Strategies in Trauma and Limb Reconstruction

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2008 | December | Volume 3 | Issue 3

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Original Article

Freih Odeh Abu Hassan

Hand dominance and gender in forearm fractures in children

[Year:2008] [Month:December] [Volume:3] [Number:3] [Pages:3] [Pages No:101 - 103]

Keywords: Forearm fractures, Hand, Children, Gender

   DOI: 10.1007/s11751-008-0048-6  |  Open Access |  How to cite  | 


No published studies have addressed the role of hand dominance in various types of forearm fractures. The present study aims to investigate the effects of the dominant hand and gender in forearm fractures in children and adolescents. In a prospective study, 181 children aged 2–15 years presenting with unilateral forearm fracture were examined over a 6-year period, investigating the role of the dominant hand, fractured side, fractured site, and gender in different types of forearm fractures. Forearm fractures occur more often in boys and are more common on the left side (P = 0.001, 0.029, respectively). Isolated distal radius fracture is more common than distal radius and ulna fracture in right-handed children (P = 0.008). Increases in the number of middle forearm fractures in the dominant hand in left-handed children (P = 0.0056) may be due to mechanisms of injury other than a simple indirect fall or severe injury preventing the use of the dominant hand as a preventive measure. The mean age for boys and girls at the time of forearm fractures was 8.97 and 5.98 years, respectively, which may be attributed to older girls tending not to do as many outside-the-home activities as boys at this age. Overall, forearm fractures are more common in the non-dominant hand, in boys, and in both distal forearm bones.


Original Article

Khaled M. Emara, Mohamed Farouk Allam, Mohamed Nabil M. A. ElSayed, Khaled Abd E. L. Ghafar

Recurrence after correction of acquired ankle equinus deformity in children using Ilizarov technique

[Year:2008] [Month:December] [Volume:3] [Number:3] [Pages:4] [Pages No:105 - 108]

Keywords: Equinus, Ilizarov, External fixation, Ankle, Deformity

   DOI: 10.1007/s11751-008-0045-9  |  Open Access |  How to cite  | 


To describe our Ilizarov technique for the treatment of acquired equinus deformity in children and to determine if compliance with continuous use of an ankle foot orthosis (after removal of the fixator and until skeletal maturity) can influence the severity of recurrence. A cohort of 26 children with post-traumatic or post-burn contractures producing an equinus deformity was followed up for a minimum of 2 years after skeletal maturity. Cases with a bony deformity and/or nerve injury were excluded from this study. All patients were managed by a percutaneous tendo-Achilles lengthening followed by application of an Ilizarov external fixator. Post-operative treatment was in the form of gradual correction at a rate of 0.5 mm per day. Correction started from the second postoperative day until an over-correction of 15 degrees dorsiflexion was achieved. Ankle range of movement was encouraged 4 weeks prior to removal of the external fixator. On removal of the fixator, a posterior splint was applied until substituted by an ankle foot orthoses (AFO). The AFO was used continuously during the first 2–3 months and at nighttime thereafter until skeletal maturity. Fifteen children were compliant with the use of the AFO until skeletal maturity and 11 non-compliant. We compared the recurrence and the size of deformity between the two groups. The rate of recurrence, degree of equinus at recurrence and number of episodes of external fixation surgery showed statistical significant differences (P < 0.01) between the groups. The Ilizarov technique for treatment of acquired equinus deformity secondary to soft tissue scarring is a safe and effective technique. The use of an AFO until skeletal maturity can decrease the risk and degree of recurrence.


