How long does treated supracondylar humerus fracture in children take to recover elbow range?

Background: Our goal was to address requirement of physiotherapy after treatment of supracondylar humerus fractures in children and evaluate result of casting on elbow without injury using control group of distal forearm fractures.Methods: 57 cases of supracondylar fractures were included in this retrospective study and compared with group of 54 children with distal forearm fractures treated with long arm casting for 28 days. Passive elbow ROM was checked with goniometer on day of cast removal, 2 weeks later, and then every month until the elbow ROM returned to 95% ROM (ROM-95) of uninjured side. No physiotherapy was given.Results: Average time in cast for supracondylar fracture group was 31.8 days and distal forearm fracture group was 32.4 days. The elbow total flexion angle reached a plateau of 139 degrees at 1month after cast removal whereas forearm group required less than 2 weeks. Total rotation ROM required half the time to reach 139 degrees in forearm group. From the paired t test it took more time for pronation to recover than supination in supracondylar fractures. In supracondylar group there was positive correlation between casting period and recovery period of ROM-95 elbow extension (p=0.021) and days of casting (p=0.021) and ROM-95 flexion recovery period. There was no statistically significant impact between casting and recovery period in other directions and recovery of ROM-95 & F-ROM and the subclassification and type of treatment of individual fractures.Conclusions: Lessons learned: thorough assessment of elbow function post cast removal, lack of need of physiotherapy in management protocol and elbow stiffness is related to initial injury and associated treatment not merely immobilisation

Novel mathematical method for quantitative expression of deviation from the Higuchi model

A simple mathematical method to express the deviation in release profile of a test product following Higuchi's kinetics from an ideal Higuchi release profile was developed. The method is based on calculation of area under the curve (AUC) by using the trapezoidal rule. The precision of prediction depends on the number of data points. The method is exemplified for 2 dosage forms (tablets of diltiazem HCl and microspheres of diclofenac sodium) that are designed to release the drug over a 12-hour period. The method can be adopted for the formulations where drug release is incomplete (<100%) or complete (100%) at last sampling time. To describe the kinetics of drug release from the test formulation, zero-order, first-order, Higuchi's. Hixson-Crowell's, and Weibull's models were used. The criterion for selecting the most appropriate model was based on the goodness-of-fit test. The release kinetics of the tablets and microspheres were explained by the Higuchi model. The release profiles of the test batches were slightly below the ideal Higuchi release profile. For the test products, observed percentage deviation from an ideal Higuchi profile is less than 16% for tablets and less than 11% for microspheres. The proposed method can be extended to the modified release formulations that are designed to release a drug over 6, 18, or 24 hours. If the data points are not evenly separated, the ideal drug release profile and AUC are calculated according to the specific sampling time. The proposed method may be used for comparing formulated products during the research and development stage, for quality control of the products, or for promoting products by comparing performance of the test product with that of the innovator's product