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Nonoperative + fractures + children

Michael J Stark, Michael J DeFranco
INTRODUCTION: Injuries to the medial clavicle in pediatric patients typically involve the physis and/or sternoclavicular joint. Clavicle fractures are one of the most common injuries in children, but ones at its medial end are rare. Most medial clavicle fractures are treated nonoperatively, but surgery is indicated in some cases. This original case report is unique in describing the use of an elastic intramedullary nail for fixation of a completely displaced medial clavicle fracture in a pediatric patient...
2017: Case Reports in Orthopedics
John D Roaten, Derek M Kelly, Joseph L Yellin, John M Flynn, Micaela Cyr, Sumeet Garg, Alexander Broom, Lindsay M Andras, Jeffrey R Sawyer
BACKGROUND: To determine if the AAOS clinical practice guidelines (CPG) for the treatment of pediatric femoral shaft fractures (2009) changed treatment, we analyzed pediatric femoral shaft fractures at 4 high-volume, geographically separated, level-1 pediatric trauma centers over a 10-year period (2004 to 2013). METHODS: Consecutive series of pediatric femoral shaft fractures (ages, birth to 18 y) treated at the 4 centers were reviewed. Treatment methods were analyzed by age and treatment method for each center and in aggregate...
April 10, 2017: Journal of Pediatric Orthopedics
Jennifer J Beck, Richard E Bowen, Mauricio Silva
BACKGROUND: Medial epicondyle fractures are predominantly seen in adolescent, male patients. Historically, nonoperative intervention was the mainstay of treatment. With increasing upper extremity demands of young athletes and reports of valgus instability after nonoperative treatment, there has been an increased interest in operative indications. Controversy regarding proper imaging and measurement of displacement complicates decision-making algorithms. Review of recent literature is required for improved decision making...
November 17, 2016: Journal of Pediatric Orthopedics
R Guzmán-Vargas, D F Rincón-Cardozo, J A Camacho-Casas
Subtrochanteric fractures in children are rare events that occur in only 4% of all femur fractures; most injuries occur as a result of high-energy trauma, being young male patients the most affected. The management of this type of injury is controversial; there are many forms of treatment, including the use of plaster spica 90-90, closed reduction and use of elastic or rigid intramedullary nails, open reduction and plate placement, and the use of external fixators. Most suggest that for children under 10 a nonoperative approach should be preferred and that older ones should be managed surgically, but it is between six and 12-year-olds that most of the controversy exists...
March 2016: Acta Ortopédica Mexicana
Jaclyn F Hill, Benton E Heyworth, Anneliese Lierhaus, Mininder S Kocher, Susan T Mahan
In this descriptive analysis of pediatric Lisfranc injuries, records of 56 children treated for bony or ligamentous Lisfranc injuries over a 12-year period were reviewed. Overall, 51% of fractures and 82% of sprains were sports-related (P=0.03). A total of 34% of the cohort underwent open reduction internal fixation, which was more common among patients with closed physes (67%). Full weight bearing was allowed in open reduction internal fixation patients at a mean of 14.5 weeks, compared to 6.5 weeks in the nonoperative group...
March 2017: Journal of Pediatric Orthopedics. Part B
Federico Canavese, Lorenza Marengo, Mattia Cravino, Vanessa Giacometti, Bruno Pereira, Alain Dimeglio, Carlo Origo, Antonio Andreacchio
BACKGROUND: The main objective of this study was to retrospectively evaluate the clinical and radiographic outcomes of displaced humeral shaft fractures in children treated by Desault's bandage (DB), external fixation (EF), and elastic stable intramedullary nailing (ESIN). METHODS: During the study period, 36 consecutive children with displaced humeral shaft fracture were treated by DB (Group A), EF (Group B) or ESIN (Group C). All the patients underwent full-length preoperative and postoperative anteroposterior and lateral radiographs of the injured humerus...
April 2017: Journal of Pediatric Orthopedics
Meredith C Larsen, Kyle C Bohm, Amir R Rizkala, Christina M Ward
BACKGROUND: Despite the frequent occurrence of these injuries, we know little about the natural history of Salter-Harris II (SH II) distal radius fractures. We conducted a systematic review of studies examining the radiographic and clinical outcomes of nonoperatively managed SH II distal radius fractures. METHODS: Systematic searches of the MEDLINE and Cochrane computerized literature databases and manual searches of bibliographies were performed. We reviewed both descriptive and quantitative data...
