1
|
Lackey JT, Seiler PL, Lee BR, Sinclair MK. Clinically Significant Treatment Delay in Pediatric Scaphoid Fractures. J Hand Surg Am 2024; 49:108-113. [PMID: 38069948 DOI: 10.1016/j.jhsa.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/11/2023] [Accepted: 10/25/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Pediatric scaphoid fractures present to treatment in a delayed manner 8% to 29% of the time. The indications for cast immobilization in this population are not clear. The definition of a clinically important treatment delay is based only on anecdotal reports. Successful treatment with a cast may be more desirable than surgical intervention. However, it remains unclear what clinical and radiographic factors may predict success with casting. METHODS A retrospective analysis of all scaphoid fractures treated at a single pediatric hospital was performed to identify fracture characteristics, the presence of cystic change, treatment method, and healing rate. A cut-point analysis was performed to determine the number of days of treatment delay, predictive of casting failure. Kaplan-Meier assessments were performed to determine the differences in time in cast. Characteristics of the delayed group were described and stratified by treatment success or failure. RESULTS After review, 254 patients met the inclusion criteria. Cut-point analysis determined that a presentation delay of ≥21 days was associated with failure to unite with casting. The median time in the cast for the acute and delayed groups was not significantly different. The casting union rate of delayed fractures was less than acute fractures (75.0% vs 97.0%). CONCLUSIONS Delayed presentation of scaphoid fractures 21 days or more after injury predicts a greater risk of casting failure; however, the union rate remains high with comparable time in cast. Cast immobilization for scaphoid fractures presenting 21 days or more after injury is a reasonable option. TYPE OF STUDY/LEVEL OF EVIDENCE Prognosis IV.
Collapse
Affiliation(s)
- J Taylor Lackey
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, Kansas City, MO.
| | - Paige L Seiler
- School of Medicine, University of Kansas, Kansas City, KS
| | - Brian R Lee
- Department of Health Outcomes and Health Services Research, Children's Mercy Hospital, Kansas City, MO
| | - Micah K Sinclair
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, Kansas City, MO; Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO
| |
Collapse
|
2
|
Abusaq I, Martins A, Mansour M, Samba A, Dimeglio A, Canavese F. Radiologic, clinical, and functional evaluation of children with lateral humeral condyle fractures using the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire. J Pediatr Orthop B 2023; 32:121-126. [PMID: 36445362 DOI: 10.1097/bpb.0000000000001019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study investigated the clinical and radiologic outcomes of lateral humeral condyle (LHC) fractures in children and evaluated the functional outcome of these injuries according to the type of treatment using the Quick DASH questionnaire. Data on consecutive children admitted to the Emergency Department for LHC fracture (01/11-12/18) were collected from their charts. Anterior-posterior and lateral radiographs of the injured elbow were used to classify each fracture according to Jakob's classification, and to detect any other concomitant bone lesions. Data on pain, stiffness, impact on daily activities, skin lesions, surgical-site infection, and range of motion were retrieved. The Quick DASH questionnaire was used to evaluate functional outcome. Forty-eight children with a mean age at trauma of 6.06 ± 2.22 years (32 males; mean follow-up: 75 ± 25 months) were reviewed. The overall Quick DASH score was 4 (0-15.9); it was 2.69 ± 0.31 in Jakob-1 ( n = 12; 25%), 3 ± 1.06 in Jakob-2 ( n = 19; 39.6%), and 3.06 ± 1.56 in Jakob-3 fractures ( n = 17; 35.4%). Functional outcomes were similar irrespective of the severity of displacement, type of treatment, length of postoperative immobilization, and presence of associated fracture ( P > 0.05). Quick DASH scores in children less than 8 years (2.77 ± 0.44) and in those more than 8 years (3.47 ± 2.13) were similar ( P > 0.05). Five out of 48 patients developed one complication (10.5%). Good functional and radiologic outcomes can be expected in children with LHC fractures irrespective of the amount of initial displacement, type of treatment, length of postoperative immobilization, and age at surgery. Families should be warned about potential complications although these are most often minor. Level of evidence: III.
