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Purpose: This study investigated the clinical and functional outcomes of children with distal both-bone forearm fractures treated by fixation of the radius only compared to fixation of both the radius and ulna. Methods: A total of 71 patients from two centres with distal both-bone forearm fractures (30 in the ulna-yes group, 41 in the ulna-no group) who underwent closed reduction and percutaneous pinning treatment were retrospectively analysed. Operation duration, number of fluoroscopic exposures, loss of reduction rate and angulation based on radiographic assessment were compared between the two groups. Evaluation of wrist function including Gartland-Werley Score and Mayo Wrist Score were compared at the last follow-up. Results: Ulna angulation upon bone healing on the posteroanterior and the lateral plane of ulna-no group (6.11 ± 1.56°; 6.51 ± 1.69°) was significantly greater than that of ulna-yes group (4.49 ± 1.30°; 5.05 ± 2.18°) (p < 0.05). No significant difference was found in the loss of reduction rate between ulna-yes group (6.67%, 2/30) and the ulna-no group (4.88%, 2/41) (p > 0.05). At last follow-up, no significant difference was found between the Gartland-Werley Scores of the ulna-yes group (1.83 ± 3.25, range: 0–16) and ulna-no group (1.85 ± 2.72, range: 0-11.5) (p > 0.05). No significant difference was found between the Mayo Wrist Scores of the ulna-yes group (92.60 ± 6.20) and ulna-no group (92.15 ± 7.58) (p > 0.05). Conclusions: For distal both-bone forearm fractures in children, fixation of only the radius appears to be a viable method with equivalent clinical outcomes compared to fixation of both the radius and ulna. [ABSTRACT FROM AUTHOR]

Abstract Purpose This study investigated the clinical and functional outcomes of children with distal both-bone forearm fractures treated by fixation of the radius only compared to fixation of both the radius and ulna. Methods A total of 71 patients from two centres with distal both-bone forearm fractures (30 in the ulna-yes group, 41 in the ulna-no group) who underwent closed reduction and percutaneous pinning treatment were retrospectively analysed. Operation duration, number of fluoroscopic exposures, loss of reduction rate and angulation based on radiographic assessment were compared between the two groups. Evaluation of wrist function including Gartland-Werley Score and Mayo Wrist Score were compared at the last follow-up. Results Ulna angulation upon bone healing on the posteroanterior and the lateral plane of ulna-no group (6.11 ± 1.56°; 6.51 ± 1.69°) was significantly greater than that of ulna-yes group (4.49 ± 1.30°; 5.05 ± 2.18°) (p 0.05). At last follow-up, no significant difference was found between the Gartland-Werley Scores of the ulna-yes group (1.83 ± 3.25, range: 0–16) and ulna-no group (1.85 ± 2.72, range: 0-11.5) (p > 0.05). No significant difference was found between the Mayo Wrist Scores of the ulna-yes group (92.60 ± 6.20) and ulna-no group (92.15 ± 7.58) (p > 0.05). Conclusions For distal both-bone forearm fractures in children, fixation of only the radius appears to be a viable method with equivalent clinical outcomes compared to fixation of both the radius and ulna.

Tim Cheok,1– 3 Matthew Jennings,1,4 Morgan Berman,1 Kanihska Williams,1,3 Jaideep Singh Rawat,1,5,6 Bruce K Foster1,5 1Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia; 2Department of Orthopaedic Surgery, Palmerston North Hospital, Palmerston North, New Zealand; 3College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; 4Department of Plastics and Reconstructive Surgery, Women’s and Children’s Hospital, Adelaide, South Australia, Australia; 5Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia; 6Department of Orthopaedic Surgery, Women’s and Children’s Hospital, Adelaide, South Australia, AustraliaCorrespondence: Tim Cheok, Email tim.cheok@flinders.edu.auCase: We present a case of acute unstable valgus slipped capital femoral epiphysis (SCFE) in an 8-year-old female who presented after a trip and fall. The patient was managed with emergent closed reduction and percutaneous screw fixation and prophylactic fixation of contralateral side after 6 weeks. At 18-month follow-up, the patient was symptom free with a good range of movement and no evidence of slip progression, chondrolysis or avascular necrosis of the femoral head.Conclusion: We demonstrate that, in this case, closed reduction and percutaneous fixation provided satisfactory outcome at 18-month follow-up. This case highlights the need for both anteroposterior and lateral radiographs.Keywords: SCFE, closed reduction, percutaneous pinning, valgus slip

Introduction: This study aimed to evaluate the clinical and radiological outcomes of conservative treatment and closed reduction with anterograde pinning for the treatment of 5th metacarpal (MC) neck fractures. Methods: Data of patients who underwent surgery for 5th MC neck fractures between January 2017 and December 2020 were retrospectively analyzed. Two groups were formed: those treated with closed reduction and anterograde intramedullary Kirschner wire fixation and those treated with closed reduction and casting. The groups were statistically compared in terms of pre- and post-treatment radiological angulation, functional outcomes, and return to work times. Quick-Disability of Arm, Shoulder and Hand Outcome Measure and visual analog scale (VAS) were used for functional scoring. Results: The study included 33 patients (6 male, 27 female) treated conservatively and 32 patients (4 male, 28 female) treated with closed reduction and anterograde percutaneous pinning. In the closed reduction and casting group, the post-treatment angulation was measured as 19 degrees (10-30). In the anterograde pinning group, the post-treatment angulation was 15 degrees (9-20). At the end of the first year, 5th MC joint flexion was measured as 75 degrees (30-100) in group 1 and 75 degrees (50-100) in group 2. The DASH score was 0 (0-25) in group 1 and 0 (0-40) in group 2. The VAS score was 96 (18-100) in group 1 and 100 (30-100) in group 2. Conclusion: The results of this study suggest that intramedullary Kirschner wire fixation is a safe option for treating 5th MC neck fractures. In addition, an increase in angulation was observed after closed reduction even in cases where acceptable limits of angulation were maintained. While emphasizing the need for more comprehensive research, this study also suggests that surgical treatment could be effective in different angulations.

