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Shaver TB, Hogarth DA, Case AL, May CC, Abzug JM. Radiographic Scapholunate Interval in the Pediatric Population Decreases in Size as Age Increases. Hand (N Y) 2024; 19:760-767. [PMID: 36779506 DOI: 10.1177/15589447231153166] [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] [Indexed: 02/14/2023]
Abstract
BACKGROUND Widening of the scapholunate (SL) interval greater than 2 mm is diagnostic of an injury in adults; however, this absolute number cannot be used for skeletally immature individuals due to the ossification of the carpal bones. The purpose of this study was to determine age-appropriate normative values for the radiographic SL interval in the skeletally immature population. METHODS Normal pediatric wrist radiographs were identified. The radiographic SL interval was measured as the distance between the scaphoid and the lunate at the mid-joint space between the scaphoid and the lunate, and the SL and capitolunate angles were measured on lateral views. An initial inter-rater reliability assessment was completed with strong inter-rater reliability. RESULTS In all, 529 radiographic series of children (276 male), aged 4 to 17 years, were reviewed. A negative linear correlation between chronological age and distance at the mid-joint space was observed. The average values for the radiographic SL interval ranged from 9.07 to 1.57 mm. The average SL and capitolunate angles were 52.0° and 10.6°, respectively. No linear relationship was found between chronological age and SL or capitolunate angle (R = 0.07 and 0.03, respectively). CONCLUSIONS The visible radiographic distance between the scaphoid and the lunate decreases with increasing age as the carpal bones ossify. The normative values defined in this study can be used to determine whether a true widening of the SL interval is present in the pediatric population. No linear relationship exists between chronological age and SL or capitolunate angle.
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Affiliation(s)
| | | | | | | | - Joshua M Abzug
- University of Maryland School of Medicine, Baltimore, USA
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2
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Kralj R, Kurtanjek M, Gržan IS, Bumči I, Višnjić S, Žic R. Flexed position of the wrist in the cast reliably prevents displacement after physeal Salter-Harris I and II distal radius fractures. HANDCHIR MIKROCHIR P 2024; 56:242-247. [PMID: 38604235 DOI: 10.1055/a-2208-7909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Salter-Harris I and II fractures of the distal radius are common injuries. In our facility, immobilisation is performed in a way that counteracts angulation forces. The aim of our study was to determine whether there are significant differences between patients with and patients without a loss of reduction treated with this method and to determine what degree of flexion reliably prevents secondary displacement. PATIENTS AND METHODS We conducted a retrospective study of 112 patients (mean age: 12 years) who had sustained a Salter-Harris type I or II fracture of the distal radius and were treated with reduction. Patients were grouped according to fracture type and whether they sustained a loss of reduction or not. Patients were compared for gender, age, initial angulation, angulation after reduction, degree of flexion/extension of the wrist in the cast, residual angulation, duration of immobilisation, and complication rate. We also analysed whether a 45-degree flexed position of the wrist in plaster provides reliable protection against secondary displacement. RESULTS In group I, patients with no loss of reduction had a significantly greater degree of wrist flexion in the cast, a significantly shorter duration of immobilisation and significantly less residual angulation. Patients with an apex-volar deformity with the wrist immobilised at more than 45 degrees of flexion had no loss of reduction at all and had significantly less residual angulation compared with patients with the wrist immobilised at less than 45 degrees of flexion. In this patient group, loss of reduction was noted in 28% of cases. The patients in group II with loss of reduction showed a significantly higher angulation after the reduction. During the follow-up examination, one patient experienced physeal arrest followed by an ulnar impaction syndrome. Other complications recorded were minor. CONCLUSIONS In summary, based on our results, we recommend that all physeal fractures of the distal radius with an apex-volar angulation can be safely treated with reduction and immobilisation counteracting the forces of angulation. For apex-dorsal fractures, palmar flexion of 45° allows for reliable reduction.
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Affiliation(s)
- Rok Kralj
- Pediatric Surgery, Klinika za dječje bolesti Zagreb, Zagreb, Croatia
| | - Mario Kurtanjek
- Pediatric Surgery, Klinika za dječje bolesti Zagreb, Zagreb, Croatia
| | | | - Igor Bumči
- Pediatric Surgery, Klinika za dječje bolesti Zagreb, Zagreb, Croatia
| | - Stjepan Višnjić
- Pediatric Surgery, Klinika za dječje bolesti Zagreb, Zagreb, Croatia
| | - Rado Žic
- Department of Plastic Reconstructive and Aesthetic Surgery, School of Medicine University of Zagreb, University Hospital Dubrava, Zagreb, Croatia
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3
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Liu DS, Murray MM, Bae DS, May CJ. Pediatric and Adolescent Distal Radius Fractures: Current Concepts and Treatment Recommendations. J Am Acad Orthop Surg 2024:00124635-990000000-01010. [PMID: 38833725 DOI: 10.5435/jaaos-d-23-01233] [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] [Received: 12/20/2023] [Accepted: 04/27/2024] [Indexed: 06/06/2024] Open
Abstract
Distal radius fractures are the most common skeletal injuries requiring intervention in children. These injuries are classified by fracture pattern, location, displacement, and angulation. While each unique fracture pattern warrants slightly modified treatment plans and follow-up, the goals of treatment remain constant. Successful outcomes depend on restoration of motion and function, and attaining acceptable sagittal and coronal alignment is a necessary first step. For displaced fractures, closed reduction is often necessary to restore alignment; well-molded cast application is important to maintain fracture alignment. Fractures with bayonet apposition, if well aligned, may not need formal reduction in some patients. Special attention should be paid to the physis-not only for physeal-involving fractures but also for all distal radius fractures-given that the proximity to the physis and amount of remaining skeletal growth help guide treatment decisions. Casting technique is essential in optimizing the best chance in maintaining fracture reduction. Surgical intervention may be indicated for a subset of fractures when acceptable alignment is not achieved or is lost at subsequent follow-up. Even among experts in the field, there is little consensus as to the optimal treatment of displaced metaphyseal fractures, illustrating the need for prospective, randomized studies to establish best practices.
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Affiliation(s)
- David S Liu
- From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
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4
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Patel V, Nguyen NP, Brown N, Mendenhall SD, Zoga AC, Nguyen JC. Return to Play in Youth Athletes: Role of the Radiologist with Focus on the Upper Extremity. Semin Musculoskelet Radiol 2024; 28:180-192. [PMID: 38484770 DOI: 10.1055/s-0043-1778029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Increase in youth sports participation, longer duration of play, and earlier starting points have increased the prevalence of acute and repetitive overuse musculoskeletal injuries. This rise in injury rates has led to increased efforts to better understand the susceptible sites of injury that are unique to the growing immature skeleton. Upper extremity injuries are currently the best studied, particularly those that occur among pediatric baseball players and gymnasts. The weak link in skeletally immature athletes is the growth plate complex that includes those injuries located at the epiphyseal and apophyseal primary physes and the peripherally located secondary physes. This article reviews the anatomy and function of these growth plate complexes, followed by a discussion of the pathophysiologic mechanisms, spectrum of imaging findings, and existing evidence-based guidelines for injury prevention and return to play.
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Affiliation(s)
- Vandan Patel
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Drexel University College of Medicine, Philadelphia, Pennsylvania
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ngan P Nguyen
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Naomi Brown
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shaun D Mendenhall
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adam C Zoga
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Jefferson, Philadelphia, Pennsylvania
| | - Jie C Nguyen
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Stark D, Denzinger M, Ebert L, Brandl R, Knorr C. Therapeutic approaches of diametaphyseal radius fractures in children. Arch Orthop Trauma Surg 2024; 144:1179-1188. [PMID: 38231205 DOI: 10.1007/s00402-023-05118-z] [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: 10/31/2022] [Accepted: 10/28/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND There are clear standards for when to operate on both distal epiphyseal and diaphyseal forearm fractures in children. However, paediatric surgeons are often faced with fractures in the transition zone between metaphysis and diaphysis. This aim of the study is to compare different treatment approaches for diametaphyseal forearm fractures, to classify different types of these fractures, and to define further assessment parameters and treatment recommendations. METHODS This retrospective study included all patients with diametaphyseal radial fractures who were seen at a paediatric surgery clinic between 01.01.2010 and 31.12.2013. Patients were treated either non-surgically (C) or surgically using bicortical Kirschner wire (BC-KW), intramedullary K-wire (IM-KW), elastic stable intramedullary nailing (ESIN), or combined bicortical and intramedullary K-wire (BCIM-KW). RESULTS During the study period, 547 patients presented with forearm fractures of which 88 patients (16%) had a fracture in the diametaphyseal region. The majority of diametaphyseal fractures were greenstick fractures (54.4%) followed by transverse fractures (44.3%). Distal fractures were predominantly treated with bicortical K-wiring (BC-KW, 40.5%) or non-surgically (C, 26.2%). Proximal fractures were treated by ESIN osteosynthesis (50%), followed by IM-KW (30%). Intermediate fractures were just as likely to be treated with one out of the 5 above-mentioned techniques. The ulna was involved in 64 of 88 cases. Depending on the type of fracture, it was treated either by ESIN osteosynthesis or non-surgically. No superior operative technique was identified. CONCLUSIONS The description of diametaphyseal fractures as a separate entity is important, because the therapy of these fractures is heterogeneous and challenging. A classification into proximal, intermediate, and distal may be useful in clinical decision-making. Despite the retrospective nature of this study, our data suggest that the use of a K-wire or combined technique BCIM-KW-technique, whenever technically feasible, achieves better radiological results without secondary dislocation. Further prospective studies are needed to provide better guidance to trauma surgeons.
