Background & Aims: supracondylar humerus fracture is one of the most common pediatric elbow fractures accounting for about 16% of the pediatric fractures. Loss of reduction is one of the complications after closed and percutaneous fixation. This research is aimed to investigate the factors involved in the loss of reduction. Method: In this descriptive study, the children with supracondylar humerus fractures were examined. 175 children under the age of 10 with type 3 and 4 supracondylar humerus fracture fractures who underwent closed fixation and pinning were entered into the study. The studied factors were analyzed by a logistic regression method. Results: in this study 175 children under the age of 10 including 71 girls and 104 boys (59. 4%) with the average age of 5. 4± 2. 4 were investigated. In 153 cases, (87. 4%) the fixation was anatomical and stable during the follow-up; while 22 cases (12. 6%) had the loss of fixation. The most important anatomical disorder was internal rotation displacement in the medial distal part of fracture in these 22 cases. Pinning technique and obesity were among the effective factors in the failure of the anatomical reduction. In a way that obese children (above 85 percentile or IBM>25) and the lateral pinning location were divergent but they crossed in the fracture site and were effective with odd ratios of 1. 3 (CI 95% 0. 8-2. 3) and 1. 8 (CI 95% 0. 9-2. 3), respectively. In 14 cases (63. 6%) the failure was due to the place of fracture cross and in 8 cases (36. 6%) the complication occurred in the obese children. The fracture type had no effect on the loss of reduction as no difference was observed. Conclusions: Obesity and fixation technique are among the effective factors in the loss of reduction in pediatric supracondylar humerus fractures. In obese children, cross-suitable fixation should be considered to prevent complications.

Background: Distal radius fracture represent approximately one-sixth of all fractures treated in emergency departments. According to high incidence rate, different mechanisms of injury and new treatments for this fracture, it is becoming one of the most challenging of all kinds of fractures.Objective: to compare treatment outcome of traditional cast immobilization versus modern percutaneous pinning procedure in patients with distal radius fractures.Methods: In this randomized clinical trial study, 198 patients with "displaced but stable distal radius fracture without joint incongruity", were split into two groups and each group was treated by one of the following standard protocols: A- Closed reduction+Long arm cast; B- Closed reduction and Percutaneous pinning and Short arm cast. The patients were followed up after operation for three months from the point of view of: 1- satisfaction (based on Saito chart) 2-Loss of Reduction 3- Finger stiffness 4- Pin tract infection and 5-The mean of post operation follow up visits. For statistical analysis the Fisher's exact test and chi-square test were used by SPSS software16 Results: In group A, six cases of loss of reduction were detected in the first week who were treated by re-reduction and P.C pinning procedure; But no cases of loss of reduction were diagnosed in group B. Satisfaction percentage for Excellent value was 81.8% in group A and 93.9% in group B (p=0.131). Finger stiffness incidence rate in group B was meaningfully lower than group A (p=0.039). Pin tract infection incidence rate was 15.1% in group B; all of them were treated by pin removal and oral antibiotic therapy. The mean of post operation visits was 4.4 in group B and 3.6 in group A out of five sessions (p<0.0001).Conclusion: It seems that closed reduction and P.C pinning is a safer and less complicated procedure, especially in decreasing finger stiffness in these fractures.

Background: Supracondylar humeral fractures constitute about 60% and 13% of all pediatric elbow and pediatric skeletal fractures, respectively, with a peak incidence in the 5-7 years age group. The aim of this study was to evaluate and compare closed reduction with open reduction and pin fixation in type III supracondylar humeral fractures in children younger than 12 years. Materials and Methods: In this retrospective study, all children under 12 years of age with type III supracondylar humeral fractures who referred to two teaching hospitals in Mashhad, Iran, between March 2017 and March 2019 were included. Patients were divided into two groups: open reduction and fixation with pin (OR) (n= 30), and closed reduction and percutaneous pinning (CR) (n=15). The method of surgery for each individual patient was chosen based on the surgeon’ s preference. For patients who had a follow-up of at least 6 months, subsequent elbow radiographs were requested. Results: No significant differences were observed between the two groups in terms of range of motion of the fractured limb and radiographic angles at follow-up (p > 0. 05). However, operation time was significantly shorter in the CR group compared with the OR group (p < 0. 001). Three patients (6%) had cubitus valgus (all of whom were in the OR group [10%]), and two patients (4%) had cubitus varus (one patient in the OR group [3. 33%] and the other in the CR group [5%]). Wound dehiscence was only seen in one patient in the OR group (3. 33%). Conclusion: Based on the results, there was no significant difference between the open and closed reduction methods in type III supracondylar humeral fractures with respect to elbow function and union of the fracture.

Background: Tibia is the most commonly fractured long bone. Since it is subcutaneous, open fractures are more common and delayed union, nonunion and infections are common complications of fractures of the shaft of tibia. Although commonly advocated in the past, non-operative treatment now is generally reserved for closed stable fractures. Patients and Methods: In this prospective study, 150 patients including 134 males and 16 females with a mean age of 25 years with fracture of the shaft of tibia were treated by closed reduction and casting over a six-year period. The patients were followed up for a mean of 12 months. Results: At the end of follow up, 77 percent of the patients had anatomical or functional reduction. Nonunion was absent but malunion in the order of 5 to 10 degrees, shortening of less than 10 millimeters and infection complicated patients in 30.4, 26, 1.7 percent, respectively. The mean time for union was about 9.5 weeks. Conclusion: Although the treatment of choice for most tibial shaft fractures is surgical treatment, when confronted with large number of casualties such as in an earthquake or war and operative facilities are limited, fractures of the shaft of tibia may be treated by closed reduction and casting with a 77 percent success rate.

