Isometric Exercise of Quadriceps and Gluteal Muscle in Patient with Close Femur Fracture

Femur fracture is a fracture in the largest bone in the body. The femur requires significant force to fracture. One of the treatments for femoral fracture is reduction and immobilization using traction. Immobilization in traction-attached patients before preoperatively requires isometric exercises to maintain muscle strength. Isometric exercise is a muscle contraction exercise, the patient contracts the muscles without moving the muscles to maintain muscle and prevent atrophy. The purpose of this paper is to identify the effectiveness of isometric exercises to increase isometric muscle strength in patients with lower limb fracture. The methodology used is a case study. The application of isometric exercises can increase muscle strength in patients with skin traction attached. Nurses need to pay attention to factors that can affect the patient's ability to perform isometric exercises so that the results obtained can be more optimal and the patient experiences an increase in the ability of his limbs. Keywords : Isometric Exercises; Muscle Strength, lower limb fracture

SERIAL IMAGING OF A CHILD WITH LEGG-CALVE-PERTHES DISEASE AT BETHESDA HOSPITAL, YOGYAKARTA: A CASE REPORT

Background: Legg-Calve-Perthes disease (LCPD) is a rare condition of idiopathic avascular necrosis of the femoral head, mostly affects children under fifteen old. Most cases only affect one femoral head; bilateral involvement only occurs in about 15% of cases. Early diagnosis and prompt intervention play an important role in the prognosis to prevent degenerative damage on the bones and joints. Objective: To describe a case of Legg-Calve-Perthes disease in a 9-year-old boy in Bethesda Hospital, Yogyakarta. Case Description: A 9-year-old boy came with one month history of worsening pelvic pain to Bethesda Hospital, Yogyakarta. He also showed limping and limited mobility. Initial imaging studies did not find any abnormalities. Further follow-up with MSCT scan related to the complaint of persistent pain showed defects of left hip joint indicating Legg-Calve-Perthes disease. The patient undergone skin traction treatment which shows modest improvement on serial radiographic examinations during hospital admission. Conclusion: The rarity of LCPD warrant thorough imaging studies on children with unexplainable severe hip joint pain. Treatment should be initiated as early as possible after diagnosis to prevent further bone damage and worsening prognosis. Conservative management with skin traction would benefit the patient in restoring normal anatomy and optimal joint congruence to prevent degenerative damage to the joints.

Surveillance ultrasonography for conservative treatment of femoral shaft fractures in young children

Background The treatment for femoral shaft fracture (FSF) depends on the age of the patient. While the Pavlik harness is the first choice for patients under 6 months of age, spica casting is preferred for patients over 6 months and under preschool age. Minimally-invasive surgery using elastic stable intramedullary nails is also used in some cases. Skin traction is another treatment choice for some patients who are not candidates for the above methods. This study aimed to evaluate the feasibility of surveillance ultrasonography (US) for the conservative treatment of FSFs in young children. Materials and methods This retrospective study included 92 children who were diagnosed with FSF in our hospital from April 2017 to May 2019. After applying the inclusion and exclusion criteria, they were divided into US surveillance (A) and control (B) groups. All patients received conservative treatment by skin traction. For group A, US was used to assess the femur fractures and adjust its reduction on days 1, 3, 5, 7, 10, and 14 until the fracture stabilized. For group B, the fractures were checked by radiographs on days 1, 3, 5, 7, 10, and 14 until the callus appeared. The FSF angle was measured using anteroposterior and lateral radiographs. Results All patients were followed up for 18 months. The radiographic evaluation of both groups at the final follow-up showed a significant difference in the FSF angle. The radiograph times and accumulated radiation also showed significant differences between the two groups. However, there was no significant difference in the incidence of complications. Conclusions For FSF closed reduction, surveillance US is a better option compared to radiographs in children treated by skin traction. This approach can significantly decrease exposure to X-ray radiation and improve the reduction. Level of evidence III

Paediatric bilateral femoral neck fractures in osteopetrosis treated conservatively

The treatment of pathological femoral neck fracture in children due to osteopetrosis is not clear as only a few cases have been reported to date. We encountered a 7-year-old osteopetrotic girl with asynchronous bilateral femoral neck fractures. Radiographical assessment showed markedly dense bones with loss of corticomedullary differentiation, sandwich vertebrae and increased density of the ribs. Her mother had a similar radiological picture. Genetic testing showed CLCN-7 mutation which confirmed the diagnosis of autosomal dominant osteopetrosis. As the parents opted against operative treatment, the femoral neck fractures were managed conservatively with skin traction. At the 2-year follow-up, both fractures had united, although with coxa vara, and the patient had excellent functional outcome as she could walk without difficulty, had unrestricted motion at both hips, and there was no pain. Lifestyle modifications were suggested to prevent recurrent fractures and genetic counselling was done.

