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Comparison of two methods of percutaneous pin fixation in displaced supracondylar fractures of the humerus in children.

Purpose. To conduct a prospective randomised controlled study to compare the stability and risk of nerve injury between fractures treated by medial-lateral pin fixation and those treated by 2-lateral pin fixation. Methods. Patients with displaced supracondylar fractures admitted between May 2000 and December 2001 were recruited into the study. They were randomised to treatment either with medial-lateral pin fixation (n=34) or with 2-lateral pin fixation (n=32). Results. 66 children with the mean age of 5.78 years were admitted during the study period. 11 of them were lost to follow-up. The mean follow-up period of the remaining 55 patients was 8.93 months. The difference in the carrying angle between injured and normal elbows was 3.57° and 3.70° in medial-lateral pin fixation and 2-lateral pin fixation, respectively. The extension and flexion loss was 7.14° and 8.68° respectively in medial-lateral pin fixation, and 7.11° and 11.26° respectively in 2-lateral pin fixation. The Baumann angle difference was 5.96° in medial-lateral pin fixation, and 5.30° in 2-lateral pin fixation. The difference in the medial epicondylar epiphyseal angle was 6.07° in medial-lateral pin fixation and 6.92° in 2-lateral pin fixation. Statistical analyses show that these differences are not significant. Five iatrogenic ulnar nerve injuries developed in the group treated by medial-lateral pin fixation, while 2 ulnar nerve and one radial nerve injuries were seen after 2-lateral pin fixation. Again the differences were not statistically significant. Conclusion. Both methods of fixation were comparable in terms of stability, duration of bone healing, and risks of injury to the nerve.

Rectus femoris transfer for children with cerebral palsy: long-term outcome.

The purpose of this study was to evaluate the long-term results of rectus femoris transfer in cerebral palsy children with stiff-knee gait. Thirty-eight affected limbs in 24 children were evaluated preoperatively and 1 year postoperatively by gait analysis, with 26 limbs in 18 patients having final study, averaging 4.6 years postoperatively. Functional ambulatory status was evaluated based on Hoffers criteria on ambulation. There were statistically significant improvements of 9.8° in maximum swing-phase knee flexion and 7.0° in total range of knee motion at 1 year, with a small loss of knee extension in stance. At final gait analysis, the improvement in the swing-phase knee flexion was maintained, but improvement in total range of knee motion was decreased. There were no significant changes in temporal parameters. Improvement in swing-phase knee flexion and foot clearance after rectus femoris transfer was associated with loss of knee extension at long-term follow-up. Hamstring lengthening in patients who develop excessive stance-phase knee flexion may be necessary.

Giant cell tumour of bone with late presentation: review of treatment and outcome

Purpose. To review cases of giant cell tumour of bone or osteoclastoma managed at the University Malaya Medical Center, University of Malaya, Kuala Lumpur, from January 1990 to December 1999. Methods. Medical records of all patients with musculoskeletal tumours were reviewed. Demographic data, clinical presentation, surgical management, and clinical outcomes were reviewed retrospectively. Results. Most of the 31 patients who were treated for giant cell tumour of bone presented late on the basis of the duration of their symptoms and radiological features. Five of the patients had been referred for local recurrences. 26 patients were treated for primary tumours: 18 needed wide excision, 7 curettage, and one amputation. The joint could not be preserved and arthrodesis was performed for 11 patients. Three (12%) of the 26 patients had local recurrence during a mean follow-up of 60 months, including one (6%) who had recurrence after wide excision and 2 (29%) after curettage. Pulmonary metastasis was noted in 4 cases, 2 of which were confirmed histologically. Conclusion. Even in an advanced stage of disease, good clinical outcomes can be achieved with adequate excision and appropriate reconstruction. For lesions around the knee, autologous rotational grafting is a good alternative method of reconstruction.

Supracondylar nailing for difficult distal femur fractures.

Purpose. To evaluate outcome following supracondylar nailing for distal femur fractures. Methods. The clinical and radiological outcome for 13 patients treated between January 1995 and December 1998 at the University Malaya Medical Center was assessed. Patients were seen for follow-up for a mean duration of 20.2 months. Results. There were no cases of non-union or infection. Overall assessment of clinical outcome based on the criteria of Schatzker and Lambert was graded excellent in 6 patients, good in 3 patients, fair in 3 patients, and one graded as a failure. Conclusion. Supracondylar nailing for fixation of supracondylar (Arbeitsgemeinschaft für Osteosynthesefragen [AO] type A) and less comminuted intercondylar (AO type C1 and C2) fractures is recommended by the authors.

Diluted povidone-iodine versus saline for dressing metal-skin interfaces in external fixation

Purpose. To compare infection rates associated with 2 dressing solutions for metal-skin interfaces. Methods. 60 patients who underwent distraction osteogenesis with external fixators were equally randomised into 2 dressing solution groups (diluted povidone-iodine vs. saline). Fixations were attained using either rigid stainless steel 5-mm diameter half pins or smooth stainless steel 1.8-mm diameter wires. Half-pin fixation had one metal-skin interface, whereas wire fixation had 2 interfaces. Patients were followed up every 2 weeks for 6 months. Results. Of all 788 metal-skin interfaces, 143 (18%) were infected: 72 (19%) of 371 in the diluted povidone-iodine group and 71 (17%) of 417 in the saline group. Dressing solution and patient age did not significantly affect infection rates. Half-pin fixation was more likely to become infected than wire fixation (25% vs 15%). Conclusion. Saline is as effective as diluted povidone-iodine as a dressing solution for metal-skin interfaces of external fixators. Saline is recommended in view of its easy availability and lower costs.