Original Article

Konstantinos N. Malizos, Nikolaos E. Gougoulias, Zoe H. Dailiana, Nikolaos Rigopoulos, Theofanis Moraitis

Relapsed clubfoot correction with soft-tissue release and selective application of Ilizarov technique

[Year:2008] [Month:December] [Volume:3] [Number:3] [Pages:9] [Pages No:109 - 117]

Keywords: Clubfoot, Ilizarov, Recurrent, Relapsed, Release

   DOI: 10.1007/s11751-008-0049-5  |  Open Access |  How to cite  | 


The Ilizarov technique is an alternative for the treatment of complex foot deformities in children. The authors retrospectively reviewed children with relapsed clubfoot deformity, treated with soft tissue procedures and additional correction with an Ilizarov frame. Twelve consecutive patients (13 feet) with relapsed clubfoot deformity after previous surgical correction were reviewed. Treatment included open releases. An Ilizarov frame was applied as an adjunct in seven patients (mean age of 7.8 years) with severe deformity where complete intraoperative correction was not achieved. Clinical and radiographic assessment was undertaken. The mean Laaveg–Ponseti score, for the 7 feet treated with the Ilizarov frame, was 85.1 after minimum 4 years follow-up. One recurrence of forefoot deformity required metatarsal osteotomies. Postoperative radiographic measurements revealed values that can be considered as normal. Complications included pin tract infections (12% of inserted wires). Flat-topped talus was observed in 3 feet. Deformity correction was possible when soft tissue procedures were combined with the use of Ilizarov technique, in order to support and gradually improve surgical correction.



Shabir A Dhar, Mohammed Farooq Butt, Mohammed Ramzan Mir, Murtaza Fazal Ali, A. A. Kawoosa

Use of the Ilizarov apparatus to improve alignment in proximal humeral fractures treated initially by a unilateral external fixator

[Year:2008] [Month:December] [Volume:3] [Number:3] [Pages:4] [Pages No:119 - 122]

Keywords: Proximal humerus, Malaligned, Ilizarov fixator

   DOI: 10.1007/s11751-008-0044-x  |  Open Access |  How to cite  | 


One of the recommended methods for the management of displaced unstable proximal humeral fractures is the unilateral external fixator. In polytrauma cases this method may be especially useful for the stabilisation of these fractures. However, problems may arise if the fracture is fixed in a malaligned or distracted position. Conversion of the treatment concept to other modalities is difficult because of the problem of pin tract infection. The Ilizarov apparatus provides an useful method in such situations, as it allows distraction, translation and compression without the need for further anaesthesia and additional fixation.



Pedro Gutiérrez Carbonell, Eloisa Felíu Rey, Javier Roca Vicente-Franqueira, Antonio Perez Trigueros

Infrequent physeal wrist injury of the ulna and radius: a case report

[Year:2008] [Month:December] [Volume:3] [Number:3] [Pages:3] [Pages No:123 - 125]

Keywords: Physeal ulna injury, TFCC injury in children, MRI in physeal wrist injury

   DOI: 10.1007/s11751-008-0046-8  |  Open Access |  How to cite  | 


We describe the case of a 13-year-old patient with a left wrist physeal fracture of the ulna and radius. X-Ray showed a Salter–Harris type II injury of the radius, and CT and MRI identified the following: type II epiphysiolysis of the radius with a metaphyseal wedge and type IV fracture of the ulna, with interposition in the focus of the fracture of the extensor carpi ulnaris tendon, as well as a tear in the central area of the triangular fibrocartilage complex. All these injuries were checked intraoperatively during open reduction. We believe that this clinical case illustrates the importance of carefully assessing physeal wrist injuries when they occur, especially in those cases involving the ulna and the radius. Diagnostic methods such as CT and MRI scans are indispensable for through evaluation and treatment of the injury.



Koray Unay, Oguz Poyanli, Kaya Akan, Arzu Poyanli

Profunda femoris artery pseudoaneurysm after surgery and trauma

[Year:2008] [Month:December] [Volume:3] [Number:3] [Pages:3] [Pages No:127 - 129]

Keywords: Aneurysm, false, Femoral artery, Femur, Femoral fractures, Osteonecrosis

   DOI: 10.1007/s11751-008-0043-y  |  Open Access |  How to cite  | 


Pseudoaneurysms of the profunda femoris artery have been reported following different types of trauma and from orthopedic procedures performed in the proximal femur. Two cases of profunda femoris artery pseudoaneurysm with two rare causes are presented. The first one is a core decompression of femoral head for osteonecrosis and the second one is a proximal femur fracture nailing. Awareness and careful follow-up are the key issues for the early diagnosis.


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