PHALANGEAL NECK FRACTURES IN CHILDREN: CLASSIFICATION AND OUTCOME IN 66 CASES

2001 ◽  
Vol 26 (2) ◽  
pp. 112-121 ◽  
Author(s):  
M. M. AL-QATTAN
Keyword(s):  
Young Children ◽  
Type I ◽  
Type Ii ◽  
Mechanism Of Injury ◽  
Bone Contact ◽  
Initial Management ◽  
Fractures In Children ◽  
Wire Fixation ◽  
Fixation Type ◽  
Almost All

A series of 66 children with 67 phalangeal neck fractures in the hand is presented. Young children (1–3 years of age) made up 44% of the series. The mechanism of injury was entrapment of the digit in a closing door or a swing in almost all cases. Type I fractures (n=13) were undisplaced and treatment with a splint resulted in excellent results in almost all cases. Type II fractures were defined as displaced fractures with some bone-to-bone contact. There were 47 Type II fractures and the outcome was significantly affected by the method of initial management. Fractures treated without K-wire fixation had a significantly worse outcome than those who underwent K-wire fixation. Type III fractures (n=7) were displaced with no bone-to-bone contact. If inadequately treated, these fractures did not unite.

Phalangeal Neck Fractures in Adults

2006 ◽  
Vol 31 (5) ◽  
pp. 484-488 ◽  
Author(s):  
M. M. AL-QATTAN
Keyword(s):  
Proximal Phalanx ◽  
Proximal Fragment ◽  
Type I ◽  
Distal Fragment ◽  
Type Ii ◽  
Middle Phalanx ◽  
Bone Contact ◽  
Pattern Of Injury ◽  
Wire Fixation ◽  
The Mean

The author investigated the pattern of injury and outcome of management in 11 adults with phalangeal neck fractures. The mean age was 40 years. The fracture occurred at the neck of the proximal phalanx of the thumb in seven cases and at the neck of the middle phalanx of the fingers in the remaining four cases. One patient had an undisplaced (Type I) fracture and was treated with splinting; the final result was graded as excellent. Nine patients had Type II fractures (the displaced distal fragment maintaining bone-to-bone contact with the proximal fragment) and all patients were treated with closed reduction and single K-wire fixation. The final outcome of Type II fractures was considered good in eight patients and fair in one patient. One patient had a Type III fracture (the displaced distal fragment was rotated 180° with no bone-to-bone contact with the proximal fragment). The fracture required open reduction and K-wire fixation and the final result was poor.

scholarly journals Failed Dermal Allograft Procedures for Irreparable Rotator Cuff Tears Can Still Improve Pain and Function: The “Biologic Tuberoplasty Effect”

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986343 ◽  
Author(s):  
Raffy Mirzayan ◽  
Michael A. Stone ◽  
Michael Batech ◽  
Daniel C. Acevedo ◽  
Anshuman Singh
Keyword(s):  
Rotator Cuff ◽  
Clinical Improvement ◽  
Rotator Cuff Tears ◽  
Type I ◽  
Type Ii ◽  
Bone Contact ◽  
Type Iii ◽  
Goutallier Classification ◽  
Functional Scores ◽  
The Mean

