Aims. To propose a new method for evaluating paediatric
Introduction – Elbow dislocation in children is a rare lesion and most of the times is associated with a fracture of the medial epicondyle. When there is a fracture of the radial neck it is even more rare and usually represents a major instability with large soft tissue disruption. Methods – Between 1984 and 2003, 56 patients with unilateral elbow dislocations were identified ranging from 4 to15 years of age. In 8 patients a
We made a prospective study of angulated
This study compares the outcomes of two methods
of fixation of displaced fractures of the radial neck. The 58 patients
with a mean age of 38.5 years (18 to 56), were treated in a non
randomised study with screws (n = 29) or a plate and screws (n =
29) according to the surgeon’s preference. The patients were reviewed at one year. Radiographs and functional
evaluations were carried out up to one year post-operatively, using
the Broberg and Morrey functional evaluation score, range of movement,
and assessment of complications. The mean functional scores did not differ significantly between
groups (90 (55 to 100) Cite this article:
We report the treatment of six adult patients with displaced fractures of the radial neck by intramedullary reduction and stabilisation. Nine months after operation all the patients had good joint function, little or no pain, complete healing and no significant periarticular calcification. This simple semi-closed procedure may help to avoid resection of the radial head in some cases.
Displaced fractures of the radial neck in children can lead to limitation of elbow and forearm movements if left untreated. Several management techniques are available for the treatment of
A new ‘tripod’ technique using three crossed screws to stabilise
Introduction: In the past, displaced
Introduction: Pediatric
The aim of this study is to discuss the results of intramedullary devices in the management of paediatric
The purpose of this prospective study was to determine the predictive factors and hence optimal management of closed uncomplicated proximal radial fractures. We examined all patients presenting to our unit over an 18-month period with isolated closed proximal radial fractures. 237 consecutive patients were included. Demographic data, physical examination, radiographs, treatment and complications were recorded. Patients were reviewed at 2, 6, 12, 26 and 52 weeks post injury. Outcome was determined via functional assessment and Mayo Elbow Score (MES). Data were analysed using SPSS. There were 156 (66%) radial head fractures and 81 (34%)
AIM: The purpose of this prospective study was to asses the outcome of antegrade intramedullary wiring of displaced distal end of fifth metacarpal fracture in skeletally immature. Intramedullary wiring for fracture metacarpals have been well described in the literature. Retrograde wiring for neck of metacarpal fractures have been associated with limitation of extension at metacarpo-phalangeal joint due to involvement of gliding extensor mechanism. Foucher described ‘Bouguet’ osteosynthesis with multiple wires for metacarpal neck fracture which can be technically demanding in small bones of children. We describe an antegrade wiring using a single bent K-wire at the tip for reducing and stabilising displaced metacarpal neck fracture by rotating 180 degree after crossing fracture site, a method similar to Methaizeau technique for stabilisation of displaced
For a long time treatment of all forarm fractures was coservatively in principle. Retrospective analysis of more than 1000 fractures showed that 97,8% were treated orthopedically, 22% finished consolidation with an axial malalignment of more than 10∞ and 6,9% showed bad functional results 3–13 years later. Most bad results were found in shaft fractures of both bones on the same level or in oblique fractures with convergent displacement. The introduction of elastic stable intramedullary nailing (ESIN) gave the opportunity to stabilize instable diaphy-seal fractures with less [Aufwand], with an implant adequate for children and with the possibility of immediate postoperative movement. Within three years, 161 diaphy-seal forearm fractures were managed by cast (27%), reduction (32%) or osteosynthesis (41%). In 14 cases (8,7%), secondary osteosynthesis took place because of secondary or re-displacement during orthopedic treatment. The functional results following ESIN are very good. In
This paper presents the results of forearm fractures in twenty children treated with flexible intramedullary nailing, over a period of 3 yrs. Forearm fractures in children are an extremely common injury and excellent results are obtained in the majority of cases by closed reduction and plaster immobilisation. If adequate reduction cannot be achieved or maintained by conservative means or if it fails, some form of internal fixation will be required. Flexible nails are an extremely effective way for addressing this problem. Twenty children had flexible intramedullary nailing done following forearm fractures over a 3-year period from 1997–2000 [failed reduction (10), unstable post MUA(3), slipped in plaster(6) and open fractures(1)]. There were 15 male and 5 female patients, the mean age being 10. 9. The nature of the injury were radial neck (3); proximal radius (1), galeazzi (1) and both bone fractures (15). Nine patients had closed nailing, while 11 required a mini open approach of which, 5 needed exposure only on one side. Patients were protected post surgery until signs of union were seen. The patients had regular clinical and radiological assessment and nails were removed on an average of 6–8 months, though in patients with
Heterotopic ossification (HO) is a common complication after elbow trauma and can cause severe upper limb disability. Although multiple prognostic factors have been reported to be associated with the development of post-traumatic HO, no model has yet been able to combine these predictors more succinctly to convey prognostic information and medical measures to patients. Therefore, this study aimed to identify prognostic factors leading to the formation of HO after surgery for elbow trauma, and to establish and validate a nomogram to predict the probability of HO formation in such particular injuries. This multicentre case-control study comprised 200 patients with post-traumatic elbow HO and 229 patients who had elbow trauma but without HO formation between July 2019 and December 2020. Features possibly associated with HO formation were obtained. The least absolute shrinkage and selection operator regression model was used to optimize feature selection. Multivariable logistic regression analysis was applied to build the new nomogram: the Shanghai post-Traumatic Elbow Heterotopic Ossification Prediction model (STEHOP). STEHOP was validated by concordance index (C-index) and calibration plot. Internal validation was conducted using bootstrapping validation.Aims
