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Although acute vascular injury is a common complication in children with severely displaced supracondylar humeral fractures, the management of patients with a pink pulseless hand still remains controversial. Between 1994 and 2006, 66 children with displaced supracondylar fractures of the humerus were treated. Five patients had an absence of the radial pulse with an otherwise well perfused hand. In one patient, radial pulse returned after closed reduction of the fracture. In four patients, open reduction and vascular exploration was required. Three patients had brachial artery occlusion because of thrombus formation. Thrombectomy was performed, which led to the restoration of a palpable radial pulse. In one patient with open fracture, brachial artery contusion and spasm were found, and treated by removal of adventitia. Surgical exploration for the restoration of brachial artery patency should be performed, even in the presence of viable pink hand after an attempt at closed reduction.Résumé Au cours d'une fracture supra condylienne du coude déplacée, les complications vasculaires sont relativement fréquentes. Le traitement, lui aussi, est largement controversé, notamment lorsqu'il existe une absence de pouls radial après la fracture. Entre 1994 et 2006, 66 enfants présentant une fracture supra condylienne du coude ont été traités. 5 présentaient une complication vasculaire avec absence de pouls radial. Chez un des patients, le pouls radial est réapparu après réduction à foyer fermé. Chez les 4 autres patients, il a été nécessaire de faire une réduction sanglante avec exploration vasculaire. 3 des patients avaient une occlusion de l'artère humérale. La thrombectomie a été réalisée avec restauration du pouls radial. Sur un patient, il s'agissait d'une contusion de l'artère brachiale avec spasme et une réapparition du pouls après endar térectomie. L'exploration vasculaire chirurgicale doit être réalisée même si la main se recolore après une réduction à foyer fermé.

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The long-term outcomes of our series support the effectiveness of first generation ACI in both pain relief and functional rehabilitation of patients with large full-thickness osteochondral defects of the knee.

BackgroundTo compare two different techniques of proximal pin placement for the treatment of intertrochanteric fractures in elderly patients utilizing the Orthofix Pertrochanteric Fixator.MethodsSeventy elderly high-risk patients with an average age of 81 years were treated surgically for intertrochanteric fracture, resulting from a low energy trauma. Patients were randomly divided in two groups regarding to the proximal pin placement technique. In Group A the proximal pins were inserted in a convergent way, while in Group B were inserted in parallel.ResultsAll fractures healed uneventfully after a mean time of 98 days. The fixator was well accepted and no patient had significant difficulties while sitting or lying. The mean VAS score was 5.4 in group A and 5.7 in group B. At 12 months after surgery, in group A the average Harris Hip Score and the Palmer and Parker mobility score was 67 and 5.8, respectively. In group B, the average Harris Hip Score and the Palmer and Parker mobility score was 62 and 5.6, respectively. No statistically significant difference was found regarding the functional outcome. The mean radiographic exposure during pin insertion in Group A and Group B was 15 and 6 seconds, respectively. The difference between the two groups, regarding the radiographic exposure, was found to be significant.ConclusionProximal screw placement in a parallel way is simple, with significant less radiation exposure and shorter intraoperative duration. In addition, fixation stability is equal compared to convergent pin placement.