Predicting cubitus varus in supracondylar fractures of the humerus by Baumann's angles in post reduction X-rays

OBJECTIVES

The present study presents the technique to predict cubitus varus by post reduction Affected Side and Normal Side Baumann's angle difference (ASBA and NSBA) respectively. It intends to correlate the Baumann's angle to the final carrying angle of the injured elbow and presents the relevant mathematical clinical rule along with its prediction test characteristics.

MATERIAL AND METHODS

Total 57 patients of 6.5+/-1.67 yrs, 22 were males and 8 females with 19/30 having left side injury. Isolated closed supracondylar fractures of humerus up to 5 days duration included and previous trauma, pathological fracture, other injury, elbow disease were excluded .30/57 completed >1 year follow-up.

RESULTS

The Mean NSBA was 74.4+/-4.14 masculine. The mean normal side carrying angles (NSCA) were 9.56 +/- 2.2 masculine. The NSCA IQR (Inter Quartile Range) was 8.8-10 masculine. The ASBA was 79.9+/-9.1 masculine and affected side carrying angles (ASCA) was 0.20+/-8.7 masculine. The ASCA was best predicted by the difference between ASBA-NSBA (ASCA=3.87-0.65(ASBA- NSBA; F=15.91). At a cut off of 8.8 masculine (the lower limit of IQR for NSCA), a value >0 masculine for ASBA- NSBA was 80% predictive of cubitus varus. With pre test probability of varus at 70%, sensitivity was 0.94 and specificity 0.42.

DISCUSSION

A prediction rule to predict the final carrying angle from ASBA NSBA difference is presented with a positive predictive value 0.80, specificity of 0.42, and sensitivity of 0.94 at a pre test probability of 0.70.When the diagnosis of cubitus varus is ASCA<8.8 masculine (Lower limit of the IQR for NSCA).

CONCLUSION

If affected side Baumann's Angle - Normal Side Baumann's Angle is equal to or greater than 0 then there was 80% probability of having cubitus varus.

Pseudoaneurysm of the inferior medial geniculate artery following primary total knee arthroplasty: delayed presentation with recurrent haemorrhagic episodes

Arterial complications in primary total knee arthroplasty operation are rare. An 83 year old lady is described who presented with three recurrent haemorrhagic episodes eroding through the medial skin 4 weeks following primary total knee arthroplasty. A pseudoaneurysm of the geniculate artery should be suspected with recurrent or persistent haemarthrosis/haemorrhagic episodes. Early exploration, evacuation of the aneurysmal cavity and ligation of the feeding vessel should be undertaken if the false aneurysm is large in diameter.

Uncemented Austin-Moore and cemented Thompson unipolar hemiarthroplasty for displaced fracture neck of femur--comparison of complications and patient satisfaction

Austin-Moore and Thompson monobloc prostheses are both commonly used for hemiarthroplasty for displaced fractures of the neck of femur in adults. There is an ongoing debate about, which of these prostheses should be preferred. We present a comparison of two groups of patients with this fracture treated using cemented Thompson prosthesis and uncemented Austin-Moore prosthesis. Mortality, morbidity and patient satisfaction in the two groups were compared. Cemented Thompson hemiarthroplasty was associated with significantly better patient satisfaction scores. There was no difference in the mortality rates and hospital stay. Patients preferred cemented unipolar Thompson hemiarthroplasty over the uncemented unipolar Austin-Moore hemiarthroplasty. A larger randomised prospective trial is needed to confirm this finding.

Osteosarcoma in pregnancy

Osteosarcoma in pregnant women is rare. Delay in diagnosis may be due to lack of any signs or symptoms during gestation, clinical misdiagnoses, religious attitude and refusal of the patients. Most cases soft-tissue and bone tumors during pregnancy can be managed successfully with surgery during gestation. Therapies with fetal toxicity were more likely to be deferred to postpartum period. This case is rare and liable to be missed, hence is reported.

Osteosarcoma in Pregnancy

Osteosarcoma in pregnant women is rare. Delay in diagnosis may be due to lack of any signs or symptomsduring gestation, clinical misdiagnoses, religious attitude and refusal of the patients. Most cases soft-tissueand bone tumors during pregnancy can be managed successfully with surgery during gestation. Therapieswith fetal toxicity were more likely to be deferred to postpartum period. This case is rare and liable to bemissed, hence is reported.

Type IIIB tibial intercondylar eminence fracture associated with a complex knee dislocation in a grossly obese adult

Avulsion fractures of the intercondylar eminence or tibial spine mostly occur in children and adolescents, and are extremely uncommon in adults. A type IIIB intercondylar eminence fracture (i.e. completely displaced and rotated tibial spine) associated with a complex knee dislocation is an extremely rare combination.

