Magnetic resonance (MR) images of 18 patients with a cervical spinal cord injury were analysed for prognostic signs of paralysis. Serial MR images were obtained within 48 hours (acute stage), then 2 weeks (subacute stage) and an average of 12 months (range 6-24 months) after injury. The patterns of signal intensity in the acute stage were divided into two types, slightly-low/low (SL/L) type and slightly-low/high (SL/H) type on Tl-weighted images (Tl WI) and T2-weighted images (T2WI). The patterns in the subacute stage were divided into two types, high/high (H/H) type and normal/high (N/H) type on TlWI and T2WI. Six patients showed SL/L type in the acute stage and H/H type in the subacute stage. Five of the patients had a paralysis of grade A and one of grade B at admission which remained unchanged after treatment. One patient showed SL/H type in the acute stage and H/H type in the subacute stage. The patient had a paralysis of grade A that improved to no more than grade B. The remaining 11 patients showed SL/H type in the acute stage and N/H type in the subacute stage. Their paralysis was from grade B to D at admission and grade D or E at the follow up. The signal intensity of SL/L type in the acute stage and H/H type in the subacute stage are bad prognostic signs.

BACKGROUND: Trigger finger is caused by formation of nodule or thickening of A1 pulley by its fibrocartilage metaplasia resulting in entrapment of the flexor tendon. Conservative treatment of this condition consists of NSAIDs, splint immobilization and steroid injection into the tendon sheath. Failure of the conservative treatment is the indication of an open release. Percutaneous release of trigger finger is advised by several authors. The purpose of this prospective study is to evaluate the results of percutaneous release of trigger finger with 18 gauge needle. METHODS: Fifty one patients with 58 trigger digits were treated by percutaneous release using 18 gauge needle under local anaesthesia. Patients were followed up for an average of 12 months. RESULTS: Overall, 97% achieved an excellent or good result. Two digits experienced recurrent symptoms and required an open release. There was no clinical evidence of digital nerve injury or tendon bowstringing. CONCLUSIONS: We recommend this technique as a safe and effective outpatient procedure for releasing trigger finger. DOI: http://dx.doi.org/10.3126/noaj.v1i1.8126 Nepal Orthopaedic Association Journal Vol.1(1) 2010

Background: Distal radius fractures are a common injury and without proper treatment leads to high functional impairment and frequent complications. Objective: The aim of this study was to see the functional outcome in patients with comminuted distal radius fractures treated with combined external fixation and open reduction with volar plating. Materials and methods: All comminuted distal radius fractures classified as type C in AO/OTA classification were enrolled for the study from 2005 till 2008. The clinical scoring chart modified by Cooney was used to evaluate the functional outcome. Results: There were twenty-two patients with the average age of 42.18 years (range 19-60) with 15 male and 7 females. The follow-up period was from 14 to 46 months. Accordingly, there were 11 (50%) excellent, 7 (31%) good, 2 (9%) fair and 2 (9%) poor results. There were very few complications in our series. In three patients additional K-wire supplementation was necessary along with external and open internal fixation. Conclusions: Comminuted intra-articular fractures of distal radius should be treated by open reduction and combined internal and external fixation to achieve a high rate of patient satisfaction and satisfactory functional outcome. Key words: distal radius fractures; volar plating; external fixationDOI: 10.3126/kumj.v7i4.2756 Kathmandu University Medical Journal (2009) Vol.7, No.4 Issue 28, 369-373

BACkGROUND: Various surgical treatment methods are available for unstable distal radius fractures. Clinical and radiological outcome with volar locking plate has been very satisfactory. The purpose of this prospective study is to evaluate the results of the treatment of unstable fractures with the volar locking plate with regard to loss of reduction, functional outcome and complications. METHODS:Unstable distal radius fractures were enrolled for the study from May 2008 until July 2010. All patients were treated with 3.5 mm distal radius volar locking plate and assessed by clinical and radiological examination. The clinical scoring chart modified by Cooney was used to evaluate the functional outcome.RESULTS: eighteen male and 12 female patients with the average age of 42.53 (range 30-64years) were followed up for a period of 9 to 34 months (average.23 months). There were fourteen A3 fractures, nine C1 fractures, six C2 fractures, and one C3 fracture, whereas one had a Gustilo grade I open wound on the volar aspect. Seven of the fractures had associate fracture of the ulnar styloid. The functional outcome was excellent in 23 (76%), good in 6 (20%), fair in 1 (4%) and none had poor outcome. There were very few complications in our series. CONCLUSION:Unstable fractures of distal radius treated by open reduction with volar locking plate provides adequate fixation with no collapse in reduction and also have satisfactory functional outcome with minimal complications.

Introduction: Supracondylar fractures of the humerus occur commonly in the paediatric age group. Gartland type III fractures are treated by closed manipulation and percutaneous pinning with K-wires. Open reduction is indicated in open fractures, failed closed reductions and in a dysvascular limb. There are various approaches that can be utilized to perform an open reduction. The approach of choice must be safe, surgeon and patient friendly and should provide a good access to the fracture and the important surrounding structures. The anterior approach has been described as the most versatile approach. The aim of the study was to review the advantages and drawbacks of the anterior approach and to assess the functional outcome of fractures treated via this approach.  Methods: Twenty ve (15 male and 10 female) patients out of a hundred and twenty eight children with Gartland type III extension variety of supracondylar fractures of the humerus from underwent open reduction and internal xation with K-wires via an anterior approach January 2007 to January 2011. The results were assessed at six months using Flynn’s radiological and clinical criteria. Results: Twenty ve patients (19.53%) out of hundred and twenty eight patients underwent open reduction and internal xation. According to Flynn’s clinical and radiological criteria, 20 (80%) were found to have excellent and 5 (20%) good results.  Conclusion: The anterior approach is safe, easy and provides direct exposure of the surrounding neurovascular structures with good to excellent results.  Keywords: anterior approach, open reduction, supracondylar fractures humerus.