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Register a new userEarly complications of Surgical treatment of Supracondylar Humeral Fracturesin Children and management
المضاعفات الباكرة للعلاج الجراحي لكسور فوق اللقمتين العضديتين عند الأطفال و طرق تدبيرها
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Tishreen University ورقة بحثية
Publication date
2015
fields
Medicine
and research's language is
العربية
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Shamra Editor
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شملت الدراسة 40 حالة كسر فوق لقمتين عضديتين عند الأطفال ممن راجعوا مشفى الأسد الجامعي في اللاذقية بين عامي 2013-2014. تراوحت أعمار المرضى بين 2-13 سنة, و نسبة الذكور للإناث كانت 3,4/1 . اليد اليسرى هي الأكثر اصابة بنسبة 77,5%. استخدمنا طريقة الرد المغلق و الأسياخ عبر الجلد عند 33 مريض و الرد الجراحي مع أسياخ متصالبة عند 7 مرضى. حدثت الاختلاطات بعد العمل الجراحي عند 7 مرضى بنسبة 17,5% منها 5 اصابات عصبية و حالة واحد لإنتان سطحي حول الأسياخ و حالة واحد لتأخر اندمال, و تم شفاء كلالحالات دون عقابيل. النتائج الوظيفية بعد 5 أشهرمن العلاج الفيزيائي مرضية عند 97% من المرضى المعالجين بالأسياخ عبر الجلد, و عند 71,4% من المرضى المعالجين بالرد الجراحي .
The study included 40 cases of supracondylar humeral fracture in children whose attended al-Assad University Hospital in Lattakia between 2013 and 2014. Patients' ages ranged between 2 and 13 years , the ratio of males/female was 3,4/1. Greatest range of injury in left arm 77,5% . Closed reduction and percutaneous pinning was used in 33 patients and open reduction with cross-wiring in 7 patients .Postoperative complications occurred in seven(17,5%) patients. They consisted in iatrogenic nerve injuries in five (12,5%) patients ,one case of infection around the pins ,and one case of nonunion, All recovered without sequels. Satisfactory outcomes were noted after 5 months of physical therapy in 32 (97%) patients in the percutaneous pinning group,and5 (71,4%) patients in the open reduction with cross-wiring group .
References used
Aitken,A.T.Fractures of the epiphysis .1 St , ClinOrthopRelat Res ,New York, 1965,22
Farnsworth ,C.L; Silva, P.D; Mubarak, S.J. Etiology of supracondylar humerus fractures. PediatrOrthop USA,J.1, 1998,38-42
Nork, S.E;Hennrikus, W.L;Loncarich, D.P .Relationship between ligamentous laxity and the site of upper extremity fractures in children: extension supracondylar fracture versus distal forearm fracture. PediatrOrthop Berlin,J.2, 1999,90-92
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The fixation of the humeral,s supracondylare fractures in children by percutaneous pinning is considered a new and good principle in without the disadvantages that appear by treating it by open reduction and internal fixation . A prespective and pers
pective study was done for 48 kids whose old was between 2 – 14 year, those kids were admitted and treated surgically by these two methods ( pinning and ORIF ) In AL-ASSAD hospital in LATTAKIA in TISHREEN-UNIVERSITY in 2014 The ages of patients were between 2 – 14 , female ratio was ( 62.5% ) and male ( 37.5% ) the common reasons for these fractures were sportive and home accidents and the dominant upper limb was left . Fractures were isolate in 90% of cases and we noted 4 cases with accompanied and nondisplaced fractures in forearm and wrist that were treated conservatively . Pins and cast were removed in the four weeks . The more common complications were the secondary displacement , movement limitation and cubitus varus. The percutaneous pinning stills an easy way in understanding and application and gives good results for long period functionally and cosmetically , and this way has no important complications which can be avoided .
Introduction: Ileus commonly occurs after abdominal surgery, and is associated
with complications and increased length of hospital stay. Post-operative ileus (POI) is an
important reason for remaining patients not permit oral (NPO) in post-operativ
e period.
