BackgroundThe current research is a retrospective study that involves the description of a new trochleocapitellar index (TCI), on basis of anteroposterior (AP) radiographs of normal and fractured paediatric elbows. This index may be useful in assessing the alignment of the elbow with a supracondylar fracture.MethodsThe index was evaluated to define its normal and pathological range in children between the ages of 1–13 years. A total of 212 elbows in 141 children were radiographically evaluated. 70 children without fracture elbows were evaluated by radiographs taken at the time of trauma. 35 children with unilateral fractures that healed in a normal alignment were compared to 33 patients that had a mal-union and three patients with bilateral elbow fractures. The patients were radiographically assessed at the time of fracture as well as after fracture healing as part of a routine clinical assessment. Treatment included observation, cast or internal fixation as needed.ResultsThe current study establishes that the normal range of the TCI was 0.25-0.8. The average TCI is 0.45. The lower range correlates with a valgus alignment of the elbow while the higher range indicates a neutral alignment. The TCI in fractured elbows that have healed in a clinically normal alignment is different than the contra-lateral elbow’s TCI. This might indicate a sub-clinical remaining deformity.ConclusionsIn current practice, paediatric patients with elbow trauma, often undergo bilateral radiographs during emergency room visits. The TCI has high negative and positive predictive values and might be superior to direct angle measurement that is currently in use. The use of the TCI measurement is expected to reduce exposure to irradiation in elbow trauma patients as bilateral comparative films appear to be superfluous when this measurement is used.
Trochanteric bursitis is a common cause of musculoskeletal pain and often requires medical intervention and should be distinguished from sciatica and irradiating pain of pelvic and spinal origin. Previously, the etiology of the trochanteric pain syndrome was thought to be caused by inflammation. The current study was performed in order to assess the efficacy of trochanteric injections. Methods: 158 patients were treated for trochanteric bursitis (132 females/26 males, range 22-88 years). 59b were treated with corticosteroid injection, 60 with hyaluronate and 39 were injected using a combination of both. Patients were followed by the HOOS score for a minimum of 12 months. Results: Pre-operative HOOS scores were similar in all groups. Following injection, the HOOS score increased from 27 ± 4 to 66 ± 2 after six months and 77 ± 4 after a year. At 12-month follow-up, the average score of patients treated by corticosteroids injection was 44 ± 7 compared with 62 ± 8 for the hyaluronate injected group and 64 ± 6 for the combination injection group. Discussion: It appears that injection therapy is highly efficacious for treating trochanteric bursitis. The effect of hyaluronate or hyaluronate and steroid combination appears to be longer lasting than that of steroid alone.
Lateral epicondylitis or tennis elbow, is a common elbow malady the extensor carpi radialis brevis origin. It is commonly treated by local injections of steroids are often associated with severe side effects and limited long term efficacy. Recently, hyaluronate is being increasingly used for the treatment of different degenerative processes of joints and soft tissue. Hyaluronate significantly and dose-dependently inhibits cell proliferation and decreased the expression level of mRNA for adhesion-related pro-collagens and cytokines. It is possible that such hyaluronate injections might improve results of injection therapy in tennis elbow syndrome.
BackgroundsAngulations deformity (cubitus varus and valgus) is the most common complication of displaced supracondylar fractures. Most deformity seems to be related to coronal plane angulations [1]. It should also be appreciated that rotation of the distal fragment often worsens varus and valgus angulations [2]. The deformity results from two factors: primary mal-reduction of the fracture and the limited remodelling in the coronal plane [3]. Prevention of angulations depends on the accurate reduction of the fracture. The gold standard in clinical practice, today, is an assessment of reduction quality using Baumann's angle. Baumann's angle formed by the intersection of a line drawn down the humeral axis and a line drawn along the growth plate of the capitellum of the elbow [4]. This angle correlates closely with the carrying angle [5]. The mean Baumann's angle is 72°±4°. The new TCI of the elbow is the ratio between the smaller trochlear and larger capitellar angles of the measured elbow (Figure 1). The rationale is that an index based on the AbstractBackground: In children supracondylar fracture of the humorous is one of the most common fractures in the first decade of life. This study was conducted to establish the efficacy and the accuracy of a new own method for measuring the Trochleocapitellar index (TCI) in the management of supracondylar humeral fracture in children versus Baumann's angle. Methods: This study made on base AP elbow radiograms and clinical charts of 54 children that were treated due to supracondylar fracture of the elbow. Cases included were of either gender with age range from four to 13 years with a supracondylar fracture presenting within 72 hours of the reduction. Outcome measures: Two measure roentgen logic modalities studied for comparison: Baumann's angle and TCI were taken into consideration when examining the AP roentgenograms (immediately after the reduction and during 1-3 months thereafter). Results: During 1-3 months after the reduction Baumann's angle modality gave normal results in 51 (94.4%), valgus result in one (1.9%) and varus result in two (3.7%) patients. While TCI showed normal results in 31 (57.4%), valgus result in one (1.9%) and varus results in 22 (40.7%) patients. Correlation was found between the measurements of the normal Baumann's angle and normal TCI immediately after fracture reduction (r=0.75, p<0.001) and on the period between one to three months follow-up (r=0.54, p<0.001). TCI was found as more accurate for detection of cubitus varus. Conclusions: Authors recommends post reduction measurement of the TCI in supracondylar fractures to determine the adequacy of reduction.
Bell's palsy (BP) is the one of the most common causes of facial nerve neuropathy cause facial paralysis. Etiology of the BP is not known. Diagnosis made according to anamnestic data and clinical examination. Other pathology as CVA, Lyme disease, viral infection, brain tumors must be excluded. A degree of nerve damage graduate according to modified House-Brackmann score. Corticosteroids, antiviral therapy, symptomatic treatment, physiotherapy, alternative medicine and surgical intervention, in some severe cases with residual palsy, are the treatments of choice. About 70% of patients had a full recovery and in some cases without any treatment. However, 30% had residual damage to the facial nerve, and functional disability and 12% have a recurrence. In the article, authors present new treatment modality known as Pulsed Signal Therapy (PST®) that was applied as management for severe pain around the ear of the affected side and surprisingly cased for full recovery of two patients with BP between two to six weeks after treatment.
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