Background. Supracondylar fractures are the commonest elbow injury in
children. Most displaced supracondylar fractures are manipulated and
held with a medial/lateral entry or two lateral Kirschner wires.
This clinical study has results purely from a three lateral divergent
wire technique. Methods. Displaced supracondylar fractures were
manipulated closed and three lateral divergent wires inserted. Primary
study end points were range of movement and carrying angle relative to
the contralateral uninjured elbow (Flynn's grading system) and
presence of iatrogenic nerve or vessel injury. Results. 25 children
between 3 and 10 years (median 5, range 3–10) suffered a displaced
fracture (15 type III, 10 type IIB). 15 left-, 10 right-sided
fractures, 14 boys and 11 girls). 23 were fixed primarily, of these 21
in the first 24 hours. 2 were delayed due to swelling. 2 were fixed
secondarily with lateral k-wires after loss of position (from a
primarily fixed crossed wire technique). One radial and one median
nerve palsy sustained at injury settled. No iatrogenic nerve injuries
occurred. 21 Excellent, 3 good and 1 poor result on Flynn's grading.
Conclusions. The use of three wires on the lateral side in this cohort
showed no evidence of slip in fracture position and no iatrogenic
nerve injury.
Previous descriptions of the pattern of communication between the digital flexor tendon sheaths have been largely based on imaging studies. An anatomic study on 12 cadaveric hands was conducted using water soluble dye and directly observed patterns of communication between the digital flexor tendon sheaths and the radial and ulnar bursae. Four out of twelve specimens (33%) demonstrated a communication between the radial and ulnar bursae. The ulnar bursa communicated with the ring finger flexor sheath in two specimens, and the index finger flexor sheath in two specimens. One hand (8.3%) showed communication between the middle finger tendon sheath and radial bursa and between the index finger flexor tendon sheath and radial bursa. These findings show a considerable level of variation in communicating patterns between the synovial sheaths of the hand and wrist. Clinicians should be aware of the possibility of variations to the classical presentation of spread of infection through the digital flexor sheaths.
Background
The mechanism of injury (MoI) for a patellar dislocation has not been fully established. The aim of this study was to use systematic video analysis to determine the MoI of a patella dislocation.
Methods
A systematic search was conducted of three video sharing websites and three popular search engines to identify videos demonstrating a patellar dislocation. Videos were reviewed by three surgeons trained in systematic video analysis, who commented on the position of the lower limb and the situation in which the injury occurred. The results were reviewed to build a consensus of the MoI for each video. Statistical analysis was conducted for interobserver agreement (p < 0.05).
Results
Initial search yielded 603 videos with 13 meeting the inclusion criteria. The injuries were sustained performing a sporting activity (n = 9) or whilst dancing (n = 4). The injury was predominantly sustained during a non-contact situation (n = 10). The most common mechanism was an unbalanced individual with a flexed hip sustaining a valgus force to their flexed knee with the tibia externally rotated.
Conclusions
This study provides some insight into the MoI for a patellar dislocation and the findings may assist in developing injury prevention programmes and rehabilitation protocols as well as guiding future research.
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