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Pediatric + proximal + humerus + fractures

A Z Gladstein, A T Schade, A W Howard, M W Camp
INTRODUCTION: The majority of proximal humeral fractures in the skeletally immature are treated non-operatively. Operative indications vary but are largely based on degree of displacement. Non-union is rare. Non-operatively treated fractures are typically monitored radiographically to assess healing. HYPOTHESIS: We hypothesize that the decision to treat fractures operatively is made at the time of first imaging and that follow-up X-rays do not lead to a change in management...
November 25, 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
James E Moyer, Jennifer M Brey
Shoulder injuries in pediatric athletes are typically caused by acute or overuse injuries. The developing structures of the shoulder lead to injury patterns that are distinct from those of adult athletes. Overuse injuries often affect the physeal structures of the proximal humerus and can lead to pain and loss of sports participation. Shoulder instability is common in pediatric athletes, and recurrence is also a concern in this population. Fractures of the proximal humerus and clavicle are typically treated with conservative management, but there is a trend toward surgical intervention...
October 2016: Orthopedic Clinics of North America
Ido Stahl, Mark Eidelman
Pediatric proximal humerus fractures are uncommon and mostly treated conservatively. However, surgical treatment should be considered in displaced fractures classified as Neer-Horowitz grade III-IV in children older than 11 years. We describe a three-point fixation method of applying two Kirschner wires, prebent into a wave shape, and inserted into the proximal humerus through a single cortical hole. In this minimally invasive approach, we treated four boys, obtaining accurate reduction and stable fixation, with all patients starting pendulous exercises the day after surgery...
January 2017: Journal of Pediatric Orthopedics. Part B
Shivanand M Bandekar, Mihir R Desai
INTRODUCTION: Injuries around the elbow are common in pediatric population. Amongst them, most common is fractures of the supracondylar part of humerus, followed by condylar fractures. Fractures of the neck of the radius account for five-ten percent of the total injuries. Various techniques for closed reduction of the fracture have been described in literature. Open reduction and fixation is indicated when closed reduction fails to provide satisfactory results and the angulation remains more than 45-60 degrees...
October 2015: Journal of Orthopaedic Case Reports
Tomoki Nakamura, Akihiko Matsumine, Kunihiro Asanuma, Takao Matsubara, Akihiro Sudo
The aim of the present study was to investigate the mid- to long-term clinical performance of calcium phosphate cement (CPC) in the treatment of benign bone tumors in pediatric patients with a follow-up of at least 2-years. The cases of 33 patients with benign bone tumors treated by curettage and subsequent implantation of CPC were retrospectively reviewed. The patients consisted of 13 males and 20 females, with a median age of 13 years and median follow-up time of 79 months. All patients were alive at the time of review...
January 2016: Oncology Letters
Joseph Benevenia, Francis Patterson, Kathleen Beebe, Kimberly Tucker, Jeffrey Moore, Joseph Ippolito, Steven Rivero
Limb-salvage for primary malignant bone tumors in pediatric patients presents a unique challenge when resection includes an active physis. Early expandable prostheses required open surgical procedures to achieve lengthening. Newer prostheses are capable of achieving expansion without open procedures through the use of an electromagnetic field. This study reports our results with 90 consecutive expansion procedures using the Repiphysis(®) prosthesis. We retrospectively reviewed the records of 20 patients (22 limbs) who underwent limb-salvage using the Repiphysis(®) prosthesis from 2003 to 2015...
2015: SpringerPlus
Jonathan S Zember, Zehava S Rosenberg, Steven Kwong, Shefali P Kothary, Maria A Bedoya
A growing number of magnetic resonance (MR) imaging studies of the shoulder are being performed as a result of greater and earlier participation of children and adolescents in competitive sports such as softball and baseball. However, scant information is available regarding the MR imaging features of the normal sequential development of the shoulder. The authors discuss the radiographic and MR imaging appearances of the normal musculoskeletal maturation patterns of the shoulder, with emphasis on (a) development of secondary ossification centers of the glenoid (including the subcoracoid and peripheral glenoid ossification centers); (b) development of preossification and secondary ossification centers of the humeral head and the variable appearance and number of the secondary ossification centers of the distal acromion, with emphasis on the formation of the os acromiale; (c) development of the growth plates, glenoid bone plates, glenoid bare area, and proximal humeral metaphyseal stripe; and (d) marrow signal alterations in the distal humerus, acromion, and clavicle...