Background:Acellular dermal matrices (ADMs) have been used in the treatment of shoulders with massive rotator cuff tears (MRCTs). Despite clinical improvement, correlation of clinical findings with ADM integrity on imaging has not been investigated.Hypothesis:The pain in shoulders with MRCTs is partially due to bone-to-bone contact between the tuberosity and acromion. Coverage of the tuberosity with an intact graft or a graft that is torn in a way that the tuberosity remains covered will act as an interpositional tissue, preventing bone-to-bone contact and leading to clinical improvement.Study Design:Case series; Level of evidence, 4.Methods:Between 2006 and 2016, a total of 25 shoulders with MRCTs underwent a procedure with an ADM. Pre- and postoperative visual analog scale (VAS) results, American Shoulder and Elbow Surgeons (ASES) score, Hamada grade, and Goutallier classification were reviewed. A postoperative magnetic resonance imaging (MRI) was obtained in 22 (88%) shoulders. The status of the graft was divided into the following categories: type I, intact graft; type II, graft tear with tuberosity covered; and type III, graft tear with tuberosity uncovered (bare).Results:The mean patient age was 61 years (range, 49-73 years), and the mean follow-up was 25.6 months (range, 10-80 months). Mean length from surgery to postoperative MRI was 13.9 months (range, 6-80 months). The graft was torn in 59% (13/22 shoulders). Significant improvements were found in VAS and ASES scores (7 vs 0.7 and 32.6 vs 91.2, respectively; P < .01) for type I grafts and in VAS and ASES scores (8.1 vs 1.3 and 26.3 vs 84.6, respectively; P < .01) for type II grafts. No difference was found in postoperative VAS and ASES (0.7 vs 1.3 and 91.2 vs 84.6, respectively; P = .8) between type I and type II grafts. No improvement was seen in VAS (7.3 vs 5.7; P = .2) or ASES (30.6 vs 37.2; P = .5) for type III grafts.Conclusion:MRI appearance of the graft has a significant impact on functional outcomes. Patients with an intact graft or a graft tear leaving the tuberosity covered have lower pain and higher functional scores than those in whom the torn graft leaves the tuberosity uncovered.

scholarly journals Bisphosphonate Treatment and the Characteristics of Femoral Fractures in Children With Osteogenesis Imperfecta

2017 ◽  
Vol 102 (4) ◽  
pp. 1333-1339 ◽  
Author(s):  
Ilkka Vuorimies ◽  
Mervi K. Mäyränpää ◽  
Helena Valta ◽  
Heikki Kröger ◽  
Sanna Toiviainen-Salo ◽  
...  
Keyword(s):  
Osteogenesis Imperfecta ◽  
Femoral Fractures ◽  
University Hospital ◽  
Type I ◽  
Fracture Type ◽  
Long Term Effects ◽  
Fracture Characteristics ◽  
Fractures In Children ◽  
Distal Shaft ◽  
Almost All

Abstract Context: The short-term benefits of bisphosphonates (BPs) are evident in the treatment of children with osteogenesis imperfecta (OI), but some concerns related to long-term effects remain. Objective: To elucidate the effect of BPs on characteristics of femoral fractures in children with OI. Design and Setting: Retrospective cohort study at a university hospital. Patients and Main Outcome Measure: The study included 93 patients with OI. We recorded fracture histories and analyzed all femoral fractures for location and fracture type using radiographs obtained at fracture diagnosis. Effects of BPs were evaluated by comparing fracture characteristics in three groups: patients (1) naive to BPs, (2) receiving ongoing BP treatment, and (3) whose treatment was discontinued. Results: In total, 127 femoral fractures occurred in 24 patients. Of the fractures, 63 (50%) occurred in patients naive to BPs, 44 (35%) during BP treatment, and 20 (16%) after treatment discontinuation. Mid or distal shaft fractures were most common (41%), followed by subtrochanteric (33%) and distal (20%) fractures. Almost all fractures were transverse (65%) or oblique (28%). The pattern of femoral fractures was similar in all three BP treatment groups (P = 0.78 for location; P = 0.35 for fracture type) and was not related to cumulative BP dose. Instead, OI type correlated with fracture characteristics, and distal location and transverse configuration were more common in the more severe types III and IV compared with type I OI. Conclusion: Characteristics of femoral fractures in children with OI are affected by OI type but not by BP exposure.

scholarly journals Meningiomas with Hemorrhagic Onset: A New Bleeding Classification and its Clinical Significance

2021 ◽  
Author(s):  
Zuo-run Xie ◽  
Hong-Cai Wang ◽  
Yi-Lei Tong ◽  
Shi-Wei Li ◽  
Mao-Song Chen ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Rare Event ◽  
Brain Parenchyma ◽  
Neurological Deficits ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Peritumoral Brain Edema ◽  
Rare Category ◽  
Almost All