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Affiliation(s)
- D Stark
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany.
| | - M Denzinger
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany
| | - L Ebert
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany
| | - R Brandl
- Klinik für Radiologie, Krankenhaus der Barmherzigen Brüder, Regensburg, Germany
| | - C Knorr
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany
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Lee J, Värk PR, Mendenhall SD, Chang B, Buttrick E, Shah AS. Physeal Fractures of the Distal Ulna: Incidence and Risk Factors for Premature Growth Arrest. J Pediatr Orthop 2024; 44:151-156. [PMID: 38062866 DOI: 10.1097/bpo.0000000000002585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND The aim of this study is to assess the rate of distal ulnar growth arrest following physeal fracture and to identify specific risk factors for premature physeal closure. METHODS A retrospective review of patients with a distal ulnar physeal fracture was performed at a single United States children's hospital. Patients without 6-month follow-up were excluded. Patient demographics, injury characteristics, treatment, and outcomes were abstracted. Fractures were classified by the Salter-Harris (SH) system. All follow-up radiographs were reviewed for changes in ulnar variance or signs of premature physeal arrest. RESULTS Fifty-six children with distal ulnar physeal fracture at a mean age of 10.7±3.3 years were included with a mean follow-up of 1.9 years. The most common fracture pattern was a SH II (52.7%), versus SH I (29.1%), SH III (9.1%), and SH IV (9.1%). Of displaced fractures (41.1%), the mean translation was 40.2±38.3% the and mean angulation was 24.8±20.9 degrees. Eleven fractures (19.6%) demonstrated radiographic signs of growth disturbance, including 3 patients (5.4%) with growth disturbance but continued longitudinal growth and 8 patients (14.3%) with complete growth arrest. The average ulnar variance was -3.4 mm. Three patients underwent subsequent surgical reconstruction including ulnar lengthening with an external fixator, distal ulna completion epiphysiodesis with distal radius epiphysiodesis, and ulnar corrective osteotomy. Patients with displaced fractures and SH III/IV fractures were more likely to develop a growth disturbance (34.8% vs. 3.2%, P =0.003; 50.0% vs. 11.1%, P =0.012, respectively). Children with less than 2 years of skeletal growth remaining at the time of injury had a higher risk of growth disturbance (46.2% vs. 9.5%, P =0.007). CONCLUSIONS SH III and IV fractures are more common injury patterns in the distal ulna compared with the distal radius. Growth disturbance or growth arrest occurs in ~20% of distal ulnar physeal fractures. Displaced fractures, intra-articular fractures, fractures requiring open reduction, and older children are at increased risk of distal ulnar growth arrest and should be followed more closely. LEVEL OF EVIDENCE Level IV--case series.
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Affiliation(s)
- Julianna Lee
- Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Pille-Riin Värk
- Department of Pediatric Surgery, Tartu University Hospital, Tartu, Estonia
| | - Shaun D Mendenhall
- Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Benjamin Chang
- Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Eliza Buttrick
- Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Apurva S Shah
- Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA
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7
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Strauss G, Brennan J, Momtaz D, Ghali A, Landrum M, Rose R. Physeal Closure and Fracture Pattern in Adolescent Transitional Distal Radius Fractures. J Pediatr Orthop 2024; 44:147-150. [PMID: 38088208 DOI: 10.1097/bpo.0000000000002586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE To show a correlation between grade of physeal closure and fracture pattern in adolescent transitional distal radius fractures. METHODS A retrospective chart review was performed of 490 distal radius fractures, ages 14 to 18, at a single institution between 2007 and 2020. A board-certified orthopaedic hand surgeon reviewed all images. Thirty-six distal-radius fractures were considered adolescent transitional fractures. The review included Salter-Harris classification, fracture fragments, and grade of physeal closure. RESULTS Distal radial physeal closure is 50 times more likely to be of a higher grade in the presence of Salter-Harris type IV fractures ( P <0.001). Closure of the physis is also 7.37 and 13.08 times more likely to be of higher grade in the absence of a dorsal metaphyseal fracture and in the presence of an ulnar corner fracture, respectively ( P =0.011 and 0.021). CONCLUSION Adolescent transitional fractures of the distal radius occur when the growth plate has a partial closure. The closure pattern of the distal radial physis begins centrally, with subsequent ulnar and then radial closure. In this cohort, there is a correlation between grade of physeal closure and fracture pattern in adolescent transitional distal radius fractures. LEVEL OF EVIDENCE Level IV-diagnostic.
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Affiliation(s)
- Gus Strauss
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX
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Jacobs H, May CC, Abzug JM. What is causing this young athlete's wrist pain? JAAPA 2024; 37:46-48. [PMID: 38270656 DOI: 10.1097/01.jaa.0000997716.80311.1e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Haley Jacobs
- At the University of Maryland in Baltimore, Md., Haley Jacobs practices in pediatric orthopedics at the University of Maryland Medical Center, Catherine C. May is a clinical research coordinator in the School of Medicine, and Joshua M. Abzug is a professor in the School of Medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Ding D, Zhu H, Zheng M, Kang C. Effect of platelet content on occurrence and prognosis of distal radius fracture. Medicine (Baltimore) 2023; 102:e35043. [PMID: 37682171 PMCID: PMC10489189 DOI: 10.1097/md.0000000000035043] [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: 07/17/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
Fractures of the distal radius are a common fracture with an increasing incidence. However, the underlying factors for distal radius fractures (DRFs) remain unclear. A total of 123 patients with distal radial fractures were recruited. To document clinical and follow-up data, and measure the levels of white blood cells, hemoglobin, platelets, and red blood cells in the bloodstream for qualitative observation of their expression effects within the human body, specifically assessing whether the magnitudes of these indicators are associated with potential factors influencing DRF. Pearson chi-square test and Spearman correlation were used to analyze the relationship between DRF and related parameters. Univariate and multivariate logistic regression and multivariate Cox proportional risk regression were used for further analysis. Pearson chi-square test and Spearman correlation analysis showed a significant correlation between platelet and red blood cell levels and the occurrence of DRFs. Univariate logistic regression analysis demonstrated a significant correlation between platelet count (OR [odds ratio] = 6.286, 95% CI [confidence interval]: 2.862-13.808, P < .001) and red blood cell count (OR = 2.780, 95% CI: 1.322-5.843, P = .007) with DRFs. Increasing levels of both indicators were associated with a higher susceptibility to DRFs. Multivariate logistic regression showed that platelets (OR = 6.344, 95% CI: 2.709-14.855, P < .001) were significantly associated with DRFs. Multivariate Cox regression analysis showed sex (HR [hazard ratio] = 0.596, 95% CI: 0.381-0.931, P = .023) and platelet (HR = 3.721, 95% CI: 2.364-5.855, P < .001) were significantly associated with maintenance time from recovery to recurrence (MTRR) of DRFs. In other words, the platelet content in the body of different genders is different, and the MTRR of DRF is different. Platelets were significantly associated with DRFs. The higher the platelet count, the higher the risk of DRF and the shorter the time of DRF recurrence.
