To assess the clinical outcomes of patients that had perilunate or lunate dislocations treated with either open or closed reduction and wiring without repair of the scapholunate interosseous ligament (SLIL). Current literature states that acute perilunate dislocations should be treated with open reduction and repair of the dorsal scapholunate ligament. This is to prevent dissociative carpal instability and potential long term degenerative arthrosis.Aim:
Background:
Internal rotation (IR) contracture of the shoulder is a frequent complication of obstetric brachial plexus injury, even in the face of full neurological recovery. Surgical procedures to treat this complication include tendon transfers, capsular release and osteotomies. We compared the outcomes in patients who had arthroscopic release only and those who also underwent a tendon transfer. We retrospectively reviewed the clinical records of all patients with OBPI presenting to our unit in the years 2002–2012 who underwent surgical procedures for the treatment of an IR contracture of the shoulder. Increase in range of external rotation (ER) in adduction and abduction intra-operatively was recorded. At follow-up, active ER, the Mallet score, presence of an ER contracture and the “drop-arm” sign was recorded.Purpose of study
Methods
Over the five years 1997 and 2001 we evaluated five children (age range 10 to 14 years) with pathological femoral fractures due to rickets. All had quadriplegic cerebral palsy, and all were at home rather than in institutions. Four had been on long-term anticonvulsant therapy (ACT). Radiographs showed typical features of rickets, with osteopoenia, cupping of metaphyses and widened growth plates. Biochemical analysis showed mean serum calcium of 1.87 mmol/l (1.71 to 2.2 – the normal range is 2.05 to 2.64), mean serum phosphate of 0.6 mmol/l (0.3 to 0.98 – the normal range is 1.0 to 1.85), and mean alkaline phosphatase of 1272 IU/l (414 to 2135 – normally less than 360). The fractures were treated with Thomas splint traction or spica immobilisation. The rickets was treated with daily vitamin D (4000 IU) and calcium (1000 mg) for 3 months. The rickets healed radiologically at 2 months and the fractures united at 3 months. For long-term prophylaxis a multifactorial therapeutic approach was adopted, entailing increasing exposure to sunlight, increasing dairy product intake, and changing the ACT to sodium valproate, which is less enzyme-inducing. No vitamin D supplementation was given. At a mean follow-up of 3 years (2 to 8) no further fractures had occurred, and radiology and biochemistry were normal.