Collapse
Affiliation(s)
- Ibrahim Abusaq
- Department of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand
| | - Antoine Martins
- Department of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand
| | - Mounira Mansour
- Department of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand
| | - Antoine Samba
- Department of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand
| | - Alain Dimeglio
- Pediatric Orthopedic Department, Clinique St. Roch, Montpellier
| | - Federico Canavese
- Department of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand
- Department of Pediatric Orthopedic Surgery, Lille University Center, Jeanne de Flandre Hospital, Lille, France
| |
Collapse
|
3
|
Abstract
BACKGROUND The optimal management of pediatric scaphoid fracture nonunions is controversial. We hypothesize that pediatric patients with scaphoid fracture nonunions will have favorable functional outcomes with the utilization of nonvascularized distal radius cancellous autograft with open reduction and internal fixation (ORIF). METHODS A review was performed from 2012 to 2017 identifying skeletally immature patients with scaphoid fracture nonunions treated with ORIF and nonvascularized distal radius cancellous autograft, including demographic data, mechanism of injury, length of time from injury to treatment, operative procedure, length of immobilization, time to union, and complications. RESULTS Ten patients (9 males, 1 female) met inclusion criteria. Mean age was 14.3 SD 1.5 years. The majority of fractures were sustained during sports or secondary to a fall. Mean time between injury and orthopaedic evaluation was 33 weeks (SD 20 wk). Eight fractures occurred at the waist, and 2 occurred at the proximal pole. Four patients had a humpback deformity, and three presented with a dorsal intercalated segmental instability deformity. Nine patients were treated with a single cannulated compression screw with distal radius autograft. One patient also received a single Kirschner wire fixation in addition to a single cannulated screw and graft. Patients underwent a mean postoperative immobilization period of 14 SD 5 weeks. Two patients received a bone stimulator postoperatively. Radiographic union was documented after initial surgery in nine patients, with mean time to union of 17 SD 5 weeks. The 1 patient with persistent radiographic nonunion underwent revision fixation and repeat nonvascularized distal radius autograft, achieving union and resolution of symptoms. All patients ultimately reported full return to activity. CONCLUSIONS Pediatric scaphoid fracture nonunions that undergo ORIF using nonvascularized distal radius cancellous autograft have favorable rates of consolidation and functional outcomes. Surgeons should consider this source of grafting in operative management of scaphoid nonunions in children and adolescents. LEVEL OF EVIDENCE Level IV, therapeutic.
Collapse
|
4
|
Jørgsholm P, Ossowski D, Thomsen N, Björkman A. Epidemiology of scaphoid fractures and non-unions: A systematic review. HANDCHIR MIKROCHIR P 2020; 52:374-381. [PMID: 32992390 DOI: 10.1055/a-1250-8190] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The scaphoid is the most commonly fractured carpal bone in adults as well as in children. Previous studies have reported a wide range of fracture incidences. Scaphoid fractures and non-unions in children have been sparsely investigated. AIM To perform a systematic review of the current literature on epidemiology of scaphoid fractures and non-unions in adults and children. METHODS An electronic literature search was conducted investigating all studies in the literature published between January 1989 and June 23 2020. The systematic review following the PRISMA guidelines and searching in PubMed, Embase, Web of Science and Cochrane library databases was done in June 2020. RESULTS 42 studies met our inclusion criteria, 6 studies were prospective, 32 were retrospective and 4 were register studies. The majority of studies relied on conventional radiographs for diagnosis. Scaphoid fractures in adults are predominately found in males with a peak incidence in the age group from 20 to 29 years. Incidence rates in males are reported from 107 to 151/100 000. Females have an earlier peak, in the age group 10 to 19 years, with an incidence from 14 to 46/100 000. Most fractures occur in the middle third of the scaphoid representing 60-69 % of cases. Scaphoid fractures in children are predominately found in boys age 12 and above, while it seldomly occur for children younger than 9 years. In adults the risk for developing a scaphoid non-union is between 2 % and 5 %, the majority affecting males and predominately located at the middle third of the scaphoid. Non-unions among children are rare and mainly due to missed or delayed diagnosis of a fracture in the middle third of the scaphoid. CONCLUSION This review revealed a substantial heterogeneity among studies concerning study population, diagnosis criterial and outcome measures. Currently, evidence on epidemiology for scaphoid fractures and non-unions are low.
