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Comparison the treatment between lateral pins and medial and lateral (crossed) pins for fixation of displaced supracondylar fractures of humerus in children after closed reduction

مقارنة بين العلاج بالأسياخ من الجهة الوحشية و الأسياخ من الجهتين ( المتقاطعة ) لتثبيت كسور فوق لقمتي العضد المتبدلة عند الأطفال بعد الرد المغلق لها

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 Publication date 2016
and research's language is العربية
 Created by Shamra Editor




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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 lateral 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.

References used
ABRAHAM E, GORDON A, ABDUL-HADI O,2005-: Management of supracondylar fractures of humerus with condylar involvement in children. J Pediatr Orthop, New York, 3. 75-101
AITKEN AP , SMITH L , BLACKETT CW,2007- Supracondylar fractures in children. Am J Surg, Northern Ireland, 5.27-35
ALBURGER PD,WEIDNER PL,1992- Supracondylar fractures of the humerus in children. J Pediatr Orthop, North Carolina, 6.103- 151

Artificial intelligence review:
Research summary
تتناول هذه الدراسة مقارنة بين طريقتين لتثبيت كسور فوق لقمتي العضد المتبدلة عند الأطفال باستخدام أسياخ كيرشنر عبر الجلد بعد الرد المغلق. الطريقة الأولى تعتمد على تثبيت الأسياخ من الجهة الوحشية فقط، بينما الطريقة الثانية تستخدم الأسياخ من الجهتين الأنسية والوحشية (المتقاطعة). شملت الدراسة 100 طفل تتراوح أعمارهم بين 3 و13 عامًا، وتمت متابعتهم لمدة 6 أشهر. هدفت الدراسة إلى مقارنة خطر أذية العصب الزندي، جودة الرد الشعاعي، والوظيفة والاختلاطات الجراحية بين الطريقتين. أظهرت النتائج عدم وجود اختلاف إحصائي مهم في النتائج الشعاعية أو الوظيفية أو الاختلاطات الجراحية الأخرى بين الطريقتين. ومع ذلك، تبين أن استخدام الأسياخ المتقاطعة يزيد من خطر أذية العصب الزندي. بناءً على هذه النتائج، توصي الدراسة باستخدام طريقة الأسياخ الوحشية لتثبيت كسور فوق لقمتي العضد عند الأطفال لتقليل خطر أذية العصب الزندي.
Critical review
دراسة نقدية: على الرغم من أن الدراسة تقدم مقارنة شاملة بين الطريقتين وتستند إلى بيانات إحصائية دقيقة، إلا أن هناك بعض النقاط التي يمكن تحسينها. أولاً، كان من المفيد تضمين مجموعة تحكم لمقارنة النتائج بشكل أفضل. ثانيًا، لم يتم التطرق إلى العوامل النفسية والاجتماعية التي قد تؤثر على تعافي الأطفال، مثل الدعم الأسري والمجتمعي. ثالثًا، يمكن أن تكون فترة المتابعة لمدة 6 أشهر غير كافية لتقييم النتائج الطويلة الأمد والتأكد من عدم حدوث مضاعفات مستقبلية. وأخيرًا، كان من الممكن أن تكون الدراسة أكثر شمولية إذا تم تضمين عدد أكبر من الأطفال من مختلف المناطق الجغرافية لتعميم النتائج بشكل أفضل.
Questions related to the research
  1. ما هي الطريقتان المستخدمتان في تثبيت كسور فوق لقمتي العضد المتبدلة عند الأطفال؟

    الطريقة الأولى تعتمد على تثبيت الأسياخ من الجهة الوحشية فقط، بينما الطريقة الثانية تستخدم الأسياخ من الجهتين الأنسية والوحشية (المتقاطعة).

  2. ما هو الهدف الرئيسي من هذه الدراسة؟

    الهدف الرئيسي هو مقارنة خطر أذية العصب الزندي، جودة الرد الشعاعي، والوظيفة والاختلاطات الجراحية بين الطريقتين.

  3. ما هي النتائج الرئيسية التي توصلت إليها الدراسة؟

    أظهرت الدراسة عدم وجود اختلاف إحصائي مهم في النتائج الشعاعية أو الوظيفية أو الاختلاطات الجراحية الأخرى بين الطريقتين، ولكن استخدام الأسياخ المتقاطعة يزيد من خطر أذية العصب الزندي.

  4. ما هي التوصيات التي قدمتها الدراسة بناءً على النتائج؟

    توصي الدراسة باستخدام طريقة الأسياخ الوحشية لتثبيت كسور فوق لقمتي العضد عند الأطفال لتقليل خطر أذية العصب الزندي.

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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 .
Background: Kid's body has major ability for remodeling and correcting all of displacement that could happened on fractures.There is many ways for treatment of these fracture,we can put them in tow guidelines: Surgical treatment, conservative trea tment. Aim: Comparison between conservative treatment result and result of surgical treatment via ESIN in treatment of midshaft forearm fractures in children, and chose the best method that achieve healing in fast time and with less complications. Methods: the study included 40 kids ,that have been chosen in random way from children that came to the ER and clinics in Alassad and Tishreen university hospitals in time between 2012 and 2017,with age of 9 to 14 years. Results: The results were similar between conservative treatment and surgical treatment via esin according to healing ,time at hospital ,and costs .time to return to daily life is shorter in surgical treatment. complications were found in two methods but there were no effect on the extremity or the child.
IMF serves as a cornerstone during surgeries related to reconstruction orthognathic and facial trauma surgery. Successful treatment of mandibular fractures depends on reduction and restoration of normal occlusion and immobilization. So this study attempts to evaluate dental root damage through intermaxillary fixation with pre-drilled bone screws in the management of non-displacement or mini-displacement mandibular fractures. Complications were observed clinically and radiologically to evaluate the damage and loss vital to the adjacent tooth root. Data were subjected to statistical analysis using Chi Square Test. P-Value<0.05 was considered significant .This study found out that the intermaxillary fixation screws proved to be a safe technique to the intermaxillary fixation; however, it is not without complications or potential consequences which the surgeon must be aware of in order to provide safe and effective treatment.
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 ra nge 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 .
This study was done to determine whether use of nebulized salbutamol therapy for treatment of an acute attack of asthma in children is associated with hypokalaemia and if so what is its frequency, severity and what is accompanying clinical symptoms 103 child, aged 3 years to 14 years with asthma attack, treated with three doses of nebulized salbutamol 0.15mg/kg, every 20 min participated in the study. Blood for serum potassium was obtained at the beginning and after three doses of nebulized salbutamol therapy.The mean serum potassium level decreased from 3.94 mEq/L to 3.28 mEq/L (P < 0.05). A decrease in serum potassium concentration was noted in 93 child (90.3%).). Mild hypokalemia formed the highest proportion in 43child (41.7%) followed by moderate hypokalemia in 28 child( 27.2%). Severe hypokalemia did not happen.This decrease was accompanied with clinical symptoms (palpitations 23,muscle weakness 21,nausea 15, headache 12,myalgia 11,vomiting 9).These symptoms were moreclosely to moderate hypokalemia.
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