Redisplacement of unstable forearm fractures in plaster is common and may be the result of a number of factors. Little attention has been paid to the influence of immobilisation with the elbow extended versus flexed. We prospectively treated 111 consecutive children from two centres with closed forearm fractures by closed reduction and casting with the elbow either extended (60) in China or flexed (51) in Israel. We compared the outcome of the two groups. There was no statistically significant difference in the distribution of the age of the patients, the site of fracture or the amount of angulation and displacement between the groups. During the first two weeks after reduction, redisplacement occurred in no child immobilised with the elbow extended and nine of 51 children (17.6%) immobilised with the elbow flexed. Immobilisation of unstable forearm fractures with the elbow extended appears to be a safe and effective method of maintaining reduction.
Introduction A prospective pooled case series was used to assess the value of frequent radiographic examinations during treatment of closed forearm fractures in children from major university pediatric medical centers in Israel and China. Methods The sample consisted of 202 consecutive children (mean age 7 years; range 3-12 years) with closed forearm fractures treated nonoperatively. Children with open, growth-plate fractures or fractures associated with dislocation of the nearby joint (i.e., monteggia fractures) were excluded. In 28 children who had torus fractures, radiographic examination was performed at the time of cast removal, 3 weeks after the start of treatment. In 63 children who had stable fractures that did not require reduction (undisplaced or minimally displaced, complete or greenstick), radiographic examination was performed 1 week after the start of treatment and again at cast removal 4-6 weeks later. In the remaining 111 children with complete, displaced, or greenstick fractures (all with angulation of more than 15°) who underwent closed reduction, an additional X-ray was taken 2 weeks after cast placement. All children (except those with torus fractures) were followed clinically, without further radiographic examination, for 3 months after cast removal. Results Radiographs at cast removal showed good union in all stable fractures, indicating that additional X-rays on cast removal would have had no added value. In the children with unstable fractures, only 9 showed redisplacement with angulation of more than 15°on repeated X-rays during the first 2 weeks after cast placement. All 9 underwent successful re-reduction. On clinical evaluation 3 months after cast removal, all patients in the sample had full range of elbow and forearm motion. Repeated fracture did not occur in any of the patients. Conclusions On the basis of these results, radiographs are recommended 2 weeks after cast placement for greenstick or complete fractures. At the time of cast removal, if clinical examination does not show signs of nonunion or malalignment, no radiographic examination is necessary.
Fixation with a pre-bent elastic stable intramedullary nail is an effective, safe and convenient method for treating distal radial shaft fractures in children.
Meloidogyne graminicola is a destructive soil-borne pathogen that causes rice yield losses (Oryza sativa L.) in tropical and subtropical areas. This study investigated the effect of M. graminicola population densities on plant height, heading, and the photosynthetic parameters of rice in a greenhouse. Two-week-old rice plants were inoculated with different M. graminicola densities (250, 500, 750, 1000, 1500, and 2000 J2s/plant) and observations were recorded at 30, 60, and 90 days after inoculation (DAI). Reductions in growth and photosynthetic parameters caused by M. graminicola densities were calculated in relation to a control (non-inoculated rice). Results revealed that M. graminicola infection with low population densities (0–500 J2s/plant) did not influence the rice plant height during 30–60 DAI, but significantly lowered the plant height, panicle growth rate, and panicle length of rice at 90 DAI. The chlorophyll content of rice inoculated with 500–2000 J2s was significantly lower than that of the control. Furthermore, M. graminicola infection with 500 J2s/plant significantly lowered the transpiration rate and net photosynthetic rate by 21.21% and 21.81%, respectively, compared with the control (p < 0.05). M. graminicola with a low population density significantly reduced the net photosynthetic rate of rice, which affected organic matter accumulation, resulting in growth retardation and lower yields (p < 0.05).
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