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Pilotto JM, Valisena S, De Marco G, Vazquez O, De Rosa V, Mendoza Sagaon M, De Coulon G, Dayer R, Ceroni D, Steiger C. Shear fractures of the capitellum in children: a case report and narrative review. Front Surg 2024; 11:1407577. [PMID: 39027917 PMCID: PMC11254701 DOI: 10.3389/fsurg.2024.1407577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
The shear fractures of the capitellum are rare fractures in the pediatric population. Their diagnosis is challenging because of the high cartilaginous component of the growing elbow, requiring a high level of clinical suspicion especially in the case of small osteochondral or chondral fragments. The literature on capitellar shear fractures is mainly represented by case reports, which provides a patchy view of the topic. For this reason, we aimed to draw a narrative review presenting the available management strategies and their outcomes, and present two cases treated in our institution.
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Affiliation(s)
- Jean-Marc Pilotto
- Service de Chirurgie Orthopédique et Traumatology de L’appareil Locomoteur, Hopitaux Universitaires de Genève, Genève, Switzerland
| | - Silvia Valisena
- Service de Chirurgie Orthopédique et Traumatology de L’appareil Locomoteur, Hopitaux Universitaires de Genève, Genève, Switzerland
- Unité d’orthopédie et Traumatology Pédiatrique, Hopitaux Universitaires de Genève, Genève, Switzerland
| | - Giacomo De Marco
- Unité d’orthopédie et Traumatology Pédiatrique, Hopitaux Universitaires de Genève, Genève, Switzerland
| | - Oscar Vazquez
- Unité d’orthopédie et Traumatology Pédiatrique, Hopitaux Universitaires de Genève, Genève, Switzerland
| | - Vincenzo De Rosa
- Servizio di Chirurgia e Ortopedia Pediatrica, Bellinzona, Switzerland
| | | | - Geraldo De Coulon
- Unité d’orthopédie et Traumatology Pédiatrique, Hopitaux Universitaires de Genève, Genève, Switzerland
| | - Romain Dayer
- Unité d’orthopédie et Traumatology Pédiatrique, Hopitaux Universitaires de Genève, Genève, Switzerland
| | - Dimitri Ceroni
- Unité d’orthopédie et Traumatology Pédiatrique, Hopitaux Universitaires de Genève, Genève, Switzerland
| | - Christina Steiger
- Unité d’orthopédie et Traumatology Pédiatrique, Hopitaux Universitaires de Genève, Genève, Switzerland
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Kraus R, Lieber J, Schwerk P, Rüther H, Tüshaus L, Karvouniaris N, Sommerfeldt DW, Kaiser MM. Incidence, treatment techniques, and results of distal humeral coronal shear fractures in children and adolescents-a multicenter study of the German Section of Pediatric Traumatology (SKT). Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02370-1. [PMID: 37815546 DOI: 10.1007/s00068-023-02370-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Distal humeral coronal shear fractures (CSF) are uncommon and may be challenging to treat due to their size, location, and intraarticular nature. The purpose of this study was to analyze treatment concepts of this rare entity in the growing age. METHODS Based on a multi-center data analysis we retrospectively reviewed patients below 16 years of age with CSF treated at 13 high-volume pediatric trauma centers. RESULTS Data from 51 patients with a CSF treated between 01/2012 and 12/2021 were analyzed. The mean age was 12.9 years (10-15), and there was a trend towards male patients (30: 21). The initial diagnostic approach was conventional X-ray in all cases. In addition, a CT scan (n = 33), MRI scan (n = 9), or both (n = 3) were performed. All fractures except two showed relevant displacement. Consequently, only two cases received conservative treatment consisting of plaster immobilization. Surgical treatment was performed in 49 cases consisting of open or mini-open reduction and metal/resorbable screw osteosynthesis (n = 39), plates (n = 4), K-wire pinning (n = 6), and others (n = 6), as well as combinations. In 1 case open reduction without osteosynthesis was performed. Postoperative additional plaster immobilization was performed in 40 cases (for a mean of 19 days (2-42)), physiotherapy was initiated in 29 cases, and metal removal was performed in 28 cases (after a mean of 18.1 weeks (4-44)). After a mean follow-up of 9.9 months (2-25), elbow axial deviation (5° valgus) was observed in one case and mild loss of elbow ROM in six cases (11.7%). Complications included revision of the osteosynthesis because of insufficient articular reconstruction (n = 4), removal of a free joint body (n = 1), an osteonecrosis (n = 1), and a cartilage defect (n = 1). CONCLUSION In pediatric patients CSFs start to occur at the age of 10, but are typically observed at the age of 13 and older. Because of their intraarticular nature and predilection toward displacement, these fractures are frequently treated operatively. The surgical strategy requires open reduction and anatomic reconstruction of the articular surface. Stable internal fixation, most often achieved by screws, permits early mobilization and leads to good outcomes in most cases. This is presumably due to the fact that mostly simple fractures occur in children and mostly complex injuries in older adults. LEVEL OF EVIDENCE III, retrospective analysis.
