Aims. The aim of this study was to explore parents and young people’s experience of having a
Aims. The management of fractures of the medial epicondyle is one of the greatest controversies in paediatric fracture care, with uncertainty concerning the need for surgery. The British Society of Children’s Orthopaedic Surgery prioritized this as their most important research question in paediatric trauma. This is the protocol for a randomized controlled, multicentre, prospective superiority trial of operative fixation versus nonoperative treatment for displaced
The June 2015 Children’s orthopaedics Roundup. 360 . looks at: ACL reconstruction in paediatric knees; Hips, slips and cams; The adolescent clavicle; 3D fluoroscopy in DDH?; The psychiatric aspects of hip pain in adolescents; Adolescent bunions: dealer’s choice?;
Certain technical advances, such as flexible intramedullary fixation and bioreabsorbable implants, have further increased enthusiasm for surgical management of pediatric fractures.» (Flynn et al.). In the Paediatric Surgery Department biodegradable pins of solid polydioxanone (PDS) in management of paediatric fractures have been used since April 1986. PDS pins are too soft for the osteosynthesis in fractures with fragments under high tensile pressures. However, we have successfully carried out a large number of internal fixations in children’s elbows. This is based on accurate distribution of PDS pins and careful positioning of periostal sutures and the adjacent disrupted muscles. Our technique, as presented at the 2nd European Congress of Paediatric Surgery in Madrid in 1997, is to fix temporarily the repositioned fractured fragment with Kirschner’s metal wire. Following osteosynthesis with PDS, the protruding K-wire is left in place for seven days until the limb is safely immobilized. A total of 96 patients were operated. The purpose of the study is to compare osteosynthesis with PDS pins (Group A) with that of metallic K-wire (Group B). Each group consisted of 48 children. General characteristics (age, sex, and fracture types) were statistically the same (P >
0.05). In Group A, with children between 2 and 13 years, or 9.3 on average, 21 children were with the lateral condyle fractures (43.75%), 25 children with
In 2017, the British Society for Children’s Orthopaedic Surgery engaged the profession and all relevant stakeholders in two formal research prioritization processes. In this editorial, we describe the impact of this prioritization on funding, and how research in children’s orthopaedics, which was until very recently a largely unfunded and under-investigated area, is now flourishing. Establishing research priorities was a crucial step in this process. Cite this article:
The aim of our study is to report on our experience with elbow dislocations in childhood, the spectrum of the associated injuries and the various treatment modalities used. In a period of 18 years, 52 children (33 male and 12 female) with elbow dislocations were treated in our clinic. 45 patients were followed-up with an average time of 7.2 years. 13(29%) dislocations were pure while associated injuries were present in 32(71%). Three had compound injuries. 23 of the associated injuries involved
Introduction and Aims: To review paediatric elbow dislocations treated in our institution over a ten year period and assess outcome. Method: Prospective data collected on elbow injuries in our unit was used to identify elbow injuries and elbow dislocations over a ten-year period. Thereafter, a comprehensive case note and radiological review was performed. Results: 1761 elbow injuries exclusively treated in our unit in a ten-year period. Sixty-three elbow dislocations were identified. Male to female preponderance of around 2:1 (44:19), left more common than right (37:26). There was a seasonal variation. Eighty percent of all dislocations occurred as a result of a low fall or simple sporting injury. Sixty of the 63 dislocations were posterior with two anterior and one divergent dislocation. Associated fractures were common (46%), with 33% of patients having a
Shockwave treatment in our unit is provided in conjunction with our Urological colleagues. Shock Wave Therapy has been used as a last option in patients with difficult and chronic Orthopaedic conditions with an informed consent for all patients. Material and Methods: 28 patients from Ealing Hospital and West Middlesex Hospital were referred to The Lithotripsy unit at Charing Cross Hospital for Shock wave therapy. Patients were consented by the Orthopaedic surgeon and the treatment was administered by urologist. The cases included:. 4 Humeral fractures: 1 Case in HIV +ve 19 years old. 5 Femoral non-union: 1 case bilateral in Osteogenesis imperfecta. 4 Tibial non-union: 1 Recurent Fracture in 65 years old man. 2 Osteochondritis of the Talus. 2 Osteochondritis of the knee. 4 Scaphoid fractures: 1 case had been fixed and grafted.