Comparative Study of Management of Closed Comminuted Femoral Shaft Fractures with Closed Interlocking Intramedullary Nail and Open Reduction and Dynamic Compression Bridge Plating

Fracture shaft of the femur are life-threatening injuries and can cause severe permanent disability. Nowadays die interlocking nailing is regarded as the operative technique of choice for fracture shaft of femur. However, the advantages and disadvantages have rarely been compared with plate osteosynthesis. This is prospective study to compare the two methods of treatments in terms of time to union, hospital slay (including readmission), wound infection, shortening of limb, delayed union, malunion, joint stiffness and implant failure. 54 patients, age (16 to 66) years, were treated by DCP (22), and interlocking nail (24). Eight patients were lost to follow up. The study was conducted in Services Hospital, Department of Orthopaedics and Ittefaq Hospital, Lahore, Pakistan from June 1996 to Dec 1997. Written consent was taken regarding the type of surgery to be performed. Open fractures of Gustilo Grade n or in, femoral shaft fractures associated with other fractures of the same femur, fractures in immature skeleton and segmental fracture were excluded. Winquist and Hansen classification was used to classify fracture comminution. Patients were alternately allocated. In the plating group, primary bone grafting was done in all cases. Time to union in nailing group was 16.43t2.48 weeks and in plating 19.88±3.46 weeks, p-value<0.05. Mean hospital stay in nailing group was 12.8±2.75 day and plating group 21.1±2.73 days, p>0.05. There were 2 deep infections in the plating group and none in nailing group. There was no shortening of limb in die plating group but 2 patients in the nailing group had shortening of 2 cms. Delayed union occurred in 2 patients in nailing group but 5 in plating group. One patient in the nailing group had external rotation of at least 10 degrees and none in plating group. Two patients in the nailing group had knee stiffness and 6 patients in me plating group. One patient in the nailing group had a broken interlocking screw 2 patients in the plating group had bent plates. Closed interlocking intramedullary nailing as a method of treating closed communited femoral shaft fracture is better than plating in terms of rate of postoperative complication including infection.Key Words: Comminuted fractures shaft of femur, static interlocking nailing and bridge plating.

HIV AIDS Related Knowledge, Attitude and Practice among High School Students in Eastern Nepal

Abstract

Research output of a cohort of orthopaedic consultants in Great Britain

There has been renewed emphasis on research following the Calman recommendations for higher training. It is often considered essential for progression in training to have participated in research projects and to have some publications to one's credit. Orthopaedic surgery is usually thought to lag behind other disciplines in this respect. It was decided to conduct a review of the research output of a cohort of orthopaedic consultants in Great Britain to obtain baseline information for future comparisons. A group of surgeons who graduated at least 25 years ago was chosen as it was felt this would provide the pattern of research output throughout the surgical career of the cohort. The type of publication and the various factors that may affect research output were studied. There was a significant difference in the output of consultants working in teaching hospitals and large centres compared to those in district general hospitals. Is the soil as important as the seed?

A comparative analysis of infant mortality in major Ohio cities: significance of socio-biological factors

"Using linked birth and infant death records for Ohio for the 1984-87 birth cohorts, this paper examines differentials in neonatal, postneonatal, and infant mortality rates in four major Ohio cities....It was found that, compared to Toledo, Cleveland had 51% higher risk of infant death, Cincinnati had 45% higher risk, [and] Columbus had 13% higher risk of infant death. Although in each of these cities, black infants had significantly higher risk of death than white infants, controlling for race alone reduced but did not eliminate the infant mortality differentials among the cities. The results of the hazards analyses reveal that maternal education, marital status, maternal age, birth order, prenatal care, gestational age, and birth weight had a profound net impact on the risk of infant death and that, even after controlling for these and other maternal and infant characteristics, significant city differentials persisted in infant mortality."

beta(2)-Microglobulin increases the expression of vascular cell adhesion molecule on human synovial fibroblasts

BACKGROUND

beta(2)-Microglobulin (beta(2)m) amyloidosis is a destructive articular disease that affects patients on dialysis. The disease presentation is similar to other forms of arthritis in which adhesion molecules are felt to be pathogenic. Therefore, we hypothesized that beta(2)m directly increases the expression of vascular cell adhesion molecule-1 (VCAM-1) by synovial fibroblasts. We also examined the effect of alteration of beta(2)m by advanced glycation end products on this cellular response.

METHODS

Human synovial fibroblasts were isolated and incubated with beta(2)m with and without alteration with advanced glycation end products. VCAM-1 expression was determined by immunohistochemistry, flow cytometry, and Western blot and Northern blot analyses.