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Background: Fractures of the distal radius constitute one of the most common skeletal injuries treated by orthopaedic surgeons. Colle’s fracture was first described by Abraham Colle of Dublinin Ireland. There are variety of treatment modalities in treating extraarticular non-comminuted fractures of distal radius. Each one has got their own advantages and disadvantages. Increased life expectancy of the population increases and as accidents also increase, the incidence of this fracture is expected to increase. Percutaneous pinning is one of the most simple, cost effective,easy procedure with good results. Objective: To analyze the outcome of Distal Radial Fractures treated with closed reduction and percutaneous pinning. Materials and Methods: This is a prospective study of 30 cases of distal radius fractures .noncomminuted aged between 20 to 70 years of age. They were treated with closed reduction and internal fixation with Percutaneous pinning with 2-3 K-wires. Postoperatively they were immobilized with below elbow dorsal slab. After 3 weeks slab was removed and physiotherapy started, K-wires were removed after 6 weeks. Post operative x-rays were done at 3 weeks,6 weeks and 6 months. Results: There were 30 cases in our study. 60% (18) males and 40% (12) females. The mean ageof the patients was 52 years. The mechanism of injury in most cases was fall on out stretched hand 76.6% (23). The side of involvement was right in 56% (17) and 44% (13) in left hand. 66% (19) belonged to type A, 34% (10) belonged to Type C according to Fernandez classification. 54% (16) patients belonged to A type, 36 % (11) belonged to type B as per AO classification. 60% (18) showed excellent outcome under subject evaluation, 67% (20) patients showed excellent end results. Total 13% (4) showed complications in the study. Among them 7%(2) were pin tract infection, followed by malunion and Reflex Sympathetic Dystrophy each 3%(1). [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the clinical and radiological outcomes of conservative treatment and closed reduction with anterograde pinning for the treatment of 5th metacarpal (MC) neck fractures. Methods: Data of patients who underwent surgery for 5th MC neck fractures between January 2017 and December 2020 were retrospectively analyzed. Two groups were formed: those treated with closed reduction and anterograde intramedullary Kirschner wire fixation and those treated with closed reduction and casting. The groups were statistically compared in terms of pre- and posttreatment radiological angulation, functional outcomes, and return to work times. Quick-Disability of Arm, Shoulder and Hand Outcome Measure and visual analog scale (VAS) were used for functional scoring. Results: The study included 33 patients (6 male, 27 female) treated conservatively and 32 patients (4 male, 28 female) treated with closed reduction and anterograde percutaneous pinning. In the closed reduction and casting group, the post-treatment angulation was measured as 19 degrees (10-30). In the anterograde pinning group, the post-treatment angulation was 15 degrees (9-20). At the end of the first year, 5th MC joint flexion was measured as 75 degrees (30-100) in group 1 and 75 degrees (50-100) in group 2. The DASH score was 0 (0-25) in group 1 and 0 (0-40) in group 2. The VAS score was 96 (18-100) in group 1 and 100 (30-100) in group 2. Conclusion: The results of this study suggest that intramedullary Kirschner wire fixation is a safe option for treating 5th MC neck fractures. In addition, an increase in angulation was observed after closed reduction even in cases where acceptable limits of angulation were maintained. While emphasizing the need for more comprehensive research, this study also suggests that surgical treatment could be effective in different angulations. [ABSTRACT FROM AUTHOR]

Background: Supracondylar humeral fracture is probably the most common elbow fracture in children requiring surgical intervention. We observed a subtype of pediatric supracondylar humeral fracture with a sideward translation, without substantial displacement in the sagittal plane on initial radiographs. The purpose of this study was to calculate the incidence of this fracture subtype and suggest a modification to the standard operative technique, to achieve the desired fracture alignment and fixation. Methods: We reviewed the clinical records and radiographs of all pediatric patients with supracondylar humeral fractures surgically treated in our institution between the years 2006 and 2014. The fracture types, fixation configuration and any complications were recorded. Results: Overall, 263 consecutive patients were included. The incidence of supracondylar fracture of the humerus with solely sideward displacement was 6%. The fracture was characterized clinically and radiographically. We proposed a modification to the standard operative technique for this fracture subtype for successful closed reduction and percutaneous pinning. Conclusions: Special attention to this fracture subtype, including appropriate operating room setup and the application of a suitable reduction and pinning technique, has the potential to achieve successful results and avoid the need for open reduction.

Amaç: Amacımız, distal tibia eklem hattına uzanan tibia diyafiz kırıklarında intramedüller çivilemenin sonuçlarının araştırılması ve minimal invaziv plak osteosentez yöntemi ile karşılaştırılmasıdır. Gereç ve Yöntem: Kliniğimizde tibia distal eklem hattına uzanan ancak eklemde impaksiyon izlenmeyen tibia diyafiz kırığı nedeni ile 2019 – 2021 yılları arasında tedavi ve takibi yapılan tüm hastalar retrospektif olarak araştırıldı. Tüm hastaların yaş, cinsiyet ve taraf gibi demografik verileri, yaralanma mekanizmaları, tibia diyafiz ve pilon kırık tipleri, klinik ağrı skorları, radyolojik kaynamaları ve komplikasyonları değerlendirildi. Bulgular: Çalışmaya dahil edilen 27 hastadan 15 hasta (%55,56) intramedüller çivileme ile tedavi edilirken, 12 hastada (%44,44) minimal invaziv plak osteosentez kullanılmıştır. İMÇ uygulanan grubun ortanca yaşı 62 (Aralık: 34-67 yaş) iken, MİPO uygulanan grupta ortanca yaşı 51 (Aralık: 33-52) olduğu ve aralarında anlamlı fark olduğu görüldü (p=0,038). Yaralanma mekanizmaları açısından gruplar arasında anlamlı fark tespit edildi (p=0,023). Taraf, cinsiyet, kırık tipi ve ağrı skorları açısından iki grup arasında fark görülmedi (p>0,050). Hastaların tamamında radyolojik tam iyileşme elde edildi. Dört hastada (%14,81) yara yerinde yumuşak doku ilişkili komplikasyonlar tespit edildi. Komplikasyon gelişen hastaların tamamının MİPO grubunda olduğu görüldü ve gruplar arasında komplikasyon gelişimi açısından anlamlı fark tespit edildi (p=0,028). Sonuç: Distal tibia eklem hattına uzanan tibia diyafiz kırıklarında, eklemde impaksiyon eşlik etmiyor ise, perkütan kanüllü vidalar ile eklemde mutlak stabilitenin elde edilmesini takiben uygulanan intramedüller çivileme ile tatminkar klinik ve radyolojik sonuçlar ve düşük komplikasyon oranları elde edilebilir.

Objectives: It is aimed to compare biomechanically the 3 different pin techniques and the lateral onset cross-pinning (LXP) technique in supracondylar humeral fractures. Methods: Biomechanical testing was performed on 52 synthetic humeri Four pin configurations techniques were tested: crossed pins (XP), 2 lateral pins (2LP), 3 lateral pins (3LP), and LXP technique. Biomechanical testing was performed on Shimadzu Autograph measuring machine. Each pin configuration was tested in a total of 13 humeri: 4 in varus bending, 4 in valgus bending, and 5 in flexion bending. Displacement (mm), and load (N) data were sampled at 10 Hz during each test. Results: Varus values were statistically lower in 2 LP group comparing to XP, 3 LP, LXP groups (p=0.01, p=0.02, p=0.012, consequently). Flexion load values statistically lower in 2 LP group comparing to XP, 3 LP, LXP groups (p=0.03, p=0.001, p=0,031, consequently). There was no difference between the groups in terms of valgus values (p>0.05). Conclusion: LXP technique is biomechanically similar to the traditional XP technique. In situations where orthopedic surgeons choose to use medial pins in addition to lateral pins such as distal humerus fractures with medial-sided defects. [ABSTRACT FROM AUTHOR]

Background: Supracondylar humeral fracture is probably the most common elbow fracture in children requiring surgical intervention. We observed a subtype of pediatric supracondylar humeral fracture with a sideward translation, without substantial displacement in the sagittal plane on initial radiographs. The purpose of this study was to calculate the incidence of this fracture subtype and suggest a modification to the standard operative technique, to achieve the desired fracture alignment and fixation. Methods: We reviewed the clinical records and radiographs of all pediatric patients with supracondylar humeral fractures surgically treated in our institution between the years 2006 and 2014. The fracture types, fixation configuration and any complications were recorded. Results: Overall, 263 consecutive patients were included. The incidence of supracondylar fracture of the humerus with solely sideward displacement was 6%. The fracture was characterized clinically and radiographically. We proposed a modification to the standard operative technique for this fracture subtype for successful closed reduction and percutaneous pinning. Conclusions: Special attention to this fracture subtype, including appropriate operating room setup and the application of a suitable reduction and pinning technique, has the potential to achieve successful results and avoid the need for open reduction. [ABSTRACT FROM AUTHOR]

Copyright of Sakarya Tıp Dergisi is the property of Sakarya Tip Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Supracondylar humerus fractures are the most common upper limb injury in children, but the incidence of flexion-type fractures is relatively low. Herein, we report the clinical results for three children with Gartland type II flexion-type supracondylar humeral fractures treated by closed reduction and percutaneous pinning. From April 2004 to March 2020, 102 children with supracondylar humeral fractures underwent surgery at our hospital and related institutions. Four had a flexion-type supracondylar humeral fracture (3.9%). Three patients (1 boy and 2 girls) with Gartland type II flexion-type supracondylar humeral fractures were followed for more than 12 months. The patients were treated by closed reduction and percutaneous pinning. Age was 7-13 years at the time of injury, and the duration of postoperative follow-up was 12-16 months. In one case, ulnar nerve paresis was observed as a preoperative complication. After performing closed reduction, percutaneous Kirschner wire cross-fixation was performed. Subsequently, long upper limb cast fixation was carried out for 4 weeks postoperatively. One patient developed preoperative nerve paralysis but recovered in approximately 3 months, without postoperative complications such as infection, nerve paralysis, or cubitus varus or valgus deformity. Flynn’s criteria results were excellent for two patients and good for one patient. To maintain anatomical reduction of the fracture fragment, closed reduction using a traction table and percutaneous steel wire fixation are useful for treating flexion-type supracondylar humerus fractures in children with Gartland type II fractures. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Although there are numerous studies on outcomes and comparison of open and closed reduction but there is no clarity on relationship between outcomes and complications with type of surgical intervention done for Type 3 Gartland supracondylar humerus fracture. The aim of this study is to compare the outcomes and complications of closed vs open reduction in Type 3 Gartland supracondylar humerus fractures. MATERIAL AND METHODS Electronic literature searches of Embase, MEDLINE and the Cochrane Library was conducted in February 2022 using the terms “supracondylar”, “humerus”, “fracture”, “Gartland type 3” and synonymous. The data extracted included the study details, demographic data, procedure performed, final functional and cosmetic outcome according to Flynn criteria and complications of included studies. RESULTS Pooled data analysis revealed no significant difference in mean satisfactory outcome rate according to Flynn cosmetic criteria in open group (97%, 95% CI 95.5%–98.5%), as compared to closed group (97.5%, 95% CI 96.3%–98.7%), although a statistically significant difference in mean satisfactory rate according to Flynn functional criteria in open group (93.4%, 95% CI 90.8%– 96.1%) as compared to closed group (98.5%, 95% CI 97.5%–99.4%) was noted. On separate comparison of the two-arm studies, closed reduction favoured better functional outcomes (RR 0.92, 95% CI 0.86–0.99). CONCLUSIONS Closed reduction and percutaneous fixation have better functional outcome than open reduction with K-wire fixation. But there was no significant difference in cosmetic outcomes, overall complication rate and nerve injury with either open or closed reduction. The threshold of converting a closed reduction to an open reduction in supracondylar humerus fractures of children should be high. [ABSTRACT FROM AUTHOR]

Abstract Background Controversy exists surrounding the optimal approach to managing pediatric lateral humeral condyle fractures (LHCF). The difficulty in assessing the articular surface using radiography and the intra-articular element potentially involved make LHCF susceptible to complications and delayed diagnoses. Arthrography has been used to delineate the articular surface to aid in deciding whether closed or open reduction is necessary. However, there has been scarce evidence to determine the accuracy of using radiography versus arthrography to predict articular disruption in LHCF displaced 1–5 mm. This study assesses; (1) the utility of intraoperative arthrography in modifying the method of operative reduction, (2) the accuracy of plain radiography in identifying articular integrity, and (3) the clinical outcomes of early operative treatment. Methods This was a single-center prospective study that involved operatively treated pediatric LHCF with a displacement of 1–5 mm. Patient demographics, radiographic displacement, predicted radiographic articular integrity, articular integrity on arthrograms, modification of management and follow-up clinical outcomes were obtained. Results A total of 72 patients were included with a mean displacement of 2.6 mm and a mean follow-up of 16 months. The articular surface was disrupted in 21% of patients. The reduction method (open versus closed) was modified in 15 patients (21%) after an intraoperative arthrogram. Out of 25 patients with displacement 4 mm displacement had an intact articular hinge that were managed with closed reduction and percutaneous pinning (CRPP). All patients achieved union with no documented major complications. The ability of radiography to discriminate between disrupted/ intact articular integrity decreases as displacement decreases. Conclusions Data from this study suggest using the degree of displacement measured on plain radiography is insufficient in predicting articular integrity for fractures displaced 1–5 mm. The use of arthrography guides reduction method and adequacy, avoiding scenarios of unnecessary open reduction and insufficient closed reduction. Further, a significant amount of outliers exist that have intact articular hinges above 4 mm and disrupted hinges below 2 mm of displacement. Finally we report favorable outcomes using a lower threshold for early operative treatment.

Introduction:It is thought that transulnar (a Kirschner wire from radius to ulna) pinning provided less collapse at the fracture site in the percutaneous pinning of distal radius fracture. In this study, we compared the radiological and clinical results of the patient groups with and without transulnar pinning for percutaneous pinning of distal radius fracture.Methods:Patients who underwent 16 isolated radius pinning and 11 radius pinning and additional transulnar pin between 2016 and 2021 were included in the study. Disabilities of the arm, shoulder, and hand (DASH) score, range of motion of the injured wrist at final examination and radiological parameters in terms of ulnar variance, radial height, and volar tilt of the operated wrist were evaluated. The results were compared between the two groups.Results:There was no statistical difference in terms of DASH score, radial height, volar tilt, radial inclination, pronation, supination, and flexion degrees between the two groups. The final extension degrees were found to be statistically higher in the transulnar pinning group.Conclusion:It was observed in our study that radius collapse and radial shortening were less in patients who underwent transulnar pinning in addition to radius pinning; but the difference was not statistically significant.

Background: Unstable extra-articular proximal phalanx fractures are common injuries to the hand that are often treated by closed reduction and percutaneous pinning. Fracture-induced shortening of the proximal phalanx leads to an extensor lag at the proximal interphalangeal joint. We describe a biomechanical study in cadaver hands to compare the ability of each of three different pin configurations to resist shortening in unstable fractures. Methods: Seventeen fresh frozen hands were disarticulated at the proximal ends of the metacarpals. The second, third, and fourth proximal phalanges were tested. A 5-mm section of bone was resected from the mid-shaft of proximal phalanx to simulate an unstable fracture. Three techniques were employed and randomized for each finger: transmetacarpophalangeal joint pinning using 1 or 2 Kirschner wires (K-wires) and periarticular cross pinning using 2 K-wires. Compressive axial loads and energy at 1 mm, 2 mm, 3 mm, 4 mm, and 5 mm of subsidence were examined. Results: The forces and energy required to shorten the finger for each amount of subsidence were similar for all 3 pinning techniques and for all 3 finger types. Greater amounts of shortening were found to require larger forces. Conclusion: Closed reduction and percutaneous pinning using any of the presented techniques is an adequate method of treatment for unstable proximal phalanx fractures. All of the techniques were equivalent in their ability to resist axial loading, regardless of the complexity of technique, the number of pins used, or finger that was pinned. [ABSTRACT FROM AUTHOR]

Introduction Distal humerus fractures are relatively rare and being intra-articular are difficult to manage. As the number of elderly people grows steadily and also with increasing use of motor vehicles in the developing countries, it can be said that the frequency of intraarticular fractures of the distal humerus will increase similar to the fractures of the distal end of the radius, hip, and spine. There are several treatment plans for managing intraarticular fractures of the distal humerus depending on fracture anatomy. We conducted this study to assess which approach is superior, closed percutaneous reduction with K-wires or ORIF. Methods A total of 30 patients who satisfied the inclusion criteria were included, out of which 16 patients underwent ORIF and 14 patients underwent closed reduction and percutaneous pinning (СRPP). Patients included were between 21–50 years of age with intraarticular nonpathological closed distal humerus fractures without preoperative neurovascular deficit and presented less than 10 days between the fracture event and treatment. Results In our study, mean age of patients undergoing CRPP was 28.1 years while the mean age of patients undergoing ORIF was 30.1 years. This study showed that distal humerus fractures are more common in younger age groups. In our study, mean arc of motion at 6 months postoperatively in patients which underwent CRPP was 106.07 degrees while the mean arc of motion in patients which underwent ORIF was 80.94 degrees. In patients who underwent ORIF, only 6.2 % (1/16) had excellent outcome, 56.3 % (9/16) patients had good outcomes, 31.3 % (5/16) patients had fair outcomes, and 6.2 % (1/16) had poor outcome. It was found that out of a total of 14 patients which underwent CRPP, only 7.1 % (1/14) had cutaneous impingement. Fracture union occurred in 100 % of patients except 3 patients in ORIF group; however, they had partial union up till 6 months of follow-up. Conclusion Our study concludes that even displaced intra-articular fractures of the distal humerus can be satisfactorily treated with closed reductions and percutaneous pinning.

Objectives. In this study, we aimed to compare complication rates and fluoroscopy exposure time, as well as to analyze the functional results of percutaneous K-wire fixation and K-wire fixation with mini-open techniques in pediatric distal radius fractures. Materials and Methods. In this retrospective design study, one-hundred patients with completely displaced fracture of the distal radius were evaluated in terms of demographic data, radiological and functional evaluations, fluoroscopy exposure time, and complications. In Group 1, 50 patients were treated by closed reduction and percutaneous K wire application. In Group 2, 50 patients were treated with close reduction and K-wire fixation using a mini-incision. Results. There were no statistically significant differences between the two groups in terms of age, fracture degree, reduction degree, and follow-up duration. We found the fluoroscopy time and redisplacement rate were significantly lower in group 2. We did not notice tendon irritation and neuropraxia complications in any of the patients in group 2. We observed good functional results and no malalignment in both groups. Conclusions. The mini-open incision technique had lower complication rates and fluoroscopy durations. Based on the results of this study, K-wire fixation with the mini-open technique may be recommended as an alternative method for pediatric distal radius fractures.

Summary: Bennet's fracture represents one of the most common injuries of the hand district, involving the base of the thumb, and it is affects children and elderly patients the most. The fracture is caused by direct axial trauma to a partially flexed first metacarpal and it is always intra-articular: the fracture line separates the palmar ulnar aspect of the first metacarpal base from the remaining first metacarpal. The fracture pattern is such that the first metacarpal shaft moves dorsally, proximally, and radially due to the pull of the abductor pollicis longus, extensor pollicis longus, extensor pollicis brevis, and the adductor pollicis brevis, which remain attached to the fracture fragment. The surgical treatment consists of closed reduction with percutaneous pinning or open reduction with either pins or interfragmentary screws. The decision to treat these fractures with either open reduction or closed reduction is still a matter of debate. To the best of our knowledge, there are no cases of bilateral Bennett's fracture reported in literature. The aim of this paper is to present a rare case of bilateral Bennet's fracture, the decision of two different treatments, and the good clinical outcomes.

Background: Controversy exists surrounding the optimal approach to managing pediatric lateral humeral condyle fractures (LHCF). The difficulty in assessing the articular surface using radiography and the intra-articular element potentially involved make LHCF susceptible to complications and delayed diagnoses. Arthrography has been used to delineate the articular surface to aid in deciding whether closed or open reduction is necessary. However, there has been scarce evidence to determine the accuracy of using radiography versus arthrography to predict articular disruption in LHCF displaced 1–5 mm. This study assesses; (1) the utility of intraoperative arthrography in modifying the method of operative reduction, (2) the accuracy of plain radiography in identifying articular integrity, and (3) the clinical outcomes of early operative treatment. Methods: This was a single-center prospective study that involved operatively treated pediatric LHCF with a displacement of 1–5 mm. Patient demographics, radiographic displacement, predicted radiographic articular integrity, articular integrity on arthrograms, modification of management and follow-up clinical outcomes were obtained. Results: A total of 72 patients were included with a mean displacement of 2.6 mm and a mean follow-up of 16 months. The articular surface was disrupted in 21% of patients. The reduction method (open versus closed) was modified in 15 patients (21%) after an intraoperative arthrogram. Out of 25 patients with displacement < 2 mm, four of which (15%) had disrupted articular surface and were subsequently treated with open reduction internal fixation (ORIF). While eleven patients with > 4 mm displacement had an intact articular hinge that were managed with closed reduction and percutaneous pinning (CRPP). All patients achieved union with no documented major complications. The ability of radiography to discriminate between disrupted/ intact articular integrity decreases as displacement decreases. Conclusions: Data from this study suggest using the degree of displacement measured on plain radiography is insufficient in predicting articular integrity for fractures displaced 1–5 mm. The use of arthrography guides reduction method and adequacy, avoiding scenarios of unnecessary open reduction and insufficient closed reduction. Further, a significant amount of outliers exist that have intact articular hinges above 4 mm and disrupted hinges below 2 mm of displacement. Finally we report favorable outcomes using a lower threshold for early operative treatment. [ABSTRACT FROM AUTHOR]

Background: Rapid motorization of society has increased the incidence of motor vehicular accidents and its consequences and distal radial fractures are common injuries seen following road traffic accidents. The present study was conducted to assess the outcome of percutaneous pinning for non-comminuted extraarticular fractures of distal radius. Material & methods: The present study was conducted among 50 patients with extraarticular distal radius fractures who were prospectively enrolled for the study. The patients underwent closed manipulation and percutaneous pinning with crossed K-wires as the primary procedure. Radiographic measurements of the postoperative dorsal angle and the ulnar variance were recorded/and compared with the radiographs taken at the final assessment at six months. Results: The mean pre-reduction dorsal angulation and ulnar variance were 21.98 degrees and 3.67mm, respectively. After surgery, the mean dorsal angulation and ulnar variance were -6.23degrees and 1.12 mm, respectively. At six months follow-up, dorsal angulation was - 5.64 degrees and the ulnar variance was 1.54 mm. Pin loosening was encountered in 10% cases. Pin tract infection, malunion, Joint stiffness, reduced grip strength occurred in 4% respectively, were the other complications observed. Conclusion: The present study concluded that percutaneous pinning for non-comminuted extraarticular fractures of distal radius allows early post-surgical wrist motion and has good radiological outcome. [ABSTRACT FROM AUTHOR]

Introduction: It is thought that transulnar (a Kirschner wire from radius to ulna) pinning provided less collapse at the fracture site in the percutaneous pinning of distal radius fracture. In this study, we compared the radiological and clinical results of the patient groups with and without transulnar pinning for percutaneous pinning of distal radius fracture. Methods: Patients who underwent 16 isolated radius pinning and 11 radius pinning and additional transulnar pin between 2016 and 2021 were included in the study. Disabilities of the arm, shoulder, and hand (DASH) score, range of motion of the injured wrist at final examination and radiological parameters in terms of ulnar variance, radial height, and volar tilt of the operated wrist were evaluated. The results were compared between the two groups. Results: There was no statistical difference in terms of DASH score, radial height, volar tilt, radial inclination, pronation, supination, and flexion degrees between the two groups. The final extension degrees were found to be statistically higher in the transulnar pinning group. Conclusion: It was observed in our study that radius collapse and radial shortening were less in patients who underwent transulnar pinning in addition to radius pinning; but the difference was not statistically significant. [ABSTRACT FROM AUTHOR]

Background: Previous studies have explored the outcomes of closed reduction and percutaneous pinning in managing dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint, although these studies were limited in scope. Objectives: This study aims to report this technique's clinical and radiographic outcomes in the treatment of PIP joint dorsal fracture-dislocation.... [ABSTRACT FROM AUTHOR]

Purpose: Unique anatomy, precise articulations, fragile vascularity, and the demand for anatomic reduction make talar neck fractures challenging to treat, whether with screws and/or plates. Multifocal percutaneous pin fixation (MPPF) offers an alternative to ORIF, particularly in the polytraumatized patient. Methods: Unless an open lateral wound or medial malleolus fracture was present, a standard anteromedial approach was performed. K-wires placed within the talar head were used as joysticks to facilitate and finalize reduction. At least 3 wires were placed medially and 2 laterally across the talar neck. Incisions were closed in 2 layers, and either a well-padded short leg splint or adjunctive ankle-spanning external fixation was utilized. Patients remained non-weightbearing until K-wire removal in the office at approximately 6–8 weeks postoperatively. Results: MPPF was performed in 7 patients, the majority of whom were female (6 of 7). The average patient age at the time of injury was 30.3 years (range 17–51 years). The median time of final follow up was 27 months. Comminution was present in all patients. Avascular necrosis (AVN) developed in 3 patients and non-union occurred in 2 patients. All patients developed subtalar posttraumatic arthritis, and 6 additionally developed tibiotalar arthritis. No patients underwent talectomy or osteotomy, and there were no superficial pin site infections or loosening of pins prior to scheduled removal. Conclusions: Obtaining and maintaining an adequate reduction is possible with minimal soft tissue compromise through MPPF. Despite the complexity of the series, outcomes utilizing MPPF are comparable to those reported in the literature.

Background: A stab incision and blunt dissection prior to wire placement are believed to decrease the risk of injury to underlying structures during percutaneous pinning of distal radius fractures (DRF). However, only a few studies have compared stab incision and blunt dissection to direct wire placement. The aim of this cadaveric study is to analyse the structures at risk during percutaneous pinning of DRF and compare the two methods of wire placement. Methods: A total of 10 cadavers (20 upper limbs) were divided into two groups of five each. Five 2.0 mm Kirschner (K)-wires were inserted into the distal radius under fluoroscopic control in a standard fashion to simulate percutaneous pinning of DRF. In group 1, the K-wires were inserted directly, whereas in group 2, the wires were inserted after making a stab incision and blunt dissection to reach the bone. Each cadaveric limb was then dissected carefully to measure the distance of the K-wires from the branches of the superficial radial nerve (SRN), the cephalic vein and the first dorsal compartment and to determine the structures injured (pierced or in close contact) by the K-wires. Results: Out of the 100 K-wires placed, 18 wires were in close contact or pierced an underlying structure. These included 11 wires injuring tendons, six wires injuring branches of the SRN and one wire injuring the cephalic vein. Direct wire placement (group 1) resulted in injury to eight structures (44.4%) while stab incision and blunt dissection prior to wire placement (group 2) resulted in injury to 10 structures (55.5%). This difference was not statistically significant. Conclusions: Percutaneous pinning of DRF is associated with a high risk of injury to the extensor tendons and branches of the SRN. This risk is not reduced by making a stab incision and blunt dissection prior to K-wire placement. [ABSTRACT FROM AUTHOR]

Background: Olecranon fractures are a rare entity in children. The classification and treatment strategies are still discussed controversially. Methods: A retrospective chart review of all patients < 17 years admitted with an olecranon fracture at a Level I Trauma Center between 2005 and 2017 has been performed. 46 subjects were included. For classification of olecranon fractures in children the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO-PCCF) was used. Fractures were classified along the fracture line, dislocation, joint involvement and affection of the apophysis. For statistical analysis, a comparison of two groups was performed using Student t test. One-way ANOVA and Tukey's multiple comparison test was used to identify differences between more than two groups. For all analysis p ≤ 0.05 was considered statistically significant. Results: The mean age of the children was 8.5 years (2–16 years). Most children were treated with a conservative therapy (n = 29, 63.0%). 17 patients (36.9%) underwent osteosynthesis (plate or tension band wiring) of which three were initially treated with a conservative therapeutic approach. Children with operative treatment were significantly older compared to children treated conservatively. Interestingly, all patients with luxation were characterized by an oblique fracture line, one of them extraarticular, three intraarticular. Conclusion: Taken together, this study analyzed one of the largest selections of pediatric patients with olecranon fracture in regard to fracture type and treatment strategy. Based on the assumption that treatment strategies follow a fracture classification, a consistent classification method is needed which should take into account fracture morphology and localization, as considered by the AO-PCCF, and the dislocation as measured by Braque. Surgical treatment is needed in case of dislocation ≥ 5 mm, intra-articular fractures, instable fracture conditions caused by the fracture line, open fractures and the affection of the apophysis. Otherwise, the conservative treatment shows insufficient results in the elbow mobility. The reliable choice of treatments based on our classification was mirrored by the very low rate of conversion of treatment strategies. Level of evidence: Level III-retrospective comparative study. [ABSTRACT FROM AUTHOR]

Introduction: The percutaneous pinning method described by Iselin is one of the techniques used for treating Bennett fractures at the base of the thumb metacarpal. There is little published data on the medium- and long-term outcomes of this treatment, with most studies having a mean follow-up of 4 years. The primary objective of this study was to evaluate the functional and radiological outcomes of percutaneous pinning by Iselin's method with a mean follow-up of 6 years. The secondary objective was to look for evidence of radiographic carpometacarpal (CMC) arthritis., Hypotheses: 1) The functional outcomes are good, and the clinical outcomes are comparable to the contralateral side. 2) While radiographic CMC arthritis may be present in the medium term, it will not interfere with work and recreational activities., Methods: This was a single-center, multiple-surgeon, retrospective case series. Twenty-nine patients were included who had a mean and median follow-up of 6 years (min 2, max 14). The functional outcomes (satisfaction, pain, subjective strength deficit, DASH), clinical outcomes (tip pinch, key pinch and grip strength compared to contralateral side) and the thumb's mobility (abduction angle, Kapandji score) were determined. Return to work and recreational activities were documented. CMC arthritis was assessed on lateral radiographs of the thumb in neutral position based on the Eaton-Littler classification., Results: The average patient satisfaction score was 87% (20; 100). The mean pain level was 0.7/10 (0-8) at rest and 2/10 (0-10) during effort. The subjective strength deficit was 12% ± 16. The mean DASH score was 8.8/100 (0-43). The mean tip-pinch strength in the operated thumb was significantly lower than the contralateral side (-9.3% ± 16.5), as was the mean key-pinch (-6.3% ± 16.9). Thumb abduction was significantly reduced relative to the contralateral side (-4.1° ± 5.24) as was the Kapandji score (-0.5 ± 0.81). CMC arthritis was visible on 100% of radiographs (96% were stage 1 or 2)., Discussion: The surgical treatment of Bennett fractures by percutaneous pinning using the Iselin method produces satisfactory functional outcomes in the medium term, although there was a moderate loss of strength and mobility in the thumb., Level of Evidence: IV; retrospective, single-center case series., Competing Interests: Declaration of competing interest TD, PJL, CC: these authors declare that they have no competing interest. MS: no competing interest in relation to this work. Occasional Consultant for Quanta Medical™ and Cousin Surgery™, Associate Editor for Orthopaedics & Traumatology: Surgery and Research (OTSR)., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Abstract Background Ultrasound examination can be applied to the diagnosis of pediatric elbow fracture. This study aims to analyze the application value of ultrasound in the surgical treatment of supracondylar humeral fractures. Methods 64 children with supracondylar humeral fractures were treated with ultrasound-guided closed reduction and percutaneous pinning (CRPP), 31 patients were treated with CRPP under radiography guidence. The reduction effect of supracondylar humeral fractures was determined through the perioperative ultrasound images of the lateral, medial and posterior aspects of the elbow. Percutaneous pinning was performed after supracondylar humeral fractures were well reduced. A follow-up examination was performed and all the patients were evaluated according to Flynn’s criteria. Results The mean duration of surgery was 58.3 min (42–108 min) in the ultrasound group and 41.5 min (24-63 min) in the radiography group (P 0.05). After surgery, three patients had pin tract infection. One patient had ulnar nerve neurapraxia in the radiography group. No cases with Volkmann’s contracture were reported. Conclusion Ultrasound-guided CRPP is a safe and reliable surgical treatment of pediatric supracondylar humeral fractures. Trial registration Retrospectively registered.

Background: Preoperative antibiotics may not be necessary, given the very low infection rates associated with percutaneous pinning (PP) procedures of the upper extremity (UE). The purpose of this study was to determine the patterns and variation surrounding the use of preoperative antibiotics when performing PP procedures of the child's UE. Methods: A survey was sent to all members of Pediatric Orthopedic Society of North America to assess the use and opinions regarding preoperative antibiotics for PP procedures of the UE. Queries included the surgeon's current practice and thoughts regarding the need for preoperative antibiotics based on the anatomical location of the procedure. Results: Eight-one percent of the 295 respondents routinely order preoperative antibiotics for all PP procedures of the UE; however, only 60% felt that all patients must receive preoperative antibiotics. The requirement for preoperative antibiotics varied based on the anatomical location—81% for shoulder, 70% for elbow, 66% for wrist, and 62% for hand/finger. Canadian surgeons were significantly less likely to believe that preoperative antibiotics must be used in all UE cases, all shoulder cases, and all elbow cases (all P s =.04). Conclusion: The vast majority (81%) of surgeons surveyed routinely prescribe antibiotics for PP procedures of the UE despite the fact that 40% of surgeons felt that antibiotics were not necessary for all procedures. As the PP procedure is performed more distally on the UE, fewer surgeons feel preoperative antibiotics are necessary. Future studies assessing infection rates with and without the use of preoperative antibiotics are necessary to determine the true need for these medications. [ABSTRACT FROM AUTHOR]

Background: Open or closed reduction with Kirschner wires, screws, and flexible nails has been documented for the treatment of displaced proximal humeral fractures, however percutaneous K-wire fixation is the most widely utilized procedure. Objective: This study aimed to evaluate short-term clinical and radiographic results of percutaneous pinning of surgical neck-humerus fractures in children and adolescents using k-wire. Patients and Methods: Our study was done on 18 patients with fractures of the surgical neck of the humerus at Zagazig University Hospital treated by percutaneous pinning using k-wire. The humerus fractures were followed up clinically and radiologically for 6 months. Neer and Horwitz classification was used to classify fractures. Constant-Murley shoulder scoring system were used to evaluate results. Results: According to Constant-Murley scoring system the result obtained were excellent in 14 patient (77.78%) and good only in 4 cases (22.22%). Concerning the complications of the current study, 11 cases had no complication (61.11%), 3 cases had stiffness (16.67%) and 4 cases had superficial infection (22.22%). 4 cases of superficial infection were treated with antibiotics and daily dressing. K-wires were not required to be removed early. All of them achieved excellent results. 3 cases of stiffness were completed by physiotherapy, 2 of which yielded good results and 1 of which yielded excellent results. Conclusion: Fractures of the surgical neck in children and adolescents can be successfully treated with percutaneous kwires technique, which provides stability after reduction of fractures. Early and adequate physiotherapy program gives better results regarding the range of motion. [ABSTRACT FROM AUTHOR]

Background: Type III supracondylar fractures represent a difficult injury to treat and there is no universal consensus regarding the best treatment. The purpose of this study is to assess the incidence of complication associated with open reduction and compare open reduction vs closed reduction, in order to determine which treatment lead to better clinical and radiological outcomes. Is open reduction really associated with a higher number of iatrogenic complication and worse clinical outcomes in comparison to closed reduction?Methods: A total of 55 patients, affected by type III supracondylar humerus fracture, were retrospectively selected and divided into two groups according to which type of treatment they received (open reduction or closed reduction). Major complications correlated with surgical procedure, such as infections, neurovascular iatrogenic lesions, elbow stiffness and painful scarring were assessed. The treatment outcomes and clinical features were compared among the two groups. A statistical analysis to find association between the type of reduction, the restored elbow anatomy and the clinical outcomes were performed. The follow-up varies between 1 year and 7 years.Results: No major complications occurred in our series of patients. Excellent and good outcomes were reported among all 26 patients that underwent an open reduction surgery and in 23 out of the 29 patients who received a closed reduction surgery. A higher number of patients in the open reduction group presented angles with normal values; moreover 3 out of the 6 patients with unsatisfactory outcomes presented with angles not in range, underlying the presence of a connection between the restored elbow anatomy and the clinical outcomes. There were no differences among the two groups regarding the presence of complications.Discussion: Open reduction should not be considered as a first line option of treatment in any pediatric patient with a type III supracondylar humerus fracture, but in several cases open surgery must be viewed as the choice with the best outcomes not only in presence of neurovascular lesion but also in case of irreducible fracture. [ABSTRACT FROM AUTHOR]

Abstract Background Surgical site infections (SSI) after distal radius fracture (DRF) surgery have not previously been studied as the primary outcome in a large population with comparative data for different surgical methods. The aims of this study were 1) to compare SSI rates between plate fixation, percutaneous pinning and external fixation, and 2) to study factors associated with SSI. Methods We performed a nation-wide cohort study linking data from the Swedish national patient register (NPR) with the Swedish prescribed drug register (SPDR). We included all patients ≥18 years with a registration of a surgically treated DRF in the NPR between 2006 and 2013. The primary outcome was a registration in the SPDR of a dispensed prescription of peroral Flucloxacillin and/or Clindamycin within the first 8 weeks following surgery, which was used as a proxy for an SSI. The SSI rates for the three main surgical methods were calculated. Logistic regression was used to study the association between surgical method and the primary outcome, adjusted for potential confounders including age, sex, fracture type (closed/open), and a dispensed prescription of Flucloxacillin and/or Clindamycin 0–8 weeks prior to DRF surgery. A classification tree analysis was performed to study which factors were associated with SSI. Results A total of 31,807 patients with a surgically treated DRF were included. The proportion of patients with an SSI was 5% (n = 1110/21,348) among patients treated with plate fixation, 12% (n = 754/6198) among patients treated with percutaneous pinning, and 28% (n = 1180/4261) among patients treated with external fixation. After adjustment for potential confounders, the surgical method most strongly associated with SSI was external fixation (aOR 6.9 (95% CI 6.2–7.5, p

The management of distal radius fractures has evolved considerably in the last two decades. Techniques and hardware have improved so much that the surgeon can usually assure good results in these debilitating fractures. Yet no one method can be used for all injuries, as the personality of each fracture demands a customized approach. Furthermore, what works in one age group may not work in another. For this reason, every available treatment has its own space in our options. The need for surgeons to be well versed in all techniques is critical. We offer a concise update of important evolutionary and current treatment guidelines for this common fracture. [ABSTRACT FROM AUTHOR]

A 12-year-old male came to our Emergency Department with chief complaints of pain and inability to move the right shoulder for one day following a fall while playing. The range of motion of the right shoulder was restricted and painful in all directions. Initial radiographs revealed a transverse, displaced proximal humerus fracture at the head-shaft junction. The patient was managed by closed reduction internal fixation with percutaneous K-wiring (Kirschner wires). The K-wires were removed after four weeks, and the shoulder was mobilized. The patient had a near-normal and pain-free range of motion at three months of follow-up. Percutaneous K-wiring remains a viable option for the treatment of paediatric proximal humerus fractures, and good post-operative rehabilitation can help restore near-normal function, as demonstrated in this report., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nair et al.)

Background: Ultrasound examination can be applied to the diagnosis of pediatric elbow fracture. This study aims to analyze the application value of ultrasound in the surgical treatment of supracondylar humeral fractures. Methods: 64 children with supracondylar humeral fractures were treated with ultrasound-guided closed reduction and percutaneous pinning (CRPP), 31 patients were treated with CRPP under radiography guidence. The reduction effect of supracondylar humeral fractures was determined through the perioperative ultrasound images of the lateral, medial and posterior aspects of the elbow. Percutaneous pinning was performed after supracondylar humeral fractures were well reduced. A follow-up examination was performed and all the patients were evaluated according to Flynn's criteria. Results: The mean duration of surgery was 58.3 min (42–108 min) in the ultrasound group and 41.5 min (24-63 min) in the radiography group (P < 0.05). The mean carrying angle was 8.2° (0°–15°) in the ultrasound group and 9.4°(3°–16°) in the radiography group; The mean Baumann's angle was 75.5°(60°–85°) in the ultrasound group and 73.4°(62°–82°) in the radiography group; The mean lateral humerocapitellar angle was 38.4° (26°–54°) in the ultrasound group and 41.6°(29°–52°) in the radiography group; No significant differences were observed between the two groups. According to the Flynn's criteria, 49 (76.6%) patients had excellent, 10 (15.6%) patients achieved good, 3 (4.7%) patients showed fair results and 2 (3.1%) patients achieved poor results in the ultrasound group; 22 (70.9%) patients had excellent, 6 (19.4%) patients achieved good, 2 (6.5%) patients showed fair results and 1 (3.2%) patients achieved poor results in the radiography group; No statistically significant difference was noted between the results of these two groups (P > 0.05). After surgery, three patients had pin tract infection. One patient had ulnar nerve neurapraxia in the radiography group. No cases with Volkmann's contracture were reported. Conclusion: Ultrasound-guided CRPP is a safe and reliable surgical treatment of pediatric supracondylar humeral fractures. Trial registration Retrospectively registered. [ABSTRACT FROM AUTHOR]

Aim: The treatment protocol for supracondylar humeral fracture has mainly been based only on the severity of displacement and percutaneous pinning has been recommend as a first treatment. However, a long oblique fracture line is difficult to fix by the traditional cross pinning. The purpose of this study is to assess the prevalence of high-long oblique supracondylar humeral (HLO) fracture and evaluate the surgical outcome of percutaneous pin fixation.Methods: We reviewed 690 children who had undergone an operation for the displaced supracondylar humeral fracture. HLO fracture was defined as having a fracture line starting from either cortex above the metaphyseal-diaphyseal junction and finishing at the opposite cortex around or below the olecranon fossa. Clinical and radiographic parameter outcomes were assessed.Results: There were 14 patients diagnosed with the HLO fracture (14/690) and all the patients were treated by pin fixation. The median age was 5 years 1 month (range, 2–11 years). The common mode of injury was direct contact injury to the elbow. There were 6 patients with lateral HLO fracture, and 8 patients had medial HLO type. In medial HLO type, medial pinning only was done in 3 patients due to the difficulty in lateral pin insertion. In addition, the lateral pin was not a bicortical fixation through capitellum entry in 2 patients who had it fixed by cross pinning. The final Baumann angle and lateral humero-capitellar angle were 20.5 (5–67.6) degrees and 49.3 (23.3–71.9) degrees, respectively, without statistical significance compared to the normal side. Flynn's cosmetic grade showed satisfactory results in all patients.Conclusion: The prevalence of HLO fractures was 2% in the displaced supracondylar humeral fracture. The mechanism of injury of HLO fractures may be direct contact injury. In medial HLO fractures, medial pinning is important for stability, and sometimes lateral pinning was impossible. Contrarily, lateral HLO fracture could easily be fixed by lateral-only pinning, but the correct lateral pinning is necessary because medial pinning is difficult. The HLO fracture is a difficult pattern to treat by traditional percutaneous pinning and another surgical option should be considered.

Objective: The aim of the study was to evaluate the functional outcome of closed reduction and percutaneous pinning (CRPCP) and open reduction and internal fixation (ORIF) after failed closed reduction in displaced supracondylar fractures of the humerus in children. Methods: It's a prospective study conducted from September 2013 to October 2015. Total of 40 patients who fulfilled the inclusion and exclusion criteria were included in this study. Only one attempt of closed reduction under fluoroscope guidance was done in all the patients. The cases in which reduction was achieved closely were managed with CRPCP and were placed in group A while those cases in which closed reduction was unsuccessful were managed with ORIF via posterior approach and were placed in group B. The fractures were stabilized using cross pinning and was splinted postoperatively in long arm back-slab at 800 of flexion. Patients were followed up for 3 months. Functional assessment was done using Flynn criteria, and carrying angle (CA) for the cosmetic outcome. The time of union was used to assess the radiological outcome. Results: Twenty- four patient were in group A and 16 patients were in group B. The average age of the patient in group A was 6.17 ± 1.09 years (range 4-8 years) while that in group B was 6.69 ± 1.08 years (range 5-10 years). Male to female ratio in both group was 1.67. Average time to union was significantly better in group A than group B (5.71 ± 0.69 weeks vs 6.88 ± 0.62 weeks). There was no statistically significant difference in Baumann angle, carrying angle (CA) of affected limb and loss of range of motion (ROM) in both group. In group A, 22 (92%) patient had excellent result while 2 (8%) patient had good result according to Flynn criteria. In group B, 14 (87.5%) patient had excellent result, 1 (6.25%) patient had good and fair result each. We had 3 cases of ulnar palsy in group A while no ulnar nerve injury was recorded in group B. Conclusion: The functional outcome was comparable in both group and thus we recommend low threshold to conversion to open reduction where closed reduction fails to reduce further damage to soft tissue in displaced supracondylar fracture of humerus in children. Earlier union was achieved with CRPCP than with ORIF. [ABSTRACT FROM AUTHOR]

Background: Distal radius fractures constitute 17% of all fractures and 75% of forearm fractures in adults. Due to the vital role of the hands in a wide range of daily tasks, quick recovery and fewer complications for the patients are important. The purpose of this study was to compare the two common treatments of distal radius fractures namely, percutaneous pinning and pin-in-plaster. Methods: An observational analytical cohort study was conducted on 74 patients with distal radius fracture treated with percutaneous pinning fixation and pin-in-plaster techniques. The patients, aged more than or equal to 18 years with unilateral, closed and unstable distal radius fractures were treated in Shahid Beheshti Hospital during 2007 to 2010.The data were entered into the SPSS Version 20 statistical software and analyzed by student’s t-test, one-way ANOVA and repeated measures test. Results: Randomly, 31 patients were in pin-in-plaster group and 43 patients in percutaneous pinning group. The patients’ age range was 18-74 years. The average of radial inclination and palmar tilt after 6 weeks was significant (P=0.02, p

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To compare the outcomes of non-operative versus operative treatment for distal radius fractures in patients aged from 18 to 64 years, we performed a retrospective analysis using the OptumLabs® Data Warehouse using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes of distal radius fracture. Of the 34,184 distal radius fractures analysed, 11,731 (34%) underwent operative management. Short-term complications within 90 days of fracture identified an overall complication rate of 16.6 per 1000 fractures and the 1-year upper extremity-specific complication rate was 287 per 1000 fractures. Overall, post-injury stiffness was the most common 1-year upper extremity-specific complication and was associated with operative management (202.8 vs. 123.4 per 1000 fractures, operative vs. non-operative, p < 0.01). Secondary procedures were significantly more common following non-operative management (8.7% vs. 43%, operative vs. non-operative, p < 0.01) with carpal tunnel release representing the most common secondary procedure. Operative management of distal radius fractures resulted in significantly fewer secondary procedures at the expense of increased overall 1-year complication rates, specifically stiffness. Level of evidence: III [ABSTRACT FROM AUTHOR]