Background: Supracondylar fractures of the humerus are among the most common type of pediatric fractures. The outcome of severely displaced supracondylar fracture of the humerus in children subjected to wide controversies in term of safety, functional and cosmetic outcome. Closed reduction and percutaneous pinning is now considered as the gold standard rule, but open reduction still applicable in certain cases where intraoperative imaging is not available, in comminuted lateral column fractures and uneducable fractures. Aim of the Study: To compare the outcome (functional and cosmetic) of anterior (Henry) approach with the posterior (Campbell) approach used in two groups of patients' sustained displaced supracondylar fractures. Patients and Methods: This prospective study was performed on 48 pediatric patients who were been admitted to the Emergency Hospital in Sulaimani province sustained displaced supracondylar humeral fractures and treated during the period from the first of October 2009 to the thirty-one of January 2011. The study included 28 boys, 20 girls; their mean age was 7.5 years; their ages range 2-13 years. We used the modified Gartland classification to assess the fractures displacement and only Gartland type II B and III were included and managed operatively by open reduction and internal fixation with 2 crossed K-wires. Follow up continued for 6 months and the results finally assessed using Flynn's criteria. Results: According to the criteria of Flynn et al., 20 patients (83.3%) treated by the anterior approach had excellent functional results while 4 patients (16.7%) had good functional results. While those treated by the posterior approach, 16 patients (66.6%) had excellent functional results, 6 patients (25%) had good results and 2 (8.3%) patients had fair outcome. Cosmetic results were excellent in 22 patients in the anterior approach group and 20 patients in the posterior approach group. Conclusion: Posterior Campbell approach is simpler than anterior Henry approach, but it creates additional soft tissue damage that can affect the circulatory status and R. M. N. Fatah et al. 114 hence possible osteonecrosis of the trochlea and a higher percentage of limitation in joint mobility. While the anterior approach is technically more demanding, but it gives better functional results.
Introduction. Giant cell tumor of the tendon sheath (GCT-TS) is a benign tumor which most commonly affects hand tendons but rarely affects the large joints. GCT-TS usually occurs in individuals between the ages of 30 and 50 years, with a predominance for females, and exhibits the tendency for local recurrence following surgical resection. Marginal excision is the standard treatment of GCT-TS. Case presentation. The case studied is a 51-year-old female with a one-year history of gradual onset of pain in the left knee. She denied any history of trauma. The pain was worse at night and during walking and she was on regular pain medication. She was referred as a case of osteoarthritis not responding to conservative treatment. The purpose of this report is to emphasize the possibility of other pathologies whenever the pain is not responding to usual conservative treatment even in the presence of radiological features. Discussion. GCT-TS in large joints may be more difficult to diagnose, as there are few and nonspecific symptoms. GCT-TS most frequently occurs in the digits of the hands and feet and is rarely seen in the larger joints. Although GCT-TS is a benign tumor, it has a high incidence of recurrence following resection (10-40%), Conclusion. Giant cell tumor of the suprapatellar region is unusual especially when accompanied by pain presentation in a patient who is diagnosed as another case of osteoarthritis. Careful surgical excision is effective in preventing recurrence despite relatively high recurrence rates.
Introduction. AHydatid disease of the bone is a rare presentation of hydatid disease since it accounts for 4% of the infection rate, which mostly involve the lungs and liver, the human being is infected with contaminated food that contain eggs and it represent the intermediate stage of the disease transmission. Case presentation. A 55 years old male who was a known case of hydatid disease of the tibia and distal femur presented with gradual onset of right hip pain which made him bed ridden, serological test proved the infection, MRI showed heavy infection of the proximal femur. Discussion. Bone involvement is very slow process owing to the compact nature, the parasites replaces the hard tissue of the bone and eventually breaches the outer cortex and spread to the soft tissue around the bone, multiple bone involvement is rare, since there are few reports of coincedence existence of pelvis and proximal femur. Skeletal hydatid disease is notorious for its high recurrence rate especially when it involve the coxofemoral and pelvic region, so it is wise to offer radical treatment from the start in a way similar to bone tumors with adjuvant chemotherapy and radiotherapy, however extensive surgeries in this region carries a high risk of complications. Conclusion. Multiple bony hydatid cyst involvement with pathological fracture is a rare presentation in the lower limb, the importance of early diagnosis is paramount to avoid major complication especially in the coxal region of the femur, skeletal survey is an important step to avoid missing skip lesions.
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