Evaluation of surgical or conservative treatment of forearm fracture in pediatric floating elbow injuries.

OBJECTIVE: Floating elbow, which refers to a humerus fracture in the supracondylar region and a forearm fracture, is a very unusual injury. The purpose of this study is to compare the clinical results of patients with "floating elbows" who underwent surgical therapy and who were given forearm immobilization with a splint as follow-up care. PATIENTS AND METHODS: Fifteen patients who had been diagnosed with floating elbow owing to trauma were scanned retrospectively and followed up for at least a year. Eight individuals who suffered from broken forearms underwent surgical repair. After initial treatment, a lengthy arm splint was used to immobilize seven patients' arms. The modified Flynn criteria were used to analyze the data, and comparisons were made between the groups. RESULTS: The median age and mean follow-up time for patients whose forearms were conservatively followed was 6.1 years and 13.8 months, respectively. The median age of the patients who underwent forearm surgery was 8.5 years, and the average follow-up was 14.2 months. Five of the seven patients whose forearms underwent conservative follow-up had outstanding clinical outcomes, while two had poor and moderate outcomes. Four individuals who got surgical treatment for their forearms had excellent and good clinical outcomes, while the other four had intermediate and poor outcomes. Between the two groups, there was no discernible difference (p = 0.60). CONCLUSIONS: In the pediatric population with floating elbow injuries, using a cast for forearm fractures may not necessarily result in worse outcomes compared to surgical management.

Periprosthetic infection risks and predictive value of HbA1c/albumin ratio for total joint arthroplasty in patients with diabetes mellitus.

OBJECTIVE: There are no gold standard markers to estimate the risk of developing periprosthetic infections in diabetes mellitus. Our aim is to compare the risks of periprosthetic infection in patients undergoing total joint arthroplasty with diabetes mellitus and to investigate the predictive significance of the HbA1c/ albumin ratio. PATIENTS AND METHODS: Between January 2012 and January 2020, 690 patients who underwent total joint arthroplasty were analysed. 264 diabetic patients were included in the study. 104 of them had periprosthetic infection. 8 risk factors (Hba1c/albumin, HbA1c, albumin, age, BMI, ASA, hospital stay, operation time) were analysed. RESULTS: The rate of HbA1c/albumin was 14.6 times higher than the patients with ≤2.37 cut-off value. (Hba1c/albumin ratio (odds ratio (OR) = 14.6, 95% CI: 3.18-67.1, p: 0.01). HbA1c (OR = 2.6, 95% CI: 1.529-4.754, p: 0.001), BMI (OR = 1.6, 95% CI: 1.168-2.199, p<0.003), DM (OR = 0.365, 95% CI: 0.135-0.987, p: 0.04) and glucose (OR = 1.016, 95% CI: 1.004-1.029, p: 0.011) were risk factures for periprosthetic infection. Albumin (OR = 0.503, 95% CI: 0.109-2.314, p: 0.378) did not pose a significant risk for periprosthetic infection. CONCLUSIONS: According to our findings, the HbA1c/albumin ratio has a more prognostic capacity than other risks in determining the risk of periprosthetic infection for total joint arthroplasty. HbA1c/albumin ratio is a cheap and easy-to-apply marker. Patients with an HbA1c/albumin cut-off ratio above 2.37 mg/dl in total joint arthroplasty should be followed more closely for the risk of periprosthetic infection.

Comparison of complications and results of early vs. delayed surgery for pediatric supracondylar humeral fractures.

OBJECTIVE: Pediatric supracondylar humerus fracture (SCHF) is one of the most common elbow fractures in children aged 5-7 years. There is a continuous discussion regarding the optimal timing for conducting surgery for fractures of this nature. Therefore, we aimed to determine whether the timing of surgery in pediatric SCHFs has an impact on the frequency of early postoperative complications. PATIENTS AND METHODS: Between January 2018 and March 2020, pediatric SCHF patients who underwent surgery at our hospital were retrospectively reviewed. Patients operated on within 12 hours after the fracture and those operated on later were respectively included in the early and late groups. Early postoperative complications, including neurological deficits, iatrogenic ulnar nerve injury, vascular injury, compartment syndrome, K-wire migration, and unexpected returns to the operating room, were compared between the two groups. We investigated surgical duration, reduction, and perioperative radiographic data. RESULTS: For modified Gartland type II or type III fractures, there was no significant difference in the incidence of early complications between the early and delayed groups. Additionally, there were no noticeable differences between the two groups in terms of perioperative radiographic data, reduction procedure, or surgical duration. CONCLUSIONS: Delayed surgery in type II or type III supracondylar humerus fractures was not associated with an increased incidence of early postoperative complications. The difficulty or effectiveness of reduction is not influenced by the timing of surgery.