Despite the limited number of patients, we can conclude that good final outcome does not necessarily follow a specific approach.

BackgroundSeveral types of Magnetic resonance imaging (MRI) are commonly used in imaging of femoroacetabular impingement (FAI), however till now there are no clear protocols and recommendations for each type. The aim of this meta-analysis is to detect the accuracy of conventional magnetic resonance imaging (cMRI), direct magnetic resonance arthrography (dMRA) and indirect magnetic resonance arthrography (iMRA) in the diagnosis of chondral and labral lesions in femoroacetabular impingement (FAI).MethodsA literature search was finalized on the 17th of May 2016 to collect all studies identifying the accuracy of cMRI, dMRA and iMRA in diagnosing chondral and labral lesions associated with FAI using surgical results (arthroscopic or open) as a reference test. Pooled sensitivity and specificity with 95% confidence intervals using a random-effects meta-analysis for MRI, dMRA and iMRA were calculated also area under receiver operating characteristic (ROC) curve (AUC) was retrieved whenever possible where AUC is equivocal to diagnostic accuracy.ResultsThe search yielded 192 publications which were reviewed according inclusion and exclusion criteria then 21 studies fulfilled the eligibility criteria for the qualitative analysis with a total number of 828 cases, lastly 12 studies were included in the quantitative meta-analysis.Meta-analysis showed that as regard labral lesions the pooled sensitivity, specificity and AUC for cMRI were 0.864, 0.833 and 0.88 and for dMRA were 0.91, 0.58 and 0.92. While in chondral lesions the pooled sensitivity, specificity and AUC for cMRI were 0.76, 0.72 and 0.75 and for dMRA were 0.75, 0.79 and 0.83, while for iMRA were sensitivity of 0.722 and specificity of 0.917.ConclusionsThe present meta-analysis showed that the diagnostic test accuracy was superior for dMRA when compared with cMRI for detection of labral and chondral lesions.The diagnostic test accuracy was superior for labral lesions when compared with chondral lesions in both cMRI and dMRA. Promising results are obtained concerning iMRA but further studies still needed to fully assess its diagnostic accuracy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1443-2) contains supplementary material, which is available to authorized users.

Seventy children with displaced type II and III supracondylar fractures of the humerus were managed with percutaneous lateral cross-wiring technique from January 2006 to January 2007. There were 54 boys and 16 girls with a mean age of 6.1 +/- 3.07 years. All patients were operated within 24 h after trauma using the Dorgans percutaneous lateral cross-wiring technique. Patients were followed up for a mean period of 6.1 +/- 2.6 months and assessed both radiologically for union; and functionally and cosmetically according to Flynn's criteria. All patients achieved solid union. Functionally, all patients achieved satisfactory results, while cosmetically, 91.4% of patients had satisfactory results and 8.6% had unsatisfactory results. The most frequently occurring complications were minor pin tract infection in six patients, deep infection in two patients, and 32 patients suffered excessive granulation tissue formation mostly around the proximal pin. There was no iatrogenic neurological injury either for the ulnar or for the radial nerves. The obtained results and minor complications reported signify this technique as a viable treatment method for displaced type II and III supracondylar fractures in children.

The purpose of this study was to report a new entity of epiphyseal slipping, which is a slipping of the upper humeral epiphysis in neonates due to birth trauma, and reporting the results of their management. Eight neonates presented with pseudo-paralysis with associated shoulder swelling and pain on passive movements of the upper limb; the radiographs revealed slipping of the proximal humeral epiphyses in six cases and associated shoulder dislocations in the other 2 cases. Failed attempts of closed reduction were done for all cases; they were managed through open reduction of the slipping and relocation of the glenohumeral joint when dislocated. The deltopectoral approach was used for management, and the slipping was fixed with k-wires through the skin. A full painless range of motion of the shoulder was achieved in all patients; no limb-length discrepancy or deformity was detected and no recurrent shoulder dislocation. In the last follow-up, all radiographs showed an anatomic reduction of the epiphyses, and all the epiphyseal plates were open. All cases showed normally growing well-formed epiphyses with no evidence of a vascular necrosis or collapse. A new entity of epiphyseal slipping was reported in this study; slipping of the upper humeral epiphysis in neonates due to birth trauma whether it is associated with shoulder dislocation or not is a benign injury with excellent results with open reduction.

The aim of this work was to evaluate the results of rigid nailing of pediatric femoral shaft fractures inserted antegrade through the tip of the greater trochanter. Twenty-three femoral shaft fractures in 23 children were fixed with rigid interlocking nails inserted through the tip of the greater trochanter at Mansoura Emergency Hospital in the period between June 2009 and August 2011. The average age of the patients at the time of injury was 12.6 years (range 9.2-15 years). The final follow-up radiographs were assessed for evidence of avascular necrosis (AVN) of the femoral head and any deformity of the proximal femur, the neck-shaft angle, the articulotrochanteric distance, and the femoral neck diameter. Patients were followed to a mean period of 31 months (range from 25 to 36 months) postoperatively. All fractures united in a range of 9 weeks (from 8 to 13 weeks) with no limb length discrepancy more than 2 cm and no clinically evident rotation in either direction; no case had a vascular necrosis of the femoral head or significant proximal femoral deformity by the final follow-up. Fixation of fractures of the shaft of the femur in children with rigid interlocking nails inserted through the tip of the greater trochanter is a rigid way for fixation controlling rotation and length. It is a safe technique without causing AVN of the femoral head or proximal femoral deformity.