ObjectiveBicycle spoke wheel injuries can be as simple as minor abrasions and lacerations even to amputation of toes and heel injuries. The purpose of this study was to assess the severity of soft tissue damage and skeletal injuries in such injuries. MethodsThis prospective observational study included all the cases with spoke wheel injuries presenting ResultsA total of 50 cases were included in the study with 29 males ( 58%) and 21 females (42% ). Their age ranged from 6 yrs to 12 yrs (mean 9 yrs.). The mean interval from injury to presentation in hospital was 5 hrs (range 1-22 hrs). Majority had injury to right ankle and foot. Fore foot and mid foot injuries were more common when the feet got entrapped in front wheel. 36 cases had sustained injury while riding as pillion on the back seat and their injury was on posterior ankle (n=20) and posterolateral aspect of ankle and foot (n=16). Majority of cases were of grade 0 and 1 injury. Two patients had grade 3 injury, one with great toe amputation another with partial heel avulsion and exposed tendoachilles. All cases were managed with wound care, tetanus prophylaxis and splintage of the foot. ConclusionIn our study we found that these spoke wheel related injuries were more common in children and are important cause of temporary loss of daily activities. Although all injuries healed properly, risk of severe injuries like amputations and heel pad loss and tendoachilles transaction and fractures of foot and ankle still prevails where bicycle is a common mode of transportation.
Supracondylar fracture is common fracture in children and choice of treatment in displaced fracture is closed reduction and percutaneous pinning. There are different methods of fixation techniques described and practiced. This study was undertaken to evaluate the results of lateral pin fixation for the displaced supracondylar fracture of humerus in children. 25 children with displaced Supracondylar fracture were treated with closed reduction and percutaneous lateral fixation by two K-wires. Above elbow slab applied for 4 weeks (mean 28.4 days ± SD 2.27) followed by physiotherapy and were followed for mean of 73.24 days( ± SD 3.66 days). The Flynn’s grading system was used to evaluate functional and cosmetic outcome. Loss in Baumann’s angle was measures. All the patient had satisfactory outcome with excellent to good grading as per Flynn’s criteria. The mean Baumann’s angle loss was 5.52 degrees(SD ± 1.75). Two pin tract infections noted which responded to oral cloxacillin for 5 days. No neurovascular or serious complication noted. In view of results obtained, lateral K -wire fixation provided good fracture stability, good union and satisfactory outcome with minimal complication and virtually no iatrogenic nerve injury. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 13-17 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6820
ObjectiveTo study the epidemiology of fractures in the pediatric population. MethodsAll the cases of fractures of age 14 yrs or less presenting in emergency room or outdoor patient department of Orthopaedics during the time period of January 2013 to December 2013 were included in the study and prospectively studied. Demographic data were collected and analysed by descriptive methods. ResultsThe incidence of fracture was more in male child. Most fractures occurred in age group of 6 to 14 years. Lower limb fractures (56.8%) were more common than upper limb fractures. Incidence of injuries was more during summer most common mode of trauma being motor vehicle accidents (26%). ConclusionProper supervision and guidance during outdoor activities, on the play ground and proper home safety measures with improved road conditions and proper traffic knowledge can markedly reduce the incidence of pediatric trauma.
Tethering of the spinal cord in the lumbosacral region with myelomeningocele is a well-known phenomenon. Only sporadic cases of tethering along the rest of the neuraxis, including the hindbrain, cervical, and thoracic spinal cord have been documented, always along with some associated congenital malformations (hydrocephalus, Chiari malformation, myelomeningocele, meningocele, hamartomatous stalk, spina bifida occulta, intramedullary lipoma, intradural fibrous adhesions, the fusion of the sixth and seventh cervical vertebrae, split cord malformation, or low-lying cord). In this report, 14-year-old male developed symptoms related to tethering of the cervical spinal cord, but without any associated congenital malformations, that is the pure tethered cervical cord. This causes his moribund status and makes the manuscript unique and contributes to the hitherto literature. The authors discuss the diagnosis, treatment, and postoperative course of this entity. The uniqueness in treatment is that we have operated the case without the help of intraoperative somatosensory evoked potentials and motor evoked potential from posterolateral approach under local anesthesia.
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