BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the h...BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb.Stable K-wire fixation can be succeeded either by closed or open reduction method.AIM To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.METHODS We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department.All patients underwent clinical and radiological examination recording elbow range of motion,function and deformity.RESULTS The standard lateral approach was carried out in all patients while in 47 cases(35.9%)additional medial approach was used.Average follow-up time was 5.4 years(1-14 years).Fracture healing was completed at 4-6 weeks.The average operative time was 50 min(range:37-75 minutes,SD:11.307)and the average duration of radiation exposure based on image intensifier usage time was 20 seconds(range:7-45 seconds,SD:9.864).No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion,Patient-Reported Outcome Measures(Disabilities of the Arm,Shoulder,and Hand questionnaire,Mayo Elbow Performance Scores)at 2-year follow-up was satisfying.CONCLUSION Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden.Moreover,the risk of neurovascular injuries due to manipulations of closed reduction,is minimized while complications related to surgical approaches are insignificant provided there is expertise.展开更多
Background: Forearm fractures amongst children are quite a common presentation. The accuracy of correct alignment in forearm bones is important as it determines the degree of forearm rotation (pronation-supination). H...Background: Forearm fractures amongst children are quite a common presentation. The accuracy of correct alignment in forearm bones is important as it determines the degree of forearm rotation (pronation-supination). However in children due to the potential for continuous growth, a degree of angulation is acceptable. The aim of this study was to determine the effect of angulation of forearm fracture on forearm rotation using computer stimulation. Methods: Using a 3D computer modelling software (Wildfire Pro Engineer 4.0, Creo by PTC, Needham, MA), an accurate to scale model of the radius and ulna was replicated from a 7 year old forearm. A realistic representation of pronation/supination of the forearm was applied and a fracture at the junction of proximal one third and distal two third was created. A rotational simulation was created and ended when maximum pronation and supination was reached. Maximum pronation and supination was reached when either no more rotation could occur due to a misalignment of the radius and ulna or there was a collision of the bones. The simulation was repeated in increments of angulation of 2° up to 26°. The angulations that resulted in a combined range of motion (50° pronation and 80° supination) less than 130° were recorded as unacceptable and the others were as acceptable. Findings: The study showed that radius angulation fracture of >16° in the proximal third of the radius would result in an unacceptable reduction of pronation-supination to less than 130°. Conclusion: Patients with more >16° of radius angulation in a distal third shaft fracture of the radius may result in clinical reduction in forearm rotation.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)has a major influence on all parts of society.AIM To examine the consequences of the national lockdown and political initiatives during the first surge of the COVID-19 pand...BACKGROUND Coronavirus disease 2019(COVID-19)has a major influence on all parts of society.AIM To examine the consequences of the national lockdown and political initiatives during the first surge of the COVID-19 pandemic expressed by changes in incidences of musculoskeletal paediatric injuries.METHODS Study design was a retrospective multicenter cohort study.A‘pandemic’cohort was established from 16 March 2020 to 21 April 2020,where all institutions including day care and schools were closed.A‘pre-pandemic’cohort was established from the same period in 2019 for comparison.Included were all patients admitted at the emergency departments with paediatric musculoskeletal injuries(aged 0-15 years)identified by a relevant musculoskeletal ICD-10 diagnosis(DSxxx),concussions(DZ033D),or burns(DT2xx).RESULTS The‘pre-pandemic’cohort consisted of 2101 patients,and the‘pandemic’cohort consisted of 1070 patients,indicating a decrease of paediatric musculoskeletal injuries of 51%.The incidence of paediatric injury in the‘pre-pandemic’cohort was 10460/100000/year.In the‘pandemic’cohort,the incidence was 5344/100000/year.CONCLUSION A resource re-allocation to help serve the COVID-19 patients might be possible without reducing the level of care for injury-related paediatric patients.展开更多
Purpose： The aim of this study is to discuss the results of different intramedullary devices used in the management of paediatric radial neck fractures and to suggest methods to avoid the pitfalls of the technique. M...Purpose： The aim of this study is to discuss the results of different intramedullary devices used in the management of paediatric radial neck fractures and to suggest methods to avoid the pitfalls of the technique. Methods： Thirty patients with isolated Judet III and IV fractures were included in this prospective study. Judet I and II fractures and radial neck fractures associated with other injuries were excluded. The final results were graded using the Metaizeau functional scoring system and Oxford Elbow Score. Results： The functional result was good to excellent in 24 of 30 cases （80%）. The mean Oxford Elbow Score was 44.32. The mean follow-up was 40.11 months. The complications seen were radiocapitellar joint penetration - 6 cases at mean 4.87 weeks, redisplacement - 6, radial epiphyseal sclerosis - 5, and heterotopic ossification 1 case. Conclusion： lntramedullary K wires may result in radiocapitellar joint penetration. Titanium Elastic Nail System should not be used as purely fixation devices as they may not prevent redisplacement. Regular follow-up until at least 6 weeks is essential. Patients who have a Judet IV fracture and need open reduction should be given a guarded prognosis. The paper highlights the pitfalls of the technique and makes recommendations regarding the type of implant, follow-up and patient counselling in Judet IV fractures.展开更多
文摘BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb.Stable K-wire fixation can be succeeded either by closed or open reduction method.AIM To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.METHODS We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department.All patients underwent clinical and radiological examination recording elbow range of motion,function and deformity.RESULTS The standard lateral approach was carried out in all patients while in 47 cases(35.9%)additional medial approach was used.Average follow-up time was 5.4 years(1-14 years).Fracture healing was completed at 4-6 weeks.The average operative time was 50 min(range:37-75 minutes,SD:11.307)and the average duration of radiation exposure based on image intensifier usage time was 20 seconds(range:7-45 seconds,SD:9.864).No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion,Patient-Reported Outcome Measures(Disabilities of the Arm,Shoulder,and Hand questionnaire,Mayo Elbow Performance Scores)at 2-year follow-up was satisfying.CONCLUSION Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden.Moreover,the risk of neurovascular injuries due to manipulations of closed reduction,is minimized while complications related to surgical approaches are insignificant provided there is expertise.
