1,721,039 research outputs found
Current concepts on humeral intercondylar fractures in children and adolescents
No full textiNtrOductiON: Humeral intercondylar fractures are rare in children and adolescents. complication such as stiffness
and reduction of elbow motion are extremely frequent. anatomical reduction and restoring of articular surface are the
aims of surgical intervention. the goal of this study is to review the literature on management, complications and prognosis of intercondylar fractures in children and adolescents.
eVideNce acQuiSitiON: a literature search was performed using the pubMed, Scopus, and cochrane library databases from the earliest date possible up to September 2018. the inclusion criteria were: 1) studies regarding intraarticular distal humerus fractures; 2) studies focusing on children and adolescents aged up to 18 years; 3) studies with a
level of evidence of 1 to 4. case-reports were excluded. data on 145 patients were collected from the studies.
eVideNce SYNtHeSiS: Most of the studies in the available literature on this topic are retrospective, include a little
number of patients and no consensus has been found regarding the best surgical treatment.
cONcluSiONS: Humeral intercondylar fractures pose treatment challenges with both initial injury and complications.
Despite the relative rarity of these injuries, there have been signifcant efforts in recent years to better understand the
nature and outcomes associated with this fracture as well as best treatment options. although current data still report high
rates of elbow stiffness and loss of joint motion, future research should be directed at determining whether treatment
algorithms will decrease complication rates and improve patient clinical and functional outcome.
(Cite this article as: alberghina F, andreacchio a, canavese F. current concepts on humeral intercondylar fractures in children and adolescents. Minerva Ortop traumatol 2019;70:
Congenital Clubfoot: from the Ponseti to the French Physical Therapy and “hybrid” methods with “surgery à la carte"
No full textclubfoot has multiple clinical facets. conservative treatment of clubfoot has established itself as the primary treatment
of choice; that is the treatment by plasters, the method of ponseti, or by manipulations, the French functional physical
therapy method. Both protocols aim to achieve a pain-free supple plantigrade foot with as little surgery as practicably
possible, and to decrease the risk of relapse. Surgical treatment is only needed when the orthopedic treatment is no longer
effective and it should be limited to an “à la carte” approach. With an “à la carte” approach, surgery should be considered
as a complementary procedure to non-operative treatment, which aims to reduce the extent of surgery in case it is requested. to achieve a long-term correction with a foot that is fully functional and pain free, a combination of approaches
that applies the strengths of ponseti and French functional physical therapy method is needed (“hybrid method”). the
purpose of our review was to summarize the principles of clubfoot treatment using the ponseti method, the French physical therapy method or the ‘hybrid’ method.
(Cite this article as: dimeglio a, canavese F, andreacchio a, alberghina F. congenital clubfoot: from the ponseti to the
French physical therapy and “hybrid” methods with “surgery à la carte”. Minerva Ortop traumatol 2019;70:11-8. dOi:
10.23736/S0394-3410.19.03900-6)
Key words: clubfoot - conservative treatment - physical therapy modalities - Surgical procedures, operative
Rare injuries of the elbow: fracture capitulum humeri, coronoid process and humeral troclea
No full text
Displaced diaphyseal femur fractures managed by elastic stable intramedullary nailing with or without the use of intraoperative traction during nail insertion: comparative analysis of 69 patients
No full textSingle-Stage Surgery Using Calcium Sulfate Pellets in Association with Tumor Resection as Treatment for Intraosseous Hemangioma of the Radius Shaft in a 2-Year-Old Boy
No full textIntraosseous hemangiomas are uncommon benign vascular tumors. Here the authors
report a case of intraosseous hemangioma of the radial shaft in a 2-year-old boy,
surgically treated by tumor mass resection and application of calcium sulfate pellets
with no signs of relapse over a 2-year follow-up. Moreover, the lesion healed with new
bone formation, and the last plain radiographs suggested homogenous normal
trabecular bone density. The radius grew in length and remodeled to an almost normal
shape. Clinically, elbow flexion-extension and forearm pronation and supination were
within normal limits at the last follow-up visit.