Collapse
Affiliation(s)
| | - Daniel Ossowski
- Department of Translational Medicine - Hand Surgery, Lund University and Skane University Hospital
| | - Niels Thomsen
- Department of Translational Medicine - Hand Surgery, Lund University and Skane University Hospital
| | - Anders Björkman
- Department of Translational Medicine - Hand Surgery, Lund University and Skane University Hospital.,Department of Hand Surgery, Sahlgrenska Academy
| |
Collapse
|
5
|
Engel H, Xiong L, Heffinger C, Kneser U, Hirche C. Comparative outcome analysis of internal screw fixation and Kirschner wire fixation in the treatment of scaphoid nonunion. J Plast Reconstr Aesthet Surg 2020; 73:1675-1682. [PMID: 32473855 DOI: 10.1016/j.bjps.2020.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/21/2020] [Accepted: 03/25/2020] [Indexed: 11/15/2022]
Abstract
In cases with difficult scaphoid screw placement due to small, fragile bone fragments, or transplants and insufficient space, the internal Kirschner wire fixation is a fallback option; however, controversy remains regarding its stability, safety, and outcome. Between 2001 and 2011, 95 patients were treated in our center (n = 80 with cannulated compression screws and n = 15 with Kirschner wires), and retrospectively analyzed. The outcome measurements included the analysis of patient data, union rate and analysis of functional measures, and quality of life. Bony reconstructions were performed with Vascularized Bone Grafts (VBG) based on the 1,2-Intercompartmental Supraretinacular Artery (ICSRA) , Medial Femoral Condyle (MFC)-VBG, cancellous bone, and iliac crest grafts. Bony healing and functional outcome showed no significant differences between Kirschner wire fixation and cannulated compression screws, although significantly more 1,2-ICSRA-VBG were treated with Kirschner wires. Although predominantly used as an intraoperative fallback option, our data demonstrate that Kirschner wire internal fixation can be safe and reliable, with comparable bony union rates and excellent functional outcomes.
Collapse
Affiliation(s)
- Holger Engel
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Centre, BG Trauma Centre, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen/Rhine, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany; Ethianum Clinic for Plastic and Reconstructive Surgery, Aesthetic and Preventive Medicine at Heidelberg University Hospital, Heidelberg, Germany
| | - Lingyun Xiong
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Centre, BG Trauma Centre, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen/Rhine, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany; Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Christian Heffinger
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Centre, BG Trauma Centre, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen/Rhine, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Centre, BG Trauma Centre, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen/Rhine, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Centre, BG Trauma Centre, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen/Rhine, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany.
| |
Collapse
|
6
|
Oestreich K, Jacomel TUY, Hassan S, Horwitz MD, Lindau TR. Pediatric Scaphoid Nonunions: A Case Series, Review of the Literature, and Evidence-Based Guidelines. J Wrist Surg 2020; 9:2-12. [PMID: 32025347 PMCID: PMC7000270 DOI: 10.1055/s-0039-3401035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
Background Scaphoid fractures represent less than 3% of hand and wrist fractures in the pediatric population. Nonunions are very rare. We present a case series ( n = 18) of nonunions in skeletally immature children and adolescents. We further present a review of the literature on pediatric scaphoid nonunions. Materials and Methods We reviewed the literature by searching the main databases on pediatric scaphoid nonunions, but to identify factors that lead to nonunion, we also searched for databases on scaphoid fractures. Seventy articles were found for the period between 1961 and 2019, all with level 4/5 evidence. Results The nonunion rate of pediatric scaphoid fractures in the literature is on average 1.5%, occurring mostly as a result of missed or underdiagnosed injuries, similar to our presented case series. Half ( n = 9) of the injuries in our case series were missed initial injuries, leading to scaphoid nonunions and half developed nonunions after initial treatment. We found excellent outcomes and with surgical and nonoperative management, with few complications. Not surprisingly, the duration of immobilization is longer with nonoperative management. Conclusions Based on the literature, we recommend a period of nonoperative management before surgery in undisplaced nonunions. In displaced nonunions, open reduction and internal fixation ± bone grafting is necessary. In pediatric scaphoid fractures, similar to adult cases, we identified that suspicious scaphoid fractures should be considered for initial immobilization, and repeat X-rays and early magnetic resonance imaging (MRI) or computed tomography (CT) scans should be considered at follow-up. Immobilization time and type of plaster should be appropriate in relation to the fracture site, similar to the adult scaphoid fracture. Level of Evidence This is a Level IV study.
