Predictors of failure of nonoperative treatment for type-2 supracondylar humerus fractures.

BACKGROUND: Closed reduction and casting for type-2 supracondylar fractures is a viable treatment option, but studies have shown that some patients will fail to maintain the initial reduction in a cast. This study sought to identify predictors of failed treatment of closed reduction and casting for these fractures. METHODS: We performed a retrospective case-control study of type-2 supracondylar fractures treated by closed reduction and casting. Using radiographic failure of reduction as our primary outcome measure, we examined injury, postreduction, and follow-up films evaluating the anterior humeral line, cast flexion angle, and degree of cast padding in an attempt to identify predictors of failure. RESULTS: We reviewed 645 fractures. Of 126 type-2 fractures, 61 fractures were included in the study. There were 49 (80%) nonoperative treatment successes and 12 failures (20%) with an average follow-up of 41 days (range, 20 to 161 d). We found that (1) the degree of fracture extension using an index based on the anterior humeral line on the injury film was significantly related to failure of cast treatment (P=<0.01), and (2) the width of the soft tissue shadow of the upper arm on the postreduction film was of borderline significance (P=0.02). Cast flexion angle and cast padding were not predictive of radiographic loss of reduction (P=0.94 and 0.70). CONCLUSIONS: Despite adequate reduction and casting of type-2 supracondylar fractures, some fractures will lose reduction and require delayed pinning. The degree of extension of the distal fragment at the time of injury may help to predict the likelihood of failure of nonoperative treatment.

Social and economic benefits of flexible intramedullary nails in the treatment of pediatric femoral shaft fractures.

All patients between the ages of 5 and 15 years with isolated femoral shaft fractures treated at our institution with flexible intramedullary nails between 1996 and 1998 were examined and compared to an age-matched group of patients treated with spica casting. All fractures healed well with no significant complications. Patients treated with flexible intramedullary nails achieved earlier independent ambulation, at an average of 19 days, compared to 106 in the control group (P<.0001). They also attained earlier independent bathroom use (21 versus 79 days, P<.0001). Hospital stays were significantly shorter as well (6 versus 29 days, P<.0001). These patients also returned to school earlier, at 28 days postinjury, compared to 120 days for patients in spica casts (P<.0001). The use of flexible intramedullaty nails allowed patients and their families to achieve independence months earlier than the spica cast patients. Earlier return to school, independent ambulation, and independent bathroom use are advantages of this treatment modality.

Posterior sternoclavicular disruption with ipsilateral clavicle fracture in a nine-year-old hockey player.

Posterior sternoclavicular joint disruptions are rare, and a concomitant fracture is even less common in the pediatric population. This case report concerns a posterior sternoclavicular joint disruption and ipsilateral medial clavicle fracture in a 9-year-old male hockey player. We describe the various imaging modalities that may be necessary for this injury, the complications to be considered in dealing with this injury as well as an internal fixation technique using FiberWire.