Early identification and conservative management of paediatric Monteggia fractures has been shown to correlate with good results. Nevertheless, several authors advocate more aggressive management with open reduction and internal fixation (ORIF) for unstable fractures. We herein present the experience of a tertiary paediatric hospital in the management of Monteggia fractures. 41 patients with Monteggia fractures (26 male and 15 female) were admitted and treated over a period of 20 years (1989 to 2009). The age of the patients ranged between 3 and 14 years (mean 7.5 years). Based on the Bado Classification, 29 fractures were type I, 3 were type II, 8 type III and 1 fracture was classified as type IV. Out of the 41 patients, 32 were managed with manipulation under anaesthesia (MUA) and above elbow plaster, whereas 9 underwent open reduction and internal fixation (ORIF) of the ulna.Introduction
Methods
Lateral humeral condyle fractures account for 17% of the distal humeral condyle fractures. They affect children between 5 and 10 years of age. Recent reports advocate closed reduction and internal fixation for the less displaced fractures. We retrospectively reviewed children treated with open reduction internal fixation of these fractures at a single institution over a period of 13 years. All cases of lateral humeral condyle fractures treated with ORIF were identified through the trauma register. Case notes and radiographs were retrieved. Fracture classification, mode of fixation, time to union, and clinical examination at latest follow up were reviewed.Introduction
Methods
Implant alignment in knee arthroplasty has been identified as critical factor for a successful outcome. Human error during the registration process for imageless computer navigation knee arthroplasty directly affects component alignment. This cadaveric study aims to define the error in the registration of the landmarks and the resulting error in component alignment. Five fresh frozen cadaveric limbs including the hemipelvis were used for the study. Five surgeons performed the registration process via a medial parapatellar approach five times. In order to identify the gold standard point, the soft tissues were stripped and the registration was repeated by the senior author. Errors are presented as mm or degrees from the gold standard registration. The error range in the registration of the femoral centre in the coronal plane was 6.5mm laterally to 5.0mm medially (mean: −0.1, SD: 2.7). This resulted in a mechanical axis error of 5.2 degrees valgus to 2.9 degrees varus (mean: 0.1, SD: 1.1). In the sagittal plane this error was between −1.8 degrees (extension) and 2.7 degrees (flexion). The error in the calculation of the tibial mechanical axis ranged from −1.0 (valgus) to 2.3 (varus) degrees in the coronal plane and −3.2 degrees of extension to 1.3 degrees of flexion. Finally the error in calculating the transepicondylar axis was −11.2 to 6.3 degrees of internal rotation (mean: −3.2, SD: 3.9). The error in the registration process of the anatomical landmarks can result in significant malalignment of the components. The error range for the mechanical axis of the femur alone can exceed the 3 degree margin that has been previously been associated with implant longevity. The technique during the registration process is of paramount importance for image free computer navigation. Future research should be directed towards simplifying this process and minimizing the effect of human error.