March 2016: Hand: Official Journal of the American Association for Hand Surgery
Jason W Stoneback, Patrick M Carry, Katherine Flynn, Zhaoxing Pan, Ernest L Sink, Nancy H Miller
BACKGROUND: To evaluate lower extremity strength and alignment among children who underwent submuscular plating (SMP). METHODS: Subjects who underwent SMP for a length unstable femoral fracture returned for isokinetic strength testing ≥2 years after surgery. Extensor and flexor strength deficits (percent difference) between the operative and nonoperative limbs were evaluated. Radiographic measurements of mechanical alignment [anatomic lateral distal femoral angle (aLDFA)] and qualitative measurements (The Pediatric Outcomes Data Collection Instrument, PODCI) were obtained from all subjects...
June 2, 2016: Journal of Pediatric Orthopedics
Tamir Bloom, Daniel A Seigerman, Caixia Zhao, Sanjeev Sabharwal
We sought to determine the diagnostic utility of additional full-length radiographs of the forearm and humerus for pediatric supracondylar humerus fractures. A pediatric orthopedic surgeon and a senior orthopedic resident individually reviewed the initial humerus, forearm, and elbow radiographs of 55 children with a supracondylar humerus fracture and recommended definitive treatment (operative vs. nonoperative) on the basis of the modified Gartland classification. Interobserver agreements for classification and the recommended treatment were highest for the elbow radiographs (weighted κ=0...
September 2016: Journal of Pediatric Orthopedics. Part B
Christopher A Iobst
Most tibia fractures in children can be treated nonoperatively. For fractures that do require surgery, however, the most common methods of management include plating or flexible nail insertion. Some fracture patterns, such as periphyseal fractures, fractures with bone and/or soft tissue loss, or fractures with delayed presentation, are not easily amenable to these techniques. Hexapod external fixators are especially helpful in these difficult cases. The purpose of this review is to discuss the principles of performing hexapod circular external fixation applied to pediatric tibia fractures...
June 2016: Journal of Pediatric Orthopedics
Jennifer M Weiss, Hooman Nikizad, Kevin G Shea, Samvel Gyurdzhyan, John C Jacobs, Peter C Cannamela, Jeffrey I Kessler
BACKGROUND: The frequency of osteochondritis dissecans (OCD), a disorder of the subchondral bone and articular cartilage, is not well described. PURPOSE: To assess the frequency of pediatric OCD lesions that progress to surgery based on sex, joint involvement, and age. STUDY DESIGN: Descriptive epidemiology study. METHODS: A retrospective chart review (2007-2011) was performed on OCD. Inclusion criteria included OCD of any joint and patients aged 2 to 19 years...
March 2016: Orthopaedic Journal of Sports Medicine
Al Haitham Al Shetawi, C Anthoney Lim, Yash K Singh, Jason E Portnof, Stephen M Blumberg
PURPOSE: To review the epidemiology and management of facial fractures in a pediatric population. MATERIALS AND METHODS: This study was a retrospective review of patients younger than 18 years who presented to a pediatric emergency department during a 5-year period in an urban, academic, level 1 designated trauma center. RESULTS: Of the 156 patients identified, most were boys (87%) and the mean age was 13.5 years (standard deviation, 4.9 yr; interquartile range, 12 to 17 yr)...
July 2016: Journal of Oral and Maxillofacial Surgery
Ahmed Kotb, Taylor Yong, Amr Abdelgawad
Fractures of the lateral end of the clavicle are common in pediatric patients; most of these fractures occur at the physeal level representing Salter Harris injuries. The vast majority of fractures of the lateral end of the clavicle are managed nonoperatively. In this report, we describe a unique type of fracture of the distal end of the clavicle in the pediatric patients in which the fracture occurs in the metaphyseal lateral clavicle with the proximal edge of the fracture displaced posteriorly through the trapezius muscle causing obvious deformity...
2016: Case Reports in Orthopedics
Marcus D Biggers, Timothy M Bert, Alice Moisan, David D Spence, William C Warner, James H Beaty, Jeffrey R Sawyer, Derek M Kelly
To compare clinical and radiographic outcomes of medial epicondylar fractures treated operatively to those treated nonoperatively, 30 patients with 31 fractures were divided into three groups: (a) nondisplaced, six treated nonoperatively; (b) incarcerated fragment, four with operative treatment; and (c) displaced but not incarcerated, 21 fractures, 14 treated operatively and seven nonoperatively. Clinical outcomes were assessed with follow-up examination and the Japanese Orthopaedic Association elbow assessment score...