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Affiliation(s)
- Ralf Kraus
- Clinic for Trauma Surgery and Orthopedics, Klinikum Bad Hersfeld, Bad Hersfeld, Germany.
| | - Justus Lieber
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Philipp Schwerk
- Department of Pediatric Surgery, University Hospital Dresden, Technical University of Dresden, Dresden, Germany
| | - Hauke Rüther
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, Göttingen University Medical Center, Göttingen, Germany
| | - Ludger Tüshaus
- Department of Pediatric Surgery, University Hospital Schleswig Holstein-Campus Lübeck, Lübeck, Germany
| | - Nikos Karvouniaris
- Department of Orthopedics and Trauma Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Dirk W Sommerfeldt
- Department of Pediatric Traumatology, Altona Children's Hospital, Hamburg, Germany
| | - Martin M Kaiser
- Department of Pediatric Traumatology and Surgery, University Hospital Halle (Saale) of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Department of Pediatric Traumatology, Bergmannstrost Hospital Halle, Halle (Saale), Germany
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Capitellum and Capitellar-Trochlear Shear Injury in Children. J Orthop Trauma 2023; 37:e68-e72. [PMID: 36658698 DOI: 10.1097/bot.0000000000002471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We report our clinical results following surgical intervention for capitellar fractures in a pediatric population, highlighting approaches, surgical instruments, and possible prognostic factors. DESIGN Retrospective descriptive case-series study. SETTING A tertiary referral hospital. PATIENTS Twelve pediatric patients with capitellar or capitellar-trochlear injuries were treated between 2017 and 2021. INTERVENTION Open reduction and internal fixation primarily using cannulated headless screws. MAIN OUTCOME MEASUREMENTS The mean follow-up period was 22 months (range: 10-35 months). Functional outcomes were assessed using the Mayo Elbow Performance Score. Post-traumatic elbow arthrosis was assessed using the Bromberg and Morrey rating system. RESULTS All fractures healed within 5-7 weeks. The mean Mayo Elbow Performance Score value was 98 (range, 85-100). Three patients developed arthrosis, and one had capitellar osteonecrosis. CONCLUSIONS Based on our experience, the Kocher approach and fixation of 2-3 retrograde cannulated screws together represent an appropriate surgical technique for isolated capitellar fractures, whereas good functional outcomes are attainable for capitellar-trochlear shear fractures using the transolecranon approach with 3 cannulated screw fixations. Further injuries to the osseoligamentous structures around the elbow joint are suspected to be an unfavorable prognostic factor. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Alberghina F, Andreacchio A, Pavone V, Mansour M, Dimeglio A, Canavese F. Review of pediatric functional outcomes measures used to evaluate surgical management in pediatric patients with an upper extremity fracture. J Pediatr Orthop B 2022; 31:260-269. [PMID: 34406161 DOI: 10.1097/bpb.0000000000000909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For two decades, many scores, questionnaires, and rating systems have been used to evaluate the functional outcome of children with an upper extremity fracture (UEF). However, only a few of these were created specifically for children, and many assess only elbow function. In the absence of any published review on this topic, we set out to identify and categorize different scores used to evaluate the clinical and functional outcomes of surgically treated pediatric UEFs. A literature search was performed, and 38 studies were identified. The scores used more often were the shortened version of the Disability of the Arm, Shoulder and Hand questionnaire and the Mayo Elbow Performance Score/Index. In a lower number of studies, authors used other scoring systems, including the Mayo Wrist Score, the Patient-Rated Wrist Evaluation, the Patient-Rated Elbow Evaluation, the Métaizeau functional scoring system, the Oxford Elbow Score, the Price and Flynn criteria, the Hardacre Functional Score, the Neer Shoulder Score, the Constant-Murley Shoulder Score, the Modified Orthopedic Trauma Association Score, the Medical Outcomes Study Short Form-36, and the Pediatric Outcomes Data Collection Instrument. Some specific pediatric scoring systems to evaluate the functional outcome of children with a UEF have been suggested, but a single tool that is valid and reliable for skeletally immature patients of all ages is not yet available. Further studies are needed to identify specific pediatric measurements to increase validity, responsiveness, sensitivity, and interpretability of upper limb functional outcome scores in common clinical practice.
