Does clavicular shortening after nonoperative treatment of midshaft fractures affect shoulder function? A systematic review

Trauma Surger

Displaced distal radius fractures in children, cast alone vs additional K-wire fixation: a meta-analysis

Purpose Displaced distal radius fractures in children are common and often treated by reduction and cast immobilization. Redisplacement occurs frequently and may be prevented by additional treatment with K-wire fixation after initial reduction. This meta-analysis aims to summarize available literature on this topic and determine if primary K-wire fixation is the preferred treatment for displaced distal radius fractures in children. Methods A search in eight databases identified studies that compared cast immobilization alone to additional K-wire fixation as treatment for displaced paediatric distal radius fractures. The primary outcome was the redisplacement rate. Secondary outcomes were secondary reduction rate, range of motion and complications. This meta-analysis was performed according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. Results Three RCTs and 3 cohort studies, analysing 197 patients treated with cast immobilization alone and 185 with additional K-wire fixation, were included in this meta-analysis. Redisplacement occurred less frequently after additional K-wire fixation than after cast alone (3.8 versus 45.7%; OR 0.07, 95% CI 0.03-0.15). Secondary reduction was performed in 59.8% of the redisplaced fractures. Complications, other than redisplacement, occurred more often after additional K-wire fixation than after cast alone (15.7 versus 3.6%). Range of motion did not differ after both treatments. Conclusions Additional K-wire fixation is a suitable treatment to prevent redisplacement and secondary operations after initial reduction of displaced distal radius fractures in children, but is associated with post-procedural complications. Additional K-wire fixation does not result in a better range of motion than cast immobilization alone. More research is needed to identify those patients who will benefit the most from K-wire fixation as a treatment for displaced distal radius fractures in children.Trauma Surger

Risk factors for fracture redisplacement after reduction and cast immobilization of displaced distal radius fractures in children: a meta-analysis

Purpose Displaced distal radius fractures in children are common and often reduced if necessary and immobilized in cast. Still, fracture redisplacement frequently occurs. This can be prevented by fixation of fracture fragments with K-wires, but until now, there are no clear guidelines for treatment with primary K-wire fixation. This meta-analysis aimed to identify risk factors for redisplacement after reduction and cast immobilization of displaced distal radius fractures in children, and thereby determine which children will benefit most of primary additional K-wire fixation. Methods Eight databases were searched to identify studies and extract data on the incidence of and risk factors for redisplacement of distal radius fractures after initial reduction and cast immobilization in children. Results Twelve studies, including 1256 patients, showed that initial complete displacement (odds ratio [OR] 4.69, 95% confidence interval [CI] 2.98-7.39) and presence of a both-bone fracture (OR 1.95, 95% CI 1.34-2.85) were independent risk factors for redisplacement. Anatomical reduction reduced the redisplacement risk (OR 0.14, 95% CI 0.05-0.40). No significant influence on redisplacement risk could be established for female sex, experience level of the attending surgeon, Cast Index < 0.8, Three-Point Index < 0.8 and patient's age. Conclusions For children with a displaced distal radius fracture, the presence of a both-bone fracture, complete displacement of the distal radius and non-anatomical reduction are risk factors for redisplacement after reduction of their initially displaced distal radius fracture. Children with one or more of these risk factors probably benefit most of reduction combined with primary K-wire fixation.Trauma Surger

Molecular fingerprinting of the Egyptian medicinal plant Cocculus pendulus

Background and aims: The genus Cocculus belongs to the family Menispermaceae which comprises about 35 species of shrubs or woody climbers. Only one species, Cocculus pendulus is found in Egypt. This plant is reported to have good medicinal values in traditional system of medicine. Despite the wide occurrence of C. pendulus in the Egyptian deserts, attention was paid only to its distribution and morphological description ignoring the biochemical constitution, the genome makeup and environmental aspects which are not given due consideration. Since no information about the genome of C. pendulus is available, the current study deals with molecular investigation of C. pendulus expressed by DNA fingerprinting of the young leaves of this plant using amplified fragment length polymorphism (AFLP) technique with four primer combinations. The obtained results revealed a total of 228 bands with an average of 57 bands for each primer combination, of which 61 bands were polymorphic (26.8%) ranging in size from 59 to 570 bp. The number of amplicons/primer pairs ranged from 48 (E-AGG/M-CAC) to 72 (E-AAC/M-CAG) while the number of polymorphic amplicons varied from 13 to 21 with polymorphism percentage of 22.03–29.17%. Thus the average number of polymorphic fragments/combinations was 15. In this regard, the combination E-AGG/M-CAC was more efficient as confirmed by computing the discriminating power (D) of all primer combinations. Also, the AFLP marker gives a complete informative and highly discriminative picture about C. pendulus as shown by (PIC = 0.99)