Aims: To review paediatric elbow dislocations treated in our institution over a ten year period in terms of incidence, aetiology, management and follow up. Methods: Prospective data collected on elbow injuries in our unit was used to identify elbow injuries and elbow dislocations over a ten year period. This was followed by a case note and x ray review. Results: 1761 elbow injuries exclusively treated in our unit in a ten year period. Of these patients 63 had elbow dislocations. We found a male to female preponderance of around 2:1 (44:19), left more common than right (37:26). There was a seasonal variation with more injuries in the summer months. 80% of all dislocations occurred as a result of a low fall or simple sporting injury. 60 of the 63 dislocations were posterior with 2 anterior and 1 divergent dislocation. Associated fractures were common with 33% of patients having a
Proximal Radius – Fractures of the proximal radius in children account for slightly more than 1% of all children’s fractures, represent 5 to 10% of all elbow fractures and accounts for 5% of all fractures involving the growth plate. The average age in the literature is 10 years (4 to 16 years) with no difference between boys and girls. The anatomical aspects should be emphasized for the comprehension of this fracture: 1) the radial head of the child only starts to ossify at age 5 so it is very rare to have a fracture before this age since all the head is cartilaginous and therefore more resistant to trauma. At the same time it makes more difficult the diagnosis because of the absence of ossification of the epiphysis. 2) There is a valgus angulation of 12.5° between the radial head and the shaft of the radius in the AP plan and an anterior angulation of 3° on the lateral plane that should not be misinterpreted as fractures. 3) The radial head is intrarticular in a similar way like the femoral head and trauma to this region may lead to AVN as a result of damage to the vascular supply of the epiphysis. 4) The proximal radioulnar joint has a very intimate continuity contributing to exact congruence of the articular surfaces. The axis of rotation lies directly in the center of the radial neck. Any deviation of the epiphysis over the neck has a major reflect over the axis of rotation causing a “cam” effect when the radial head rotates with loss of pronosupination. The mechanism of injury responsible for this injury result from a fall on the outstretched upper extremity in which the elbow is extended and a valgus force is applied to the elbow joint. In more rare cases it result from direct pressure to the radial head during dislocation of the elbow. There are different classifications mostly based on the anatomical lesion or degree of deformity. Wilkins divides this fracture in two major groups: Group I (valgus fracture) subdivided in three types: type A – the Salter-Harris type I and II, type B – Salter-Harris type IV and type C – fractures involving only the proximal radial metaphysis and Group II (fractures associated with elbow dislocation) subdivided in two types: type D – reduction injuries and type E – dislocation injuries. O’Brien divides the common valgus injury in three types according to the degree of angulation between the radial head and the axis of the radius: Type I (0 to 30° angulation) Type II (between 30° and 60°) and Type III (more than 60°). The clinical symptoms may vary according to the magnitude of the injury. The child will mostly complaint of pain and tenderness on the lateral side of the joint. In young children pain may first be referred to the wrist. The pain usually increases with pronosupination and extension of the elbow. The diagnosis relies mostly on the x-ray view (AP and lateral) and the fracture will be easily visualized in either film. In the cases where the fracture line is superimposed over the ulna an oblique view will be necessary. In the young child, whereas the epiphysis is still not ossified, an ultrasound may be helpful differentiating the position of the radial head. An arthrogram may also be of benefit especially during the process of reduction to check the accuracy of the treatment. The prognosis of this lesion depends on several factors. A poor result can be expected if the fracture is associated with other injuries such as elbow dislocation and ulna or
High-quality clinical research in children’s orthopaedic surgery
has lagged behind other surgical subspecialties. This study used
a consensus-based approach to identify research priorities for clinical
trials in children’s orthopaedics. A modified Delphi technique was used, which involved an initial
scoping survey, a two-round Delphi process and an expert panel formed
of members of the British Society of Children’s Orthopaedic Surgery.
The survey was conducted amongst orthopaedic surgeons treating children
in the United Kingdom and Ireland.Aims
Methods