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Affiliation(s)
- Flavia Alberghina
- Pediatric Orthopedic Department, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Antonio Andreacchio
- Pediatric Orthopedic Surgery Department, 'Vittore Buzzi' Children's Hospital, Milano
| | - Vito Pavone
- Department of General Surgery, Section of Orthopedics and Traumatology, A.O.U. Policlinico 'Rodolico - San Marco', University of Catania, Catania, Italy
| | - Mounira Mansour
- Pediatric Surgery Department, University Hospital Estaing, Clermont Ferrand
| | - Alain Dimeglio
- Pediatric Surgery Department, Clinique St. Roch, Montpellier
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Center, Jeanne de Flandre Hospital, Lille, France
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Ju L, Jiang L, Zhang Y, Wu J, Li M, Liu X, Qu X. Therapeutic analysis of Herbert screw fixation for capitellar fractures via the anterior approach in adolescent patients. J Orthop Surg Res 2021; 16:394. [PMID: 34147121 PMCID: PMC8214782 DOI: 10.1186/s13018-021-02536-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/08/2021] [Indexed: 12/03/2022] Open
Abstract
Objective The aim of this study is to analyze the efficacy of open reduction and Herbert screw fixation for coronal fractures of the capitellum via the anterior approach in adolescents. Methods We retrospectively analyzed the clinical and imaging data of 15 adolescents with capitellar fractures who were admitted to our hospital from May 2014 to May 2019. The fracture was reduced through the cubital crease incision via the anterior approach and was internally fixated with Herbert screws. A follow-up was conducted after the operation to examine fracture healing and elbow function. The postoperative functional recovery of patients was evaluated with the Mayo Elbow Performance index (MEPI) and the Broberg-Morrey rating system. Results Patients underwent surgery 3.7 days after injury on average. Intraoperative fracture reduction was satisfactory. No vascular injury or nerve injury occurred. Bony union occurred in an average of 6 weeks after the operation. All adolescents completed a 12- to 36-month follow-up. At the last follow-up, the Mayo Elbow Performance index was considered excellent in 12 patients and good in three patients. The Broberg-Morrey score was considered excellent in 12 patients, good in two patients, and fair in one patient. Conclusion Open reduction with Herbert screw fixation via the anterior approach is a feasible surgical method for the treatment of coronal fractures of the capitellum in adolescents. Levels of evidence Therapeutic, retrospective study-Level IV
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Affiliation(s)
- Lingpeng Ju
- Department of Orthopedics, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Linjun Jiang
- Department of Orthopedics, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Yuan Zhang
- Department of Orthopedics, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Jun Wu
- Department of Orthopedics, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Ming Li
- Department of Orthopedics, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Xing Liu
- Department of Orthopedics, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Xiangyang Qu
- Department of Orthopedics, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.
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Ruan JH, Cui HM, Sun ZY, Chen S, Wang W, Fan CY. Midterm Outcomes After Open Arthrolysis for Posttraumatic Elbow Stiffness in Children and Adolescents. J Pediatr Orthop 2021; 41:e266-e271. [PMID: 33492039 PMCID: PMC7952043 DOI: 10.1097/bpo.0000000000001748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Open arthrolysis is used for treating elbow stiffness in adults. This study evaluated the midterm outcomes after open arthrolysis in children and adolescents with posttraumatic elbow stiffness. METHODS Data of 31 children and adolescents with posttraumatic elbow stiffness following open arthrolysis with or without hinged external fixation from 2010 to 2014 were retrospectively analyzed. Their mean age was 15 (range: 6 to 19) years. At baseline and the follow-up (>4 y), we evaluated the outcomes (range of motion and Mayo Elbow Performance Index) and postoperative complications (pain, ulnar nerve symptoms, infections, and instability) and analyzed the association between outcomes and clinical variables. RESULTS The Mayo Elbow Performance Index improved from 67.9 (range: 35 to 95 points) to 93.7 points (range: 65 to 100 points; P<0.001). The elbow active flexion/extension arc increased significantly from 49 degrees (range: 0 to 120 degrees) to 108 degrees (range: 0 to 120 degrees; P<0.001), with a mean flexion of 123 degrees (range: 70 to 140 degrees; P<0.001) and mean extension of 15 degrees (range: 0 to 85 degrees; P<0.001) postoperatively. The increasing age at surgery was associated with improved elbow motions (P=0.004). Patients with increased preoperative serum alkaline phosphatase level demonstrated decreased arc of motion (P=0.015). Patients with extra-articular fractures had better outcomes than the other patients. At the final follow-up, 8 patients experienced recurrent contracture in the flexion arc with heterotopic ossification. Two patients had postoperative pain, 1 elbow instability, and 1 ulnar neuropathy. CONCLUSIONS Most patients showed satisfactory functional outcomes after arthrolysis, indicating that open release with or without hinged external fixation is an effective and maintained technique for children and adolescents with posttraumatic elbow stiffness. The age at surgery, preoperative alkaline phosphatase level, and injury type should be considered to achieve good outcomes. LEVEL OF EVIDENCE Therapeutic level III.
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Affiliation(s)
- Ji-hao Ruan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital
- Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People’s Hospital East Campus, Shanghai, China
| | - Hao-min Cui
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital
- Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People’s Hospital East Campus, Shanghai, China
| | - Zi-yang Sun
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital
- Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People’s Hospital East Campus, Shanghai, China
| | - Shuai Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital
| | - Wei Wang
- Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People’s Hospital East Campus, Shanghai, China
| | - Cun-yi Fan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital
- Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People’s Hospital East Campus, Shanghai, China
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