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Affiliation(s)
- Danyang Ding
- Gastrointestinal Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Shijingshan District, Beijing, P.R. China
| | - Hao Zhu
- Department of Orthopedics, Second Central Hospital of Baoding, Zhuozhou City, Hebei Province, P.R. China
| | - Meiliang Zheng
- Department of Orthopedics, Second Central Hospital of Baoding, Zhuozhou City, Hebei Province, P.R. China
| | - Chunbo Kang
- Gastrointestinal Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Shijingshan District, Beijing, P.R. China
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Hu J, Hu J, Su Y. Delayed open surgery for distal radius epiphyseal plate fracture in children. HAND SURGERY & REHABILITATION 2023:S2468-1229(23)00080-4. [PMID: 37201794 DOI: 10.1016/j.hansur.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/02/2023] [Accepted: 05/02/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVES This study assessed the feasibility of open surgery and determined outcome predictors for late management of epiphyseal plate fracture of the distal radius in children. METHODS This retrospective study included 25 patients (22 male, 3 female) who underwent open surgery for late management of epiphyseal plate fracture of the distal radius. Wrist function was evaluated on Cooney score. Potential predictors comprised age, gender, fracture type, days after injury (DAI), degree of violence (DOV), and dorsal angulation before surgery (DABS). RESULTS Overall, wrist function after surgery was classified as excellent for 16 patients (64%), good for 6 (24%), and fair for 3 (12%). The rate of excellent wrist function was 86.7% (13/15) in children older than 10 years but only 40% (4/10) for those aged under 10 years (p = 0.0280). Cooney score correlated positively with age, but there was no correlation with gender, fracture type, DAI, DOV or DABS. CONCLUSION Open reduction surgery for late management of distal radius epiphyseal fracture yielded good results in patients aged over 10 years. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jianyang Hu
- Department of Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China.
| | - Jie Hu
- Department of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.
| | - Yuxi Su
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China.
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11
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Barr ML, Jain NS, Bunting H, Benhaim P. Proximal Plate Migration After Internal Fixation of a Pediatric Distal Radius Fracture. Hand (N Y) 2023; 18:NP1. [PMID: 36779567 DOI: 10.1177/15589447221130083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
We present a case of a 26-year-old right-hand-dominant male stage manager who underwent open reduction internal fixation of right open both-bone forearm fractures at the age of 13. The patient presented 13 years and 8 months later with proximal hardware migration, soft tissue erosion, and subsequent hardware exposure. The patient underwent hardware removal with resolution of pain and improvement in range of motion. To the best of our knowledge, this complication has not been published before.
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12
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Cha SM, Shin HD, Kim YK, Lee KW. Ulnar shortening osteotomy for posttraumatic ulnar impaction syndrome in adolescent (younger than 18 years) - Based on the Cha & Shin assessment. Injury 2022; 53:4038-4047. [PMID: 36243581 DOI: 10.1016/j.injury.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE We performed ordinary ulnar shortening osteotomy (USO) in patients younger than 18 years old with secondary ulnar impaction syndrome (UIS) after traumatic events. Here, we report the clinical and radiologic outcomes with a review of the previous literature through a retrospective case series. METHODS Twenty-two adolescents treated by USOs from 2006 to 2018 were investigated. The amount of shortening was classified into three categories. The first category was for a still open physis on the medial half of the radius in those younger than 15. In this category, we osteotomized the ulna for the physis level to be left neutral or negative by 1-2 mm. The second category had no growth potency in the radius. If the patient was younger than 15, we considered only residual growth of the ulna, thus performing USO for the ordinary UV to be negative by 2-3 mm. For patients aged 15-18 years old, if growth potency was nearly absent in the ulna, we performed traditional USO with a neutral ulnar variance (UV). RESULTS Categories 1, 2, and 3 for the amount of USO were determined for 4, 4, and 14 patients, respectively. All USOs properly healed without substantial complications. The mean preoperative UV was 2.91 mm, and the final value decreased to 0.23 with statistical significance (p < 0.001). The range of wrist motion was improved after USO from 133.86° and 132.73° to 154.77° and 160.68° (all, p < 0.001 in flexion-extension and pronation-supination arcs, respectively). The preoperative VAS and MMWS scores also improved from 2.77 to 75.00 to 0.18 and 88.86, respectively, at the final follow-up (all, p < 0.001). CONCLUSIONS UIS in adolescent populations after trauma in their children/younger adolescents could be properly treated by USO. Even with an open physis at the ulna, neutral UVs could be achieved, and the clinical outcomes were satisfactory. However, long-term follow-up is still needed regarding TFCC and DRUJ status. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
| | - Yun Ki Kim
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kun Woo Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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Khan H, Monsell F, Duffy S, Trompeter A, Bridgens A, Gelfer Y. Paediatric distal radius fractures: an instructional review for the FRCS examination. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03409-6. [PMID: 36201032 DOI: 10.1007/s00590-022-03409-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
An instructional review of the literature and guidelines relevant for the classification, management and prognosis of paediatric distal radius fractures. Aimed at the knowledge level required for the trauma and orthopaedic FRCS examination.
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Affiliation(s)
- H Khan
- Trauma and Orthopaedic Department, Epsom and St Helier NHS Trust, Carshalton, UK.
| | - F Monsell
- Bristol Royal Hospital for Children, Bristol, UK
| | - S Duffy
- Trauma and Orthopaedic Department, Bristol Royal Infirmary, Bristol, UK
| | - A Trompeter
- Trauma and Orthopaedic Department, St George's Hospitals NHS Foundation Trust, London, UK
- St George's University, London, UK
| | - A Bridgens
- Trauma and Orthopaedic Department, St George's Hospitals NHS Foundation Trust, London, UK
| | - Y Gelfer
- Trauma and Orthopaedic Department, St George's Hospitals NHS Foundation Trust, London, UK
- St George's University, London, UK
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14
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Pediatric Ulnar-sided Wrist Pain: A Review of the Current Literature. J Am Acad Orthop Surg 2022; 30:711-720. [PMID: 35862211 DOI: 10.5435/jaaos-d-21-01029] [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] [Received: 10/13/2021] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
Patients presenting with ulnar-sided wrist pain can pose a diagnostic and therapeutic challenge to physicians because there are several pathologies with similar signs and symptoms. In comparison with adult patients, other etiologies must be considered in the pediatric patient, given the skeletal immaturity and potential for known or unrecognized syndromes. In addition, these patients may not be able to articulate their symptoms as clearly as an adult patient, further stressing the importance of obtaining a pertinent history and performing a focused physical examination. Having a thorough understanding of the anatomy, the varying pathologies, and the indications for surgical and nonsurgical management will assist in improved patient outcomes.
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15
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Puneky GA, Dickerson TE, Harimtepathip PP, Bryan CA. Variant Salter-Harris Type III Distal Ulna "T" Fracture in the Setting of Galeazzi Equivalent Wrist Injury: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00001. [PMID: 35809019 DOI: 10.2106/jbjs.cc.22.00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE An 11-year-old Caucasian boy presented to the emergency department with a displaced, closed, Galeazzi equivalent (GE) left wrist fracture sustained after a fall. Closed reduction was deemed unsatisfactory because of persistent displacement of the distal ulna epiphysis. An open reduction of the distal ulna and percutaneous fracture pinning was performed. At 1 year, the patient reported return to his preinjury baseline. No evidence of subsequent pathologic growth was detected on follow-up imaging. CONCLUSION Open anatomic reduction of the distal ulna epiphysis and percutaneous fracture pinning may improve patient outcomes and limit progressive wrist deformity when treating GE wrist injuries.
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Affiliation(s)
- George A Puneky
- Children's Hospital of Georgia, Augusta University Health - Augusta, Georgia
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16
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Abstract
INTRODUCTION Premature radial physeal closure is a relatively rare occurrence in children. When isolated growth arrest of the radius with continued ulnar growth occurs, the resulting ulnar positive deformity leads to altered wrist mechanics and pain. Timely epiphysiodesis of the distal ulna with and without ulnar shortening osteotomy can address these issues, but continued ulnar overgrowth is a possible complication. We seek to evaluate the success rate of the primary epiphysiodesis of the ulna and associated clinical outcomes. METHODS A chart review was conducted at 2 children's hospitals from 2008 to 2019. Patients between the ages of 6 and 18 years old, with premature distal radius physeal closure, with or without positive ulnar variance, and >2 months follow-up were included. We evaluated the following characteristics for each patient: demographics, initial cause of premature radial physeal closure, ulnar variance, additional procedures performed during epiphysiodesis, preoperative and postoperative pain, range of motion, instability. Summary statistics were conducted and expressed as proportions, medians and means. A paired t test evaluated change in ulnar variance for those who had an ulnar shortening osteotomy performed. RESULTS Thirty-one wrists among 30 patients were identified, and the median age at the time of surgery was 12.2 years (interquartile range: 3.4). Ulnar shortening osteotomies were performed in 53.1% of cases and distal radius osteotomy in 15.6%. Bone graft was utilized in 25.8% of the epiphysiodesis procedures. There were 2 failures of primary epiphysiodesis indicating an index success rate of 93.7%. The average ulnar variance correction was 3.1 mm (95% confidence interval: 1.9, 4.4). The mean physeal time to closure was 134 days. Preoperative symptoms were resolved for 90.6% cases at final follow-up. CONCLUSION Ulnar epiphysiodesis successfully terminates ulnar physeal growth in 93.7% of cases. Preoperative symptoms were completely resolved with a median physeal closure of just over 4 months. Ulnar variance was corrected on average by 4.1 mm when a radial or ulnar shortening osteotomy was performed at the time of epiphysiodesis. LEVEL OF EVIDENCE Level IV-case series.