Outcome of Closed Reduction of Developmental Dysplasia of Hip Before First Year of Age, A Retrospective Cohort Study, Saudi Arabia

Background: Developmental dysplasia of hip (DDH) management is challenging hence there is no fixed rules or radiographic criteria to assess and manage DDH. There are many treating modalities including closed reduction, open reduction, skin traction, hip Spica and many others. This study is to assess the outcome of closed reduction in patients below 12 months of ages.Method: A retrospective study among patients with DDH who underwent closed reduction before the first year of age in a major referral medical center. The study included 100 patients and 168 hips. Average of follow up period was 5.97 years (±3.01). Couple of variables were measured in AP x ray of pelvis to assess the outcome of closed reduction. Results: Most of the hips were grade 1 and 2 according to the IHDI (International hip dysplasia institution) classification. Significant improvement in the acetabular index post closed reduction. In addition to the normalizing of CE angel's values. Also, majority of hips were severin's class 1 and 2 which were associated with good outcome.Conclusion: Safe closed reduction in patients with DDH below one year of age had a great outcome, less AVN, less growth complications and decrease the need of future open reduction.

Perinatal Femoral Fracture: A Ten-Year Observational Case Series Study

Background: perinatal femoral fractures (PFF) are relative rare birth-related fractures. Among treatment options, Bryant traction reported satisfactory outcomes in PFF of children under 3 years of age. The aim of this study is to assess the risk factors, diagnosis, management, and outcome in the 10-year multicentric experiences of all newborns treated for PFF in Catania city hospitals. Methods: 15,628 children, hospitalized in four neonatal units, were retrospectively reviewed. The following data were collected: gender, birth weight, gestational age, presentation, mode delivery, and fracture type according to AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). In each case, diagnosis was achieved after the clinical examination and X-Ray exam. Each patient underwent Bryant’s skin traction of the affected limb, and was clinically followed for at least two years. Results: eight newborns were included in the study (five males). The average birth weight was 2.656 kg with a gestational age of 37.5 weeks; 4 cases were preterm birth; 5 patients had a cephalic presentation. According to the AO PCCF classification, three fractures were ranked 32-D/4.1 and five were 32-D/5.1. The entire cohort had an excellent outcome. Conclusions: prematurity, low birth weight, and caesarean section could be PFF risk factors. Bryant’s skin traction is an effective option to achieve an excellent outcome.

A comparative evaluation of the efficacy between skeletal traction and skin traction in pre-operative management of femur shaft fractures in Korle Bu Teaching Hospital

Objectives: This study is to compare the outcomes of pre-operative skeletal and skin traction in adult femoral shaft fractures awaiting surgical fixation within two weeks of presentation to the Accident Center of Korle Bu Teaching Hospital.Methods: This study was a clinical trial on 86 recruited patients with closed femoral shaft fractures sustained within 24 hours of presentation grouped into 2 groups. Descriptive and inferential statistics comprising frequency, percentage, Chi-square, independent sample t-test and Mann-Whitney U test were used in analysing the data.Results: Of the total number of patients involved in the study, 74% (n=64) were males and 26% (n=22) were females with a mean age of 39.49 (SD ±15). There was no statistically significant difference in the mean visual analogue scale (VAS) pain assessment between the Skin traction group and Trans-tibia skeletal traction group after traction. With regards to complications, the difference between the Skin traction group and the Skeletal traction group was statistically significant (P=0.001). Moreover, the mean blood loss compared with the open type of reduction in the Transtibia skeletal traction group was significantly less than the Skin traction group (p=0.000).Conclusion: This study has shown that both Skeletal traction and Skin traction were equally effective in controlling pre-operative pain in adult patients with femoral shaft fractures and does not affect intra-operative blood loss and postoperative management. Therefore, pre-operative Skin traction can be considered a useful and cost-effective method of maintaining alignment and pain relief in adult femoral shaft fractures.Keywords: Skin traction, Trans-tibia skeletal, reamed Intramedullary nailing, Intra-operative blood loss, Visual Analogue ScaleFunding: Personal Funding