ABSTRACT
Pediatric olecranon osteochondral flap fractures are shear injuries of the humeroulnar joint with elevation of an articular cartilaginous flap from the subchondral bone of the olecranon articular surface. All previously reported cases included an osteochondral flap containing the coronoid, with varying imaging and fixation methods used. We treated 2 pediatric patients with this injury. One of our patients had a large, displaced osteochondral fracture of the medial semilunar notch including the coronoid, in addition to avulsions of the medial flexor mass and distal ulnar collateral ligament. The other patient sustained a displaced, rotated osteochondral fracture including the coronoid with subsequent humeroulnar subluxation. Both fractures were anatomically reduced and fixed with absorbable suture, leading to excellent results at 1 year. A high degree of suspicion, thorough work-up, and anatomical reduction of all injured structures are paramount in treatment of this rare, difficult-to-diagnose injury.
Subject(s)
Elbow Joint , Olecranon Process , Ulna Fractures , Child , Elbow Joint/diagnostic imaging , Elbow Joint/surgery , Fracture Fixation, Internal , Humans , Olecranon Process/diagnostic imaging , Olecranon Process/surgery , Range of Motion, Articular , Ulna , Ulna Fractures/diagnostic imaging , Ulna Fractures/surgeryABSTRACT
BACKGROUND: This study is the first to test Friberg's equation's (Vt=V0[e]) accuracy in predicting the residual angular deformity in pediatric distal forearm fractures. METHODS: Angular deformities from distal forearm fractures in 50 children (mean age, 9 y) were retrospectively measured on follow-up radiographs once healed and compared to extrapolated angles at respective follow-up intervals from 2013 to 2015. RESULTS: The predicted and actual angulations from 120 radiographs (mean follow-up, 3mo) showed that the mean predicted angle was similar to the measured angle in the radioulnar plane and only 2 degrees greater than the measured angle in the dorsovolar plane. A strong correlation was observed between predicted and measured angles in both planes. CONCLUSIONS: Friberg's equation is a valid tool for predicting remodeling potential in pediatric distal 25% forearm fractures. LEVEL OF EVIDENCE: Prognostic Study-Level II.
Subject(s)
Bone Remodeling , Radius Fractures/diagnostic imaging , Ulna Fractures/diagnostic imaging , Wrist Joint/diagnostic imaging , Alabama , Child , Female , Fracture Healing , Humans , Injury Severity Score , Male , Predictive Value of Tests , Radiography , Range of Motion, Articular , Retrospective StudiesABSTRACT
CASE: Fourteen-year-old boy presented with bilateral proximal humerus lesser tuberosity avulsions after swinging between 2 desks. Injuries were not visualized on radiographs but identified on magnetic resonance imaging. He underwent bilateral open reduction and internal fixation of the bony avulsions. Following repair, he returned to full activities, including sports, without limitations. CONCLUSION: Lesser tuberosity avulsions are rare injuries in the pediatric population that can be missed. Our case is a low energy noncontact mechanism resulting in bilateral injury, highlighting the importance of having a high index of suspicion for this diagnosis in adolescent patients with shoulder pain with normal radiographs.