Collapse
Affiliation(s)
- Kerstin Oestreich
- Hand and Upper Limb Service, Department of Plastic Surgery, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | - Tatiana Umata Yoko Jacomel
- Hand and Upper Limb Service, Department of Plastic Surgery, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | - Sami Hassan
- Hand Unit, Chelsea and Westminster Hospital, London, United Kingdom
- Pulvertaft Hand Centre, Kings Treatment Centre, Royal Derby Hospital, Derby, United Kingdom
| | | | - Tommy Roger Lindau
- Pulvertaft Hand Centre, Kings Treatment Centre, Royal Derby Hospital, Derby, United Kingdom
| |
Collapse
|
7
|
Abstract
INTRODUCTION Scaphoid nonunions (SN) are rare in adolescents. The use of vascularized bone grafts (VBG) from the distal radius as an alternative to conventional grafting for the treatment of established SN in adolescents is described. PATIENTS AND METHODS The technique was applied in 13 patients with symptomatic SN resulting from fractures. All patients were male with average age of 16.5 years (15-17.5). The average period from injury to surgery was 8.3 months (4-13). Patients underwent vascularized bone grafting and internal fixation with K-wires. In 6 patients with proximal pole nonunion a VBG from the dorsal distal radius was used, and in 7 with a waist nonunion a VBG from the palmar distal radius was used. The valuation was clinical (grip strength, range of motion, VAS pain score, DASH) and radiographic. The time to return to activity was also recorded. RESULTS The mean follow-up was 9.8 years (range, 4-16). The union rate was 100% (11/11 cases). Union was achieved in a mean period of 7.2 weeks (range, 6-10), without growth disturbance or other complications from the epiphyseal plate of the distal radius. The range of motion and grip strength was 89% and 92% of the contralateral respectively. The mean postoperative DASH score was 8 and the VAS score was 1. All patients returned to daily activities and sports in a mean period of 4.5 months. CONCLUSIONS The use of VBG from the distal radius provided a permanent solution in the rare case of SN in adolescents, without donor site morbidity or epiphyseal plate disturbance. The deformity and carpal height were corrected resulting in painless motion and grip strength.
Collapse
|
8
|
Barrera-Ochoa S, Mendez-Sanchez G, Mir-Bullo X, Knörr J, Bertelli JA, Soldado F. Vascularized Thumb Metacarpal Periosteal Flap for Scaphoid Nonunion in Adolescents: A Prospective Cohort Study of 12 Patients. J Hand Surg Am 2019; 44:521.e1-521.e11. [PMID: 30344021 DOI: 10.1016/j.jhsa.2018.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 07/15/2018] [Accepted: 08/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate clinical and radiological outcomes after surgical treatment of scaphoid nonunion in adolescents with a vascularized thumb metacarpal periosteal pedicled flap (VTMPF). METHODS Twelve patients younger than 18 years with scaphoid nonunion, who underwent a VTMPF procedure without bone grafting, were included for this prospective cohort study, at a mean follow-up of 10.2 months. Patients were operated on by 3 different hand surgeons at 3 hand surgery institutions. All patients received a VTMPF, but with different scaphoid internal fixation modalities, in 10 cases using 1 or 2 retrograde 2-mm headless compression screws and in 2 cases without internal fixation. RESULTS In 11 boys and 1 girl, the mean age was 15.6 years. There were 1 type D1 nonunions (Herbert classification), 6 type D2, 2 type D3, and 2 type D4. Six patients had previously undergone an unsuccessful surgical attempt to treat their nonunion. The mean anterior bone defect was 3.5 mm in length. The patients experienced no postoperative complications. Successful consolidation was achieved in all cases, with 79% cross-sectional trabecular bridging at 12 weeks. Pain subsided after surgery and patients experienced improvements in both their Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Modified Mayo Wrist Score (MMWS) results. Overall, 34% and 40% gains in strength and wrist motion, relative to the contralateral normal side, were observed. CONCLUSIONS In this study, the use of VTMPF for scaphoid nonunion in children and adolescents is associated with generally good outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Sergi Barrera-Ochoa
- Pediatric Hand Surgery and Microsurgery Unit, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain; Hand and Microsurgery Unit, ICATME, Hospital Universitari Quiron-Dexeus, Barcelona, Spain.