RESULTS

beta(2)m increased the protein expression of VCAM-1 by synovial fibroblasts in a dose-dependent manner. beta(2)m altered with advanced glycation end products had no effect. However, all forms of beta(2)m increased VCAM-1 mRNA. beta(2)m also increased the adhesion of peripheral blood mononuclear cells to synovial fibroblasts.

CONCLUSION

beta2m directly increases the expression of VCAM-1 by synovial fibroblasts, indicating that synovial fibroblasts may play a key role in the pathogenesis of beta(2)m amyloidosis.

Steroid-induced hypertrophic cardiomyopathy following stem cell transplantation in a neonate: a case report

We report a case of severe left ventricular outflow tract obstruction complicating steroid therapy in an infant undergoing allogeneic transplant in the first few weeks of life for treatment of Krabbe's disease. While this complication is well known to those treating premature infants, it has not been reported in the stem cell transplant setting. For young infants undergoing allogeneic transplant who require steroid therapy, cardiac monitoring after 2--3 weeks of therapy is recommended.

All-cause and cause-specific mortality of immigrants and native born in the United States

OBJECTIVES

This study examined whether US-born people and immigrants 25 years or older differ in their risks of all-cause and cause-specific mortality and whether these differentials, if they exist, vary according to age, sex, and race/ethnicity.

METHODS

Using data from the National Longitudinal Mortality Study (1979-1989), we derived mortality risks of immigrants relative to those of US-born people by using a Cox regression model after adjusting for age, race/ethnicity, marital status, urban/rural residence, education, occupation, and family income.

RESULTS

Immigrant men and women had, respectively, an 18% and 13% lower risk of overall mortality than their US-born counterparts. Reduced mortality risks were especially pronounced for younger and for Black and Hispanic immigrants. Immigrants showed significantly lower risks of mortality from cardiovascular diseases, lung and prostate cancer, chronic obstructive pulmonary diseases, cirrhosis, pneumonia and influenza, unintentional injuries, and suicide but higher risks of mortality from stomach and brain cancer and infectious diseases.

CONCLUSIONS

Mortality patterns for immigrants and for US-born people vary considerably, with immigrants experiencing lower mortality from several major causes of death. Future research needs to examine the role of sociocultural and behavioral factors in explaining the mortality advantage of immigrants.

Subvalvular Aortic Stenosis

Subvalvular aortic stenosis (SAS) is a congenital heart defect that causes fixed form of hemodynamically significant left ventricular outflow tract (LVOT) obstruction with progressive course. It has a spectrum of anatomy. It appears usually beyond infancy, causes left ventricular hypertrophy and myocardial dysfunction, and tends to involve the aortic and mitral valves in its progressive course. Although most of the patients are asymptomatic, careful monitoring is essential. Moderate to severe SAS requires surgical resection and septal myomectomy. There is a high rate of postoperative recurrence of the lesion. Recurrent lesions and the complex type of lesions with aortic valve involvement should have aortoseptoplasty (to enlarge the outflow tract) and Ross procedure (removal of the damaged aortic valve and placement of a pulmonary autograft in the aortic position and a pulmonary homograft in the pulmonary position).

A multivariate analysis of the association between social class of origin and current social class with self-rated general health and psychological health among 16-year-old Australians

BACKGROUND

A recent review of international literature concludes that there is a relative absence of social class differentials in health in early youth. There is an absence of Australian studies on the effect of social class on the health of this age group.

AIMS

To examine the association between social class and health among 16-year-old Australians.

METHODS

The data on 1048 16-year-olds came from the fifth wave (1993) of the Australian Youth Survey conducted by the former Department of Employment, Education and Training. Outcome measures were self-rated general health and psychological health (GHQ-12). Binary logistic regression was used to analyse data.

RESULTS

Neither social class of origin nor current social class was associated with self-rated general health or psychological health.

CONCLUSION

The argument that social class inequalities in health exist in childhood, disappear during early youth, and reappear later appears to hold ground within the Australian context.

Aberrant origin of the left coronary artery from the right aortic sinus: surgical intervention based on echocardiographic diagnosis

An athletic 15-year-old girl with aberrant left coronary artery from the right coronary sinus, presented with syncope during exercise. Trans-thoracic echocardiography was the only imaging technique that clearly demonstrated her anomaly. The results of magnetic resonance and selective coronary angiographic imaging were inconclusive. Surgical intervention was successfully performed on the basis of the echocardiographic diagnosis.