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17
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Wilson K, Usami Y, Hogarth D, Scheiber AL, Tian H, Oichi T, Wei Y, Qin L, Otsuru S, Toyosawa S, Iwamoto M, Abzug JM, Enomoto-Iwamoto M. Analysis of Association between Morphometric Parameters of Growth Plate and Bone Growth of Tibia in Mice and Humans. Cartilage 2021; 13:315S-325S. [PMID: 31997656 PMCID: PMC8804827 DOI: 10.1177/1947603519900800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The purposes of this study are to evaluate which growth plate parameters are associated with bone growth in mice and to compare the mouse results with those in humans. DESIGN The sagittal sections of the proximal growth plate of the mouse tibia from neonate to young adult stages were subjected to histomorphometric and functional analyses. The radiographic images of tibias of human patients until puberty were analyzed to obtain the tibia length and the proximal growth plate height. It was found that a linear correlation best modeled the relationship between the growth plate variables with the tibia growth rate and length. RESULTS In mice, total height, resting zone height, combined height of the proliferation and prehypertrophic zones, proliferation activity, and the total width of tibia growth plate showed high linear correlation with tibia bone length and bone growth rate, but the hypertrophic zone height and the growth plate area did not. In both mice and humans, the total growth plate width of tibia was found to have the strongest correlation with tibia length and growth rate. CONCLUSIONS The results validated that growth plate total height, the height of the resting zone and cell proliferation activity are appropriate parameters to evaluate the balance between growth plate activity and bone growth in mice, consistent with previous reports. The study also provided a new growth plate parameter candidate, growth plate width for growth plate activity evaluation in both mouse and human tibia bone.
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Affiliation(s)
- Kimberly Wilson
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Yu Usami
- Department of Oral Pathology, Osaka
University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Danielle Hogarth
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Amanda L. Scheiber
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Hongying Tian
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Takeshi Oichi
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Yulong Wei
- Mckay Orthopaedic Research Laboratory,
Department of Orthopaedic Surgery, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, PA, USA
| | - Ling Qin
- Mckay Orthopaedic Research Laboratory,
Department of Orthopaedic Surgery, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, PA, USA
| | - Satoru Otsuru
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Satoru Toyosawa
- Department of Oral Pathology, Osaka
University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Masahiro Iwamoto
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Joshua M. Abzug
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA
| | - Motomi Enomoto-Iwamoto
- Department of Orthopaedics, School of
Medicine, University of Maryland, Baltimore, MD, USA,Motomi Enomoto-Iwamoto, Department of
Orthopaedics, School of Medicine, University of Maryland, Baltimore, 20 Penn
Street, HSFII S022, Baltimore, MD, 21209, USA.
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18
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Scheider P, Ganger R, Farr S. Temporary epiphysiodesis in adolescent patients with ulnocarpal impaction syndrome: a preliminary case series of seven wrists. J Pediatr Orthop B 2021; 30:601-604. [PMID: 32932414 PMCID: PMC8480517 DOI: 10.1097/bpb.0000000000000805] [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] [Received: 01/07/2020] [Accepted: 08/14/2020] [Indexed: 11/30/2022]
Abstract
Adolescents with ulnar positive variance can develop ulnocarpal symptoms due to ulnocarpal impaction syndrome. Common treatment methods are conservative therapy, distal ulna epiphysiodesis or eventually ulnar shortening osteotomy. The aim of this preliminary case series was to investigate a recently described, new therapeutic approach using a reversible, temporary epiphysiodesis technique, following the principles of guided growth. Seven cases with the diagnosis of a painful ulnar positive variance, which underwent a temporary epiphysiodesis, were retrospectively evaluated. These cases consisted of four individual patients who received an intraoperatively customized plate fixation to slow down growth. The following parameters were collected: diagnosis, age at surgery, age at explantation, growth plate status at explantation, ulnar variance before and after surgery, complications and any clinical and radiological abnormalities. The radiological measurements of ulnar variance were performed according to the Gelbermann method. The seven investigated cases (average age at surgery 12.4 years; average age at explantation 14.7 years), in which a temporary epiphysiodesis was performed, showed an average ulnar variance of +3.9 mm (range: from +1.9 mm to +6.1 mm) before the start of therapy. After explantation, an average ulnar variance of +0.1 mm (range: from -3.2 mm to +5.0 mm) was observed, which corresponds to an average reduction/improvement of -3.8 mm (range: from -0.5 mm to -9.3 mm). The ulnocarpal wrist complaints were significantly reduced after the intervention. One case needed a secondary ulnar shortening osteotomy. The described method of a temporary, reversible epiphysiodesis is an elegant, less invasive technique to correct the ulnar positive variance without irreversibly closing the growth plate. In case of therapy failure, a secondary ulna shortening osteotomy is still possible.
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Affiliation(s)
- Philipp Scheider
- Orthopaedic Hospital Speising, Department of Pediatric Orthopaedics and Foot and Ankle Surgery, Vienna, Austria
| | - Rudolf Ganger
- Orthopaedic Hospital Speising, Department of Pediatric Orthopaedics and Foot and Ankle Surgery, Vienna, Austria
| | - Sebastian Farr
- Orthopaedic Hospital Speising, Department of Pediatric Orthopaedics and Foot and Ankle Surgery, Vienna, Austria
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Sarkar AS, Bandyopadhyay R, Niyogi PG. Single-stage Distal Radius Dome Osteotomy with Ulnar Diaphyseal Shortening and Distal Ulnar Epiphysiodesis in A Case of Manus Valgus Deformity Secondary to Post-Traumatic Physeal Growth Arrest - A Case Report. J Orthop Case Rep 2021; 11:4-7. [PMID: 34557429 PMCID: PMC8422011 DOI: 10.13107/jocr.2021.v11.i05.2182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Distal radius physeal growth arrest in children secondary to trauma is a rare complication. Various modalities of surgical treatment exist. Correction of severe deformity by a single-stage surgery is rare in current literature. We describe a case of surgically treated posttraumatic manus valgus deformity in an adolescent female with a satisfactory surgical outcome. Case Report A 13-year-old right-hand dominant girl presented to us with a painless, gradually progressive left wrist deformity for the past 3 years. She sustained a left wrist injury 3.5 years back for which she received native treatment. She was able to do most of her daily activities and cosmetic disability was her primary concern. She had a 20° fixed radial deviation deformity with further radial deviation up to 60°. Forearm rotation was from 70° supination to 60° pronation. Her pre-operative Mayo Modified Wrist Score was 25/10/10/25/70 (Pain/Satisfaction/Range of motion/Grip strength/Total). Radiologically, there was the obliteration of lateral distal radial physis with overgrowth of medial physis. Distal ulnar physeal overgrowth led to positive ulnar variance. Radiologically, the magnitude of deformity was 43° manus valgus (+24° radial inclination). We performed dome osteotomy at distal radius metaphysis with distal radius plating through modified Henry approach. Simultaneous ulnar diaphyseal shortening osteotomy with plate fixation was done through a dorsal approach and distal ulnar epiphysiodesis was done by physeal drilling to prevent future overgrowth. At 13 months follow-up, the wrist has clinically no deformity and radiologically 5° manus valgus (+24° radial inclination). Both the osteotomy sites have united and ulnar variance is restored. Now, her ulnar deviation was 20° and radial deviation was 30°. Her forearm rotational arc was maintained. Mayo Modified Wrist Score was 25/25/10/25/85 (Pain/Satisfaction/Range of motion/Grip strength/Total) with no hindrance of daily activity. Conclusion Correction of wrist deformity, restoration of ulnar variance, and normal wrist mechanics is possible in a single-stage surgery with judicious planning and can provide satisfactory result.
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20
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Rizk PA, Ihnow S, Chan CM. Corrective Osteotomy and Physeal Bar Resection for Distal Radial Physeal Arrest After Flexible Nailing: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00074. [PMID: 35102047 DOI: 10.2106/jbjs.cc.21.00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE A 9-year-old girl developed a physeal bar after flexible nailing for a proximal radius fracture. The patient presented 2 years after initial injury with gross deformity of the wrist with confirmed physeal bar. The patient underwent physeal bar resection, cement interposition, and corrective osteotomy with improvement of radial height, wrist deformity, and function. CONCLUSION This case illustrates the importance of meticulous flexible nail insertion technique and the subsequent, successful treatment for the complication.