Abstract Meningiomas are the commonest benign intracranial tumors and frequently present with a gradual onset of neurological deficits; however, their acute presentation with hemorrhagic onset appears to be a rare event. Nonetheless, because the mainstay of treatment is early surgical evacuation, prompt diagnosis of this rare category of intracranial hemorrhage is imperative. The purpose of this single-center study was to investigate the radiological characteristics and proposed a new bleeding classification for guiding diagnosis and treatment. A total of 19 consecutive patients diagnosed with hemorrhagic meningioma were enrolled in this retrospective study. Intracranial extra-axial mass, tumor-associated hemorrhage, and peritumoral brain edema were the three main radiological features. The site of tumor-associated hemorrhage included peritumoral space, subarachnoid space, subdural space, brain parenchyma, and/or intratumor. Based on the anatomical relationship between meningioma and hematoma, the spontaneous hemorrhage stemming from meningiomas were further summarized into three bleeding patterns involving purely intratumoral hemorrhage (type I), purely extratumoral hemorrhage (type II), and combined intra/extratumoral hemorrhage (type III); moreover, the type III hemorrhage usually came from the type I bleeding that extended into the surrounding regions. The symptoms in type I patients were generally mild, and early surgery was performed following adequate preoperative evaluations; the symptoms in type II patients were sometimes mild and may be sometimes moderate to severe, so early or emergency surgery was chosen according to the patients’ clinical statuses; almost all type III patients had moderate to severe symptoms, and these patients usually needed emergency surgery. In addition, the patients with different bleeding types may have different pathological mechanisms underlying the bleeding. Apart from being convenient for diagnosis, this concise and practical bleeding classification could offer some implications for the treatment strategy and facilitate understanding of the associated mechanisms.

scholarly journals Efficacy and complications after delayed fixation of femoral neck fractures in children

2019 ◽  
Vol 28 (1) ◽  
pp. 230949901988968 ◽  
Author(s):  
Chunxing Wu ◽  
Bo Ning ◽  
Ping Xu ◽  
Jun Song ◽  
Dahui Wang
Keyword(s):  
Femoral Neck ◽  
Closed Reduction ◽  
Open Reduction ◽  
Femoral Neck Fractures ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Fractures In Children ◽  
Reduction Group ◽  
Time From Injury

Objective: This study evaluated the efficacy of surgery for femoral neck fractures in children after a 24-h delay and the factors affecting the risk of complications. Methods: The study included 16 children who underwent surgery after the first 24 h for femoral neck fractures. According to Delbet’s classification, there were 2 type I, 11 type II, and 3 (four hips) type III cases. The mean time from injury to surgery was 85 h (range 27–240 h). According to Garden’s classification, there were 1 type II, 14 type III, and 1 type IV (two hips) cases. Initial surgery consisted of closed reduction and hematocele drainage with a 20-mL needle tube. If the procedure failed, open reduction was performed. Internal fixation (K-wire pinning, screw) was performed after closed ( n = 9) or open ( n = 8) reduction. The results were assessed using the Ratliff criteria after a mean follow-up of 23.2 months. Patient age, type of fracture, complications, treatment, and avascular necrosis (AVN) were evaluated. Results: The results were good in 15 hips (88.2%) and fair in 2 hips (11.8%, one type II case with closed reduction and one type I case with open reduction). The most frequent complication was AVN (4 of 17; 23.5%; three Ratliff good and one fair), which was significantly related to poor outcomes. AVN occurred in one hip in the closed reduction group (Delbet’s type II, 12.5%) and in three in the open reduction group (one Delbet’s type I, 50%; two Delbet’s type II, 66.7%). There were no significant differences in the time from injury to operation (27, 54, 64, and 116 h) and AVN incidence or Ratliff criteria. Conclusions: The efficacy of delayed reduction fixation of the femoral neck was better in the closed reduction group than in the open reduction group. Fracture location closer to the femoral head and older age affected the incidence of AVN.

scholarly journals SPECIFIC CUTANEOUS REACTIONS AND CIRCULATING ANTIBODIES IN THE COURSE OF LOBAR PNEUMONIA

1931 ◽  
Vol 54 (5) ◽  
pp. 637-652 ◽  
Author(s):  
Maxwell Finland ◽  
W. D. Sutliff
Keyword(s):  
Type I ◽  
Type Ii ◽  
Skin Reactions ◽  
Positive Skin ◽  
Similar Frequency ◽  
Hospital Patients ◽  
Protective Antibodies ◽  
Cutaneous Reactions ◽  
Circulating Antibodies ◽  
Almost All