Social epidemiology of chronic liver disease and cirrhosis mortality in the United States, 1935-1997: trends and differentials by ethnicity, socioeconomic status, and alcohol consumption

This study examines trends and ethnic and socioeconomic differentials in chronic liver disease and cirrhosis mortality in the United States. Age-adjusted death rates from the National Vital Statistics System were used to analyze race and sex-specific mortality trends from 1968 through 1997. Age-adjusted liver cirrhosis mortality and per capita alcohol consumption data from 1935 through 1996 were modeled using time-series regression. Moreover, the Cox hazards regression was applied to the National Longitudinal Mortality Study, 1979-1989, to examine socioeconomic differentials at the individual level, whereas multivariate ordinary least squares regression was used to model state-specific cirrhosis mortality from 1990 to 1992 as a function of socioeconomic variables and alcohol consumption at the ecological level. Chronic liver disease and cirrhosis continues to be an important cause of death in the United States, even after three decades of consistently declining mortality rates. For both men and women aged 25 years and older, significant mortality differentials were found by age, race/ethnicity, marital status, family income, and employment status. For men, marked differentials were also found by nativity, rural-urban residence, and education. Unemployment, minority concentration, and alcohol consumption were major predictors of state-specific cirrhosis mortality. Both time-series and cross-sectional data indicate a strong correlation between alcohol consumption and US cirrhosis mortality. Substantial ethnic and socioeconomic differences in cirrhosis mortality suggest the need for social and public health policies and interventions that target such high-risk groups as American Indians, Hispanic Americans, the socially isolated, and the poor.

Five-loop coil occlusion of patent ductus arteriosus prevents recurrence of shunt at follow-up

Recent reports suggest reopening of the patent ductus arteriosus (PDA) after complete occlusion with three-loop Gianturco coils. We hypothesize that five-loop coils may produce a larger thrombus than three-loop coils, which will result in no or less probability of recanalization of PDA during follow-up. This study is designed to test this hypothesis. Follow-up echocardiographic and Doppler data of 30 patients who underwent five-loop coil occlusion of small to medium-sized PDA during a 33-month period ending December 1998 were examined. Thirty patients had no residual shunt on echo Doppler study on the day following the procedure and were followed for 6 to 30 months (median, 12) after coil implantation. At the last follow-up study, none of the patients had a residual shunt and left atrial size decreased. Careful pulsed, continuous wave, and color Doppler interrogation of left/main pulmonary artery junction and proximal descending aorta did not reveal any evidence for obstruction. The follow-up data suggest that complete occlusion of small- to medium-sized PDAs is feasible with five-loop coils without evidence for recanalization at a mean follow-up of 12 months. Much longer (2 to 5 years) follow-up data may be necessary to confirm these observations. We speculate that a greater degree of thrombosis is produced within the ductus by the five-loop coils, which in turn may be responsible for lack of shunt recurrence. We recommend use of five-loop instead of three-loop coils for transcatheter occlusion of small- to medium-sized PDAs.

beta2-microglobulin induces MMP-1 but not TIMP-1 expression in human synovial fibroblasts

BACKGROUND

beta2-Microglobulin (beta2m) amyloidosis is a destructive articular disease that causes significant morbidity in patients undergoing hemodialysis. The amyloid deposits contain beta2m, some of which is altered with advanced glycation end products (AGE-beta2m). The deposits are located principally in joint structures, with adjacent degradation of cartilage and bone. We hypothesized that one of the mechanisms by which beta2m induces joint destruction is to induce the release of matrix metalloproteinase-1 (MMP-1), but not tissue inhibitor of metalloproteinase-1 (TIMP-1), from synovial fibroblasts.

METHODS

To test this hypothesis and determine the role of AGE-beta2m, we incubated human osteoarthritic synovial fibroblasts in the presence and absence of beta2m and AGE-beta2m and measured the release of interstitial collagenase (MMP-1) and/or TIMP-1 by enzyme-linked immunosorbent assay and Northern blot analysis.

RESULTS

beta2m and AGE-beta2m at 10 and 25 microg/mL induced the release of MMP-1 from human osteoarthritic synovial fibroblasts at 24 hours. In contrast, there was no increased release of TIMP-1, leading to an increase in the MMP-1/TIMP-1 ratio indicative of uncontrolled collagenolysis. A similar dose response was observed at 48 hours, except that AGE-beta2m had no effect over control cultures. MMP-1 mRNA expression by Northern blot analysis paralleled these findings. The source of the fibroblasts did not alter the results. Finally, we demonstrated that doxycycline, a treatment for arthritis, can inhibit the release of MMP-1 from synovial fibroblasts incubated with beta2m.

CONCLUSION

beta2m, at physiologically relevant concentrations, induces the release of MMP-1 without concomitant release of TIMP-1 from human synovial fibroblasts, leading to uncontrolled collagenolysis. The alteration of beta2m with AGE did not alter this effect at 24 hours, but blocked the effect at 48 hours. These findings may account for the tissue destruction seen in beta2m amyloidosis.