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Affiliation(s)
- Paul A Rizk
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida
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21
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Fan XL, Wang J, Zhang DH, Mao F, Liao Y, Xiao R. Antegrade intramedullary fixation for adolescent fifth metacarpal neck fracture and its impact on epiphyseal growth. BMC Musculoskelet Disord 2021; 22:546. [PMID: 34130660 PMCID: PMC8204464 DOI: 10.1186/s12891-021-04436-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/06/2021] [Indexed: 11/22/2022] Open
Abstract
Background Antegrade intramedullary nailing (AIMN) with Kirschner wire (K-wire) is a minimally invasive osteosynthesis technique. This procedure has been widely performed to treat the fifth metacarpal neck fracture (FMNF) in adults. This study was performed to determine whether using AIMN with a single K-wire to treat FMNF in adolescents would have good clinical and radiographic outcomes. Methods In this retrospective study, 21 children (aged 11–16 years) with FMNF were treated using AIMN with a single K-wire from May 2017 to January 2020 in our hospital. Indications for intervention were severe displacement with malrotation deformity, apex dorsal angulation of greater than 40°, or both. Collected data included apex dorsal angulation, range of motion (ROM) in the fifth metacarpophalangeal (MCP) joint, Visual Analog Scale (VAS) for pain, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results All patients were followed up for 12–24 months (average, 16.57 months), and all patients obtained anatomical reduction postoperatively. The healing time was 2.69 ± 0.83 months (range, 2–4 months). Average apex dorsal angulation was reduced significantly from 44.49°±2.64° to 15.74°±2.47° (P < 0.001). The average ROM in the MCP joint and apex dorsal angulation of the injured side were not significantly different from those of the uninjured side. The average DASH score was 1.76 ± 1.48 (range, 0–4), the mean VAS was 0.19 ± 0.60 (range, 0–2), and the mean grip strength was 91.55 %±4.52 % (range, 85–101 %). No secondary displacement, dysfunction, nonunion, infection, or osteonecrosis was observed during the follow-up. Although premature epiphyseal closure was found in one patient, no long-term clinical finding of angulation or shortening was identified. Conclusions Antegrade intramedullary fixation with single K-wire was an effective and reliable technique that successfully resulted in good functional and cosmetic outcomes for treating adolescents with FMNF. The impact on the growth plate was low in this population given that most patients were at or approaching skeletal maturity. Level of evidence Level IV. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04436-w.
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Affiliation(s)
- Xiao-Lei Fan
- Department of Orthopaedics, Xiangya Hospital, Central South University, 410008, Changsha, China.,Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - Jian Wang
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - De-Hua Zhang
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - Feng Mao
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - Yi Liao
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China.
| | - Rui Xiao
- Department of Surgical Center, Karamay Central Hospital of Xinjiang, 834000, Karamay, China. .,Karamay District Center for Disease Control and Prevention , 834000, Karamay, China.
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22
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Jerome JTJ. Salter-Harris II distal radial fractures treated with the intrafocal K-wire technique: a retrospective study of 20 cases. J Hand Surg Eur Vol 2021; 46:471-475. [PMID: 34027732 DOI: 10.1177/1753193420953078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We retrospectively reviewed 20 children with Salter-Harris II fractures of the distal radius treated with intrafocal pinning according to Kapandji. Unlike conventional crossed K-wire pinning, this method avoids crossing the physis with the pins and thus minimizes the risk of physeal damage. None of the children had fracture re-displacement, angulation or growth deformities. The age, sex, side of injury, fracture displacement or angulation, treatment delay or immobilization period had any significant impact on the functional outcome. At a mean follow-up of 49 months (range 47-60), plain radiographs and MRI showed no growth arrests or physeal bars or bridges. Grip strength, wrist motion and patient-reported outcomes were almost normal with no or minimal pain at the injury site. We conclude that intrafocal K-wire pinning is simple, safe and affordable. We cannot provide data on what is acceptable fracture displacement for different age groups to allow for acceptable final remodelling of any malalignment.Level of evidence: IV.
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23
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Huang Q, Su F, Wang ZM, Xue HZ, Sun L, Ma T, Wang Q, Lu Y, Li M, Ren C, Zhang CM, Zhang K, Li Z. Prying reduction with mosquito forceps versus limited open reduction for irreducible distal radius-ulna fractures in older children: a retrospective study. BMC Musculoskelet Disord 2021; 22:147. [PMID: 33546669 PMCID: PMC7866453 DOI: 10.1186/s12891-021-04024-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are disputes about which reduction technique should be adopted in treatment of distal radius-ulna fractures in older children who failed to achieve manual reduction. This study compared clinical effects between prying reduction with mosquito forceps (PRMF) and limited open reduction (LOR) of treating irreducible distal radius-ulna fractures in older children. METHODS One hundred ten children with irreducible distal radius-ulna fractures were selected from January 2015 to December 2017 in Xi'an Hong Hui hospital. Retrospective analysis was performed. According to different reduction techniques, these children were divided into PRMF group (59 cases) and LOR group (51 cases). All children were treated with percutaneous Kirschner wire fixation and external fixation with plaster. Operation indexes, complications and wrist joint functions were compared between the two groups. RESULTS Operation time of PRMF group was shorter than that of LOR group (P < 0.05). Incision length in PRMF group was less than that in LOR group (P < 0.05). Bleeding volume of PRMF group was less than that of LOR group (P < 0.05). Incidence of complications in PRMF group was lower than that in LOR group. CONCLUSIONS Compared with limited open reduction, it has better clinical effects of prying reduction with mosquito forceps in treatment of irreducible distal radius-ulna fractures in older children. This technique has the advantages of simple operation, less trauma, less bleeding and fewer complications, which is worthy of clinical promotion.
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Affiliation(s)
- Qiang Huang
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Fei Su
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Zhi Meng Wang
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Han Zhong Xue
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Liang Sun
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Teng Ma
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Qian Wang
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Yao Lu
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Ming Li
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Cheng Ren
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Cong Ming Zhang
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Kun Zhang
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China.
| | - Zhong Li
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China.
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Abstract
The distal radial physis is a common site for injury in gymnasts because of the significant amount of load applied during upper extremity weight-bearing. Wrist pain has been reported in up to 88% of gymnasts. The long-term consequences of overuse wrist injuries, such as distal radial physeal arrest, include degenerative conditions that often cause pain and functional limitations. In the more immediate stage of many overuse injuries, early diagnosis can promote quicker care and recovery and thus faster return to play. Less time lost to injury can be very important in maintaining an athlete's quality of life.
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25
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Tomori Y, Nanno M, Takai S. Premature closure of the distal radial physis without evident history of trauma: A case report. Medicine (Baltimore) 2020; 99:e21515. [PMID: 32756191 PMCID: PMC7402883 DOI: 10.1097/md.0000000000021515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The distal radius is the region of the body with the highest incidence of physeal injury. However, it is uncommon for the distal radius to undergo growth arrest without a history of trauma. We present a case of premature closure of the distal radial physis without evident history of trauma in a girl. PATIENT CONCERNS A 14-year-old girl presented with chronic progressive deformity and painful functional limitation of her right forearm. The right wrist pain had begun when the patient was 5 years old. There was no evident history of trauma. The deformity and persistent right wrist pain had prevented her from performing sports activities and activities of daily living. DIAGNOSES Radiography and computed tomography showed a volarly angulated distal radius and dorsally protruding distal ulna with a length discrepancy between the distal radius and ulna due to premature physeal closure of the right distal radius. INTERVENTIONS To eliminate the deformity and achieve painless functional recovery of the wrist, an opening wedge osteotomy of the distal radius with an iliac bone graft was performed, followed by a shortening osteotomy of the distal ulna. OUTCOMES Radiography at final follow-up 1 year and 9 months postoperatively showed good alignment of the distal radioulnar joint without length discrepancy between the two forearm bones. The range of motion of the left wrist had reached 100% of the contralateral wrist without any pain, and the right grasp strength was 18 kg, which was 82% compared with the dominant left wrist. LESSONS Premature closure of the distal radial physis impairs the growth potential of the physis and leads to wrist dysfunction due to deformities. In the present case, a satisfactory outcome was achieved via corrective osteotomy of the distal radius with an iliac bone graft combined with ulnar shortening osteotomy.
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Affiliation(s)
- Yuji Tomori
- Department of Orthopaedic Surgery, Nippon Medical School Musashi Kosugi Hospital, Kanagawa
- Department of Orthopaedic Surgery, Ukima Central Hospital
| | - Mitsuhiko Nanno
- Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
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26
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Bryan CA, Hyer LC, Westberry DE. Iatrogenic Distal Radial Physeal Fracture During Insertion of Intramedullary Fixation for a Both Bone Forearm Fracture: A Case Report. JBJS Case Connect 2020; 10:e19.00595. [PMID: 32649156 DOI: 10.2106/jbjs.cc.19.00595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 12-year-old boy with an isolated both bone forearm fracture was treated with closed reduction and flexible intramedullary nailing 11 days postinjury and after the loss of initial fracture alignment. On nail insertion, an intraoperative distal radial physeal fracture was encountered, thereby warranting modification in treatment. CONCLUSION Physeal injury is a rare intraoperative complication of intramedullary fixation of forearm fractures. This report provides insight regarding the management and prevention of this rare complication.
