Delayed fixation of displaced type II and III pediatric femoral neck fractures

Background:

Time from injury to fixation of femoral neck fractures has been postulated as a vital determinant for rate of complications; however, no prospective study is available in the English literature. Delay, unfortunately, is inevitable in developing countries. The aim of the present study is to retrospectively review the outcome after delayed fixation of displaced type II and III femoral neck fractures in children.

Materials and Methods:

Using a standard assessment chart, we retrospectively reviewed medical records of all pediatric patients having femoral neck fractures presenting to our institution from June 1999 to May 2006. Inclusion criteria were children between 5 and 15 years of age sustaining displaced Delbet type II and III femoral neck fractures having a complete follow-up of at least 2 years. Patients with known metabolic disease, poliomyelitis or cerebral palsy, were excluded from the study. After application of inclusion and exclusion criteria, 22 patients having 22 fractures (13 type II and 9 type III) were studied. Surgery could be performed after a mean delay of 11.22 days (ranging from 2 to 21 days). Closed reduction was achieved in 14 cases and 8 cases required open reduction through anterolateral approach.

Result:

Osteonecrosis was noted in eight patients (36.37%) who included two of nine patients (22.22%) operated in the first week, three of eight patients (37.51%) operated in the second week, and three of five patients (60%) operated in the third week of injury. Nonunion was seen in four (18.18%) cases, and two of them were associated with failure of implants. One was treated by valgus osteotomy and the other by Meyer''s procedure. Fractures united in both children but the latter developed avascular necrosis. Functional results, as assessed using Ratliff''s criteria, were good in 14 (63.63%), fair in 2 (9%), and poor in 6 (27.27%) patients.

Conclusion:

Delay in fixation, type of fracture, and ability to achieve and maintain reduction are factors primarily responsible for the outcome. We also found that delay after the first week further adversely affects the outcome.     

Pneumosinus dilatans and multiplex: report of three rare cases and review of the literature

Pneumosinus dilatans is a term used to describe a localized abnormal dilatation of one or more paranasal sinuses without radiological evidence of localized bone destruction, hyperostosis or mucous membrane thickening. The involvement of all paranasal sinuses and mastoid air cells has been named pneumosinus dilatans multiplex. Although the involvement of one or more paranasal sinuses has been reported widely, all paranasal sinuses and the concomitant involvement of mastoid air cells has been reported in only one case. Herein, we present three unusual cases of pneumosinus dilatans (one is a second case of pneumosinus dilatans multiplex in English literature, another is the first reported case of a frontal pneumosinus dilatans case associated with frontoethmoidal meningocele, mental retardation and facial asymmetry and the third one is pneumosinus dilatans with a huge arachnoid cyst) along with the review of relevant literature.     

Comparison of ultrasonographic and anthropometric methods to assess body fat in childhood obesity

BACKGROUND: Pattern of fat distribution rather than obesity is of importance for cardiovascular morbidity and mortality. The accurate measurement of total and regional fat mass requires sophisticated and often expensive methods that have limited applicability in the clinical setting. OBJECTIVE: The aim of this study is to evaluate body fat distributions by ultrasound (US) as a gold standard method for measuring visceral, preperitoneal and subcutaneous fat layers and comparing with anthropometric results, and then to find the most reliable anthropometric measurement in childhood obesity. MATERIALS AND METHODS: Study group of 51 obese children (21 F, 30 M) (mean age+/-s.d.: 11.5+/-2.6 years) and control group of 33 non-obese children (17 F, 16 M) (mean age+/-s.d.: 12.2+/-2.7 years) were recruited for this study. Anthropometric measurements as body mass index (BMI), waist circumference (WC), waist/hip ratio (WHR), triceps and subscapular skinfold thicknesses were taken from all the participants. Abdominal preperitoneal (P), subcutaneous (S) fat at their maximum (max) and minimum (min) thickness sites, visceral (V), triceps (TrUS) and subscapular (SsUS) fat thicknesses were also measured ultrasonographically. RESULTS: In the obese group, BMI was significantly correlated with US measurements of fat thicknesses, except Pmin and SsUS, whereas in the control group, BMI was significantly correlated with all US fat measurements. The relation of US measurements with skinfold thickness and WC was more significant in the control than in the obese group. No relation between WHR and US fat thickness measurements was found in both groups. Multiple regression analysis, using V as the dependent variable and anthropometric parameters, gender and the group as the independent variables, revealed BMI was the best single predictor of V (R(2): 0.53). CONCLUSION: This study suggests that the validity of the anthropometric skinfold thickness in the obese children is low. Despite the limitations reported in the literature, in our study, BMI provides the best estimate of body fat. WHR in children and adolescents is not a good index to show intra-abdominal fat deposition.     

