Social implications This paper concluded by encouraging the need for all stakeholders to pay more attention to this invisible yet vulnerable group to ensure no one is left behind as people fight through this pandemic and its social implications. Originality/value To the best of the authors’ knowledge, this study is the first to explore the impact of COVID-19 on older people in displacement in Nigeria. This is because they have been relatively invisible to research endeavours.

Intra Focal K-Wiring for Distal End Radius (Kapandji Technique): Surgical Technique

Many years distal end radius fractures (DRF) are the most encountered type of fracture. In standard form, extra-articular distal end radius fractures were fixed after manual reduction and then pinned extra-articular by drilling distal cortex and passing fracture site to fix proximal fragment (Figure 1). But after 2 to 3 weeks depending upon osteoporosis fracture collapse(cancellous bone heal by collapse) and flexibility of the K wire distal fragment moves back until the K wire abut the inferior edge of the proximal fragment and does not avoid secondary displacement (Figure 2) [1].

Geographies of Doing Nothing–Internal Displacement and Practices of Post-Disaster Recovery in Urban Areas of the Kathmandu Valley, Nepal

Disaster-related internal displacement is on the rise in many countries and is increasingly becoming an urban phenomenon. For many people, as in the case of the earthquake disaster 2015 in Nepal, protracted or multiple disaster displacements are a lived reality. While the drivers of displacement are relatively well understood, significant uncertainties remain regarding the factors that trigger prolonged or secondary displacement and impede ending of displacement or achieving durable solutions. The purpose of this article is to illustrate and theorise the discourse of reconstruction and return that shapes experiences, strategies, and policies in order to gain a better understanding of the obstacles to pursuing durable solutions that are still shaping the reality of life for urban internally displaced people (IDPs) in Kathmandu Valley. I use the concepts of ‘fields of practice’ and ‘disaster justice’ to provide insights into the theorisation of the links between social inequality, structural forms of governance, and the reconstruction process itself. Findings demonstrate that the application of these concepts has great potential to expand our understanding of ‘realities of life’ and practices of IDPs, and thus contribute to a more differentiated evidence base for the development and implementation of appropriate disaster risk reduction policies and practices.

Distinctive features of the results of operative treatment of intraarticular and extraarticular fractures in HIV-infected patients

The purpose — to evaluate the effectiveness of the developed algorithm for determining the tactics and methods of treating intraarticular fractures in HIV-infected patients. Material and methods. From 2016 to 2020, 56 HIV-infected patients with intra-articular fractures underwent surgical treatment. In the course of treatment, an algorithm developed in the clinic for determining the tactics and method of treating HIV-infected patients was used, which proved effective in treating extra-articular fractures. Results. The results were evaluated in the average expected time of the fracture consolidation of the selected location, as well as 6 and 12 months from the moment of surgery using the algorithm developed by us for determining the tactics and method of treating fractures in HIV-infected patients. Good results (according to the Luboschitz — Mattis scale) were noted in 16 (30,8%), satisfactory — in 27 (51,9%) and unsatisfactory — in 9 (17,3%) cases. For patients of this category, the most typical complications were the rapid progression of deforming arthrosis of the joints, the secondary displacement of bone fragments against the background of bone resorption, and the development of an inflammatory process of predominantly non-infectious etiology. Conclusion. The use of the developed algorithm for determining the tactics and method of treatment in HIV-infected patients with extra-articular fractures, taking into account the effect of HIV infection and antiretroviral therapy on the processes of bone remodeling and soft tissue regeneration, can significantly reduce the number of unsatisfactory treatment results. At the same time, the peculiarities of the effect of HIV infection on the state of cartilage, subchondral bone and synovial fluid determine the nature and risks of postoperative complications in HIV-infected patients. In the future, it is planned to correct the developed algorithm taking into account the data obtained and to carry out a comparative analysis of the treatment results.

Association of secondary displacement of distal radius fractures with cortical bone quality at the distal radius

Introduction The aim of this study was to investigate the associations of patient characteristics, bone mineral density (BMD), bone microarchitecture and calculated bone strength with secondary displacement of a DRF based on radiographic alignment parameters. Materials and methods Dorsal angulation, radial inclination and ulnar variance were assessed on conventional radiographs of a cohort of 251 patients, 38 men and 213 women, to determine the anatomic position of the DRF at presentation (primary position) and during follow-up. Secondary fracture displacement was assessed in the non-operatively treated patients (N = 154) with an acceptable position, preceded (N = 97) or not preceded (N = 57) by primary reduction (baseline position). Additionally, bone microarchitecture and calculated bone strength at the contralateral distal radius and tibia were assessed by HR-pQCT in a subset of, respectively, 63 and 71 patients. Outcome Characteristics of patients with and without secondary fracture displacement did not differ. In the model with adjustment for primary reduction [OR 22.00 (2.27–212.86), p = 0.008], total [OR 0.16 (95% CI 0.04–0.68), p = 0.013] and cortical [OR 0.19 (95% CI 0.05–0.80], p = 0.024] volumetric BMD (vBMD) and cortical thickness [OR 0.13 (95% CI 0.02–0.74), p = 0.021] at the distal radius were associated with secondary DRF displacement. No associations were found for other patient characteristics, such as age gender, BMD or prevalent vertebral fractures. Conclusions In conclusion, our study indicates that besides primary reduction, cortical bone quality may be important for the risk of secondary displacement of DRFs.

ON IMPROVING TREATMENT OF SUPRACONDYLAR AND CONDYLAR HUMERAL FRACTURES IN CHILDREN

The article presents the analyses of the treatment outcomes of 155 children with supracondylar (45 cases, 29%) and condylar (110 cases, 71%) humeral fractures. The age of patients ranged from 1 to 15 years; boys 107 (69%) got traumas twice as much as girls 48 (31%); the traumas of left upper extremities were more commonly registered and made up 100 cases (64,5%). All patients were examined clinically and radiologically. Domestic injuries resulted in supracondylar and condylar femoral fractures were the most commonly registered in 8-10 year old children. Most patients (63.2%) demonstrated good treatment outcomes, 42 (27.1%) patients demonstrated satisfactory outcomes, and in 15 cases (9.7%) the outcomes were unsatisfactory. Analysis of the treatment outcomes showed that stable fixation ensured good functional results and did not cause secondary joint deformation. Long-term results were studied in 136 operated patients, 94 cases (60.6 ± 3.92%) were defined as excellent, 31 cases (20.0 ± 3.21%) were found as satisfactory, 11 (7.1 ± 2, 06%) cases were unsatisfactory due to the damage to the growth zone. Following the conservative treatment of 19 patients, the articulation in the joint was restored in 7.1%; in 4 (2.6 ± 1.27%) patients the results were defined as good, in 11 (7.1 ± 2.06%) as satisfactory, and in 4 (2.6 ± 2.7%) as unsatisfactory. The decreased oedema and muscle retraction during the development of secondary displacement of fragments, closed one-step reposition and osteosynthesis with Kirchner needles was performed in 2.6% of patients. Thus, the proposed working scheme for the treatment of supracondylar and condylar femoral fractures enables to determine differentiated treatment tactics in the children depending on their age and the type of the fracture. Stable fixation ensures achieving of good functional treatment outcomes and prevents the development of the secondary joint deformation.