Background: Nonunion of humeral shaft fracture after conservative treatments or frequent failed surgical treatment of bone healing exemplify the difficulties in managing a bone defect or severely damaged individuals. Aim of the study: The present study was undertaken to evaluate three bridging tricoticocancellous bone grafts in the treatment of old non-uniting fractured humerus. Materials and Methods: From June 2014 to December 2019, three bridging tricoticocancellous bone grafts were used to treat non-union humeral shaft fractures using dynamic compression plates at Sulaimani Teaching Hospital in Iraq. Results: Sixteen patients, 11 males, and 5 females, varying in age from 28 to 64 years old (mean age 41) were recruited for the study. Six patients had previously undergone conservative treatment, and ten patients had previously undergone surgical treatment, such as open reduction and internal fixation with plates and screws or various intramedullary nails. Four out of ten patients had previously received bone transplants in conjunction with internal fixation. The nonunion lasted between 2 and 4 years (a mean of 3 years). In patients who were treated by recanalization of the medullary canal healing rate of a non-uniting fractured shaft, humerus reached 100% in all 16 patients, indicating improvements in both bone healing and functional index outcomes. The satisfaction rate score was in 15 patients (93.75%). Also, the function score was excellent in 15 patients (93.75%), while the movement score was in 14 patients (87.5%). The union rate, angular deformity, and limb shortening were used to evaluate bone results. Conclusion: When using the technique of medullary recanalization opening the bone canal, and fixation by dynamic compression plate for old non-uniting fractured shaft humerus patients, the findings confirm that three bridging tricoticocancellous bone grafts are superior in healing and union, improved arm function, and a high satisfaction rate as achieved.

Objective: Carpal tunnel syndrome (CTS) occurs when there is compression on the median nerve within the carpal tunnel in the wrist joint. It commonly affects those who make frequent, repetitive hand movements, with women being more affected than men. The present study was aimed at comparing minimally invasive and classical surgical decompression techniques for carpal tunnel syndrome. Materials and Methods: One hundred and four patients with CTS who were scheduled for carpal tunnel decompression were chosen at random. The patients were divided into two groups. Group A had standard classical long incision decompression, whereas Group B had minimally invasive decompression. The patients were evaluated with the Boston Functional Score Scale. Between the two groups, a comparison of visit reports was made at 3, 6, and 12 months after surgery. Results: There was no significant difference in patient age (Group A was 38 years old and Group B was 36 years old) and availability of bilateral CTS status (A was 34 and B was 31). The female-male ratios in groups A and B were 3.6 to 0.2 and 3.1 to 0.3, respectively, with a p-value of p<0.05 indicating significant difference. Comparing both groups, the minimally invasive decompression technique showed a high rate of functional hand grip and a low rate of complications including early wound healing, rapid resumption of palmar strength grip, and rapid return to daily activities. Conclusion: The findings indicate that patients who underwent the minimally invasive surgical decompression one-stitch technique showed significant improvement over the traditional method.

Background: This is a prospective Study to assess the occurrence of hypovolemic shock in children with traumatic isolated closed fractures femur. This is common in children and adolescent as result of trivial to high energy trauma. Methods: A prospective descriptive study was performed on children with traumatic femoral fractures from the 20th of September 2015 to the 15th August 2018. Selection of 100 patients presented with isolated closed fracture femur in children, were admitted to the Sul. Emergency Hospital. Reason was to correct the old criteria of blood transfusion immediately, without suitable indication of replacement with real blood requirements. Depend on the children clinical parameters rather than on hemoglobin or hematocrit concentration; pulse rate. Systolic blood pressure, respiratory rate, Skin capillary refill time, and the mental status. Excluded open fractures and bilateral fracture femur in children, also excluded any fracture associated with trauma to the body organ as associated injury. Results: There was no evidence of hemodynamic instability in the 100 patients of these type fractures, selection inclusion criteria of the study when compared with internationally accepted normal vital sign parameters. No any patients in the study had hemoglobin less than 8.5 g/dl, the vital sign between these groups were similar, 2-6% incidence with hemodynamic instability has found among multiple injured children with femoral fractures, has excluded from the study. Conclusions: No evidence of hemodynamic instability was found in children with traumatic isolated femoral fractures bone. The Hemoglobin and hematocrit ratios early were non dependable, later on not significantly decreased or change to abnormal rate. Depending on vital signs parameters in the femur bone fractures patients after exclusion of bilateral fractures femur, and associated injury or patients with compound fractures, we confirmed that isolated closed femoral fractures are hemodynamically stable.