CONSTRAINED HINGED ELBOW ARTHROPLASTY IN AN BONY ANKYLOSED ELBOW WITH NON UNION SUPRACONDYLAR FRACTURE HUMERUS: A CASE REPORT

Ankylosis of elbow is a very difcult case to treat. Now Total elbow arthroplasty (TEA) in managing ankylosis at elbow has evolved much in the recent times and is also most common surgical procedure used in the management of advanced bony ankylosis , rheumatoid arthritis, posttraumatic arthritis, osteoarthritis, and difcult fracture around elbow joint in elderly patients. Ÿ TEA for ankylotic elbows in elderly patients with nonunion supracondylar fracture is a good surgical option to restore adequate function of elbow joint. Total elbow prostheses have progressed over the time and now include the constrained, semiconstrained, and modular Ÿ Other joints in the extremity should be carefully examined, as well as the elbow's mobility and function, in order to construct a complete preand post-operative management plan that considers the upper extremity's whole range of motion.. Ÿ However, long-term complications, including infection, aseptic loosening, instability, and periprosthetic fracture, remain a challenge. Complication rates, reoperation rates, and survivorship of modern prostheses are discussed. Technical pearls and pitfalls are discussed

A RARE CASE OF SUPRACONDYLAR FRACTURE HUMERUS ASSOCIATED WITH IPSILATERAL DISTAL RADIUS EPIPHYSEAL INJURYCASE REPORT

Supracondylar fractures associated with ipsilateral distal radius epiphyseal injuries are a rare entity that is usually missed during preliminary clinical examination and can lead to severe complications if prompt management is not undertaken. We report a similar case which was a result of a fall on an outstretched hand and excessive energy being dissipated across both elbow and wrist which resulted in extension type of supracondylar fracture of the humerus (Gartland type-III) and ipsilateral distal radius epiphyseal injury (Salter-Harris type-II). The patient was managed with closed reduction and internal xation with k-wire pinning of both the injuries and stabilization in a posterior slab for 3 weeks. The patient had a good functional and radiological outcome following this prompt management. We recommend screening radiographs of the distal radius in cases of supracondylar fracture to exclude any epiphyseal injury or fracture for its appropriate management.

Treatment of Paediatric Supra Condylar Fracture Humerus

Introduction: One of the most frequent elbow fractures in childhood, is supracondylar fracture whichrequires rapid diagnosis and treatment. It is usually associated with neurovascular, functional problems and deformity. Objectives: To assess demographic, clinical features and treatment outcomes of the patients who underwent closed reduction and splinting, stabilization by percutaneous pinning or Open Reduction and Internal Fixation(ORIF). Materials and Methods: This retrospective study was conducted in the department of orthopedic surgery, CMH, Bogura from June 2017 to December 2018. The inclusion criteria was Gartland type I,II,III fracture who attended in emergency and casualty, between 2 to 13 years of age. Total 40 patients with the mean age 7.5 years were included in the study group. Results: All were closed fractures, 2flexion and 38 extension type. Two (5%) Gartland type I, 24(60%) and 14(35%) had type II and III fracture respectively. 2(5%) were treated by cast immobilization,8(20%)of type llby closed reduction & splinting, 22(55%) and 8(20%) of type ll&lll by crossed k-wire or by ORIF respectively. According to Flynn’s criteria our study shows 33(82.5%) excellent, 4(10%) good, 2(5%) fair and 1(2.5%) poor outcome.4(10%) had ulnar nerve neuropraxia, 1(2.5%) elbow stiffness,1(2.5%) cubitusvarus, 2(5%) experienced superficial pin tract infection. Conclusion: Management of supracondylar fracture should be decided according to patient’s age, fracture pattern and deformity status. Closed reduction and stabilization by percutaneous wiring provides an effective and safe treatment, when failed, open fractures or associated neurovascular complications ORIF should be preferred. JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 171-174

LANDMARK GUIDED BRACHIAL PLEXUS BLOCK FOR SURGERY OF PROXIMAL HUMERUS : A FORGOTTEN ART.

ABSTRACT: Fracture humerus is a common cause of morbidity among orthopedic patients. Brachial plexus block provides ideal operating conditions in a fracture humerus patient and it also takes care of post operative pain. Ultrasound guided brachial plexus has become the gold standard. Here we have discussed a safer approach to landmark guided brachial plexus block via supraclavicular approach with least possibility of pneumothorax.

Percutaneous transolecranon pinning and lateral pinning Vs lateral pinning in displaced supracondylar fractures of humerus in children: an observative study

Background: Supracondylar fracture (humerus) is type of extra-articular fracture occurring in the distal metaphyseal site of humerus. It is almost exclusively a fracture of the immature skeleton, seen in children and young teenagers. Fractures around the elbow are a great challenge to orthopaedic surgeons. Clinical diagnosis may be difficult due to noncooperative patient and massive swelling around the elbow. Displaced type of supracondylar fractures poses problem not only in reduction but also in maintenance of reduced fracture and rapid inclusion of nerves and vessels.Methods: The present study was conducted on 30 cases of displaced supracondylar fracture humerus in children, aged 2-14 years, who were treated by CRPP with either lateral entry of k-wires or a lateral wire and a vertical wire through olecranon (transolecranon).Results: Both the Groups achieved 90% satisfactory results, but 10% unsatisfactory results recorded in Group A only rather than in Group B.Conclusions: Although the transolecranon wire has the disadvantage of limiting the flexion and extension of the elbow, this does not influence the final-outcome much as the elbow is fixed in a POP splint for minimum 3 weeks-in all patients in both groups.