Methods
In response to the COVID-19 pandemic, there was a rapidly implemented restructuring of UK healthcare services. The The Royal National Orthopaedic Hospital, Stanmore, became a central hub for the provision of trauma services for North Central/East London (NCEL) while providing a musculoskeletal tumour service for the south of England, the Midlands, and Wales and an urgent spinal service for London. This study reviews our paediatric practice over this period in order to share our experience and lessons learned. Our hospital admission pathways are described and the safety of surgical and interventional radiological procedures performed under general anaesthesia (GA) with regards to COVID-19 in a paediatric population are evaluated. All paediatric patients (≤ 16 years) treated in our institution during the six-week peak period of the pandemic were included. Prospective data for all paediatric trauma and urgent elective admissions and retrospective data for all sarcoma admissions were collected. Telephone interviews were conducted with all patients and families to assess COVID-19 related morbidity at 14 days post-discharge.Introduction
Methods
The aim of this systematic review and meta-analysis is to evaluate differences in functional outcomes and complications between single- (SI) and double-incision (DI) techniques for the treatment of distal biceps tendon rupture. A comprehensive search on PubMed, MEDLINE, Scopus, and Cochrane Central databases was conducted to identify studies reporting comparative results of the SI versus the DI approach. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for search strategy. Of 606 titles, 13 studies met the inclusion criteria; methodological quality was assessed with the Newcastle-Ottawa scale. Random- and fixed-effects models were used to find differences in outcomes between the two surgical approaches. The range of motion (ROM) and the Disabilities of the Arm, Shoulder and Hand (DASH) scores, as well as neurological and non-neurological complications, were assessed.Aims
Methods
The Edinburgh Trauma Triage Clinic (TTC) streamlines outpatient
care through consultant-led ‘virtual’ triage of referrals and the
direct discharge of minor fractures from the Emergency Department.
We compared the patient outcomes for simple fractures of the radial
head, little finger metacarpal, and fifth metatarsal before and
after the implementation of the TTC. A total of 628 patients who had sustained these injuries over
a one-year period were identified. There were 337 patients in the
pre-TTC group and 289 in the post-TTC group. The Disabilities of
the Arm, Shoulder and Hand Score (QuickDASH) or Foot and Ankle Disability
Index (FADI), EuroQol-5D (EQ-5D), visual analogue scale (VAS) pain
score, satisfaction rates, and return to work/sport were assessed
six months post-injury. The development of late complications was
excluded by an electronic record evaluation at three years post-injury.
A cost analysis was performed.Aims
Patients and Methods
Mason type III fractures of the radial head are treated by open reduction and internal fixation, resection or prosthetic joint replacement. When internal fixation is performed, fixation of the radial head to the shaft is difficult and implant-related complications are common. Furthermore, problems of devascularisation of the radial head can result from fixation of the plate to the radial neck. In a small retrospective study, the treatment of Mason type III fractures with fixation of the radial neck in 13 cases (group 2) was compared with 12 cases where no fixation was performed (group 1). The mean clinical and radiological follow-up was four years (1 to 9). The Broberg-Morrey index showed excellent results in both groups. Degenerative radiological changes were seen more frequently in group 2, and removal of the implant was necessary in seven of 13 cases. Post-operative evaluation of these two different techniques revealed similar ranges of movement and functional scores. We propose that anatomical reconstruction of the radial head without metalwork fixation to the neck is preferable, and the outcome is the same as that achieved with the conventional technique. In addition degenerative changes of the elbow joint may develop less frequently, and implant removal is not necessary.
Most fractures of the radial head are stable
undisplaced or minimally displaced partial fractures without an associated
fracture of the elbow or forearm or ligament injury, where stiffness
following non-operative management is the primary concern. Displaced
unstable fractures of the radial head are usually associated with other
fractures or ligament injuries, and restoration of radiocapitellar
contact by reconstruction or prosthetic replacement of the fractured
head is necessary to prevent subluxation or dislocation of the elbow
and forearm. In fractures with three or fewer fragments (two articular
fragments and the neck) and little or no metaphyseal comminution,
open reduction and internal fixation may give good results. However,
fragmented unstable fractures of the radial head are prone to early
failure of fixation and nonunion when fixed. Excision of the radial
head is associated with good long-term results, but in patients
with instability of the elbow or forearm, prosthetic replacement
is preferred. This review considers the characteristics of stable and unstable
fractures of the radial head, as well as discussing the debatable
aspects of management, in light of the current best evidence. Cite this article:
A total of 14 women and seven men with a mean age of 43 years (18 to 68) who sustained a Mason type IV fracture of the elbow, without an additional type II or III coronoid fracture, were evaluated after a mean of 21 years (14 to 46). Primary treatment included closed elbow reduction followed by immobilisation in a plaster in all cases, with an additional excision of the radial head in 11, partial resection in two and suturing of the annular ligament in two. Delayed radial head excision was performed in two patients and an ulnar nerve transposition in one. The uninjured elbows served as controls. Nine patients had no symptoms, 11 reported slight impairment, and one severe impairment of the elbow. Elbow flexion was impaired by a mean of 3° ( We conclude that most patients with a Mason type IV fracture of the elbow report a good long-term outcome.
Several techniques are available for the treatment of displaced fractures of the neck of the radius in children. We report our experience in 14 children treated by indirect reduction and fixation using an elastic stable intramedullary nail. The patients were followed up for a mean of 28 months. One developed asymptomatic avascular necrosis. The rest had excellent results. One had a neuropraxia of the posterior interosseous nerve, which recovered within six weeks. We advocate elastic stable intramedullary nailing for the closed reduction and fixation of these fractures in children.