文摘Background: Forearm fractures amongst children are quite a common presentation. The accuracy of correct alignment in forearm bones is important as it determines the degree of forearm rotation (pronation-supination). However in children due to the potential for continuous growth, a degree of angulation is acceptable. The aim of this study was to determine the effect of angulation of forearm fracture on forearm rotation using computer stimulation. Methods: Using a 3D computer modelling software (Wildfire Pro Engineer 4.0, Creo by PTC, Needham, MA), an accurate to scale model of the radius and ulna was replicated from a 7 year old forearm. A realistic representation of pronation/supination of the forearm was applied and a fracture at the junction of proximal one third and distal two third was created. A rotational simulation was created and ended when maximum pronation and supination was reached. Maximum pronation and supination was reached when either no more rotation could occur due to a misalignment of the radius and ulna or there was a collision of the bones. The simulation was repeated in increments of angulation of 2° up to 26°. The angulations that resulted in a combined range of motion (50° pronation and 80° supination) less than 130° were recorded as unacceptable and the others were as acceptable. Findings: The study showed that radius angulation fracture of >16° in the proximal third of the radius would result in an unacceptable reduction of pronation-supination to less than 130°. Conclusion: Patients with more >16° of radius angulation in a distal third shaft fracture of the radius may result in clinical reduction in forearm rotation.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)has a major influence on all parts of society.AIM To examine the consequences of the national lockdown and political initiatives during the first surge of the COVID-19 pandemic expressed by changes in incidences of musculoskeletal paediatric injuries.METHODS Study design was a retrospective multicenter cohort study.A‘pandemic’cohort was established from 16 March 2020 to 21 April 2020,where all institutions including day care and schools were closed.A‘pre-pandemic’cohort was established from the same period in 2019 for comparison.Included were all patients admitted at the emergency departments with paediatric musculoskeletal injuries(aged 0-15 years)identified by a relevant musculoskeletal ICD-10 diagnosis(DSxxx),concussions(DZ033D),or burns(DT2xx).RESULTS The‘pre-pandemic’cohort consisted of 2101 patients,and the‘pandemic’cohort consisted of 1070 patients,indicating a decrease of paediatric musculoskeletal injuries of 51%.The incidence of paediatric injury in the‘pre-pandemic’cohort was 10460/100000/year.In the‘pandemic’cohort,the incidence was 5344/100000/year.CONCLUSION A resource re-allocation to help serve the COVID-19 patients might be possible without reducing the level of care for injury-related paediatric patients.
文摘Purpose： The aim of this study is to discuss the results of different intramedullary devices used in the management of paediatric radial neck fractures and to suggest methods to avoid the pitfalls of the technique. Methods： Thirty patients with isolated Judet III and IV fractures were included in this prospective study. Judet I and II fractures and radial neck fractures associated with other injuries were excluded. The final results were graded using the Metaizeau functional scoring system and Oxford Elbow Score. Results： The functional result was good to excellent in 24 of 30 cases （80%）. The mean Oxford Elbow Score was 44.32. The mean follow-up was 40.11 months. The complications seen were radiocapitellar joint penetration - 6 cases at mean 4.87 weeks, redisplacement - 6, radial epiphyseal sclerosis - 5, and heterotopic ossification 1 case. Conclusion： lntramedullary K wires may result in radiocapitellar joint penetration. Titanium Elastic Nail System should not be used as purely fixation devices as they may not prevent redisplacement. Regular follow-up until at least 6 weeks is essential. Patients who have a Judet IV fracture and need open reduction should be given a guarded prognosis. The paper highlights the pitfalls of the technique and makes recommendations regarding the type of implant, follow-up and patient counselling in Judet IV fractures.
