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Children with permanent brachial plexus birth injury have a high risk of developing posterior shoulder subluxation. In 2010, we implemented a protocol to reduce the incidence of this deformity, including early passive exercises, ultrasound screening, botulinum toxin-A injections, shoulder splinting and targeted surgeries. Two-hundred and thirty-seven consecutive children treated at our institution, with a mean follow-up of 11 years (range 1 to 17) were compared in three groups: children born from 1995 to 1999 (n = 53), 2000–2009 (n = 109) and 2010–2019 (n = 75). Posterior shoulder subluxation developed in 48% of all patients but the mean age at detection of shoulder subluxation decreased from 5 years to 4.9 months. Need for shoulder relocation surgery also decreased from 28% to 7%. Mean active shoulder external rotation in adduction improved from 2° to 46°. In conclusion, our established protocol has the potential to reduce the incidence of posterior shoulder subluxation in children with brachial plexus birth injury. Level of evidence: II [ABSTRACT FROM AUTHOR]

Background: The incidence of completely displaced overriding distal metaphyseal radial fractures in children is unknown, and the optimal treatment is controversial.Methods: All completely displaced distal metaphyseal radial fractures in patients <16 years old treated in our tertiary-level institution from 2014 to 2019 were identified with use of the Kids' Fracture Tool Helsinki. Etiology, fracture characteristics, management, and quality of treatment were assessed. A telephone interview with the guardian of the patient was performed for 100 (89%) of 112 patients at 1.5 to 7.2 years (median, 4.6 years) after the injury. Pain during the last month and forearm function were recorded. Treatment satisfaction was assessed with use of a 7-point Likert scale.Results: A total of 113 completely displaced overriding distal metaphyseal radial fractures in 112 patients (81 of whom were residents of Helsinki) were treated during the 6-year-long study period. The mean annual incidence was 1.42 per 10,000 population. Most (73%) of these fractures occurred in children <11 years old, and most fractures were dorsally displaced and located nearly as far proximally from the distal radial physis as the maximum width of the distal metaphysis. Closed manipulation was attempted in two-thirds of cases in the emergency department, with a failure rate of 46%. Strong opioids were administered in 70 of 112 patients. None of the 26 patients whose fractures were immobilized in an overriding position had secondary interventions, pain, or functional disability. The mean satisfaction with treatment on the Likert scale was 6.2.Conclusions: The annual incidence of overriding distal metaphyseal radial fractures patients <16 years old was shown to vary between 0.72 and 2.01 per 10,000 population. Opioids, local and general anesthesia, hospital admission, and secondary interventions can be avoided in prepubescent patients by casting these fractures in an overriding position while the patient is in the emergency department.Level Of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background and purpose — Traditionally, overriding distal radius fractures in children have been reduced and immobilized with a cast or treated with percutaneous pin fixation. There is recent evidence that these fractures heal well if immobilized in the bayonet position without reduction. We evaluated the present treatment of these fractures. Methods — A questionnaire including AP and lateral radiographs of overriding distal radius fractures in 3 pre-pubertal children was answered by 213 surgeons from 28 countries. The surgeons were asked to choose their preferred method of treatment (no reduction, reduction, reduction and osteosynthesis), type and length of cast immobilization, and the number of clinical and radiographic follow-ups. Results — Of the 213 participating surgeons, 176 (83%) would have reduced all 3 presented fractures, whereas 4 (2%) would have treated all 3 children with cast immobilization without reduction. Most reductions (77%) would have been done under general anesthesia. Over half (54%) of the surgeons who preferred anesthesia would have fixed (pins 99%, plate 1%) the fractures. An above-elbow splint or circular cast was chosen in 84% of responses, and the most popular (44%) length of immobilization was 4 weeks. Surgeons from the Nordic countries were more eager to fix the fractures (54% vs. 31%, p < 0.001) and preferred shorter immobilization and follow-up times and less frequent clinical and radiological follow-ups compared with their colleagues from the USA. Interpretation — Most of the participating surgeons prefer to reduce overriding distal radius fractures in children under anesthesia. There is substantial lack of agreement on the indications for osteosynthesis, type of cast, length of immobilization, and follow-up protocol. [ABSTRACT FROM AUTHOR]