July 2015: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Sijohn Hong, Jae-Hwi Nho, Chang-Ju Lee, Jun-Bum Kim, ByungSung Kim, Hyung-Suk Choi
In pediatric patients, proximal humeral physeal fractures are uncommon injuries compared with distal physeal fractures. Usually, the growth plate is the most vulnerable site of fracture in the proximal humerus. Proximal humeral physeal fractures accompanying posterior shoulder dislocation are very rare. There are few recent reports on the combination of glenohumeral dislocation and proximal humerus fractures. Here, we describe a case of posterior shoulder dislocation with ipsilateral proximal humerus type 2 physeal fracture in a 9-year-old boy...
May 2015: Journal of Pediatric Orthopedics. Part B
Frank Fitoussi, Brice Ilharreborde
BACKGROUND: Resection of primary malignant tumors often creates large bony defects. In children, this creates reconstructive challenges, and many options have been described for limb salvage in this setting. Studies have supported the use of an induced-membrane technique after placement of a cement spacer to aid in restoration of bone anatomy. QUESTIONS/PURPOSES: We asked: (1) What complications are associated with the induced-membrane technique? (2) How often is bone healing achieved after resection greater than 15 cm using this technique? (3) What is the functional outcome of patients treated with this technique? METHODS: We performed a retrospective evaluation of eight patients with a mean age of 13...
June 2015: Clinical Orthopaedics and related Research
Charles A Popkin, William N Levine, Christopher S Ahmad
In the pediatric population, sports participation, falls, and motor vehicle accidents can result in proximal humerus fractures. Because the proximal humeral growth plate is responsible for up to 80% of the growth of the humerus, the remodeling of these fractures in children is tremendous. Most of these injuries can be treated with a sling or hanging arm cast, although older children with decreased remodeling capacity may require surgery. Special considerations should be taken for management of proximal humerus fractures that occur in the context of Little League shoulder, lesser tuerosity avulsion fractures, fracture-dislocations, birth fractures, and fractures associated with cysts...
February 2015: Journal of the American Academy of Orthopaedic Surgeons
Riazuddin Mohammed, Prabhudheer Bhogadi, Sreenivasulu Metikala
PURPOSE: Study of a biplanar crossed pin construct by two crossed Kirschner wires in the management of displaced extension type supracondylar humeral fractures in children. METHODS: Sixty-four patients with such fractures were included and treated according to the study protocol: after achieving closed reduction under general anesthesia with fluoroscopic control, two crossed Kirschner wires of equal diameter were inserted percutaneously. The first lateral wire tracts from the posterolateral corner of the epicondyle to the anteromedial cortex proximally...
October 2014: Journal of Children's Orthopaedics
T Slongo
OBJECTIVE: Closed, anatomical reduction and reliable fixation of type III and IV supracondylar fractures that are either difficult or impossible to treat with conventional methods. INDICATIONS: According the Pediatric Comprehensive AO Classification for long bones this technique is preferred for type III and IV supracondylar fractures that cannot be reduced using closed standard manipulative techniques, where stable fixation using standard percutaneous wire configurations cannot be achieved, when severe swelling, open fracture, primary neurological or vascular problems ("pulseless pink hand") or multiple injuries indicate that optimal management of the injured limb should be free from cast...
February 2014: Operative Orthopädie und Traumatologie
Paul H Yi, Alexander A Weening, Sangmin R Shin, Khalil I Hussein, Paul Tornetta, Andrew Jawa
BACKGROUND: The incidence and injury patterns of open fractures of the proximal ulna are poorly elucidated and little evidence exists to guide management. QUESTIONS/PURPOSES: The purpose of this study was to compare the (1) bony injury patterns; (2) range of motion (ROM) and frequency of union; and (3) postoperative complications between open and closed fractures of the proximal ulna. METHODS: Seventy-nine consecutive open fractures of the proximal ulna were identified...
