Materials and Methods: This study was conducted between Oct 2010 to Dec 2015. One-hundred-fifty fracture shafts of the humerus were treated with the anteromedial plating through the anterolateral approach.
Results: One-hundred-fifty patients with a fracture shaft of the humerus were treated with anteromedial plating. Twenty were female (mean ±SD,28 years±4.5) and 130 were male (mean ± SD, 38 years±5.6). One hundred and forty-eight out of 150 (98.6%) patients achieved union at 12 months. Two of three patients developed a superficial infection, both of which were treated successfully by antibiotics and one developed a deep infection, which was treated by wound debridement, prolonged antibiotics with the removal of the plate and subsequently by delayed plating and bone grafting.
Conclusion: In the present study, we applied plate on the anteromedial flat surface of humerus using the anterolateral approach. It is an easier and quicker fixation as compared to anterolateral plating because later involved much more dissection than a medial application of the plate and this application of plate on a medial flat surface, does not required Radial nerve exposure and palsy post-operatively. The significant improvement in elbow flexion without brachialis dissection is also a potential benefit of this approach. Based on our results, we recommend the application of an anteromedial plate for treatment of midshaft fractures humerus.
Material and Methods: Nine patients with cubitus valgus deformity greater than 20° with tardy ulnar nerve palsy (TUNP) operated between 2012 and 2017 were evaluated. Correction by Milch osteotomy and fixation was done in each case, without osteosynthesis of the non-union lateral condyle humerus or transposition of the ulnar nerve. At one year post-operatively, carrying angle, elbow function (Mayo Elbow Performance Score) and ulnar nerve symptoms were assessed.
Results: The mean carrying angle pre-operatively was 30.8° on the affected side which improved to a mean of 8.3° postoperatively with an average correction of 22.5°. The mean elbow flexion pre-operatively was 129.4° which improved to 133.3° post-operatively. The mean preoperative MEP score was 76.7 which improved to a mean of 92.2 post-operatively (p < 0.01). TUNP recovered completely in all the patients.
Conclusion: Milch osteotomy is an effective procedure for cubitus valgus deformity correction and its associated tardy ulnar nerve palsy without a decrease in elbow ROM. Correction of even severe valgus deformities without concurrent anterior transposition of the ulnar nerve is likely to improve ulnar nerve symptoms.
CASE PRESENTATION: A 23-year-old trauma patient with closed fracture of left femoral shaft and left humerus presented to our emergency department (ED). 11 h after admission to ED, patient became confused, hypoxic and hypotensive. He was then intubated for respiratory failure and mechanically ventilated. Transesophageal ultrasound revealed hyperdynamic heart, dilated right ventricle with no regional wall abnormalities and no major aorta injuries. Whole-body computed tomography was normal. During central venous cannulation of right internal jugular vein (IJV), we found free floating mobile hyperechoic spots, located at the anterior part of the vein. A diagnosis of fat embolism syndrome later was made based on the clinical presentation of long bone fractures and fat globulin in the blood. Despite aggressive fluid resuscitation, patient was a non-responder and needed vasopressor infusion for persistent shock. Blood aspirated during cannulation from the IJV revealed a fat globule. Patient underwent uneventful orthopedic procedures and was discharged well on day 5 of admission.
CONCLUSIONS: Point-of-care ultrasound findings of fat embolism in central vein can facilitate and increase the suspicion of fat embolism syndrome.
METHODS: The setting was the University of Kuala Lumpur. Thirty-four Malay, 35 Chinese and 34 Indian normal pregnant middle-class women were studied longitudinally by monthly ultrasound scans for 18 to 38 weeks of gestation. The data were subjected to regression analysis; the quadratic curve was found to be the most adequate. Dummy variables were used to determine any effects by gender, parity as well as ethnicity on the length of limb growth. There was no difference in birth weights of the three ethnic groups studied, nor in gender or parity.
RESULTS: There were found to be significant differences in limb lengths of the Indians (longer) when compared with the Malays and Chinese. Parity seems to affect only Indians in whom the multiparous fetuses have shorter limb lengths than the primaparous. There appears to be no effect by gender.
CONCLUSION: There appear to be definite differences in growth of limb length between the different Malaysian ethnic groups and this should be taken into account when growth charts are used and when fetal weight formulas are calculated using limb lengths. The limitation of this study was that the numbers of subjects studied were small. Larger studies will be able to confirm or refute the findings.