Prevalence of child marriage among Bangladeshi women and trend of change over time.

Many Bangladeshi women marry early, and many marry before the legal age of 18 years. This practice has been associated with a higher risk of health and medical morbidities, and also early pregnancy with higher pre- and postnatal complications. The aim of this study was to determine the prevalence, and factors associated with, child marriage among Bangladeshi women using multiple binary logistic regression analysis of data from the BDHS-2011. Further analysis on the trend of age at first marriage was performed with additional data sets from previous surveys. The mean and median of ages at first marriage of Bangladeshi women in 2011 were 15.69±2.97 and 15.00 years, respectively. A remarkably high percentage (78.2%) married before the age of 18; of these, 5.5% married at a very early age (before 13 years of age). Binary logistic regression analysis demonstrated that uneducated women were more likely to be married early (p<0.001) than those with secondary and higher education. Child marriage was especially pronounced among women with uneducated husbands, Muslims, those with poor economic backgrounds and those living in rural areas. Further analysis including data from previous BDHS surveys showed that child marriage among Bangladeshi women had a decreasing trend from 1993-94 to 2011. These results show that child marriage was very common in Bangladesh, and closely associated with low level of education and low economic status. The decreasing trend in child marriage indicates an improvement over the past two decades but more effort is needed to further reduce and eventually eliminate the practice.

A Biomechanical Comparison between Taylor's Spatial Frame and Ilizarov External Fixator.

Abstract Taylor’s spatial frame (TSF) and Ilizarov external fixators (IEF) are two circular external fixator commonly used to address complex deformity and fractures. There is currently no data available comparing the biomechanical properties of these two external fixators. This study looks into the mechanical characteristics of each system. TSF rings with 6 oblique struts, 4 tube connectors, 4 threaded rods, and 6 threaded rods were compared to a standard IEF rings with 4 threaded rods. Compression and torsional loading was performed to the frame as well as construct with Polyvinylchloride tubes. TSF rings with 4 tube connectors had the highest stiffness (3288 N/mm) while TSF rings with 6 struts was the least stiff. The situation was reversed for torsion where TSF rings with 6 oblique struts had the highest torsional stiffness (82.01 Nm/Degree) and frame Ilizarov rings with 4 threaded rods the least. Standard TSF construct of two ring with 6 oblique struts have better torsional stiffness and lower axial stiffness compared to the standard IEF. Key Words Taylor’s Spatial Frame, Ilizarov External Fixator, Biomechanical properties

Rates of pin site infection during distraction osteogenesis based on monthly observations: a pilot study.

Purpose. To assess the monthly rates of infection of individual pin sites in 7 patients during distraction osteogenesis. Methods. Five men and 2 women aged 15 to 35 (mean, 23) years underwent distraction osteogenesis for 8 tibias using the Ilizarov ring external fixator or Taylor Spatial Frame. Patients were taught to perform standard daily pin site care at home, and were evaluated monthly for pin site infection by a single observer using a standardised grading system. Results. Of 1334 observations made on 110 pin/wire sites, there were 83 (6%) pin site infections; 44 (3%) were grade 1 and 39 (3%) were grade 2. The risk of infection was higher at half pin than wire sites. The highest rates occurred in the distal segment. Conclusion. Monthly evaluation of individual pin sites enables comparison between studies

Random Forest and Self Organizing Maps Application for Analysis of Pediatric Fracture Healing Time of the Lower Limb

Abstract In this study, we examined the lower limb fracture healing time in children using random forest (RF) and Self Organizing feature Maps (SOM) methods. The study sample was obtained from the pediatric orthopedic unit in University Malaya Medical Centre. Radiographs of long bones of lower limb fractures involving the femur, tibia and fibula from children ages 0–12 years, with ages recorded from the date and time of initial injury. Inputs assessment extracted from radiographic images included the following features: type of fracture, angulation of the fracture, contact area percentage of the fracture, age, gender, bone type, type of fracture, and number of bone involved. RF is initially used to rank the most important variables that effecting bone healing time. Then, SOM was applied for analysis of the relationship between the selected variables with fracture healing time. Due to the limitation of available dataset, leave one out technique was applied to enhance the reliability of RF. Results showed that age and contact area percentage of fracture were identified as the most important variables in explaining the fracture healing time. RF and SOM applications have not been reported in the field of pediatric orthopedics. We concluded that the combination of RF and SOM techniques can be used to assist in the analysis of pediatric fracture healing time efficiently.

Physical and Clinical Evaluation of Hip Spica Cast applied with Three-slab Technique using Fibreglass Material

Introduction: Hip spica casting is an important component of treatment for developmental dysplasia of the hip (DDH) and popular treatment method for femur fractures in children. Breakage at the hip region is a relatively common problem of this cast. We have developed a three-slab technique of hip spica application using fibreglass as the cast material. The purpose of this review was to evaluate the physical durability of the spica cast and skin complications with its use. Methodology: A retrospective review of children with various conditions requiring hip spica immobilisation which was applied using our method. Study duration was from 1st of January 2014 until 31st December 2015. Our main outcomes were cast breakage and skin complications. For children with hip instability, the first cast would be changed after one month, and the second cast about two months later. Results: Twenty-one children were included, with an average age of 2.2 years. The most common indication for spica immobilisation was developmental dysplasia of the hip. One child had skin irritation after spica application. No spica breakage was noted. Conclusion: This study showed that the three-slab method of hip spica cast application using fibreglass material was durable and safe with low risk of skin complications.