| | - Gerardo Mendez-Sanchez
- Hand and Microsurgery Unit, ICATME, Hospital Universitari Quiron-Dexeus, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Mir-Bullo
- Hand and Microsurgery Unit, ICATME, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
| | - Jorge Knörr
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jayme Augusto Bertelli
- Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianoópolis, Santa Catarina, Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Brazil
| | - Francisco Soldado
- Pediatric Hand Surgery and Microsurgery Unit, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
9
|
Functional outcome of displaced radial head fractures in children treated by elastic stable intramedullary nailing. J Pediatr Orthop B 2018; 27:296-303. [PMID: 28984681 DOI: 10.1097/bpb.0000000000000502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The objectives of this study were to retrospectively investigate the clinical and radiological outcomes of displaced radial head fractures in children treated by elastic stable intramedullary nailing (ESIN) and evaluate the functional outcome of these injuries using the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). A total of 24 patients (nine males and 15 females) fulfilled the inclusion criteria. The mean age at the time of injury was 10.7±2.8 years (range: 9.5-16.33 years). Before surgery, the mean angulation was 53.8°±18.4° (range: 28°-82°) differentiating fractures on the basis of Judet's classification. The mean Quick DASH score was a good 4 (range: 0-15.9). Functional outcomes were similar irrespective of the severity of fracture displacement (P>0.05), presence or absence of associated fracture (P>0.05), and time immobilized (P>0.05). The Quick DASH score was better in children younger than 9 years of age (1.62) than children older than 9 years of age (4.95), but without a statistically significant difference (P=0.058). Children with displaced radial head fractures treated with ESIN showed good functional outcomes. Associated fracture injuries were not a predictive factor of functional outcome. Open reduction must be avoided as it carries an increased risk of complications.
Collapse
|
10
|
Barrera-Ochoa S, Mendez-Sanchez G, Rodriguez-Baeza A, Knörr J, Bertelli JA, Soldado F. Vascularized thumb metacarpal periosteal pedicled flap for scaphoid nonunion: An anatomical study and pediatric case report. Microsurgery 2017; 39:62-69. [DOI: 10.1002/micr.30233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/02/2017] [Accepted: 08/25/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Sergi Barrera-Ochoa
- Pediatric Hand Surgery and Microsurgery Unit; Hospital Sant Joan de Deu, Universitat de Barcelona; Barcelona Spain
- Hand and Microsurgery Unit; Hospital Universitari Quiron-Dexeus, ICATME; Barcelona Spain
| | - Gerardo Mendez-Sanchez
- Hand and Microsurgery Unit; Hospital Universitari Quiron-Dexeus, ICATME; Barcelona Spain
| | - Alfonso Rodriguez-Baeza
- Human Anatomy and Embryology Department; Faculty of Medicine, Universitat Autònoma de Barcelona; Barcelona Spain
| | - Jorge Knörr
- Pediatric Hand Surgery and Microsurgery Unit; Hospital Sant Joan de Deu, Universitat de Barcelona; Barcelona Spain
| | - Jayme Augusto Bertelli
- Department of Orthopedic Surgery; Governador Celso Ramos Hospital, Florianoópolis, Santa Catarina; Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul); Tubarão Brazil
| | - Francisco Soldado
- Pediatric Hand Surgery and Microsurgery Unit; Hospital Sant Joan de Deu, Universitat de Barcelona; Barcelona Spain
| |
Collapse
|
11
|
Outcome of Conservative Versus Surgical Treatment of Humeral Shaft Fracture in Children and Adolescents: Comparison Between Nonoperative Treatment (Desault's Bandage), External Fixation and Elastic Stable Intramedullary Nailing. J Pediatr Orthop 2017; 37:e156-e163. [PMID: 27479190 DOI: 10.1097/bpo.0000000000000843] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The main objective of this study was to retrospectively evaluate the clinical and radiographic outcomes of displaced humeral shaft fractures in children treated by Desault's bandage (DB), external fixation (EF), and elastic stable intramedullary nailing (ESIN). METHODS During the study period, 36 consecutive children with displaced humeral shaft fracture were treated by DB (Group A), EF (Group B) or ESIN (Group C). All the patients underwent full-length preoperative and postoperative anteroposterior and lateral radiographs of the injured humerus. One year after the index surgery, patients were asked to answer the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). RESULTS