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Background: Supracondylar fractures in children are common, accounting for 65% of all elbow fractures in children. In types II and III displaced supracondylar humeral fractures, closed reduction is difficult to achieve because of the thin bone between the coronoid and olecranon fossae as well as stripping of the periosteum. In addition, hyperflexion for maintenance of fracture reduction leads to swelling, compartment syndrome, and neurovascular compromise. Objective: To evaluate the clinical and radiological outcome after closed reduction and pinning using a Kirschner wire inserted vertically through the olecranon and another inserted laterally for displaced supracondylar humeral fractures. Patients and methods: A prospective case series, single Centre study conducted at Al-Azhar University Hospitals from June 2020 to May 2021. It included 20 patients with Gartland type III fracture who undergone for closed reduction and percutaneous pin fixation using two Kirschner wires, the first one was inserted vertically through the olecranon across the fracture into the metaphysis of the humerus and the second wire was inserted from the lateral column across the fracture at 30-40 degree to the opposite cortex of the humerus. Results: Operative time ranged from 15- 30 minutes with a mean of 19.25 minutes. We counted the operative time after induction of anesthesia (including draping, reduction, wires insertion and splint application). Results were within normal range for all patients. The mean Baumann angle in the patients was 70.57 degree, and standard deviation was 3.01. Postoperatively, anteroposterior and lateral views were done, and wires were removed by 3 weeks if clinical and radiological evidence of early bone union was present and, if not, wires removal was postponded one week later. Thirteen patients (65%) had the wires removed by 3rd week, and 7 patients (35%), the wires were removed by 4th week with a mean of 3.35 week, and standard deviation of 0.49. Few complications occurred and all were tolerable with no effect on final outcome, and these were pin tract infection in 2 patients and loss of reduction. Conclusion: Transolecranon and lateral Kirschner wires fixation was an effective option for displaced supracondylar humeral fractures in children.

Background: Intramedullary elastic rod fixation of midshaft clavicular fracture results in rapid free movement of the shoulder and an earlier return to daily activities than the conservative treatment. In comparison with plate fixation, the procedure is less invasive, with no loss of fracture haematoma, rapid union, and less infection. No major surgery for removal with less injury to surrounded neurovascular structures. A smaller incision is required with superior cosmesis. Objective: To study the short-term results of treatment of displaced fractures of the middle third of the clavicle using percutaneous elastic intramedullary nails Patient and Methods: This prospective study was carried out on twenty patients with displaced fractures of the middle third of the clavicle presented to the Hospital and treated by percutaneous elastic intramedullary rod between November 2019 and May 2020. Results: At the end of the follow-up period, the mean score was 89.70 ± 13.55 ranging from 48 to 100 according to the modified Constant and Murley shoulder score. Fourteen patients (70%) had excellent results, four patients (20%) had good results, one patient (5%) had a fair result, and one patient (5%) had a poor result. Conclusion: Elastic stable intramedullary nailing (ESIN) is an image dependant procedure indicated best for young medically free patients with acute simple 2 part middle third clavicle fracture. Delay in surgery may necessitate open reduction. Hammering is not recommended to avoid dorsolateral cortex perforation.

Owing to the remarkable antimicrobial potential of these materials, research into the possible use of nanomaterials as alternatives to fungicides in sustainable agriculture is increasingly progressing. Here, we investigated the potential antifungal properties of chitosan-decorated copper oxide nanocomposite (CH@CuO NPs) to control gray mold diseases of tomato caused by Botrytis cinerea throughout in vitro and in vivo trials. The nanocomposite CH@CuO NPs were chemically prepared, and size and shape were determined using Transmission Electron Microscope (TEM). The chemical functional groups responsible for the interaction of the CH NPs with the CuO NPs were detected using the Fourier Transform Infrared (FTIR) spectrophotometry. The TEM images confirmed that CH NPs have a thin and semitransparent network shape, while CuO NPs were spherically shaped. Furthermore, the nanocomposite CH@CuO NPs ex-habited an irregular shape. The size of CH NPs, CuO NPs and CH@CuO NPs as measured through TEM, were approximately 18.28 ± 2.4 nm, 19.34 ± 2.1 nm, and 32.74 ± 2.3 nm, respectively. The antifungal activity of CH@CuO NPs was tested at three concentrations of 50, 100 and 250 mg/L and the fungicide Teldor 50% SC was applied at recommended dose 1.5 mL/L. In vitro experiments revealed that CH@CuO NPs at different concentrations significantly inhibited the reproductive growth process of B. cinerea by suppressing the development of hyphae, spore germination and formation of sclerotia. Interestingly, a significant control efficacy of CH@CuO NPs against tomato gray mold was observed particularly at concentrations 100 and 250 mg/L on both detached leaves (100%) as well as the whole tomato plants (100%) when compared to the conventional chemical fungicide Teldor 50% SC (97%). In addition, the tested concentration 100 mg/L improved to be sufficient to guarantee a complete reduction in the disease’s severity (100%) to tomato fruits from gray mold without any morphological toxicity. In comparison, tomato plants treated with the recommended dose 1.5 mL/L of Teldor 50% SC ensured disease reduction up to 80%. Conclusively, this research enhances the concept of agro-nanotechnology by presenting how a nano materials-based fungicide could be used to protect tomato plants from gray mold under greenhouse conditions and during the postharvest stage.

