Introduction

Venous thromboembolism (VTE) is one of the common complications after total hip replacements (THRs). To reduce the risk of VTE, early rising, active movement of the foot, the use of a foot pump or graduated compression stockings and prophylactic administration of anticoagulant drugs are important. Further, intraoperative factors should be taken intoãζζconsideration.

Purpose: The purpose of this study was to investigate the relationship between knee flexion contracture and spinal alignment.

Methods: Ten healthy women (mean age 62) participated in this study. Subjects were examined with posture analysis system, using twelve retro-reflective markers (placed at bilateral acromion, bilateral anterior and posterior superior iliac spine, iliaccrest, greater trochanter, lateral knee joint, lateral malleolus, lateral calcaneus, and fifth metatarsal head), five cameras and a force plate. Unilateral (only right side) knee flexion contractures were simulated by using a hard brace at 0, 15 and 30 degrees. First, relaxed standing was measured without simulation, and then the same measurement was performed with each simulation. The posture without brace was used as control. The shoulder tilting angle was defined by the height difference in right and left acromions. The pelvic tilting angle was defined by the height difference in right and left superior posterior iliac spines. The anterior-bent of the trunk was defined by the slope linked right acromion and right iliac crest. The posterior-bent of the pelvis was defined by the slope linked right superior anterior iliac spine and right superior posterior iliac spine. Knee resultant force (% body weight) was calculated by using inverse dynamics technique.

Results: When contracture angle increased, the trunk was significantly tilted leftward (1.4 degrees at 30 degrees contracture), and the pelvis was significantly tilted rightward (1.8 degrees at 30 degrees contracture). In anterior-bent of the trunk, no significant difference was detected. The posterior-bent of the pelvis was significantly increased (1.5 degrees at 30 degrees contracture). The severer the right knee contracture, the smaller the right knee resultant force (41.5 at controls, 28.7 at 30 degrees contracture) and the larger the left knee resultant force (40.2 at controls, 59.9 at 30 degrees contracture).

Conclusions: This study showed the influence of knee flexion contracture not only in the sagittal plane, as the previous study reported, but also in the coronal plane. Severe unilateral knee flexion contracture can cause the lumbar spine bent convexly to the contracture side. This may result in Knee-Spine Syndrome.

In 1980, we developed a specially designed brace for treating supracondylar fractures of the humerus in children, along with an easy and safe technique of reduction by skeletal traction. This method, which takes into consideration only the medial tilting and anterior angulation of the distal fragment, achieves complete reduction, ignoring any lateral, posterior and minor rotational displacements of the fragment. Skeletal traction is applied through a screw inserted into the olecranon and the angulation at the fracture site is reduced regardless of the anatomical position without manipulation.

We treated 193 children with displaced supracondylar fractures of the humerus using this method between 1980 and 2001. Only four children (2%) developed cubitus varus. The majority obtained an excellent range of movement at the elbow; one had a 25° limitation of flexion. This technique is an effective and easy method of treating supracondylar fractures of the humerus in children.

The purpose of this study is to introduce our treatment by skeletal traction in brace and to report the safety and easiness of this method and low incidence of cubitus varus.

In 1980 we developed a specially designed brace for treating the supracondylar fracture, along with a technique of spontaneous reduction by skeletal traction to develop an easy and safe treatment. The brace is made of plastics and aluminum alloy that are radiolucent. The humeral slide bar with attached axillary pad can be moved up and down to adjust the height of the upper arm for each patient.

From 1980 to 1999 we have treated 190 children with displaced supracondylar fracture of the humerus. Their ages ranged from 2 to 14 years old and average of age was 7 years old. The fractures occurred most frequently between the ages of 5 to 6. More boys than girls were injured and the left elbow were more often than the right. Among 190 cases, severely displaced cases were most common. (64%) and moderate case 20%, mild case 16%. The period of follow up was 6 months to 11 years, mean 4 years.

Placing the arm in the brace with the elbow flexed at right angle, unstable fracture site will be stabilized first. Skeletal traction is performed by a spring through the winged screw. The traction is maintained for three to four weeks. Spontaneous reduction of the displaced fragment can be expected and we emphasize that any manipulative technique is not performed during the treatment at all.

Among 190 patients, cubitus varus occurred in only 3 (1.6%) cases because of technical failure. All patients except one obtained excellent functional results, one had 25 degrees of limitation of the elbow flexion. There were no vascular problems or Volkmann’s contracture and ectopic ossification. The results were satisfactory.

Our treatment utilizing the brace and skeletal traction for supracondylar fracture of the humerus in children is safe and effective in preventing cubitus varus.