What's new in orthopaedic trauma.
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This study investigates the hypothesis that the integrity of the cartilage hinge at the distal humeral epiphysis determines the stability of fractures of the lateral humeral condyle. Sixteen patients with lateral humeral condyle fractures were studied with radiographs and magnetic resonance imaging (MRI). The clinical course of each patient was compared using these imaging studies to determine whether initial fracture displacement and the integrity of the cartilage hinge correlated with fracture stability. Radiographically, 4 fractures were considered unstable (with initial fracture displacement >3 mm) and 12 were stable (initial displacement < or =3 mm). On MRI, 6 fractures were complete (with disruption of the lateral cartilage hinge) and 10 were incomplete. All unstable fractures had complete fractures on MRI. Ten of the 12 patients with radiographically stable injuries had incomplete fractures on MRI. None of these displaced during treatment. Two patients had radiographically stable fractures and complete fractures on MRI. One of these fractures displaced, confirming the hypothesis that the stability of lateral humeral condyle fractures is related to the integrity of the cartilage hinge.
Osteochondral fractures of the glenoid fossa of the ulna are exceptional injuries in children. These lesions can present diagnostic problems because the fragments are often radiolucent. We followed four children for 3, 6, and 24 months and 12 years, respectively. The elbow was definitely dislocated in two, and was probably dislocated in two other, children. The most reliable paraclinical examination was conventional sagittal tomography. Open revision is mandatory for reduction of the fracture and, when performed early, may lead to excellent functional results.
With long-established traditions in both sports medicine and trauma in Sweden, investigations are in progress on prevention, diagnosis, treatment, and rehabilitation, with special emphasis on soft-tissue injuries. The following subjects are of current interest: injuries to the ankle ligaments, compartment syndromes, knee ligament and meniscus injuries, thigh and groin muscle injuries, shoulder dislocation, lateral epicondylitis, and rupture of the ulnar collateral ligament of the thumb. Skiing injuries and the prevention of trauma in soccer players represent important unsolved problems.
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Injury to the upper radial epiphysis is mainly a radiological diagnosis. Delayed dislocation of the radial head following such injuries, where there is no evidence of primary subluxation or dislocation, has not been recorded in the literature. We have identified three such cases that needed open reduction. As long term results of delayed treatment of dislocation of any joint is not good, we advocate the awareness of this complication and also a longer period of routine follow-up (up to a year) of all upper radial epiphysial injuries, to avoid a catastrophe in an entirely preventable situation.
The authors evaluate retrospectively in a group of 121 children with a dislocated supracondylar fracture in 1984-1993 the results of different therapeutic methods. The highest percentage of excellent and satisfactory results was recorded in children treated by closed reposition with percutaneous pinning with Kirschner wires (88%). In open reposition with Kirschner wires 60% of the results were excellent of satisfactory. The lowest percentage of excellent and satisfactory results was recorded when fixation with a plaster bandage was used (48%). The highest percentage of poor results was observed in surgical reposition with internal fixation (37%). The cause of failure in the majority of patients is according to the authors inadequate reposition of fragments. The authors discuss different types of treatment. They recommend non-surgical reposition with percutaneous pinning, even for less dislocated extension supracondylar fractures of the humerus as well as for fractures complicated by vascular injuries.
STUDY DESIGN: Test-retest reliability study. OBJECTIVES: To determine intra- and intertester reliability of the hand-held pencil (HHP) and the plumbline goniometer (PLG) methods for measuring active forearm pronation and supination motions in individuals with and without injuries. BACKGROUND: The distal forearm method has been considered the gold standard for measuring forearm pronation and supination motion. The HHP and PLG, however, are 2 more functional methods for measuring forearm motions, though limited information on the psychometric properties of these tests is currently available. METHODS AND MEASURES: Intra- and intertester reliability of the HHP and PLG methods were determined in 40 subjects of convenience (20 injured and 20 noninjured). Two testers performed 3 repeated measurements for each motion and method on all subjects. Intraclass correlation coefficients (ICC3,1 for intratester reliability, ICC2,3 for intertester reliability) and standard error of measurements (SEMs) were determined. RESULTS: The ICCs for the measurements of pronation and supination using the HHP and PLG methods were high (range, 0.86-0.98) for individuals with and without injuries, with the reliability for the PLG method being equal or slightly greater than the HHP method for the majority of pronation and supination measurements. Intratester ICCs were higher (SEMs were conversely lower) than intertester ICCs for nearly all measurements. The ICC values were generally the same or higher for individuals with injuries compared to individuals without injuries. CONCLUSIONS: The HHP and PLG are highly reliable methods for measuring functional forearm pronation and supination. Because plumbline goniometers are not commercially available and the instrumentation for the HHP method is readily accessible, clinicians should consider the latter as their method of choice for measuring functional forearm pronation and supination.
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A unique case of a coexistent fracture of the capitellum and trochlea is presented. The mechanism of injury and treatment options are reviewed.
Physeal injuries of the distal humerus comprise approximately 10% of all physeal injuries. Diagnosis of these injuries at a young age before the ossification centers have ossified and become visible radiographically is difficult. Poor outcome of distal humeral physeal injuries is not uncommon and can be best prevented by knowledge of anatomy and the use of all appropriate imaging techniques. The focus of this article is to correlate anatomy at different ages with the occurrence of specific injuries.
The ground reaction forces at the hand that produced compression forces and varus/valgus moments at the elbow joint during the double-arm support phase of the back handspring were studied. The relationship of technique, namely elbow joint flexion, to these forces were also studied. Compression forces and forces producing valgus moments have been implicated in overuse injuries to the elbow joint. Video and force plate analysis of six young female gymnasts showed that 1) the elbow joint flexed during the double-arm support phase, and 2) the reaction forces at the hand produced large compression forces (an average of 2.37 times body weight) and sizable valgus moments at the elbow (an average of 0.03 times body weight times body height). The combination of these forces may contribute to the occurrence of lateral compression injuries of the elbow joint (e.g., osteochondritis dissecans of the capitellum). Correlations of measures of elbow angle and measures of reaction force showed that large elbow flexions may protect the elbow from large valgus moments.
We report on the technique of serial casts to successfully reverse elbow flexion contractures in three patients. Patients considered for this technique had a traumatic injury to the elbow that resulted in residual soft tissue restrictions; their mean flexion deformity was 44 degrees, which had been present for an average of 6 months. Treatment consisted of traditional therapy methods to obtain initial stretch and elongation of tissue followed by application of a cylindrical fiberglass cast in the position of maximal elbow extension. The cast was worn for 3 to 5 days, then removed, and the entire process was repeated. After the use of serial casts, elbow flexion contractures were reduced to a mean of 11 degrees. These results have been maintained over an average of 26 months. The use of casts in the treatment of elbow flexion contractures appears to be a viable technique for increasing range of motion when traditional methods of treatment alone are unsuccessful and surgical intervention may be the only alternative.
Myositis Ossificans After a Supracondylar Fracture of the Humerus in a Child. In addition to the better known complications of supracondylar humerus fractures, myositis ossificans is often listed as a less common complication. This complication is extremely rare in children and historically has been attributed to high-energy trauma, manipulation, surgical intervention, aggressive passive range-of-motion exercises, or associated head injury. We present a case report of a 3-year-old girl who developed myositis ossificans after a low-energy supracondylar fracture of the humerus despite having been treated without manipulation, surgery, or physical therapy. This report illustrates that supracondylar humerus fractures can be complicated by myositis ossificans despite the best attempts at prevention.