Radial neck fractures in children secondary to horse-riding accidents: a comparative study

Percutaneous K-wire reduction and cast immobilization for severely displaced radial neck fractures in children

The purpose of this study was to compare outcomes between percutaneous K-wire reduction cast immobilization (PKRC) and percutaneous K-wire reduction elastic intramedullary nailing combined with cast immobilization (PKRNC) for the treatment of radial neck fractures in children. This was a retrospective analysis of 62 radial neck fractures in children treated with PKRC or PKRNC. Thirty-one children were treated with percutaneous K-wire reduction, K-wire removal after reduction, and cast immobilization while 31 radial neck fractures in controls were managed using PKRNC. There were no significant differences between PKRC and PKRNC with regard to preoperative angulation ( P  = 0.556). The operation time in the PKRC group was significantly shorter than that of the PKRNC group ( P  = 0.023). There was no significant difference in the displacement angle when compared between the two groups on the first day and 1 month after surgery ( P  = 0.617, 0.72). The Mayo elbow performance score of the elbow joint function did not differ significantly between the two groups ( P  = 0.587). Although the hospital stay was not significantly different between groups (4.81 ± 1.07 vs. 4.16 ± 1.59 days; P  = 0.067), the PKRNC group required a second hospitalization to remove the elastic intramedullary nail 3 months after the operation. PKRC and PKRNC both achieved satisfactory outcomes for radial neck fractures in children. The operation time in the PKRC group was significantly lower than in the PKRNC group. PKRC does not require reoperation to remove internal fixation. Therefore, PKRC is recommended for radial neck fractures in children.

Epidemiology of horse trauma: a literature review

PURPOSE

Horses are used for many recreational and occupational activities. They are large, strong, temperamental, and unpredictable animals and people involved with them are at risk for injuries, from minor abrasions to severe injuries that may lead to death. This review reports on horse trauma in relation to the characteristics of injured equestrians, characteristics of horse trauma, and clinical outcomes.

METHODS

A literature search was conducted from health-related electronic databases to identify studies from 2018 to 2023. The search returned 115 relevant full-text articles but after screening and assessment for eligibility, 39 were included in this review for a detailed examination of horse trauma epidemiology. Most studies were undertaken in the USA and the most used method was a retrospective review of hospital or trauma registry data.

RESULTS

There have only been very slight changes in horse trauma numbers and outcomes over the past 5 years. Most injuries often follow falls and kicks. Females in their late-20 s to mid-30 s who are recreational equestrians are the group most represented in the data. The commonest injuries include fractures, and head, thoracic, and abdominal trauma. Most individuals with horse trauma were treated in the Emergency Department and discharged. For the equestrians who were admitted to hospital, around one-third required surgery. Mortality rates are very low.

CONCLUSION

The popularity of occupational and recreational horse activities does not seem to wane and horse trauma continues to represent a significant concern for the health system. Health care workers need to be cognizant of the scope of trauma presentations as the mechanisms of injury can be complicated putting the equestrian at a high risk of associated injuries that may be life-threatening.

"Unhappy triad" of the trauma elbow in children: Diagnosis, classification, and mid-term outcomes

Background

The aim of this study was to describe the epidemiology, physiopathology, and outcomes of elbow "unhappy triad" trauma in children, combining a posterior dislocation, a proximal radius fracture, and a third lesion (i.e. bony or capsuloligamentous injury).

Methods

A retrospective bicentric study was conducted between 1999 and 2020. All skeletally immature children who presented to the emergency department and underwent surgery for a proximal radius injury were selected. Among this selection, only patients with two associated ipsilateral elbow injuries (i.e. posterior elbow dislocation and a bony and/or capsuloligamentous injury) were included. Active elbow ranges of motion, Mayo Elbow Performance Score and Quick-Disabilities Of The Arm, Shoulder And Hand scores and standard radiographs were recorded at last follow-up.

Results

Twenty-one patients met the inclusion criteria (mean age at surgery = 11.4 years) among 737 selected. The "unhappy triad" diagnosis was made preoperatively in nine cases (bone lesion only), intraoperatively in nine cases, and postoperatively in one case. The third lesions were surgically treated when the lesion was a bony fracture or if the elbow remains unstable between 60° and 90° of flexion (i.e. capsuloligamentous injury). Twenty patients were reviewed (mean follow-up = 5.8 years). The complications and re-operations rates were of 10%.

Conclusion

The "unhappy" triad of the child's elbow is a rare injury, where the preoperative diagnosis is frequently missed and lead to 10% of complications and re-operations.

Level of evidence

level III.