Drought is an abiotic stress that limits global rice production. Plastic mulch is one of the ways to reduce water consumption. To evaluate the closed water system in the pot, a study was conducted to determine the level of reduction of evapotranspiration that did not have an adverse effect on the vegetative growth of rice. Experimental treatments included: Treatment 1: 100 % control of evapotranspiration (The lid of the pot was always closed), Treatment 2: The pot lid was closed and the lid was left open for one hour every day. Treatment 3: The pot lid was closed and the lid was left open for one hour every two days, Treatment 4: The pot lid was closed and the lid was left open for one hour every three days, Treatment 5 (control): No control of evapotranspiration (pot lid was always open). Results showed that the control treatment (no control of evapotranspiration) had the lowest plant height, stem diameter, number of leaves per plant, leaf area, leaf relative water content, root volume, root weight, leaf fresh weight, leaf dry weight, and water use efficiency compared to the evapotranspiration control treatments. 100 % control of evapotranspiration had the lowest water consumption. In closed pots, due to the high relative humidity of the air inside the pot, the tendency of water molecules to convert from liquid to vapor decreases. Overall, the results of this study showed that it is possible to plant crops such as rice in a closed environment in terms of humidity.

Volar dislocation of the distal radio‑, ulnar joint (DRUJ) is a rare occurrence in the literature, with only a few cases reported. Dorsal dislocation is more common than a volar dislocation. It can be easily missed due to the lack of a specific clinical presentation. They can be treated by closed reduction or more commonly by open reduction internal fixation. We present a case of volar dislocation of the DRUJ with an ulnar head fracture reduced by closed reduction. We report the case of a right‑, handed 35‑, year‑, old patient with no medical history who presented to our emergency department after sustaining a fall on his left hand. The trauma dated of 1 day and X‑, ray was initially judged normal in the emergency department. Due to the persistence of the pain and the functional impotence, the patient presented again to our department. The investigation showed that the patient’, s hand was in a supine position when the fall occurred. On physical examination, the forearm was locked in supination, with no passive or active pronation elicited. There was a loss of the dorsal ulnar prominence with a palpable deformity on the volar aspect of the wrist. There was no skin lesion and the neurovascular status of the hand was normal. Initial radiographs were made. Anteroposterior and lateral radiographs of the forearm and wrist showed a volar dislocation of the DRUJ with an associated ulnar head fracture. A closed reduction attempt in the emergency department was unsuccessful. The patient was admitted and under general anesthesia, the dislocation was reduced by pronating the forearm and applying direct pressure over the distal ulna. The wrist was tested after the reduction and the DRUJ was stable. Above‑, elbow cast was applied in a pronation position for a period of 5 weeks. Upon cast removal, the result was excellent. The patient regained full range of motion of the wrist and elbow, there was no instability nor pain or tenderness. Grip force was conserved. A radiographic assessment confirmed the reduction. Volar locked dislocation of DRUJ is a rare injury. A high index of clinical suspicion and proper X‑, ray is required for prompt detection. Computed tomography scanning can be useful if the diagnosis is not certain. If the reduction of the joint is stable, there is no need for fixation. Early diagnosis and appropriate treatment are the keys for a good outcome.

Introduction & Objective: Closed intramedullary nailing has become the standard treatment for femoral shaft fractures, but because the existing closed reduction methods are difficult and demanding, in the most trauma centers these fractures usually are treated by open reduction method. Our objective was close reduction of these difficult fractures by a simple but effective method using Schanz screws for manipulating fracture fragments on a radiolucent table.Materials & Methods: In this prospective study, 30 patients whose femoral shaft fractures required reduction were operated on a radiolucent table in the lateral position and their fractures reduced closed by SchaZ pins and fixed with IM Rod. The patients were followed up 1 year.Results: We obtained reduction in 93% of patients. Average time of reduction in the first 48 hours was 9.23minutes and after 48 hours it was 19.7minutes (p<0.05). Also time to reduction was dependent on amount of preoperative traction. When the amount of preoperative traction was 5kg, that time was 19.16minutesbut in maximal amount of traction it was 10.29minutes. Time to reduction also was shorter in Winquist-Hansen type In and IV fractures than in type I and n fractures. There was 13% valgus deformity (5-10 °), 33% external malrotation (5-15°) and 37% shortening (up to 1-3 cm). But we had no infection and no need for blood transfusion or bone grafting.Conclusion: Schanz screws provide a very effective method for close reduction of femoral shaft fractures. Complications of this method are the same or even in some parts are less than other close reduction methods. The method is more successful if performed in the first 48 hours, or if the weight of preoperative skeletal traction is near to the maximum (15% of body weight).

Background: Supracondylar fractures of the humerus are common in children and there are many difficulties in management of these fractures. Objective: To determine the success rate in treatment of supracondylar fractures of the humerus by closed reduction and percutaneous pinning. Methods: This study was implemented on 26 children treated by closed reduction and percutaneous pinning in Shahid Rajaee hospital of Qazvin from October 1998 till March 2001. Findings: The results were excellent in 46.15%, good in 34.61% and poor in 3.84% of the cases. There was no movement limitation in elbow, the complications were minimum, and all the fractures healed soon in 6 weeks. Conclusions: The results conform with those of Hohl in 1996 and Ababneh in 1998. Closed reduction and percutaneous pinning of supracondylar fractures of the humerus is a simple and good method to treat these fractures.