July 2014: Clinical Orthopaedics and related Research
Nicola Lollino, Marco Assom, Sergio Fumero, Maurizio Collura, Giovanni Merolla
Proximal humeral fractures in the pediatric population are commonly treated conservatively. When there is an indication for surgery, percutaneous pinning is considered to be the elective choice. We report our experience with a new external fixator that reduces the risk of pin migration and permits an early rehabilitation. The range of motion was completely restored in all patients and no pain or discomfort was detected at follow-up. According to the literature, a small varus malunion at the first x-ray control can be tolerated in the pediatric population because of the remodeling ability of the bone...
September 2013: Techniques in Hand & Upper Extremity Surgery
Mustafa Isik, Mehmet Subasi, Oguz Cebesoy, Irfan Koca, Ugur Pamukcu
INTRODUCTION: In contrast to adults, traumatic glenohumeral dislocation is a rarely observed condition among children. In some cases, success in durable reduction with conservative methods, and achieving lasting treatment, may not be possible. CASE PRESENTATION: In this study, the case of a 7-year-old Turkish girl with a Salter-Harris type II fracture and glenohumeral dislocation of the proximal humerus due to a fall from a height of 1.5 meters who underwent open reduction surgery is presented along with a review of the literature...
June 20, 2013: Journal of Medical Case Reports
Michael P Glotzbecker, Donald S Bae, Annie C Links, Peter M Waters
BACKGROUND: Osteonecrosis of the humeral trochlea is an uncommon but challenging complication of pediatric elbow fractures. The purpose of this investigation was to characterize the clinical and radiographic presentation of fishtail deformity and outline a treatment algorithm. METHODS: Fourteen patients were treated at a tertiary children's hospital between 1995 and 2010. Mean age at presentation was 10 years (range, 2.5 to 12 y). Demographic, clinical presentation, radiographic, and treatment data were recorded...
September 2013: Journal of Pediatric Orthopedics
Nirav K Pandya, Dominque Behrends, Harish S Hosalkar
PURPOSE: Proximal humerus fractures in the pediatric population are a relatively uncommon injury, with the majority of injuries treated in a closed fashion due to the tremendous remodeling potential of the proximal humerus in the skeletally immature. Yet, in adolescent patients, open treatment is, at times, necessary due to unsatisfactory alignment following a closed reduction, loss of previously achieved closed reduction, and limited remodeling when close to skeletal maturity. The purpose of our study was to examine the open reduction of adolescent proximal humerus fractures...
June 2012: Journal of Children's Orthopaedics
A Khan, L Athlani, M Rousset, A Samba, F Canavese
PURPOSE: Displaced proximal humerus fractures within the pediatric population can be treated by elastic stable intramedullary nailing (ESIN). The main objective of our study is to evaluate functional outcome of the displaced proximal humeral fractures treated by ESIN within the pediatric group using a standardized evaluation scale. The secondary goal is to compare functional outcome of epiphyseal and metaphyseal injuries and functional outcome of children younger and older than 10 years of age...
February 2014: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
David L Skaggs, David Glassman, Jennifer M Weiss, Robert M Kay
PURPOSE: To report a new locking lateral closing wedge osteotomy used in repairing pediatric supracondylar humerus fracture malunions, which allows for coronal and sagittal plane correction of both cubitus varus and extension. METHODS: At our institution, eight children with cubitus varus resulting from prior supracondylar humerus fracture malunions underwent a new technique of lateral closing wedge osteotomy performed by a single surgeon. Preoperative templating created from radiographs of the bilateral upper extremities were compared with clinical exam to determine the angle of triangular bone that must be removed in order to correct the varus and any extension deformity...
August 2011: Journal of Children's Orthopaedics
D Dhoju, D Shrestha, N Parajuli, G Dhakal, R Shrestha
BACKGROUND: Pediatric supracondylar fracture and forearm bone fracture is common in isolation but combined supracondylar fracture with ipsilateral forearm bone fracture, known as floating elbow is not common injury. The incidence of this association varies between 3% and 13%. Since the injury is rare and only limited literatures are available, choosing best management options for floating elbow is challenging. METHOD: In retrospective review of 759 consecutive supracondylar fracture managed in between July 2005 to June 2011, children with combined supracondylar fracture with forearm bone injuries were identified and their demographic profiles, mode of injury, fracture types, treatment procedures, outcome and complications were analyzed...
April 2011: Kathmandu University Medical Journal (KUMJ)
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