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Affiliation(s)
| | - Lauren C Hyer
- Shriners Hospitals for Children-Greenville, Greenville, South Carolina
| | - David E Westberry
- Shriners Hospitals for Children-Greenville, Greenville, South Carolina
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27
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Aziz KT, Patten IS, Ingari JV. Autologous Osteoarticular Transfer From the Lateral Femoral Condyle to the Scaphoid Facet in the Treatment of a Malunited Pediatric Distal Radius Fracture With Physeal Bar. Hand (N Y) 2020; 15:NP42-NP46. [PMID: 31137969 PMCID: PMC7370394 DOI: 10.1177/1558944719850284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Injury to the articular surface of the distal radius commonly occurs after a fall onto an outstretched hand. Intra-articular fractures that cause joint depression require operative intervention and can be especially challenging in skeletally immature patients. Methods: This case report describes the use of an osteoarticular autograft in the treatment of a 13-year-old boy with a malunited distal radius fracture. Results: Osteoarticular transfer from the lateral femoral condyle provided definitive treatment of the malunion and physeal bar and resulted in significant improvement in range of motion. Conclusions: Osteoarticular autograft can be safely used to treat malunions of distal radius articular surface depression fractures in skeletally immature patients.
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Affiliation(s)
| | | | - John V. Ingari
- The Johns Hopkins University, Baltimore, MD, USA,John V. Ingari, Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA.
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Rauer T, Pape HC, Gamble JG, Vitale N, Halvachizadeh S, Allemann F. Transitional fracture of the distal radius: a rare injury in adolescent athletes. Case series and literature review. Eur J Med Res 2020; 25:21. [PMID: 32517738 PMCID: PMC7285726 DOI: 10.1186/s40001-020-00419-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/04/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Transitional fractures are fractures in adolescents where partial closure of the epiphyseal growth plate has occurred. These fractures are most commonly reported in the distal tibia. With respect to the distal radius, only a few case reports describing transitional fractures exist. Furthermore, relatively little is known about epiphyseal closure of the distal radius. A case series of four transitional fractures of the distal radius is presented by comparing non-operative and operative treatment options. At present, this is the largest case series in the literature dealing with this rare injury. CASE PRESENTATION We present three cases of four transitional fractures of the distal radius including 1-year follow-up. Patient age ranged from 16 to 18 years including a gender ratio of two males to one female. Clinical and radiographic assessments took place 6 and 12 weeks and 1 year after trauma/surgery. Three transitional fractures were treated with open reduction and internal volar plate fixation followed by functional rehabilitation. One transitional fracture was treated non-operatively. All cases showed an excellent functional outcome. CONCLUSIONS The primary treatment goal in transitional fractures is anatomic reduction of the articular surface. Non-operative treatment of transitional fractures of the distal radius is the most commonly reported treatment option. Additionally, different fixation options have been described, including the use of Kirschner wires (K-wires) and lag screws. The presented cases demonstrate that volar plate fixation followed by functional rehabilitation is a valuable treatment option in significantly displaced transitional fractures of the distal radius. Furthermore, we discuss the pathogenesis as well as the different treatment options by critical reviewing the literature.
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Affiliation(s)
- Thomas Rauer
- Division of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Hans-Christoph Pape
- Division of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | | | - Nicolo' Vitale
- Physical Medicine and Rehabilitation, Department of Biomedicine and Biotechnology, University of Catania, Catania, Italy
| | - Sascha Halvachizadeh
- Division of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Florin Allemann
- Division of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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Jozsa G, Devecseri G, Vajda P, Juhasz Z, Varga M, Juhasz T. Distance of the fracture from the radiocarpal surface in childhood: does it determine surgical technique? A retrospective clinical study: A STROBE compliant observational study. Medicine (Baltimore) 2020; 99:e17763. [PMID: 32049775 PMCID: PMC7035118 DOI: 10.1097/md.0000000000017763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Unstable distal metaphyseal and dia-metaphyseal fractures of the radius may have treated with a variety of operative techniques, Kirschner wires (K-wires), dorsally inserted titanium elastic stable intramedullary nailing (DESIN), and short titanium elastic stable intramedullary nailing (SESIN) in children.The aim of this study was to evaluate the differences in clinical and radiographic outcomes between these methods.Between January 2009 and December 2017 196 children were treated for forearm fractures in the distal third of the distal radius. Gender of the patients, different types of surgical techniques, number of postoperative X-rays, date of metal removal and degree of axis deviation after the metal removal were studied. Distance of the fracture line from the radiocarpal surface, the width of the distal epiphysis of the radius, and the cumulative width of the distal epiphysis of the ulna and radius were analyzed.Out of the 196 children, stabilization of the fracture was achieved by K-wire in 139, by DESIN in 44, and by SESIN in 13 patients. The average time of metal removal was significantly shorter (3.8 months), following stabilization with K-wire. In children treated with K-wire, axial deviation of <5° was seen in 118 patients, 5° to 10° deviation in 15 patients, while deviation was above 10° in 6 children. In the DESIN group, <5° axial deviation was found in 37 patients and 5° to 10° in seven patients. In all 13 children treated with SESIN, axial deviation was measured to be <5°. The fracture distance from the radiocarpal surface was on average 23.7 and 45.6 mm in the children treated with K-wire and DESIN, respectively.Fracture distance from the radiocarpal surface might determine the type of surgical technique required. If the distance of the fracture line is less than the width of the distal radius, osteosynthesis with a K-wire is recommended, while if the distance of the fracture is more than the cumulative width of the radius and the ulna, then DESIN may provide better results. The use of SESIN may be indicated when the area of the growth plate is injured.
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Affiliation(s)
- Gergo Jozsa
- Surgical Division of the Department of Paediatrics, Medical School, University of Pécs
| | | | - Peter Vajda
- Surgical Division of the Department of Paediatrics, Medical School, University of Pécs
| | - Zsolt Juhasz
- Surgical Division of the Department of Paediatrics, Medical School, University of Pécs
| | | | - Tamas Juhasz
- Department of Anatomy, Medical School, University of Debrecen, Hungary
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Meyers AB. Physeal bridges: causes, diagnosis, characterization and post-treatment imaging. Pediatr Radiol 2019; 49:1595-1609. [PMID: 31686166 DOI: 10.1007/s00247-019-04461-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/28/2019] [Accepted: 06/19/2019] [Indexed: 10/25/2022]
Abstract
The cartilaginous primary physis, or growth plate, at the end of long bones in children allows for longitudinal bone growth. A variety of insults to the physis can lead to physeal bridge formation, which in turn can lead to limb-shortening and angular deformities. This paper begins with a description of the causes, risk factors and mechanisms by which bridges form. Then it reviews the use of imaging in the diagnosis and characterization of bridges and in the evaluation of treatment and post-treatment complications. It is important for radiologists taking care of children to be aware of the indirect and direct imaging findings of physeal bridges to aid in their diagnosis, to be able to characterize bridges as part of preoperative planning, and to know the imaging finding of post-resection complications.
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Affiliation(s)
- Arthur B Meyers
- Department of Radiology, Nemours Children's Hospital and Health System, 13535 Nemours Parkway, Orlando, FL, 32827, USA.
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Korhonen L, Victorzon S, Serlo W, Sinikumpu JJ. Non-union of the ulnar styloid process in children is common but long-term morbidity is rare: a population-based study with mean 11 years (9-15) follow-up. Acta Orthop 2019; 90:383-388. [PMID: 30945579 PMCID: PMC6718181 DOI: 10.1080/17453674.2019.1596561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Fracture of the ulnar styloid process (USP) is common in children in connection with distal radius fracture. The long-term morbidity of USP non-union following a childhood distal radius fracture is unclear. We evaluated long-term clinical and radiographic findings of USP non-union. Patients and methods - All 208 children (< 16 years) who had suffered from distal radius fracture with or without a diagnosed concomitant ulnar fracture during 1992-1999 in the study institution were invited to follow-up at mean of 11 years (9-15) after the injury. Radiographs of both wrists of all 139 participants (67%) were taken; 22 patients showed USP non-union and they made up the study population. Distal radioulnar joint (DRUJ) instability, decreased range of motion (ROM), and weakened grip strength as compared with the uninjured side were the main functional outcomes. Elements of the "Disability of Arm, Shoulder and Hand" questionnaire were used for subjective symptoms. Results - The rate of USP non-union following childhood distal forearm fracture was 16% (22/139) and only 9 of the ulnar styloid fractures were visible in the radiographs primarily. At follow-up wrist flexion-extension ROM and ulnar and radial deviation ranges did not differ between the injured and uninjured sides. Grip strengths were similar. 6 patients reported pain during exercise. 7 had ulna minus (mean 2.3 mm) but none showed degenerative radiographic findings. Interpretation - The long-term clinical results of USP non-union following a childhood wrist fracture were good. However, one-third of the patients with USP non-union had ulnar shortening, which may predispose them to degenerative processes later in life.