1. A group of 41 non-serum treated patients with Type I, II or III pneumococcus pneumonia were studied during their disease and convalescence with respect to their skin reactions to specific pneumococcus polysaccharides and, in most instances, for the presence of circulating agglutinins and protective antibodies for all these 3 types. 2. One-half of the Type I and two-thirds of the Type II and Type III recovered cases gave the typical immediate "wheal and erythema" response to the homologous polysaccharide at or about the time of recovery. All cases tested showed protective antibodies and almost all showed agglutinins for the homologous pneumococcus. In the fatal cases, in general, positive cutaneous reactions and circulating antibodies were not obtained. 3. In cases of pneumonia receiving repeated cutaneous inoculations with various types of specific polysaccharide, antibodies for pneumococci differing from the infecting type but corresponding to the types of carbohydrate injected were present 1 week or later after such injections. These heterologous antibodies were most frequently demonstrated for Type II and were probably the result of immunization by means of the cutaneous injections. 4. Positive skin responses to homologous polysaccharides and corresponding circulating antibodies were demonstrated with similar frequency in the first 3 weeks after crisis in patients who had not previously received intracutaneous injections. In such patients heterologous antibodies were rarely found. 5. Typical skin reactions with the specific pneumococcus polysaccharides and mouse protective antibodies were demonstrated independently in a number of hospital patients who had had no recent history of pneumonia. 6. Some patients with demonstrable foci of persistent infection or with latent infections which later proved fatal showed positive cutaneous responses to the homologous type polysaccharide and circulating specific antibodies for the corresponding type. 7. The agglutination test, though less sensitive than the mouse protection test for determining the presence of antibody, has many advantages over the latter and is simplest to use in following the course of the untreated pneumonia.

scholarly journals Displaced supracondylar humeral fractures in children: Comparison of three treatment approaches

2016 ◽  
Vol 144 (1-2) ◽  
pp. 46-51 ◽  
Author(s):  
Sinisa Ducic ◽  
Marko Bumbasirevic ◽  
Vladimir Radlovic ◽  
Petar Nikic ◽  
Zoran Bukumiric ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Type Ii ◽  
Percutaneous Pinning ◽  
Cast Immobilisation ◽  
Fractures In Children ◽  
Supracondylar Humerus Fractures ◽  
Wire Fixation ◽  
Supracondylar Humeral Fractures ◽  
Humerus Fractures

Introduction. Closed reduction and percutaneous pinning are the most widely used treatment options for displaced supracondylar humerus fractures in children, but there is still no consensus concerning the most preferred technique in injuries of the extension type. Objective. The aim of this study was to compare three common orthopaedic procedures in the treatment of displaced extension type supracondylar humerus fractures in children. Methods. Total of 93 consecutive patients (66 boys and 27 girls) referred to our hospital with Gartland type II or III extension supracondylar humeral fractures were prospectively included in the study over a six-year period. At initial presentation 48 patients were classified as Gartland type II and 45 as Gartland type III fractures. The patients were subdivided into three groups based on the following treatment modality: closed reduction with percutaneous pinning, open reduction with Kirschner wires (K-wires) fixation, and closed reduction with cast immobilisation. The treatment outcome and clinical characteristics were compared among groups, as well as evaluated using Flynn?s criteria. Results. Excellent clinical outcome was reported in 70.3% of patients treated with closed reduction with percutaneous pinning and in 64.7% of patients treated with open reduction with K-wire fixation. The outcome was significantly worse in children treated with closed reduction and cast immobilisation alone, as excellent outcome is achieved in just 36.4% of cases (p=0.011). Conclusion. Closed reduction with percutaneous pinning is the method of choice in the treatment of displaced pediatric supracondylar humeral fracture, while open reduction with K-wire fixation is as a good alternative in cases with clear indications.

