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We prospectively evaluated the clinical and functional outcomes of pronator teres to extensor carpi radialis brevis transfer in children with cerebral palsy. Patients were followed-up at 6 months postoperatively, and functionally assessed using the House classification, Manual Ability Classification System (MACS) and Upper Extremity Functional Index (UEFI). Fifteen children with a mean age of 8.1 years underwent tendon transfers. All patients were of Gschwind and Tonkin Grade 2 for pronation deformity; eight patients were of Zancolli's classification Group 1 and seven, Group 2 for wrist flexion deformity. The average gain in active supination was 67°, and wrist extension 15°. An increase of 7.0 in the UEFI score was recorded, although no significant improvement in MACS and House classification was observed. We conclude that the pronator teres to extensor carpi radialis brevis transfer improves upper limb function through effective correction of forearm pronation and wrist flexion deformities. Level of evidence: II [ABSTRACT FROM AUTHOR]

Abstract: Large quantities of rice husk ash (RHA), bagasse ash (BA) and coal fly ash (FA) are available in many Asian countries as waste materials, which create a serious disposal problem. Recycling of these ashes on agricultural land can help to improve physical and chemical fertility of soil. The present field experiment was conducted for three and half years to explore the possibilities to utilize these waste materials as soil amendments to improve productivity of rice–wheat system (RWS). The treatments consisted of application of RHA and BA at 10Mgha−1 to either wheat or to rice or to both wheat and rice and 20Mgha−1 to rice alone. The rates used for FA were 15 and 30Mgha−1. Addition of RHA and BA significantly increased the grain yield of wheat and rice but FA caused small increases in crop yields. Direct application of RHA and BA to wheat was significantly superior than their application to rice in the RWS. Direct application of RHA and BA to wheat resulted in 25 and 24% increase in mean grain yield of wheat and 10 and 11% increase in subsequent rice crop, respectively. However, direct application to rice resulted in 8 and 11% yield increase in rice and 10 and 14% increase in subsequent wheat for RHA and BA, respectively. Application of RHA and BA at 20Mgha−1 to rice resulted in lower RWS productivity than that applied at 10Mgha−1 to wheat. There was no significant effect of these ashes on heavy metal contents in grain and straw of the 7th crop of wheat. Application of three types of ashes generally resulted in positive P balance in RWS, however, K balance remained negative. These results suggest that RHA and BA can be recycled successfully in rice–wheat system to improve its productivity with no adverse effect on soil health. [Copyright &y& Elsevier]

Competing Interests: Conflito de Interesses Os autores não têm nenhum conflito de interesses a declarar.

Objectives  The present study aims to identify preoperative characteristics of the patient, of the injury, as well as of imaging, which would point towards a type IV fracture. The present study shall help the operating team to predict more accurately the type IV pattern preoperatively, leading to improved counselling of the caregivers, planning of surgery, as well as preparedness regarding open reduction, if such situation arises. Methods  A retrospective study was conducted, including patients that met the following criteria: 1) age < 16 years old; 2) Gartland type-III and type-IV supracondylar fractures; and 3) with complete records. Demographic data like age, gender, laterality, mode of injury, hospital duration of the injury, history of previous attempts of closed reduction, open/closed fracture, distal neurovascular status, and radiographic data like angulation, translation, osseous apposition and fracture comminution were collected. Results  Hospital duration of the injury and previous attempts of closed reduction were the factors that had a statistically significant difference among types III and IV fractures ( p  < 0.05). A diagnosis of type IV supracondylar fractures was significantly more likely in the presence of valgus angulation of the distal fragment ≥ 17° (odds ratio [OR] = 20.22; 95% confidence interval [CI] = 3.45-118.65). Flexion angulation ≥ 10° (OR = 5.32; 95% CI = 0.24-119.88) of the distal fragment predicted Gartland type IV with a sensitivity of 41% and a specificity of 100%. Conclusion  The preoperative evaluation of suspected Gartland IV fractures can help the operating surgeon in predicting such injuries. Nonradiographic factors like increased hospital duration of the injury, attempts at previously closed reduction, and radiographic parameters like valgus and flexion angulation were more likely to be associated with type IV fractures. Level of evidence III., Competing Interests: Conflito de Interesses Os autores não têm conflito de interesses a declarar., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)

We prospectively evaluated the clinical and functional outcomes of pronator teres to extensor carpi radialis brevis transfer in children with cerebral palsy. Patients were followed-up at 6 months postoperatively, and functionally assessed using the House classification, Manual Ability Classification System (MACS) and Upper Extremity Functional Index (UEFI). Fifteen children with a mean age of 8.1 years underwent tendon transfers. All patients were of Gschwind and Tonkin Grade 2 for pronation deformity; eight patients were of Zancolli's classification Group 1 and seven, Group 2 for wrist flexion deformity. The average gain in active supination was 67°, and wrist extension 15°. An increase of 7.0 in the UEFI score was recorded, although no significant improvement in MACS and House classification was observed. We conclude that the pronator teres to extensor carpi radialis brevis transfer improves upper limb function through effective correction of forearm pronation and wrist flexion deformities. Level of evidence: II.