Staying Out of Trouble: Complications of Supracondylar Humerus Fractures.

Supracondylar fractures are among the most common fractures in children that require surgery. These fractures are also associated with some of the most serious complications of all fractures seen in children. Timely recognition and careful management can mitigate the potentially poor outcomes of these complications. Pin-site irritation and superficial infections are the most common complications seen. Cubitus varus remains another common complication, even with the use of closed reduction and pinning for management of most displaced fractures. Neurapraxias are seen in almost 10% of patients, with most resolving spontaneously. The worst complications are those that may be catastrophic for patients, causing substantial loss of function or even amputation of the limb; for example, vascular injury and compartment syndrome. Diagnosis and management of these complications should focus on strategies to ensure the best possible outcomes.

Treatment of Closed Femoral Shaft Fractures in Children Aged 6 to 10.

BACKGROUND: Management of pediatric femoral shaft fractures remains controversial, particularly in children between the ages of 6 and 10. In the current push toward cost containment, hospital type, and surgeon subspecialization have emerged as important factors influencing this treatment decision. Thus, in the present study, we use a nationwide pediatric inpatient database to compare the: (a) incidence; (b) demographic characteristics; (c) hospital costs; (d) length of stay; and (e) treatment method of pediatric closed femoral shaft fractures admitted to general versus children's hospitals. METHODS: The Kids' Inpatient Database (KID) was queried for all patients aged 6 to 10 who sustained a closed femoral shaft fracture in 2009 or 2012, and patient records were stratified into children's hospitals and general hospitals. Primary outcome measures included method of treatment, total hospital costs, and length of stay. Student/Welch t testing and χ analysis were utilized to compare continuous and categorical outcomes, respectively, between hospital types. RESULTS: The total incidence of closed femoral shaft fractures decreased between 2009 and 2012 (1919 to 1581 patients; P=0.020), as did the proportion of patients treated in children's hospitals (58.6% to 32.3%; P<0.001). In addition, patients treated at general hospitals were more likely to receive open reduction with internal fixation (45.3% vs. 41.1%) or external fixation (4.1% vs. 2.3%), and less likely to be managed with closed reduction with internal fixation (32.0% vs. 39.7%) than those treated at children's hospitals (P<0.001 for all). CONCLUSIONS: The present study demonstrates a decrease in the incidence of closed femoral shaft fractures in 6- to 10-year old patients from 2009 to 2012, as well as decreased definitive management in children's hospitals and increased selection of operative treatment. In addition, treatment in a nonchildren's hospital was associated with decreased total inpatient costs and decreased treatment with closed reduction with internal fixation in favor of open reduction with internal fixation. Future studies should seek to identify the specific surgical procedures performed and match patients more closely based specific fracture pattern. LEVEL OF EVIDENCE: Prognostic level II.

Understanding Unicameral and Aneurysmal Bone Cysts.

Bone cysts in the pediatric population are often found incidentally on radiographs or after a cyst has created cortical weakness leading to a pathologic fracture. Most bone cysts are benign, are pain free, and resolve spontaneously. The most common bone cyst is unicameral 1-chamber bone cyst, also known as simple bone cyst. General practice pediatricians may be the first to encounter these lesions, and this article aims to help elucidate their incidence, etiology, clinical findings, radiologic findings, and modern treatment approaches. The other differential diagnoses that should be considered, specifically, aneurysmal bone cyst, are also explored. This summary is not all inclusive, and it is recommended that all patients be referred to a pediatric orthopedist.

Long-term physiological T3 supplementation in hypertensive heart disease in rats.

Animal studies suggest that hypertension leads to cardiac tissue hypothyroidism, a condition that can by itself lead to heart failure. We have previously shown that short-term thyroid hormone treatment in Spontaneously Hypertensive Heart Failure (SHHF) rats near heart failure is beneficial. This study tested the hypothesis that therapeutic, long-term T3 treatment in SHHF rats can prevent or attenuate cardiac dysfunction. Female SHHF rats were treated orally with a physiological T3 dose (0.04 µg/ml) from 12 to 24 mo of age. Age-matched female SHHF and Wistar-Kyoto rats served as hypertensive and normotensive controls, respectively. SHHF rats had reduced serum free thyroid hormone levels and cardiac tissue T3 levels, LV dysfunction, and elevated LV collagen content compared with normotensive controls. Restoration of serum and cardiac tissue thyroid hormone levels in T3-treated rats was associated with no change in heart rate, but strong trends for improvement in LV systolic function and collagen levels. For instance, end-systolic diameter, fractional shortening, systolic wall stress, and LV collagen levels were no longer significantly different from controls. In conclusion, longstanding hypertension in rats led to chronic low serum and cardiac tissue thyroid hormone levels. Long-term treatment with low-dose T3 was safe. While cardiac dysfunction could not be completely prevented in the absence of antihypertensive treatment, T3 may offer additional benefits as an adjunct therapy with possible improvement in diastolic function.