Background: TKR is an effective treatment for severely arthritic knees. PSI TKR is a recent technique, which relies on preoperative formulation of specific instruments for every patient preoperatively, aiming at decreasing surgical time and instruments and increasing accuracy and functional outcome. Objective: Assessment of functional and radiological outcome of PSI TKR after a period of 3 years duration. Patients and Methods: 40 TKRs in 24 patients were done using CT-based PSI technique. Pre-and postoperative knee society score (KSS) were measured and digital long-leg X-rays were obtained for all patients. Hip-knee-ankle, proximal tibia land lateral distal femoral angles together with mechanical axis deviation were measured for all patients to assess the mechanical axis alignment after TKR. Results: HKA (hip knee ankle) has decreased from 4.70 varus preoperatively to 1.27 varus. The mean knee society score had markedly increased from 31.2 preoperatively to 85.3 with fair to excellent KSS was 95% after 3 years duration. Conclusion: PSI TKR is an effective technique in knee replacement as conventional method. With the advantages of reduction of the operative steps and concurrent potential complications.

Background. Fractured stem of the hip prosthesis is well documented in the literature. Although it is rare, it is considered as a challenging problem. Many techniques have been described to solve this problem. Purpose of the Study. Evaluation of the effect of anterolateral bone window for extraction of the cemented femoral stem of hemiarthroplasty in revision total hip replacement. Methods. The study included eight revision hip arthroplasties in eight patients, with a broken stem of cemented (Thompson) hemiarthroplasty, which has been revised by the anterolateral proximal femoral window. All cases received cemented cups and cement-in-cement stems, except one case who received cementless long stem. Clinical follow-up of cases by Harries hip score (HHS) and X-ray. Results. Functional improvement of HHS of all cases, with no signs of loosening, after a mean follow-up period of 1.5 years. Conclusion. Extraction of broken stem is a challenging procedure. Many techniques have been described for revision of cases with a fractured stem of hip prosthesis, but we think that the anterolateral femoral bone window is a reproducible technique due to the characteristics of simplicity, short-time procedure, less invasive, not requiring extra instruments, and can be successful for most patients.

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Background: Several arthroscopic techniques for the treatment of avulsion tibial spine fractures have been described in the literature. Purpose: To evaluate the outcomes of the arthroscopically assisted stainless steel wiring technique in the treatment of avulsed tibial spine in adults. Study Design: Case series; Level of evidence, 4. Methods: This retrospective study involved 28 patients (28 knees), 16 to 42 years of age, with tibial spine avulsion fracture that was treated using arthroscopic reduction and cerclage wire fixation by a single surgeon between March 2015 and August 2018. The degrees of avulsion in these patients were type II (n = 12), type III (n = 10), and type IV fractures (n = 6). Clinical assessment included International Knee Documentation Committee (IKDC) objective score (which noted swelling), range of knee movement, Tegner activity scale, Lachman test, and pivot-shift test compared with the normal opposite knee. Results: The mean follow-up period was 24.1 months (range, 18-30 months). The mean IKDC score was 93.7 (range, 88.5-98.9); the IKDC score was normal in 22 patients and nearly normal in 6 patients. The Lachman test was grade 1 in 25 patients and grade 2 in 3 patients, whereas the pivot-shift test was grade 0 in 26 patients and grade 1 in 2 patients. All patients achieved their preinjury Tegner activity levels. Radiological assessment showed healing in all patients within a mean of 12 weeks after surgery. Conclusion: The outcomes of all patients were satisfactory; fixation by cerclage wiring permitted reduction of tibial spine fragment anatomically to its fracture bed, provided stable fixation in displaced tibial spine avulsion, and allowed for early rehabilitation and weightbearing because of stable fixation.