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Affiliation(s)
- Linda Korhonen
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu;; ,Medical Research Centre Oulu; PEDEGO Research Group; Oulu Childhood Fracture and Sports Injury Study; University of Oulu, Oulu;; ,Correspondence:
| | | | - Willy Serlo
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu;; ,Medical Research Centre Oulu; PEDEGO Research Group; Oulu Childhood Fracture and Sports Injury Study; University of Oulu, Oulu;;
| | - Juha-Jaakko Sinikumpu
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu;; ,Medical Research Centre Oulu; PEDEGO Research Group; Oulu Childhood Fracture and Sports Injury Study; University of Oulu, Oulu;;
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Abstract
BACKGROUND This study is the first to test Friberg's equation's (Vt=V0[e]) accuracy in predicting the residual angular deformity in pediatric distal forearm fractures. METHODS Angular deformities from distal forearm fractures in 50 children (mean age, 9 y) were retrospectively measured on follow-up radiographs once healed and compared to extrapolated angles at respective follow-up intervals from 2013 to 2015. RESULTS The predicted and actual angulations from 120 radiographs (mean follow-up, 3mo) showed that the mean predicted angle was similar to the measured angle in the radioulnar plane and only 2 degrees greater than the measured angle in the dorsovolar plane. A strong correlation was observed between predicted and measured angles in both planes. CONCLUSIONS Friberg's equation is a valid tool for predicting remodeling potential in pediatric distal 25% forearm fractures. LEVEL OF EVIDENCE Prognostic Study-Level II.
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Percutaneous versus open reduction and fixation for Tillaux and triplane fractures: a multicenter cohort comparison study. J Pediatr Orthop B 2018; 27:551-555. [PMID: 29957617 DOI: 10.1097/bpb.0000000000000522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The goal of this study was to compare open reduction versus percutaneous fixation of adolescent ankle fractures with regards to the incidence of growth disturbance. We performed a retrospective cohort analysis of adolescent patients with triplane or Tillaux fractures. There was an even distribution of triplane fractures and mean initial displacement between cohorts. Analysis of follow-up radiographs revealed no instances of growth disturbance in the percutaneous fixation group and six in the open reduction group (P=0.29). Growth disturbance does not pose a significant concern when selecting a surgical approach. Owing to the rarity of these fractures this study was underpowered.
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Moon DK, Park JS, Park YJ, Jeong ST. Simultaneous correction of radius and ulna for secondary ulnar impaction syndrome with radial physeal arrest in adolescent: A case report and review of literatures. Int J Surg Case Rep 2018; 50:144-149. [PMID: 30149320 PMCID: PMC6170786 DOI: 10.1016/j.ijscr.2018.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/01/2022] Open
Abstract
Distal radius physeal fractures are common in pediatric patients. Distal radius physeal fracture can lead to physeal arrest. Forearm bone length discrepancy occurs, it is often asymptomatic. Surgical correction of symptomatic forearm bone discrepancy can provide a satisfactory result.
Introduction Distal radius physeal fractures are common in pediatric patients. Although most of these fractures heal without complication, some result in significant physeal arrest. If significant physeal arrest occurs, the various treatment methods can be applied depending on the severity of deformity and remaining growth of the patient. Presentation of case We present a 16-year old female with distal radial physeal arrest who presented four years after initial injury. Radiologically, forearm bone length discrepancy was 7 mm. But, she had a secondary ulnar impaction syndrome. She underwent open wedge corrective osteotomy of distal radius on volar side and ulnar shortening osteotomy, simultaneously. Early mobilization and rehabilitation were started soon after the surgery. At 18 months postoperatively, the ROM was assessed to be almost identical as the unaffected side and the patient presented with no significant symptoms. Discussion Distal radial fracture is one of the most common fractures in pediatric population. And distal radial physis is often involved in these fracture, which can lead to physeal arrest. However, even if forearm bone length discrepancy occurs, if the difference is within 1 cm, it is often asymptomatic. In this case, the forearm bone length discrepancy was mild, but due to symptom, we performed surgical treatment. Conclusion Distal radial physeal arrest due to distal radial fracture is relatively common in children, and long-term follow-up is needed. Moreover, relatively mild deformity caused by physeal arrest may also cause symptoms, so careful observation is needed.
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Affiliation(s)
- Dong Kyu Moon
- Department of Orthopaedic Surgery and Institute of Health Sciences, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jin Sung Park
- Department of Orthopaedic Surgery and Institute of Health Sciences, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
| | - Young Jin Park
- Department of Orthopaedic Surgery and Institute of Health Sciences, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Soon Taek Jeong
- Department of Orthopaedic Surgery and Institute of Health Sciences, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
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Valisena S, Gonzalez JG, Voumard NM, Hamitaga F, Ciritsis BD, Mendoza Sagaon M, De Rosa V. Treatment of paediatric unstable displaced distal radius fractures using Kapandji technique: a case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:413-420. [DOI: 10.1007/s00590-018-2297-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
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Dabash S, Prabhakar G, Potter E, Thabet AM, Abdelgawad A, Heinrich S. Management of growth arrest: Current practice and future directions. J Clin Orthop Trauma 2018; 9:S58-S66. [PMID: 29628701 PMCID: PMC5883917 DOI: 10.1016/j.jcot.2018.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 12/26/2017] [Accepted: 01/04/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Premature growth arrest can pose a challenge to the orthopedic surgeon. Various options for treating physeal arrest exist. METHODS Systematic searches were conducted on PubMed/Medline, ScienceDirect, OVID, and Cochrane Library. Secondary searching was performed, where certain articles from reference lists of the selected studies were reviewed that were not found in the primary search. RESULTS This review article discusses the different methods of management for premature growth arrest. CONCLUSIONS The use of mesenchymal stem cells provides a promising alternative treatment modality.
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Affiliation(s)
- Sherif Dabash
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, United States,Corresponding author.
| | - Gautham Prabhakar
- Department of Orthopaedic Surgery & Rehabilitation/Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States
| | - Eric Potter
- Department of Orthopaedic Surgery & Rehabilitation/Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States
| | - Ahmed M. Thabet
- Department of Orthopaedic Surgery & Rehabilitation/Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States
| | - Amr Abdelgawad
- Department of Orthopaedic Surgery & Rehabilitation/Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States
| | - Stephen Heinrich
- Department of Orthopaedics, Tulane University, New Orleans, LA, United States
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Miyamura S, Tanaka H, Oka K, Shigi A, Abe S, Yoshikawa H, Murase T. Physeal bar resection using a patient-specific guide with intramedullary endoscopic assistance for partial physeal arrest of the distal radius. Arch Orthop Trauma Surg 2018; 138:1179-1188. [PMID: 29955969 PMCID: PMC6060782 DOI: 10.1007/s00402-018-2985-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Indexed: 12/01/2022]
Abstract
The partial physeal arrest of the distal radius could result in progressive deformities and functional problems of the wrist. Despite being the most preferred surgical intervention, physeal bar resection (Langenskiöld procedure) is technically demanding. This manuscript aims to illustrate the technical tricks and present an illustrative case of premature physeal arrest of the distal radius managed with a novel method for the Langenskiöld procedure, involving complete removal of the bar using a patient-specific guide in combination with an intramedullary endoscopy technique that facilitated direct observation.
