Incidence and Risk Factors for Extensor Pollicis Longus Rupture in Elastic Stable Intramedullary Nailing of Pediatric Forearm Shaft Fractures.

BACKGROUND: Elastic stable intramedullary nailing (ESIN) is an effective means of fixation for unstable, pediatric forearm shaft fractures with the benefit of smaller incisions, less soft tissue manipulation, and ease of removal. This study was designed to evaluate the incidence of and risk factors for extensor pollicis longus (EPL) rupture after fixation of pediatric radial shaft fractures with ESIN. METHODS: A retrospective review of all patients younger than 19 years who had a repair of a forearm fracture with flexible intramedullary nailing between 2006 and 2011 was performed. Nineteen consecutive patients were identified from the electronic medical record. All patients were treated with a titanium elastic nailing system using a dorsal approach to the radius. The patients were followed postoperatively for at least 2 years, and all fractures healed. An extensive chart review assessing for persistent pain, EPL function, and risk factors for EPL rupture was performed. Implants were removed in all but 1 patient. RESULTS: Seventeen records were available for review. Fourteen (82%) were male, and the mean age at time of fracture was 10 years old (range, 5 to 14 y). Follow-up averaged 5.5 years (range, 2.9 to 7.8 y). The mean weight was 32.7 kg for males and 50.6 kg for females corresponding to the 61st and 60th percentile respectively of weight-for-age (range, 8th to 99.9th percentile). Hardware was removed in all but 1 case, and the median time from surgery to hardware removal was 21 weeks (range, 8 to 63). Three of the 17 patients (18%) experienced rupture of the EPL. Two were treated with additional surgery following hardware removal, and one was untreated due to patient preference. None of the 17 patients (including those with rupture) had independent risk factors for tendon rupture: inflammatory arthritis, diabetes, or prior steroid use. Time to removal, patient age, and percentile of weight-for-age did not correlate with EPL rupture. CONCLUSIONS: Although ESIN of pediatric forearm shaft fractures has gained acceptance as a treatment option, our series of 17 patients revealed an 18% rate of EPL rupture. With this small patient cohort, no patient characteristics proved to be significant risk factors for predicting tendon rupture. However, awareness should be raised for an increased risk of EPL rupture with this fixation method. LEVEL OF EVIDENCE: Level IV-Therapeutic.

Trauma-Induced Resolution of Solitary Osteochondroma of the Distal Femur.

Osteochondromas are benign lesions manifested as bony protrusions capped by cartilage. The exact cause of these growths is not known, and there is no treatment other than surgical excision if the lesion becomes symptomatic. Spontaneous resolution is an uncommon phenomenon that is not completely understood. A 12-year-old girl presented with a mass behind the left knee diagnosed as an osteochondroma. She was followed with serial radiographs because the lesion was minimally symptomatic. At 2.5 years after presentation, the patient reported feeling a "pop" with knee hyperflexion, and radiographic follow-up confirmed a decrease in the size of the growth. The protrusion continued to decrease in size until it was no longer detectable with radiographs, physical examination, and advanced imaging. Spontaneously resolving osteochondromas have been previously documented, but the literature is limited. There were just over 20 cases reported as of the writing of this article, and only 1 other case includes postresolution magnetic resonance imaging. This report of localized trauma inducing spontaneous resolution provides additional evidence and insight supporting previous theories on spontaneous resolution of osteochondromas, which may assist in counseling patients and their families regarding expected natural history. [Orthopedics.2016; 39(5):e1001-e1004.].

Anterolateral approach for an unusual pediatric capitellar fracture: a case report and review of the literature.

A 9-year-old boy sustained a previously unreported salter-Harris III coronal plane fracture of the anterior capitellum after a 20-foot fall from a tree. the fracture was diagnosed on x-ray and an MrI confirmed the fracture pattern. During surgical treatment, an anterolateral approach to the elbow allowed direct visualization of the fracture fragment, anatomic reduction, and fixation with a bioabsorbable pin. At one year follow-up the patient's range of motion and function was symmetric to the contralateral extremity. this paper reviews the literature regarding the epidemiology, classification, and management of the rare pediatric capitellar fracture.

Risk factors for failed closed reduction of pediatric supracondylar humerus fractures.

The purpose of this retrospective study was to examine pediatric supracondylar humerus fractures at a Level I trauma center. Data were analyzed to identify risk factors associated with closed reduction failure. Closed pediatric supracondylar humerus fractures that were treated at the authors' trauma center between October 1997 and January 2009 were reviewed. The main outcome variable was necessity of open reduction. To determine which factors were independently associated with a failed closed reduction, a multivariate logistic model was fit predicting open reduction status.A total of 174 patients required operative treatment. Of these, 23 underwent open reduction and 151 underwent with closed reduction and percutaneous pinning. For patients who required open reduction, 39.1% had an associated injury compared with 14.6% of patients treated with closed reduction (P=.008). Average time from presentation to surgery was 4.1 hours in the open reduction and 6.3 hours in the closed reduction group (P=.049). Risk factors that significantly predicted failure of closed reduction were the presence of an associated injury, initial fracture displacement, and Gartland type III fracture (P=.008, .03, and .023, respectively).Associated injury, large initial fracture displacement, and Gartland type III factures were statistically significant independent risk factors for closed reduction failure. Increased time from injury to presentation demonstrated a trend toward open reduction. Consideration should be given to the expedient transfer of patients with type III supracondylar humerus fractures with associated injuries when definitive care will be provided at another institution.