2015: Journal of Surgical Orthopaedic Advances
Maximilian Petri, Max Ettinger, Timo Stuebig, Stephan Brand, Christian Krettek, Michael Jagodzinski, Mohamed Omar
CONTEXT: Patellar dislocation usually occurs to the lateral side, leading to ruptures of the Medial Patellofemoral Ligament (MPFL) in about 90% of the cases. Even though several prognostic factors are identified for patellofemoral instability after patellar dislocation so far, the appropriate therapy remains a controversial issue. EVIDENCE ACQUISITION: Authors searched the Medline library for studies on both surgical and conservative treatment for patellar dislocation and patellofemoral instability...
September 2015: Archives of Trauma Research
Adina Badoi, Martina Frech-Dörfler, Frank-Martin Häcker, Johannes Mayr
Background Radial neck fractures represent 20 to 30% of elbow fractures in children. Incorrect treatment can lead to significant permanent functional impairment. Posttraumatic avascular necrosis may cause a deformity of the radial head and neck. Deformation of the radial head and neck can be more severe after open rather than closed reduction or orthopedic treatment without reduction. The aim of our study was to analyze the influence of immobilization time on functional outcome. Patients and Methods Retrospective, descriptive study of all children who had been treated for a radial neck fracture between 1999 and 2013 at the University Children's Hospital Basel...
December 2016: European Journal of Pediatric Surgery
Shao-ping Liu, Jian Zhao, Gang Li, Bo Lin, Yang Liu
OBJECTIVE: To explore the effective method of preventing cubitus varus deformity in nonoperative treatment of humeral supracondylar fracture in children. METHODS: From May 1992 to December 2013,319 patients with hemeral supracondylar fracture in children were treated with manual reduction and external plaster fixation in extension position. There were 253 males and 66 females, aged from 15 months to 13 years old with an average of 6.7 years. Among the patients with humeral supracondylar fracture, extension type was in 284 cases and inflexion type was in 35 cases; 167 cases on the left and 152 cases on the right...
August 2015: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Sameer M Naranje, Matthew G Stewart, Derek M Kelly, Tamekia L Jones, David D Spence, William C Warner, James H Beaty, Jeffrey R Sawyer
BACKGROUND: The options for treating femoral fractures in children and adolescents have evolved over the last 2 decades to include a variety of nonoperative and operative methods. The purpose of this study was to identify changes in the types of treatment for pediatric femoral fractures in the United States from 1997 to 2012. METHODS: From discharge estimates for 1997, 2000, 2003, 2006, 2009, and 2012 in the Kids' Inpatient Database, data were extracted using the International Classification of Diseases, 9th revision, and Clinical Modification for pediatric femoral fracture treatments...
October 2016: Journal of Pediatric Orthopedics
Jean L Labbe, Olivier Peres, Olivier Leclair, Renaud Goulon, Patrice Scemama, François Jourdel, Véronique Bertrou, Jerome Murgier
Odontoid synchondrosis fractures are rare in children, even though they are the more common cervical fracture in children less than 7 years old. Nonoperative treatment with external orthosis immobilization is the treatment of choice for stable undisplaced or minimally displaced injuries. In unstable fractures, when reduction cannot be achieved or maintained, surgical fixation is recommended. We report a 2-year-old boy with an unstable fracture of the odontoid treated surgically using an absorbable monofilament suture for C1-C2 interlaminar fixation without bone grafting...
December 2016: Journal of Pediatric Orthopedics
Yi-Rui Jiang, Zhen-Yu Wang, D-B Zhang, Gui-Shan Gu
A Hoffa fracture is an uncommon clinical entity typically seen in adults after high-energy trauma. Nonunion of a Hoffa fracture appears to be even more uncommon. To our knowledge, only three cases of nonunion of a Hoffa fracture have been documented in the literature to date, including two children and one adult. This article presents a case of an adult who had nonunion of a Hoffa fracture for 27 years and was treated by open reduction and internal fixation, and the varus deformity corrected with xenogenous bone graft...
2015: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
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