L-pinning for fifth metacarpal neck fracture in adolescents.

INTRODUCTION: Fifth metacarpal neck fracture is the most frequent type of hand fracture in adolescents between 13 and 16 years of age. It mainly affects males and the dominant hand. The L-pinning technique combines intramedullary anterograde pinning and transverse pinning between the 4th and 5th metacarpals. The present study aimed to assess L-pinning without postoperative immobilization in displaced 5th metacarpal fracture in adolescents with low residual growth. MATERIALS AND METHODS: Data for patients aged between 13 and 16 years, operated on for closed 5th metacarpal neck fracture between January 2017 and June 2019, were analyzed retrospectively. Surgery was indicated for angulation with>30° palmar tilt and/or horizontal malalignment. The technique consisted in intramedullary anterograde pinning and transverse pinning between the 4th and 5th metacarpal heads. No postoperative immobilization was applied. Hardware was removed as of day 28. The final clinical check-up was at≥12 months. RESULTS: Eighteen patients, all male, with a mean age of 14 years, were included. All had bone age≥14 years. Mean palmar tilt was 52°±6.8° versus 6°±2.4° postoperatively, for a mean correction of 45°±4.3°. Mean operating time was 15min, and X-ray exposure 0.36minutes for a mean radiation dose of 2.89 cGy/cm2. At hardware removal, all patients showed radiologic consolidation. At 3 months, 5th ray ranges of motion were normal, with no local complications. Functional results were maintained at last follow-up (≥12 months). CONCLUSION: L-pinning seemed reliable in terms of feasibility and stability of reduction in 5th metacarpal neck fracture in adolescents. Absence of postoperative immobilization facilitated self-rehabilitation and accelerated functional recovery. LEVEL OF EVIDENCE: IV.

Outcomes of isolated soft tissue surgery for in-toeing gait in patients with ambulatory cerebral palsy.

BACKGROUND: Soft tissue surgery to address in-toeing gait in young cerebral palsy (CP) patients may be an alternative in some cases to femoral derotation osteotomy (FDO), which is the currently accepted treatment. The relative contribution of muscular contracture, spasticity and bone deformity is still controversial. In this study, we determined the outcomes of soft tissue surgery on hip internal rotation (HIR) when femoral anteversion was less than 45° and the soft tissues were identified as being the cause. METHODS: This prospective study included select adolescent patients who were operated in the context of single-event multilevel surgery. The soft tissues' contribution to the HIR was identified beforehand. The surgical procedures focused on the hamstrings, adductor magnus and gluteus minimus muscles. RESULTS: Over a 6-year period, 21 patients (mean age 14 years) and 25 lower limbs were treated. The HIR improved by an average of 17.4°±4.8° (95% CI). The gait deviation index and gait profile score also improved significantly. At a mean follow-up of 36 months, no loss of correction had occurred. DISCUSSION: In-toeing gait in CP patents is due to the action of retracted and/or spastic muscles and the presence of excessive bone torsion. When femoral anteversion<45°, confirming soft tissue involvement allows us to do a surgical procedure on the soft tissues only to correct the dynamic aspect of HIR. Our findings suggest that, under the right conditions, soft tissue surgery can improve in-toeing gain in the long term. This technique has its place alongside FDO in certain CP patients who do not have severe femoral anteversion.