"Floating arm" injury in a child with fractures of the proximal and distal parts of the humerus: a case report

<p>Abstract</p> <p>Introduction</p> <p>Simultaneous supracondylar humerus fracture and ipsilateral fracture of the proximal humerus in children is rare.</p> <p>Case presentation</p> <p>A 10-year-old Turkish boy with an extension type supracondylar humerus fracture and ipsilateral fracture at the proximal metaphyseal-diaphyseal junction of the humerus was treated by closed reduction and percutaneous Kirschner wire fixation. Closed reduction was performed using a Kirschner wire as a "joystick" to manipulate the humeral shaft after some swelling occurred around the elbow and shoulder.</p> <p>Conclusion</p> <p>The combination of fractures at the proximal and distal parts of the humerus can be termed as "floating arm" injury. Initial treatment of this unusual injury should be focused on the supracondylar humerus fracture. However, closed reduction can be difficult to perform with the swelling around the elbow and shoulder. A temporary Kirschner wire can be used as a "joystick" to fix and reduce the fracture.</p

The timing and importance of motor skills course in knee arthroscopy training

Objectives: The aim of this prospective study is to evaluate the impact of the simulation training programin learning duration of arthroscopic motor skills. Furthermore, we investigated the difference betweenjunior and experienced residents in the improvement of arthroscopic motor skills duration.Methods: We established 2 study groups according to participants' year of experience in orthopedicresidency with junior group residents with three years or less than three years experience as group 1 andexperienced group with over 3 years of experience as group 2. We calculated duration change of motorskill test results for each participant before and after the course. The tools used were; auto scoring mirrortracer(ASMT), 0'Conner the tweezer dexterity test(OCTDT), etch-a-sketch with overlay(ESOT), purdue thepegboard test(PPT), two-arm coordination test(TACT) and grooved pegboard test(GPT) which were allproduced by LafayetteŞrm. These instruments were used to practice and measure the basic motor skills.Results: All postecourse test durations for participants decreased signiŞcantly when compared to precourse. We calculated percentage change of motor skill test results for each participant before and after the course. All motor skill test percentage changes were similar between two groups. In comparisonof participants according to their experiences, results revealed that there was no difference in test resultsof experienced and junior surgeons. Both groups had provided equal improvement in terms of motorskills.Conlusion: As our results revealed, residents will be able to act with a strong motivation to learn applications through basic arthroscopic information gained in early period of orthopedic training and willmake more successful applications of real patients.&copy; 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. Thisis an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/).https://dx.doi.org/10.1016/j.aott.2017.01.00

Proximal femoral nail shows better concordance of gait analysis between operated and uninjured limbs compared to hemiarthroplasty in intertrochanteric femoral fractures

Atay, Evren Fehmi (Arel Author)Purpose The purpose of this study was to compare the results of pedobarographic gait analysis between the patients treated by proximal femoral nail or bipolar partial hemiarthroplasty due to intertrochanteric fractures. Methods Thirty-seven patients with a minimum 1-year follow-up who had been operated for intertrochanteric fractures were evaluated clinically, radiologically and with pedobarographic gait analysis. Proximal femoral nail had been performed to 21 patients (group A), whilst 16 patients had been operated by partial bipolar hemiarthroplasty (group B). Pedobarographic analysis was performed by measuring plantar pressure, force and contact area values in both static and dynamic manner. Pedobarographic results of operated limb were compared among groups. Same data's also were compared between operated and uninjured limbs in each group to determine any asymmetry on weight-bearing. Results Average follow-up period in group A and group B was 36 (12–56) and 30 (12–48) months, respectively. There were no statistically significant differences among groups in terms of age, gender, body mass index, type and side of fracture, follow-up period, leg length discrepancy and postoperative hip scores. When the pedobarographic results of operated limb were compared, group B showed much more plantar force and pressure values than group A, on both static and dynamic evaluations. If the evaluation was taken into consideration to comparison of pedobarographic results between operated and uninjured limbs in each group, we found asymmetry in static load bearing, caused by higher load on uninjured limb in both groups. However, there was no statistically significant asymmetry between operated and uninjured limbs in respect to dynamic pedobarographic parameters for patients in group A. On the contrary, operated limbs in group B exposed much more plantar force and pressure values than uninjured limbs, which indicated asymmetric weight-bearing on dynamic evaluation. Conclusions Assessment of pedobarographic parameters can be another way of measuring the results of treatment in intertrochanteric fractures. Uninjured limbs of patients expose much more loading than operated limbs in postoperative static evaluation for both treatment options. However in dynamic evaluation, there is a better concordance of gait analysis between both limbs in patients operated by proximal femoral nail

The timing and importance of motor skills course in knee arthroscopy training

Objectives: The aim of this prospective study is to evaluate the impact of the simulation training program in learning duration of arthroscopic motor skills. Furthermore, we investigated the difference between junior and experienced residents in the improvement of arthroscopic motor skills duration. Methods: We established 2 study groups according to participants' year of experience in orthopedic residency with junior group residents with three years or less than three years experience as group 1 and experienced group with over 3 years of experience as group 2. We calculated duration change of motor skill test results for each participant before and after the course. The tools used were; auto scoring mirror tracer(ASMT), 0'Conner the tweezer dexterity test(OCTDT), etch-a-sketch with overlay(ESOT), purdue the pegboard test(PPT), two-arm coordination test(TACT) and grooved pegboard test(GPT) which were all produced by Lafayette firm. These instruments were used to practice and measure the basic motor skills. Results: All post–course test durations for participants decreased significantly when compared to pre-course. We calculated percentage change of motor skill test results for each participant before and after the course. All motor skill test percentage changes were similar between two groups. In comparison of participants according to their experiences, results revealed that there was no difference in test results of experienced and junior surgeons. Both groups had provided equal improvement in terms of motor skills. Conlusion: As our results revealed, residents will be able to act with a strong motivation to learn applications through basic arthroscopic information gained in early period of orthopedic training and will make more successful applications of real patients. Keywords: Arthroscopy, Arthroscopy training, Motor skill