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Register a new userComparsion Outcomes of Intramedullary Nailing Versus Conservative Treatment For Closed Shifting Isolated Fractures of The Middle Third Both Bones of Forearm in Children (9-14) Year Old
مقارنة نتائج العلاج المحافظ و العلاج الجراحي بالاسياخ المرنة عبر النقي لكسور الثلث المتوسط لعظمي الساعد المغلقة المتبدلة المعزولة عند الأطفال بين (9-14) سنة
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Tishreen University ورقة بحثية
Publication date
2018
fields
Medicine
and research's language is
العربية
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Shamra Editor
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المعلومات المرجعية: تمتلك العضوية عند الأطفال امكانية كبيرة للمعاوضة و القدرة على تصحيح أنواع التبدل التي يمكن أن تطرأ على الكسور، و هناك طرق مختلفة لتدبير هذه الكسور يمكن تصنيفها تحت عنوانين أساسيين: العلاج الجراحي , العلاج المحافظ الهدف: مقارنة النتائج الوظيفية و الاختلاطات بين طريقتي العلاج المحافظ و العلاج الجراحي باستخدام الاسياخ المرنة عبر النقي لكسور الثلث المتوسط لعظمي الساعد المغلقة المعزولة و مقارنة النتائج مع الدراسات المحلية و العالمية. و ذلك لاختيار الطريقة العلاجية الأمثل التي تحقق الاندمال بأسرع وقت ممكن و العودة للمدرسة و بأقل نسبة من الاختلاطات. الطرائق: شملت الدراسة 40 طفل ،15 طفل تم علاجهم بشكل محافظ (رد مغلق تحت التركين و بمساعدة جهاز التنظير القوسي)، و 25 طفل تم علاجهم بشكل جراحي (التثبيت بأسياخ مرنة -ميتازو- عبر النقي) تم تسجيل كافة المعلومات ضمن استمارة خاصة بكل مريض تشمل : 1- الاسم– العمر–العنوان – الهاتف -الجنس 2- جهة الإصابة 3- آلية الإصابة 4- شكل خط الكسر(تصنيفه) 5- الأذيات المرافقة (الغير عظمية) 6- طريقة العلاج المتبعة 7-المتابعات الشعاعية و السريرية حتى تحقيق الاندمال 8-المضاعفات و زمن العودة الى المدرسة و الكلفة الاقتصادية. النتائج: كانت النتائج متقاربة من حيث الاندمال و زمن العودة الى الحياة اليومية كان اقصر في العلاج الجراحي، و الكلفة الاقتصادية متقاربة و مدة البقاء في المشفى ايضا متقاربة, و كانت الاختلاطات موجودة في الحالتين لكنها لم تكن ذات تأثير على الطفل أو الطرف او الساعد و حركته ماعدا حالة واحدة في العلاج المحافظ التي استدعت تداخل جراحي لاحق.
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 treatment. 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.
References used
CANALE, S.T. AND BEATY, J.H., Campbell's Operative Orthopaedics: Adult Spine Surgery E-Book. Elsevier Health Sciences2.Rockwood-Ch17-forearm-midShaft- Fractures, 2012
RANG, M., PRING, M.E. WENGER, D.R., Rang's children's fractures. Lippincott Williams & Wilkins. 2005
MCCARTHY, J., Master Techniques in Orthopaedic Surgery: Pediatrics. JAMA, 301(22), 2009.2391-2394
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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 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.
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 .
The research aims to make a statistical approach to the cases of esophageal atresia by
its types and incidence, and to study the surgical treatment outcome and choose the best
method of treatment and follow up.
The study included 27 newborn patien
ts admitted in the Neonatal Intensive Care Unit
at Al-Assad University Hospital and Tishreen University Hospital in Lattakia, due to
diagnosis of esophageal atresia or tracheoesophageal fistula, from the beginning of January
2010 until the end of 2015. 14 of patients were males and 13 were females. Gross
classification of esophageal atresia was used, type (C) was found in 21 cases, type (A) was
found in 4 cases, type (E) was found in 2 cases, while type (B) and (D) were not seen. We
studied The clinical symptoms in newborn patients with this malformation, radial and
laboratory findings and associated malformations. We used esophageal contrast study
insure the diagnosis when needed. With type (C), we did primary anastomosis in 20 cases
and cervical esophagostomy with gastrostomy in only 1 case. With type (A), we did
esophagostomy with gastrostomy in all cases. With type (E), we closed the fistula with
cervical approach in all cases. The survival rate was 70.4%. Spitz classification was used
for risk assessment. The incidence of complications included anastomotic leakage 30% and
anastomotic stricture 69.2%.
The study included 37 cases of fractures of one or both isolated malleoluer in adult patients whose attended al-Assad University Hospital in Lattakia between 2011 and 2014. Patients' ages ranged between 20 and 75 years, the ratio of males was 54 % .
Greatest range of injury in ages from 30 to 39 years old (27%) . The largest ratio of the mechanism of injury while was walking (56.8%), followed by traffic accidents (29.7%) and during sports (13.5%). Ratio of isolated malleoluer fractures is like the isolated medial malleolus (35.1%), and the isolated lateral malleolus is (29.8%). Surgically treated 25 cases (67.6%), while 12 cases were treated conservatively (32.4%). The functional results in males were better than in females, and in the younger ages were better than the older ages. The best results were in the surgical treatment by (51.3%), especially the isolated malleoluer fractures (21.6%), the best results for patients treated conservatively were in the treatment of isolated medial malleolus fracture (8.1%), while the worst results were in the isolated lateral malleolus (5.4%).
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 .
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