B. Mahaisavariya

Pentalateral osteotomy for cubitus varus. Clinical experiences of a new technique

Several methods for the correction of cubitus varus have been described, but most reported series are small and show a high rate of complications. We report a six-year personal experience of 77 osteotomies by a new technique which provides rigid fixation and allows correction of both varus and rotation deformities. It also prevents lateral bulging at the level of the osteotomy. In 58 cases followed up for an average of 16 months, there were no serious complications, a satisfactory carrying angle and no significant loss of movement, giving 88% excellent or good results.

Ultrasonography of pulled elbow

We used ultrasonography in ten children with pulled elbow to compare measurements of the radiocapitellar distance (RCD) on the affected and the unaffected sides. Similar measurements were made in a group of ten age-matched normal children. The mean RCD in pronation of the affected and normal sides in the patients with pulled elbows was 7.2 mm +/- 0.7 and 3.8 mm +/- 0.5, respectively (p < 0.0001). In the normal children the mean RCD in pronation was 4.5 mm +/- 0.5. We conclude that ultrasonography is of value for documenting pulled elbow in children.

Cracking of the femoral shaft by the Gamma nail

The Gamma nail (Howmedica) is one of the newest intramedullary devices for fixing pertrochanteric fractures. Although it can be inserted by a closed technique that provides many theoretical advantages, it cannot be proved superior to the dynamic hip screw (Bridle et al., 19%). Because of limited experience and little published information, surgeons need more information concerning its possible complications.

Supracondylar fracture of the humerus: malrotation versus cubitus varus deformity

A study correlating the degree of medial rotational deformity of the distal humerus and the degree of cubitus varus deformity secondary to supracondylar fracture was performed in 23 patients who underwent corrective supracondylar osteotomy. The mean age of the patients at the time of operation was 10.9 years (range 5-14 years). The time interval from injury to operation averaged 3.2 years (range 1-6 years). A medial rotational deformity occurred in 20 cases. The degree of medial rotational deformity (MRD) averaged 16.2 degrees (range 0-34 degrees). Mean carrying angles (CA) of the deformed and normal sides were -19.6 degrees and 6.5 degrees, respectively. Mean humero-elbow-wrist (HEW) angles, measured from radiographs, of the deformed and normal sides, were -18.8 degrees and 7.7 degrees, respectively. There was no correlation between the degree of MRD and the degree of varus deformity, using as a comparison either the CA or the HEW angle of the deformed elbow or their differences from the normal side.

An aiming device for distal locking in closed locked femoral nailing

A method of constructing an aiming device for insertion of distal locking screws is described. The device helps facilitate the free-hand technique, lessens the difficulty of drilling and insertion and allows the surgeon to perform at a distance, away from the radiation beam.

Stable fixation of pentalateral osteotomy for cubitus varus in adults

1.. 1 J ‘ #{163} commercial party related directly or indirectly to the subject of this culiuren 5 iractures. article. In our case, the Steinmann pins provided stable fixation and also facilitated reduction by improving control of the fracture segments containing the pins. The operative exposure and periosteal stripping were minimal and pin removal was easy, although requiring a second general anaesthetic. This method is recommended for a type IV Monteggia injury in a child when closed reduction is unsuccessful.

Ultrasound or image intensifier for closed femoral nailing

We describe a method of closed, unlocked nailing for femoral fractures using ultrasound instead of an image intensifier. Radiography was used only to confirm that the guide wire had been passed into the intramedullary canal of both fragments. The method succeeded in 26 of 30 cases. The failures all occurred in fractures which could not be reduced within 20 minutes. The operating time in those nailed successfully with ultrasound control was not different from the time for 30 control cases using conventional methods with an image intensifier.

Subtrochanteric fracture: fixation using the AO tibial nail

We describe an alternative fixation for the pure uncomminuted subtrochanteric fracture by using the AO tibial nail. There were no intraoperative complications in 24 fractures with this method. The fractures healed within 4 months postoperatively in 18 non-pathological fractures that could be followed up. There were minor complications, including 10 degrees external malrotation in one case and varus angulation after nail breakage in another. The nails were removed in seven healed fractures without problems. Two pathological fractures which were stabilized by the AO tibial nail, combined with the use of bone cement to fill the bone defect, were able to have early postoperative ambulation without any problems with the fixing device.

Simplified method for closed femoral nailing

We describe the method to simplify the procedure and shorten the operating time during closed femoral nailing. This includes early surgery, using a special reduction device, a marker to help interpretation of fracture alignment, limiting the surgical field to the trochanteric area with the thigh undraped to facilitate mobilization of the undraped C-arm, avoiding unnecessary intermediate reamers, less cortical reaming and a second team for distal locking when required. For 60 simple unlocked nailings and 15 locked nailings, the operation times were 40.4 and 58.7 min, respectively. These are much shorter than in previous reports.

Lumbar vertebral growth plate displaced into the spinal canal: A case report of a 15-year-old boy

Fracture of the lumbar cartilage plate is very uncommon. When the fragment protrudes into the spinal canal, the symptoms may mimic a protruded lumbar intervertebral disc. This may delay proper surgical treatment and may reduce the chance for neural tissue recovery.