Aims. Management of displaced paediatric
We report 33 cases of femoral
The aim of this retrospective multicentre study was to report the continued occurrence of compartment syndrome secondary to paediatric supracondylar humeral fractures in the period 1995 to 2005. The inclusion criteria were children with a closed, low-energy
It is unclear whether there is a limit to the amount of distal bone required to support fixation of
Between January 1995 and December 2000, 112 children with a closed displaced
We examined differences in the rate of open reduction, operating time, length of hospital stay and outcome between two groups of children with displaced
We compared two management strategies for the perfused but pulseless hand after stabilisation of a Gartland type III
Recent reports have suggested that a delay in the management of type-III
We describe a method of pinning extension
A series of 26 children was referred to our specialist unit with a ‘pink pulseless hand’ following a
We tested the hypothesis that children who sustain a
Filling the empty holes in peri-articular locking
plates may improve the fatigue strength of the fixation. The purpose of
this in vitro study was to investigate the effect
of plugging the unused holes on the fatigue life of peri-articular distal
femoral plates used to fix a comminuted
Aims.
Symptoms due to a
This annotation discusses the findings of two papers in the current issue describing the management of the neurovascular complications of
In 1980, we developed a specially designed brace for treating
Between 1998 and 2002, 37 neuropathies in 32 patients with a displaced
We performed an audit of 71 children with consecutive displaced, extension-type
Cubitus varus is the most common complication of
We present a method of manipulative reduction, immobilisation and fixation using a U-shaped plaster with the elbow in extension for extension-type
Nine children sustained a second fracture of the distal humerus after union of an ipsilateral
We treated 22 children with a
This study aimed to evaluate the use of pin leverage in the reduction of Gartland type III
Three cases are described of elbow injuries in infants, to illustrate the difficulty of differentiating a dislocation from a
We report the results of 116 consecutive displaced extension
1. During two years eighty-five children with
1. Reduction of
Four cases are shown to illustrate remodelling of the lower end of the humerus after
We reviewed 26 patients who had had internal fixation of an open intra-articular
At operation for the correction of cubitus varus by removal of a wedge based laterally, the radial nerve fortunately was first explored and found to run through a transverse bony tunnel at the posterior level of a
1. A method of internal fixation for the
Displaced extension
We have reviewed 34 children who had been treated by open reduction through a medial incision and transarticular pinning for a severely displaced
Stable fixation after a corrective
Ninety-eight children with severely displaced
We reviewed 27 patients who had
A simple method of radiological assessment has been used to measure the angle between the long axis of the humeral shaft and the growth plate of the capitellum (the Baumann angle). In the normal arm a significant relationship was found between the Baumann angle and the carrying angle. The Baumann angle was also measured after reduction of
1. A method of treatment of displaced
1. A case, believed to be the fifth on record, of
During a six-year period we prospectively studied eight children who presented with
The management of an anterior
Cubitus varus is the most frequent complication
following the treatment of supracondylar humeral fractures in children.
We investigated data from publications reporting on the surgical
management of cubitus varus found in electronic searches of Ovid/MEDLINE
and Cochrane Library databases. In 894 children from 40 included
studies, the mean age at initial injury was 5.7 years (3 to 8.6)
and 9.8 years (4 to 15.7) at the time of secondary correction. The four
osteotomy techniques were classified as lateral closing wedge, dome,
complex (multiplanar) and distraction osteogenesis. A mean angular
correction of 27.6º (18.5° to 37.0°) was achieved across all classes
of osteotomy. The meta-analytical summary estimate for overall rate
of good to excellent results was 87.8% (95% CI 84.4 to 91.2). No technique
was shown to significantly affect the surgical outcome, and the
risk of complications across all osteotomy classes was 14.5% (95%
CI 10.6 to 18.5). Nerve palsies occurred in 2.53% of cases (95%
CI 1.4 to 3.6), although 78.4% were transient. No one technique
was found to be statistically safer or more effective than any other. Cite this article:
Of 48 consecutive children with Gartland III
supracondylar fractures, 11 (23%) had evidence of vascular injury,
with an absent radial pulse. The hand was pink and warm in eight
and white and cold in the other three patients. They underwent colour-coded
duplex scanning (CCDS) and ultrasound velocimetry (UV) to investigate
the patency of the brachial artery and arterial blood flow. In seven
patients with a pink pulseless hand, CCDS showed a displaced, kinked
and spastic brachial artery and a thrombosis was present in the
other. In all cases UV showed reduced blood flow in the hand. In
three patients with a white pulseless hand, scanning demonstrated
a laceration in the brachial artery and/or thrombosis. In all cases,
the fracture was reduced under general anaesthesia and fixed with
Kirschner wires. Of the seven patients with a pink pulseless hand
without thrombosis, the radial pulse returned after reduction in
four cases. The remaining three underwent exploration, along with
the patients with laceration in the brachial artery and/or thrombosis. We believe that the traditional strategy of watchful waiting
in children in whom the radial pulse remains absent in spite of
good peripheral perfusion should be revisited. Vascular investigation
using these non-invasive techniques that are quick and reliable
is recommended in the management of these patients. Cite this article:
We investigated a new intramedullary locking
nail that allows the distal interlocking screws to be locked to
the nail. We compared fixation using this new implant with fixation
using either a conventional nail or a locking plate in a laboratory
simulation of an osteoporotic fracture of the distal femur. A total
of 15 human cadaver femora were used to simulate an AO 33-A3 fracture
pattern. Paired specimens compared fixation using either a locking
or non-locking retrograde nail, and using either a locking retrograde
nail or a locking plate. The constructs underwent cyclical loading
to simulate single-leg stance up to 125 000 cycles. Axial and torsional
stiffness and displacement, cycles to failure and modes of failure
were recorded for each specimen. When compared with locking plate
constructs, locking nail constructs had significantly longer mean
fatigue life (75 800 cycles ( The new locking retrograde femoral nail showed better stiffness
and fatigue life than locking plates, and superior fatigue life
to non-locking nails, which may be advantageous in elderly patients. Cite this article: