Auditing the use of percutaneous pinning as a technique of fixation of unstable humeral supracondylar fractures in Sudanese children.

Background:Supracondylar fractures of the humerus in children are commonly treated with closed reduction and percutaneous pin fixation. There has been controversy regarding the optimal pin configuration inthe management of supracondylar humeral fractures in children.Objectives: To evaluate the effectiveness of closed percutaneous pinning (P.C.P.) as a treatment modality of supracondylar fractures of humerus in Sudanese children.Patients and methods: Hospital based prospective study conducted in Khartoum teaching hospital during the period from July 2006 to March 2007. It included all children less than 14 years of age, with closed type III supracondylar humeral fracture, extension variant, who treated by closedreduction and percutaneous cross pinning.Results: 34 patients were included in the study. Their age ranged between 4 -12 years, with mean ± SD of 7.68 ± 2.34 years. Twenty-four (70.6%) fractures were fixed with crossed pins whereas ten (29.4%) fractures with two lateral pins. The two lateral pins fixation was found to be significantlyassociated with loss of reduction (p=0.004).Conclusion: PCP is safe and effective with good functional outcome in treatment of unstable supracondylar fractures. The best wires configuration is that which gives ability to extend elbow with much stability

Outcome of Primary Cemented Bipolar Hemiarthroplasty compared with Dynamic Hip Screw in Elderly Patients with Unstable Intertrochanteric Fracture

Introduction: Although the treatment of choice for unstable intertrochanteric fractures in elderly patients has been internal fixation for a long time, several studies have shown mechanical and technical failures. Primary cemented bipolar (PCB) hemiarthroplasty has been proposed as an alternative with some advantages concerning earlier mobilization and minimal postoperative complications. Materials and Methods: This is a prospective cohort hospital-based study conducted at three tertiary hospitals over a period of two years. A total of 98 patients were enrolled in the study, 38 patients treated with Dynamic Hip Screw (DHS) and 60 patients treated with PCB hemiarthroplasty. Intraoperative events (e.g. duration of surgery and blood loss), hospital stay, weight bearing, Harris Hip score and post-operative complications were used as predictors of final outcome. Mean follow-up was 13.66±5.9 months in hemiarthroplasty group and 11.8±2.7 months at internal fixation group. Results: The two groups were comparable in age, sex, comorbidity, mode of trauma, and classification of fracture. Early mobilisation was significantly better in hemiarthroplasty (p<0.001) where 93.3% of patients started partial weight bearing on postoperative Day 1, while in the DHS group, 73.7% of patients started partial weight bearing after two weeks postoperatively. At the final follow-up, the mortality rate did not differ between the two groups, but general and mechanical complications were more common in the DHS group. The mean Harris Hip score was better in the hemiarthroplasty group (91.14 vs 74.11). Conclusion: Primary cemented bipolar hemiarthroplasty is a safe and valid option in treating unstable intertrochanteric fracture. Although it has been shown to have some advantages over DHS in certain circumstances, lack of randomization and difficulties in standardization of patients and treating surgeon raise a need for more studies with bigger sample size and proper randomization

Safety Issues and Neurological Improvement following C1- C2 Fusion using C1 Lateral Mass and C2 Pedicle Screw in Atlantoaxial Instability

The evolution of instrumentation methods for C1-C2 fusion from the use of posterior wiring methods to transarticular screws and C1 lateral mass with C2 pedicle screw construct have improved fusion rates to almost 100%. However, the C1 lateral mass and C2 pedicle screw technique is technically demanding. This is a prospective review of a series of ten patients who was planned for C1-C2 fusion using C1 lateral mass and C2 pedicle screw technique between January 2007 and June 2009. The procedure was converted to occipital cervical fusion due to a fracture of a hypoplastic lateral mass-posterior arch complex in one patient and Gallie fusion due to a vertebral artery injury in another. Eight patients underwent the C1-C2 fusion using C1 lateral mass and C2 pedicle screw successfully without any complications. The union rate was 100% with an average union time of 5.3 months (range from 3 to 8 months). Postoperatively, the patients achieved an average of one Frankel grade neurological improvement. In conclusion, this technique provides an excellent union rate and good neurological recovery