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Affiliation(s)
- Satoshi Miyamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Hiroyuki Tanaka
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kunihiro Oka
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
- Osaka University Healthcare Center, 17-1 Machikaneyama-cho, Toyonaka, Osaka, 560-0043, Japan
| | - Atsuo Shigi
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Shingo Abe
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Hideki Yoshikawa
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tsuyoshi Murase
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
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Wrist Injuries in Youth Athletes. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0153-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Varga M, Józsa G, Fadgyas B, Kassai T, Renner A. Short, double elastic nailing of severely displaced distal pediatric radial fractures: A new method for stable fixation. Medicine (Baltimore) 2017; 96:e6532. [PMID: 28383417 PMCID: PMC5411201 DOI: 10.1097/md.0000000000006532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
RATIONALE Short double elastic nailing is a minimal invasive, modified ESIN (elastic stable intramedullary nailing) technique for severely displaced distal radial fracture in children. The aim of this technical report is to introduce our new method and evaluate the final results of the procedure. PATIENT CONCERNS We reviewed retrospectively 24 patients who underwent short double elastic nailing due to distal radial fractures between November 2012 and December 2015. Indications for surgery included closed, severely displaced, unstable metaphyseal or diametaphyseal fractures of the radius. INTERVENTION The fractures were stabilized by 2 prebent short elastic titanium nails inserted from the distal side of the fracture. In cases of associated ulnar fracture, a classic anterograd ESIN nailing was also performed. Patients were mobilized immediately in a removable short splint which was removed after 1 to 2 weeks. There has been no additional splinting or casting. OUTCOMES There were 17 males and 7 females with an average age of 9.8 years (range, 4-16 years). The right hand was involved in 16 cases and the left hand in 8 cases. The average follow-up was 17.8 months (range, 7-28 months). Of the 24 patients, 3 presented irritation of the skin, which resolved after removal of the radial nail. All the patients regained full range of motion without any complications. LESSONS Our technique is an effective, safe, and easily learnable procedure for unstable fractures of the distal third of the radius. It achieves good functional and radiological results, and allows early mobilization without the need of casting. Avoiding the physeal plates, we reduce the risk of iatrogenic postoperative deformity. Further prospective and biomechanical investigations are necessary to verify our experience.
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Affiliation(s)
| | - Gergő Józsa
- Department of Pediatrics, Surgical Unit, University of Pécs, Pécs, Hungary
| | - Balázs Fadgyas
- Surgical Department of Heim Pál Children's Hospital, Budapest
| | - Tamás Kassai
- Sándor Péterfy Street Hospital and Casualty Centre
| | - Antal Renner
- Sándor Péterfy Street Hospital and Casualty Centre
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Otayek S, Ramanoudjame M, Fitoussi F. Les fractures de l’extrémité distale du radius chez l’enfant. HAND SURGERY & REHABILITATION 2016; 35S:S150-S155. [DOI: 10.1016/j.hansur.2016.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 02/14/2016] [Accepted: 02/19/2016] [Indexed: 11/25/2022]
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Kusnezov N, Dunn JC, Stewart J, Mitchell JS, Pirela-Cruz M. Acute Limb Shortening for Major Near and Complete Upper Extremity Amputations with Associated Neurovascular Injury: A Review of the Literature. Orthop Surg 2016; 7:306-16. [PMID: 26792651 DOI: 10.1111/os.12213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/14/2015] [Indexed: 01/09/2023] Open
Abstract
In the setting a near or complete upper extremity amputations with significant soft tissue loss and neurovascular compromise, upper extremity surgeons are faced with the challenge of limb salvage. There are a multitude of treatment options for managing skeletal and soft tissue injuries including provisional fixation, staged reconstruction, and an acute shortening osteotomy with primary rigid internal fixation. However, many complications are associated with these techniques. Complications of provisional fixation include pin tract infection and loosening, tethering of musculotendinous units, nonunion, and additional surgeries. Staged reconstruction includes a variety of techniques: distraction osteogenesis, bone transport, or vascularized and non-vascularized structural autograft or allograft, but the risks often outweigh the benefits. Risks include nonunion, postoperative vascular complications necessitating reoperation, and the inability to return to the previous level of function at an average of 24 months. Acute shortening osteotomy with internal fixation offers the advantage of a single-stage procedure that provides for decreasing the soft tissue loss, provides a rigid platform to protect the delicate neurovascular repair, and alleviates unwanted tension at the repair sites. This review discusses the literature on the surgical treatment of severe upper extremity trauma with associated neurovascular injury over the past 75 years, and aims to evaluate the indications, surgical techniques, clinical and functional outcomes, and complications associated with acute shortening osteotomy with rigid internal fixation. Although this technique is not without risks, it is well-tolerated in the acute setting with a complication profile comparable to other techniques of fixation while remaining a single procedure.
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Affiliation(s)
- Nicholas Kusnezov
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - John C Dunn
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Jeremy Stewart
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Justin S Mitchell
- Department of Orthopaedic Surgery and Rehabilitation, Beaumont Army Medical Center, El Paso, Texas, USA
| | - Miguel Pirela-Cruz
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
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Neglected epiphyseal injuries of the distal end of the radius with ulnar impaction: analysis of distal osteotomy of both bones using a dorsal midline approach. J Orthop Traumatol 2016; 18:31-36. [PMID: 27468849 PMCID: PMC5311000 DOI: 10.1007/s10195-016-0423-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 07/13/2016] [Indexed: 12/05/2022] Open
Abstract
Background To evaluate results of a technique for treating neglected epiphyseal injuries of the distal radius with ulnar impaction. Materials and methods This retrospective study involved six cases (four males; two females), all of whom sustained the primary injury during childhood (range 9–12 years of age). All presented with wrist deformity and ulnar-sided wrist pain. They were managed with osteotomy of the distal radius, osteotomy and shortening of the ulna, harvesting the bone grafts, and distal radioulnar joint (DRUJ) reduction performed simultaneously through a dorsal midline approach. Mean follow-up was 30 months (range 24–36). Results Deformity correction and pain relief was observed in all patients. Flexion arc increased from an average of 60° to 102.5°, supination from an average of 31.67° to 67.50°, and pronation from an average of 30.83° to 61.67°. The mean preoperative DASH score was 87.5, which improved to 18.72 postoperatively. Conclusion Neglected epiphyseal injuries of the distal radius are difficult to manage and many variations are described for handing each of the associated problems. Our technique provides an option for managing this injury with an easy surgical approach, single incision, and cost effectiveness. All the four components of the surgery, which include osteotomy of the distal radius, osteotomy of the ulna, harvesting the bone grafts, and DRUJ reduction were done through a single incision and in a single sitting. Level of evidence IV.
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Kox LS, Kuijer PPFM, Kerkhoffs GMMJ, Maas M, Frings-Dresen MHW. Prevalence, incidence and risk factors for overuse injuries of the wrist in young athletes: a systematic review. Br J Sports Med 2015; 49:1189-96. [DOI: 10.1136/bjsports-2014-094492] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 12/20/2022]
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Abstract
Fractures involving the distal radius and ulna are commonly seen in children and adolescents. Management of these injuries in pediatric patients should include assessment of the neurovascular status of the extremity, associated soft-tissue injury, and, most importantly, possible involvement of the physes of the radius and ulna. Treatment of these injuries may vary from simple casting and radiographic follow-up to urgent reduction and surgical fixation. Regardless of the initial treatment plan, the treating surgeon must remain aware of the potential for both early and late complications that may affect outcomes.
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Affiliation(s)
- Gurpal S Pannu
- Department of Orthopedic Surgery and Pediatrics, Drexel University College of Medicine, 230N Broad Street, Philadelphia, PA 19102, USA
| | - Marty Herman
- Department of Orthopedic Surgery and Pediatrics, Drexel University College of Medicine, 230N Broad Street, Philadelphia, PA 19102, USA.
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45
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Parikh SN. Pediatric orthopedics. Orthop Clin North Am 2015; 46:xix-xx. [PMID: 25771325 DOI: 10.1016/j.ocl.2014.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Shital N Parikh
- Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229, USA.
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Sferopoulos NK. Classification of distal radius physeal fractures not included in the salter-harris system. Open Orthop J 2014; 8:219-24. [PMID: 25132871 PMCID: PMC4133925 DOI: 10.2174/1874325001408010219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 05/22/2014] [Accepted: 06/15/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction : The most commonly used classification for pediatric physeal fractures has been proposed by Salter and Harris. Among the most suitable classification schemes are those proposed by Ogden and Peterson who added several new types of injuries. The purpose of this study was to examine the value of both schemes to classify all different types of physeal injuries of the distal radius that are not included in the Salter-Harris system and to test a new nomenclature to classify and guide treatment for the whole spectrum of these injuries. Methods : A total of 292 children who were admitted for a physeal fracture of the distal radius that could not be classified according to the Salter-Harris system were identified from the hospital database. All radiographs were carefully examined and classified according to the existing classifications of Ogden and Peterson and a modified classification scheme. The results of the treatment were also evaluated. Results : Ninety-six physeal injuries could not be classified using the classification schemes of Ogden and Peterson. All injuries could be classified in five types using the new, modified nomenclature. Growth abnormalities of the distal radius were evaluated after an average follow-up time of 11 years. Growth arrest due to a physeal bar was detected only in one patient. Discussion : The proposed modified scheme is practical, incorporates all previous classification systems, allows classification of all physeal injuries of the distal radius that are not included in the Salter-Harris system and may assist comparison of treatment outcomes.
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Affiliation(s)
- Nikolaos K Sferopoulos
- Department of Pediatric Orthopaedics, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, 54635 Thessaloniki, Greece
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