The CITRA pilot studies program: mentoring translational research

PURPOSE: We developed an innovative pilot studies program to foster partnerships between university researchers and agencies serving older people in New York City. The development of researchers willing to collaborate with frontline service agencies and service agencies ready to partner with researchers is critical for translating scientific research into evidence-based practice that benefits community-dwelling older adults. DESIGN AND METHODS: We adapted the traditional academic pilot studies model to include key features of community-based participatory research. RESULTS: In partnership with a network of 265 senior centers and service agencies, we built a multistep program to recruit and educate scientific investigators and agencies in the principles of community-based research and to fund research partnerships that fulfilled essential elements of research translation from university to community: scientific rigor, sensitivity to community needs, and applicability to frontline practice. We also developed an educational and monitoring infrastructure to support projects. IMPLICATIONS: Pilot studies programs developing community-based participatory research require an infrastructure that can supplement individual pilot investigator efforts with centralized resources to ensure proper implementation and dissemination of the research. The financial and time investment required to maintain programs such as those at the Cornell Institute for Translational Research on Aging, or CITRA, may be a barrier to establishing similar programs.     

Outcome of primary bone fragment replacement in compound depressed skull fractures

Objective: To assess the outcome in terms of infectious complications after primary bone fragment replacement in compound depressed skull fractures, regardless of the degree of wound contamination. Design: Case series. Place and Duration of Study: Combined Military Hospital, Rawalpindi, from August 2005 to October 2006. Patients and Methods: Patients of all ages and both genders with compound depressed skull fractures irrespective of the degree of wound contamination were selected. Patients with already infected skull wounds were excluded. Bone fragments were replaced in all cases. Main outcome variables were age, associated CT scan findings, type of fracture, location of fracture, wound type, admission to operation time, interval and infectious complications after surgery. Results: Of the 51 cases, the wounds were classified as clean in only 9 patients and the rest had variable degrees of contamination. Thirty five patients were operated within 24 hours, 13 were debrided and bone fragments replaced within 24-72 hours and 3 patients were treated after 72 hours. Thirty five patients were earthquake victims. The average age of the patients was 28.6 years. Three patients developed wound infection and osteomyelitis. One patient had free-floating bone fragments due to the development of hydrocephalus with no evidence of infection. Conclusion: Bone fragment removal in compound depressed skull fractures, regardless of the degree of wound contamination, is not obligatory and primary bone fragment replacement is a suitable alternative, which also avoids a second cranioplasty.     

The CITRA research-practice consensus-workshop model: exploring a new method of research translation in aging

PURPOSE: On the basis of the experience of an extensive community-based research partnership in New York City, we developed an innovative process for bridging the gap between aging-related research and practice, using a consensus-workshop model. DESIGN AND METHODS: We adapted the traditional scientific consensus-workshop model to include translation of the research into nontechnical language and the involvement of practitioners in the process. We then applied the model to the specific issue of falls prevention among community-dwelling older adults. RESULTS: The dialogue and interaction among researchers and practitioners provided new insights beyond a traditional research review. Practitioners offered astute guidance for future research based on their day-to-day field experience. IMPLICATIONS: The recommendations that emerged from the workshop demonstrated the value of close interaction between the aging-related research and practice communities. The consensus-conference model has significant potential to establish a bridge between the worlds of research and practice in a variety of settings.     

Metachronous multicentric giant cell tumour of the upper extremity in a skeletally immature girl : A rare presentation

Giant Cell tumour (GCT) or Osteoclastoma is a benign locally aggressive tumour with a tendency for local recurrence. Long tubular bones (75-90%) are frequent sites of involvement. GCT constitutes 5% of all primary bone tumours. Metachronous multicentric giant cell tumour of bone is a rare entity. Multicentric GCT, in contrast to unifocal GCT, has a tendency to involve the small bones of hands and feet, involving the metaphysis/diaphysis of long bones and tends to occur in a slightly younger population. We report a young girl presenting with metachronous multicentric recurrent benign GCT, with the lesions involving the ipsilateral right hand and distal humerus. She was successfully treated with an aggressive surgical approach (en-bloc resection).     

Cardiac arrhythmia: a simple conceptual framework

This review presents a simple trigger-substrate model of arrhythmogenesis and its application to the generation of reentrant ventricular arrhythmias. We demonstrate its broad applicability to the understanding of arrhythmic phenomena in a wide range of both hereditary and acquired arrhythmic disorders.