Estimation of Discretionary Accruals and the Detection of Earnings Management

2015 ◽  
Author(s):  
Paul Zarowin
Keyword(s):  
Earnings Management ◽  
Discretionary Accruals ◽  
Type I ◽  
Type Ii ◽  
Type I Errors ◽  
New Model ◽  
The Past ◽  
Almost All ◽  
Type Ii Errors

This article reviews recent research on the estimation of discretionary accruals and the detection of earnings management. There has been an explosive growth in research on accrual earnings management over the past twenty years, and almost all has used the Jones (1991) model or one of its close derivatives. Nevertheless, a growing literature has addressed the model’s problems and attempted to improve its estimation of discretionary accruals. The model’s incomplete characterization of how nondiscretionary accruals are determined by the firm’s operations can cause either Type I or Type II errors. This article categorizes recent articles into four groups based on their focus and solution, and while there is no panacea for the problems and no consensus on a new model or method, research offers hope that accrual earnings management is more likely to be detected when it exists and is less likely to be erroneously detected when it is absent (i.e., lower Type II and Type I errors, respectively).

scholarly journals Type II D Phalangeal Neck Fractures in Children: A Series of 20 Cases Treated According to a Preset Stepwise Algorithm

2020 ◽  
Author(s):  
Mohammad M. Al-Qattan ◽  
Saad A. Almohrij ◽  
Batool Alaskar ◽  
Turki S. Alhassan
Keyword(s):  
Closed Reduction ◽  
Demographic Data ◽  
P Value ◽  
Type Ii ◽  
Fracture Fragment ◽  
Fractures In Children ◽  
Wire Fixation ◽  
The Mean ◽  
Distal Fracture

Abstract Introduction Type II phalangeal neck fractures are defined as displaced fractures with bone-to-bone contact at the fracture site. In the type II D subtype, the distal fracture fragment is thin. A review of the literature did not reveal any study investigating the outcome of management of these fractures. Patients and Methods This is a retrospective study of 20 consecutive children with type II D phalangeal neck fractures treated over the past 4 years. Demographic data were reviewed. All cases were managed according to the preset stepwise algorithm. The outcome of management at final follow-up was documented using Al-Qattan’s grading system. Results The mean age was 30 months (range 12–80 months). There were 12 males and 8 females. The mean follow-up was 2 years (range 7 months to 3 years). The largest two categories within the management algorithm were patients with minimally displaced fractures treated conservatively (n = 8) and those with displaced fractures treated with closed reduction and percutaneous K-wire fixation (n = 9). Fischer exact test was used to compare the outcome in these two groups and the p value was significant (p = 0.015), indicating a significantly better outcome in the former group. Conclusion Several conclusions were made from the study. Type II D of phalangeal neck fractures tend to occur in young children and the majority involve the middle phalanx. The thinness of the distal fracture fragment makes standard techniques of closed reduction more difficult. However, flexion of the proximal and distal joints appears to be effective in reducing dorsally displaced type II D fractures by closed means. Finally, a more conservative approach to minimally displaced type II D fractures results in a better outcome compared with closed reduction and percutaneous K-wire fixation.

Chromosomal bacterial type II toxin–antitoxin systems

2012 ◽  
Vol 58 (5) ◽  
pp. 553-562 ◽  
Author(s):  
Mohammad Adnan Syed ◽  
Céline M. Lévesque
Keyword(s):  
De Novo ◽  
Physiological Role ◽  
Type I ◽  
Type Ii ◽  
Translation Process ◽  
Bacterial Physiology ◽  
The Subject ◽  
Almost All ◽  
Bacterial Type

Most prokaryotic chromosomes contain a number of toxin–antitoxin (TA) modules consisting of a pair of genes that encode 2 components, a stable toxin and its cognate labile antitoxin. TA systems are also known as addiction modules, since the cells become “addicted” to the short-lived antitoxin product (the unstable antitoxin is degraded faster than the more stable toxin) because its de novo synthesis is essential for their survival. While toxins are always proteins, antitoxins are either RNAs (type I, type III) or proteins (type II). Type II TA systems are widely distributed throughout the chromosomes of almost all free-living bacteria and archaea. The vast majority of type II toxins are mRNA-specific endonucleases arresting cell growth through the mechanism of RNA cleavage, thus preventing the translation process. The physiological role of chromosomal type II TA systems still remains the subject of debate. This review describes the currently known type II toxins and their characteristics. The different hypotheses that have been proposed to explain their role in bacterial physiology are also discussed.

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