Outcome determinants for coronal shear fractures of the distal humerus.

PURPOSE: Coronal shear fractures of the distal humerus involving the capitellum and trochlea are rare injuries. Internal fixation with headless compression screws provides a stable construct facilitating early mobilisation. Our study aimed to identify the key determinants of both radiological and functional outcomes of patients with distal humerus coronal shear fractures treated with internal fixation. METHODS: A retrospective analysis of 61 patients with distal humerus coronal shear fractures who were treated surgically was done. Demographics, fracture morphology, time to surgery, operative details such as surgical approach and implant used, quality of reduction, time to union, and associated complications from hospital records. Radiological outcomes were assessed using plain radiographs, and the functional outcomes were by Oxford Elbow Score (OES) and Mayo Elbow Performance Index (MEPI). RESULTS: Patients with anatomical reduction of the fracture had better functional outcomes and range of motion. The presence of posterior comminution of capitellum resulted in poorer outcomes (p = 0.03). Delayed presentation did not alter the outcome when the anatomical reduction was achieved. Myositis ossificans was noted in nine patients and non-union in five patients. Two patients developed avascular necrosis of the capitellum and arthritis of the elbow joint. CONCLUSION: Anatomical reduction and posterior comminution are the two key determinants of the functional outcome in these coronal shear fractures of the distal humerus. Early mobilisation following a stable fixation is crucial in achieving a good outcome.

Management of slipped capital femoral epiphysis: Results of a survey of the members of the Paediatric Orthopaedic Society of India (POSI).

AIM: To determine the preferred practices in the treatment of slipped capital femoral epiphysis (SCFE) among members of the Paediatric Orthopaedic Society of India (POSI). MATERIALS AND METHODS: A questionnaire with 16 vignettes was made about SCFE and sent to all members of the Paediatric Orthopaedic Society of India (POSI) to study the similarity and variation in the management of SCFE. Specifically, respondents were asked about the role of reduction, methods of fixation, prophylactic fixation of the non-affected hip, postoperative management and their view on the prevalence of Femoro Acetabular Impingement (FAI) and anticipated need for secondary surgery. RESULTS: The response rate was 94 out of 203 members of Paediatric Orthopaedic Surgeons of India (51.9%). 62 out of 94 (66%) participating surgeons had an exclusive paediatric orthopaedics workload, with 61 surgeons (65%) having more than ten years of experience. Seventy-eight surgeons (83%) were most consistent in their advice for the management of stable slips based on severity. For severe stable slips, 67 surgeons (71%) recommended Modified Dunn procedure. Around 23% of the respondents preferred to do modified Dunn's procedure for all unstable slips while the rest had different approaches to treat this. Single Partially threaded cancellous screw is the preferred implant for in-situ fixation, while a single screw and K wire construct is the preferred construct for in Modified Dunn's procedure. Only 17(16%) of the responders do prophylactic pinning of the opposite hip regularly. Almost 90 responders (96%) do counsel parents about FAI in later stages of life. CONCLUSION: Our study documents that about 70% of the practising paediatric orthopaedic surgeons prefer to do capital realignment procedure for severe stable slips. The treatment of unstable slips remains controversial without any consensus though about 70% believe that there is a role of gentle reduction or positional reduction or skeletal traction. About 50% of the respondents treat less than five slips a year and thus would not possible to generate high-quality evidence based on meagre numbers. This clearly shows that there is a need for developing a national SCFE registry to pool in all data which would help us to arrive at meaningful conclusions to arrive at the ideal management guidelines for SCFE.