The tradition was that when patients passed flatus, they were ready to consume a liquid
diet, and then a solid food diet was gradually introduced. This approach was taken to avoid
aspiration, gastric and intestinal distension, and anastomotic dehiscence. Although studies
demonstrated that the conventional strict feeding regimens were not necessary, many
surgeons still hesitated to allow early oral feeding. There has been concern that early oral
intake would result in vomiting and severe paralytic ileus with subsequent aspiration
pneumonia, wound dehiscence and anastomotic leakage. This belief has become surgical
dogma, unsupported by scientific evidence. Aim: to investigates the effect of early oral
postoperative carbohydrates feeding on postoperative outcome. Material and
methods: forty abdominal surgery patients were randomly assigned to early oral
postoperative feeding group (20) or traditional feeding group (20). In the early feeding
group (study group), patients were initially started on clear fluid only 16 h after surgery
and progressed to liquids (after 24 h) and then soft and regular diet in next day (after 48 h).
In the post-operative period, the patients were visited each 12 h and clinical signs and
symptoms such as, time of passed flatus and moved their bowels, nausea and vomiting, and
the length hospital stay were assessed. Conclusions: This study showed that early oral
postoperative carbohydrates feeding group passed flatus and moved their bowels much
sooner than the control group thus reducing the duration of POI and hospital stay, but there
is no increase in occurrence of of nausea and vomiting between tow groups.
The Research has been made on (73) patients for whom a surgical operation was
made on the thyroid in Al-Assad University Hospital in Lattakia in 2000-2007. The study
was divided into: retrospective (32patients), prospective (41patients) and (11) pa
tients of
were subjected to second operation due to existence of a malignant cancer with a
percentage of (16,66%) .
The Total Thyroidectomy on both side was the most spread intervention with a
percentage of (57,14%) and next to it was the thyroid lobectomy with a percentage of
(28,79%).
The percentage of Total Early complication is (11,9%) and the Tetania was the most
repeated complication with a percentage of (3,57%) and next to it was the Recurrent
laryngeal nerve ,the Superior laryngeal nerve and the bleeding with a percentage of
(2,38%)for each . The higher percentage of complication has occurred in the starting
operation of the Total Thyroidectomy and next to it the Thyroid lobectomy .
The surgery of the Relapsed Thyroid is subject to more dangerous complications
from the starting intervention .
Background& Objective: the early surgical intervention for neurological caludication cases which are often caused by severe degenerative lumbar canal stenosis gives excellent results especially on near term.
To confirm that early surgical interventi
on, early timing for severe lumbar canal stenosis which caused signs and symptoms of neurological claudication, can yield excellent functional and motor results for patient and it returns thim to good life activity.
Materials & Methods: This study was done retrospectively for neurological caludication cases in elderly patients admitted to neurosurgery department at Al-assad university hospital in the period between 2007– 2010 year. (53) Patients underwent posterior laminectomy, with or without vertebral fixation
accompanied.
Results: The direct improvement of the surgery was 75 % for neurological claudication and 79% after one year of surgery. Radical pain accompanied with neurological clauication improved fully in 66 % directly after surgery, up 75 % after one year. The sensory symptoms were low grade improvement, which was about 56% partial improvement directly after surgery and fully in 34%up to 28% – 66%after one year of surgery. The complications were few and mild in (11 %).
Conclusion: Early surgical intervention to all cases of neurological claudication especially in the elderly
gives magnificent results (motor & sensory) with good functional activity improvement in comparison to
conservative therapy.
Closed reduction and percutaneous pin fixation is considered
standard management for displaced supracondylar fractures of the
humerus in children. However, controversy exists regarding whether
to use pins from the lateral side or medial and latera
l side of the
elbow for fixation .
We performed this research to know the results of two ways of
treatment and to compare : 1- the risk of iatrogenic ulnar nerve
injury caused by pin fixation . 2- quality of fracture reduction in
terms of radiographic outcomes . 3- compare function of the elbow
and other surgical complications caused by pin fixation between two
ways.
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