Fibrin Glue is a Viable Alternative to Fat Graft for Interposition After Tarsal Coalition Resection.

BACKGROUND: Tarsal coalition is one of the most common foot and ankle pathologies in children, yet there is no consensus regarding what to interpose after resection. Fibrin glue could be considered, but the literature comparing fibrin glue to other interposition types is sparse. The purpose of this study was to evaluate the effectiveness of fibrin glue for interposition compared with fat graft by analyzing the rate of coalition recurrence and wound complications. We hypothesized that fibrin glue would have similar rates of coalition recurrence and fewer wound complications compared with fat graft interposition. METHODS: A retrospective cohort study was performed examining all patients who underwent a tarsal coalition resection at a free-standing children's hospital in the United States from 2000 to 2021. Only patients undergoing isolated primary tarsal coalition resection with interposition of fibrin glue or fat graft were included. Wound complications were defined as any concern for an incision site that prompted the use of antibiotics. Comparative analyses were conducted using χ 2 and Fisher exact test to examine relationships among interposition type, coalition recurrence, and wound complications. RESULTS: One hundred twenty-two tarsal coalition resections met our inclusion criteria. Fibrin glue was used for interposition in 29 cases and fat graft was used in 93 cases. The difference in the coalition recurrence rate between fibrin glue and fat graft interposition was not statistically significant (6.9% vs. 4.3%, P =0.627). The difference in wound complication rate between fibrin glue and fat graft interposition was not statistically significant (3.4% vs 7.5%, P = 0.679). CONCLUSION: Fibrin glue interposition after tarsal coalition resection is a viable alternative to fat graft interposition. Fibrin glue has similar rates of coalition recurrence and wound complications when compared with fat grafts. Given our results and the lack of tissue harvesting required with fibrin glue, fibrin glue may be superior to fat grafts for interposition after tarsal coalition resection. LEVEL OF EVIDENCE: Level III, a retrospective comparative study between treatment groups.

Less is more in the nonoperative management of complete brachial artery transection after supracondylar humeral fracture.

Supracondylar humeral fractures are the most common fracture of the elbow in children. Despite it being a familiar problem faced by surgeons, there are aspects of its management that remain controversial. Specifically, management of these fractures that result in a pink or perfused hand that remains pulseless after acceptable reduction is expectedly controversial. We present a patient with a supracondylar humeral fracture and loss of pulse. The patient was found to have complete brachial artery transection but maintained a pink and well-perfused hand. It was determined to forgo arterial reconstruction because of concerns of worsening ischemia by damage to the collateral circulation. Despite no arterial reconstruction, the patient had a successful outcome. Therefore, this report highlights that arterial reconstruction may not be required, even in cases of severe brachial artery injury.