This report points to calcium sulfate pellets as a valid alternative to autologous bone
grafting as void filler in large bone defects. Calcium sulfate pellets enable fast
osteoinduction without interfering in follow-up imaging
The advent of elastic stable intramedullary nailing for the treatment of long bone fractures in skeletally immature patients
No full textIntroduction Management of pediatric long bones fractures is a complex and rapidly evolving field. Traditionally, casting and conservative techniques played a key-role in the management of fractures in skeletally immature patients. However, the surgical approach has evolved steadily over the past four decades or so and increasing evidence has been published supporting the advantages of fixation techniques over conservative methods. The purpose of this narrative review is to outline how innovations in orthopedic surgery have changed the rationale of treating long bones fractures in children and adolescents with focus on surgical techniques, particularly elastic stable intramedullary nailing (ESIN). Material and methods We aimed to describe the main trends in pediatric long bones fractures management and to identify its specificities and difficulties as well as the best standard of care. Results The introduction of ESIN has profoundly influenced the management of pediatric upper and lower extremity fractures. Overall, in comparison to conservative techniques, advantages of ESIN include minimally invasiveness, short hospital stay, primary bone union, early mobilization and progressive weight bearing, and good outcome with low complication rate. Moreover, the flexible nail can be used as a closed reduction tool itself. Conclusions Irrespective of the technique performed, the key-concepts remain 1) the proper understanding of the injury to treat; 2) the identification the main characteristics of the patient; 3) the pros and cons of each technique; and 4) the potential complications
Extra-articular proximal femur fractures in children and adolescents treated by elastic stable intramedullary OP-080 nailing
No full textExtra-articular Proximal Femur Fractures in Children and Adolescents Treated by Elastic Stable Intramedullary Nailing
No full textAbstract
Purpose: Extra-articular proximal femur fractures (EPFF) remain challenging for their intrinsic instability. The aim of this study is to evaluate the results of elastic stable intramedullary nailing (ESIN) of extra-articular proximal femur fractures in children and adolescents.
Methods: A retrospective monocentric study of children treated by ESIN for EPFF between 2012 and 2018 was conducted. We included all patients sustaining a fracture within 10% of the femur length below the lesser trochanter. Studied data were age, sex, femur length, fracture distance below the lesser trochanter, number of days of hospitalization, time to nail removal, and complications. Beaty's criteria and the titanium elastic nailing (TEN) outcome measure scale were used to evaluate radiologic outcome and assess clinical recovery, respectively.
Results: A total of 24 cases were reviewed (18 males, 6 females). Mean age was 8.23 years (range 5-13). Mean duration of hospitalization was 3.7 days (range 2-12). Mean time to nail removal was 28 weeks (range 12-53). Malalignment was observed in five patients, but in all cases, angulation did not exceed 10°. No limb length discrepancy was observed. Twenty out of 24 patients had excellent Beaty's radiological and TEN clinical outcome scores. No poor results were observed.
Conclusions: The results of our study show that good outcomes following surgical treatment by ESIN should be expected in children younger than 14 years of age with displaced EPFF. Excellent radiological and clinical outcomes were observed in 83.7% of the cases, with a low rate of complications and short hospital stay
Closed reduction and cast immobilization of overriding distal forearm fractures under nitrous oxide as conscious sedation without the use of imaging control
No full textPurpose: The management of overriding distal forearm fractures is still controversial. This study aimed to evaluate the efficacy of immediate closed reduction and cast immobilization (CRCI) at the emergency department (ED) using equimolar nitrous oxide (eN2O2) as conscious sedation, and without the use fluoroscopic assistance. Methods: Sixty patients with overriding distal forearm fracture were included in the study. All procedures were performed in the ED without fluoroscopic assistance. Antero-posterior and lateral wrist radiographs were taken after CRCI. Follow-up radiographs were taken 7 and 15 days post-reduction, and at cast removal to evaluate callus formation. Depending on the radiological outcome, two groups of patients could be identified: Group 1 (satisfactory reduction and maintenance of alignment) and Group 2 (poor reduction or secondary displacement requiring further manipulation and surgical fixation). Group 2 was additionally divided into Group 2A (poor reduction) and Group 2B (secondary displacement). Pain was assessed using Numeric Pain Intensity (NPI) score, while functional outcome was measured according to Quick DASH questionnaire. Results: Mean age at the time of injury was 9.2 ± 2.4 years (range, 5–14). Twenty-three (38%) patients were aged between 4 and 9 years old, 20 (33%) patients between 9 and 11, 11 (18%) patients between 11 and 13, and 6 (10%) patients between 13 and 14. The mean follow-up time was 45.6 ± 12 months (range, 24–63). Satisfactory reduction with maintenance of alignment was achieved in 30 (50%) patients (Group 1). Re-reduction was performed in the remaining 30 (50%) patients (Group 2) due to poor reduction (Group 2A) or secondary displacement (Group 2B). No complications related to the administration of eN2O were recorded. No statistically significant difference could be identified between the three groups for any clinical variable (Quick DASH and NPI). Conclusion: Overriding distal forearm fractures may be safely treated with CRCI at ED using eN2O2 as conscious sedation. However, fluoroscopic assistance during CRCI might significantly improve the quality of reduction thus avoiding further treatment as the lack of relaxed muscle can restrain reduction
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