In patients with diabetic foot and pressure ulcers, early intervention with biological therapy will either halt progression or result in rapid healing of these chronic wounds. Design: In a prospective nonrandomized case series, 23 consecutive patients were treated with human skin equivalent (HSE) after excisional debridement of their wounds. Setting: A single university teaching hospital and tertiary care center. Patients and Methods: Twenty-three consecutive patients with a total of 41 wounds (1.0-7.5 cm in diameter) were treated with placement of HSE after sharp excisional debridement. All patients with pressure ulcers received alternating air therapy with zero-pressure alternating air mattresses. Main Outcome Measure: Time to 100% healing, as defined by full epithelialization of the wound and by no drainage from the site. Results: Seven of 10 patients with diabetic foot ulcers had complete healing of all wounds. In these patients 17 of 20 wounds healed in an average of 42 days. Seven of 13 patients with pressure ulcers had complete healing of all wounds. In patients with pressure ulcers, 13 of 21 wounds healed in an average of 29 days. All wounds that did not heal in this series occurred in patients who had an additional stage IV ulcer or a wound with exposed bone. Twenty-nine of 30 wounds that healed did so after a single application of the HSE. Conclusions: In diabetic ulcers and pressure ulcers of various durations, the application of HSE with the surgical principles used in a traditional skin graft is successful in producing healing. The high success rate with complete closure in these various types of wounds suggests that HSE may function as a reservoir of growth factors that also stimulate wound contraction and epithelialization. If a wound has not fully healed after 6 weeks, a second application of HSE should be used. If the wound is not healing, an occult infection is the likely cause. All nonischemic diabetic foot and pressure ulcers that are identified and treated early with aggressive therapy (including antibiotics, off-loading of pressure, and biological therapy) will not progress.

Consider a 3-pin pattern, either 3 laterally divergent pins or 2 lateral pins and 1 medial pin, for SCH fractures when a less than complete anatomical reduction is obtained.

Background and purpose Leg-length discrepancy (LLD) can be a sequela of slipped capital femoral epiphysis (SCFE). We tried to identify factors that affect the development of LLD following SCFE.Patients and method We evaluated 85 patients who had been treated using percutaneous screw fixation. The average age of the patients at the time of surgery was 12 (8–16) years. The relationship of LLD and various clinical and radiographic parameters was evaluated: the degree of slip, articulotrochanteric distance (ATD), and articulotrochanteric distance difference (ATDD) (healthy side minus the side with SCFE). We assessed the relationship between ATDD and LLD based on scanogram.Results The average LLD was 1.4 (0.1–3.8) cm at 6 (2–15) years postoperatively. 48 of 85 patients had an LLD of greater than 1 cm and 10 patients had an LLD of greater than 2 cm. There was a correlation between the magnitude of LLD and the severity of the slip. There was no statistically significant correlation between LLD and the stability of the slip, age, BMI, sex, or race. There was a significant correlation between LLD and ATDD.Interpretation Patients with a high degree of slip are prone to develop clinically significant LLD. Although ATDD does not give the exact LLD, it can be used as a primary measurement, which should be supplemented with scanogram in cases of clinically significant differences in length.

Bicortical pins placed with maximum divergence and spread at the fracture site maximizes stability for 2-pin constructs in Milch type II lateral condyle fractures. If the stability of the fracture is questionable after 2 pins are inserted, the addition of a divergent third pin enhances the stability.

Our data suggest that percutaneous direct lateral entry Kirschner wires and half-pins can be safely inserted in the distal humerus in children along the transepicondylar axis, either at or slightly posterior to the lateral supracondylar ridge, when placed caudal to the point located where the lateral supracondylar ridge line diverges from the proximal extent of the supracondylar ridge on AP elbow radiograph.