Elbow dislocation with and without an associated fracture in children: A prospective study of functional outcomes following 3 weeks of immobilization

INTRODUCTION

The initial management of elbow dislocations in children, emergency reduction and brachial-antebrachial-palmar (BABP) immobilization, remains the most widely used method. Osteosynthesis could be associated in case of fractures. On the other hand, there is no consensus on the duration of immobilization in the recent literature. The objective of this study was to describe the medium-term functional results of a prospective cohort of children presenting with an elbow dislocation immobilized for 3 weeks, with or without an associated fracture. The hypothesis of this study was that 3 weeks of immobilization was sufficient and made it possible to obtain a satisfactory, rapid functional recovery without residual instability.

MATERIAL AND METHOD

All children with an elbow dislocation with or without an associated fracture were included. The dislocation was urgently reduced and subsequent surgery could be indicated in the event of associated injuries. All the children had 3 weeks of immobilization with a BABP cast. Radiological and clinical follow-up was carried out for 2 years. The parameters evaluated were: 3 functional scores and the range of motion (ROM) of the elbow. Clinical or radiological complications were sought.

RESULTS

A total of 50 children were included, the mean age was 10.6 years (± 2.6). Functional score results were "good' or "excellent' at 3 months of follow-up, "excellent' at 6 months and thereafter. The mean limitation in ROM at the last follow-up was 4.7° (± 7.2°) with all ranges combined. Eighty-two percent of children had a mean limitation in ROM of less than 10°. None of the children presented with a recurrence of elbow dislocation and instability.

CONCLUSION

Immobilization of elbow dislocations for 3 weeks in children confers good medium-term functional results without exposing them to the risk of instability, whether or not the dislocation is associated with a fracture.

LEVEL OF EVIDENCE

II; Prospective cohort study.

Is a mounted award ceremony in equestrian sport relevant to animal welfare?

Severe accidents befalling both horses and riders have been observed during award ceremonies in equestrian sports. We hypothesised that such ceremonies and subsequent laps of honour pose a significant risk to the well-being of horses, riders and third parties. Tournament riders' opinions were sought and analysis of accidents undertaken via an online questionnaire completed by 700 tournament riders participating in dressage and showjumping in Germany. While 31.3% of the riders reported feeling tense themselves during award ceremonies, greater tension was reported in the warm-up area and throughout the competition itself. In contrast, 48% of horses were at their most tense at award ceremonies and displayed the greatest amount of stress during the lap of honour. Sixty percent of survey participants felt award ceremonies created an increased risk of injury with riders citing stressed horses as being the principal cause. Only risks associated with the warm-up area were noted by a greater proportion of riders (66.6%). The most frequent cause of accidents at award ceremonies was deemed to be kicks. Horse participation at award ceremonies was deemed to be important for spectators and sponsors and, although over half the riders were in favour of compulsory participation with a horse, they expressed the desire for exceptions to be permissible by judge(s). This study supported the hypothesis that mounted award ceremonies have a negative impact on horse welfare.

Pediatric Radial Neck Fractures: A Systematic Review Regarding the Influence of Fracture Treatment on Elbow Function

Background: This review aims to identify what angulation may be accepted for the conservative treatment of pediatric radial neck fractures and how the range of motion (ROM) at follow-up is influenced by the type of fracture treatment. Patients and Methods: A PRISMA-guided systematic search was performed for studies that reported on fracture angulation, treatment details, and ROM on a minimum of five children with radial neck fractures that were followed for at least one year. Data on fracture classification, treatment, and ROM were analyzed. Results: In total, 52 studies (2420 children) were included. Sufficient patient data could be extracted from 26 publications (551 children), of which 352 children had at least one year of follow-up. ROM following the closed reduction (CR) of fractures with <30 degrees angulation was impaired in only one case. In fractures angulated over 60 degrees, K-wire fixation (Kw) resulted in a significantly better ROM than intramedullary fixation (CIMP; Kw 9.7% impaired vs. CIMP 32.6% impaired, p = 0.01). In more than 50% of cases that required open reduction (OR), a loss of motion occurred. Conclusions: CR is effective in fractures angulated up to 30 degrees. There may be an advantage of Kw compared to CIMP fixation in fractures angulated over 60 degrees. OR should only be attempted if CR and CRIF have failed.

Radial Head Incarceration After Closed Reduction of a Pediatric Elbow Dislocation With a Radial Neck Fracture: A Case Report

Case:

A 10-year-old girl sustained a radial neck fracture with a posterior elbow dislocation. She was treated with closed reduction of the elbow with subsequent intra-articular displacement of the radial head, which necessitated open reduction and pinning of the radial neck fracture.

Conclusion:

Displacement of the radial neck fracture from impingement of the capitellum on the anterior radial head during closed reduction of the elbow dislocation is a rare injury pattern. It is important to examine the radial neck in high-energy posterior elbow dislocations before attempted reduction. We present a case with imaging depicting the injury mechanism and successful management with subsequent open reduction and fixation of the radial neck fracture.