Ten patients (27.8%) were in Group A, 11 (30%) in Group B, and 15 (41.7%) in Group C. Mean age at the time of injury was 10.8±2.3 years (range, 8 to 15.2 y), 11.7±2.5 years (range, 6.8 to 15.9 y), and 12.7±2.2 years (range, 6.9 to 15.3 y) in Groups A, B, and C, respectively (P=0.08). Groups A, B, and C did not differ significantly in their demographics (P>0.05).Surgical treatment (Groups B and C) provided a better radiologic outcome than nonoperative treatment (Group A) (P=0.05). No statistically significant differences were observed for preoperative, postoperative and at last follow-up mean displacement between Groups B and C (P>0.05).Overall, 9 of 36 patients developed a complication: 2 in Group A (20%), 4 in Group B (37%), and 3 in Group C (20.1) (P=0.92).Mean Quick DASH score was 3±8.6 (range, 0 to 27.3), 1.4±2.9 (range, 0 to 9), and 1.2±4.7 (range, 0 to 18.2) in Groups A, B, and C, respectively. All the patients were able to resume previous physical and sport activities 4 to 6 months after the last fracture reduction procedure. CONCLUSIONS Surgery is not contraindicated in children with displaced humeral shaft fractures. EF and ESIN provide a better radiologic outcome, less posttreatment pain and faster mobilization than DB. However, numerical differences, although statistically significant, were not clinically relevant for all variables but immobilization time. Nonoperative treatment was as efficacious as surgical treatment apart from the length of time for immobilization. LEVEL OF EVIDENCE Level III.
Collapse
|
12
|
Canavese F, Marengo L, Samba A, Rousset M, Mansour M, Andreacchio A, Dimeglio A. Evaluation of upper extremity function of displaced diaphyseal humeral fractures in children treated by elastic stable intramedullary nailing: preliminary results. J Pediatr Orthop B 2016; 25:399-405. [PMID: 27058818 DOI: 10.1097/bpb.0000000000000318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The aim of this study was to retrospectively evaluate the outcome of displaced humeral shaft fractures in children and adolescents treated by elastic stable intramedullary nailing (ESIN) and to evaluate upper extremity function using the Quick-DASH questionnaire. Correction was maintained over time in 14 of 16 patients. All patients were pain free at last follow-up. Shoulder and elbow ranges of motion were comparable with the noninjured side. The mean Quick-DASH score was 1. This study reports good functional outcomes in children with displaced humeral shaft fractures surgically treated with ESIN, even in the presence of residual deformity. ESIN enables stable reduction, good rotational control, and good functional outcome.
Collapse
Affiliation(s)
- Federico Canavese
- aDepartment of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand bFaculty of Medicine, University of Montpellier, Montpellier, France cDepartment of Pediatric Orthopedic Surgery, Regina Margherita Children's Hospital, Torino, Italy
| | | | | | | | | | | | | |
Collapse
|
13
|
Marengo L, Rousset M, Paonessa M, Vanni S, Dimeglio A, Samba A, Andreacchio A, Canavese F. Displaced humeral shaft fractures in children and adolescents: results and adverse effects in patients treated by elastic stable intramedullary nailing. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:453-9. [PMID: 26988699 DOI: 10.1007/s00590-016-1758-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/24/2016] [Indexed: 10/22/2022]
|
14
|
Göksel F, Ermutlu C, Gölge UH, Kaymaz B. Non-union of the great toe in a 4-year-old child. BMJ Case Rep 2015; 2015:bcr-2015-211709. [PMID: 26264951 DOI: 10.1136/bcr-2015-211709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Phalangeal fractures of the foot are very rare in children. They are treated with closed reduction and splinting. Cases reported of non-union in children are rare. We report on treatment of a 4-year-old child with non-union of the proximal phalanx of the great toe foot following an open fracture caused by a motor vehicle accident 4 months prior. No graft was used. We present this case with good clinical outcome at 1 year follow-up.
Collapse
Affiliation(s)
- Ferdi Göksel
- Department of Orthopaedics and Traumatology, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
| | - Cenk Ermutlu
- Department of Orthopaedics and Traumatology, İstanbul Training Hospital, Istanbul, Turkey
| | - Umut Hatay Gölge
- Department of Orthopaedics and Traumatology, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
| | - Burak Kaymaz
- Department of Orthopaedics and Traumatology, Çanakkale 18 Mart University, Çanakkale, Turkey
| |
Collapse
|