ABSTRACT
BACKGROUND: Fifth metacarpal neck fractures (FMCNFs) are common among paediatric patients. Complications include reduced metacarpophalangeal (MCP) range of motion and grip strength, which impede the hand's functional abilities. Various management options are available, but indications are not standardised. This systematic review aims to assimilate all available evidence on the management of paediatric FMCNFs to determine appropriate treatment pathways. METHODS: PubMed (Medline), EMBASE, Scopus and Google Scholar were used to identify evidence pertaining to the management of these fractures. RESULTS: Ten studies were identified, involving 237 patients with a mean age of 14.4 years (Range 9-17). Ninety percent of patients were male. Sixty-one (26%) patients, with an average fracture angulation of 27° (Range 16°-33°) and no rotational deformities, were managed with immobilisation alone. These patients returned to normal metacarpophalangeal range of motion and grip strength. Fifty-four (23%) patients, with an average fracture angulation of 42.7° (Range 33°-54°), were managed with fracture reduction and immobilisation. This technique did not yield sustained reduction of fractures with significant angulation or rotation after intervention. One hundred twenty-two (51%) patients, with an average fracture angulation of 48.3° (Range 30°-58°) and including cases of malrotation, were managed with fracture reduction and surgical fixation. These patients experienced good functional outcomes. CONCLUSIONS: This review suggests paediatric FMCNFs can be safely managed with immobilisation alone when there is an absence of rotational deformity and an angulation of < 30°. In the case of a higher fracture angulation or rotational deformity, fracture reduction and surgical fixation is an appropriate method of management.
ABSTRACT
BACKGROUND: Sudden, forced hyperextension injuries to the proximal interphalangeal joint leading to volar plate avulsion fractures are common hand injuries in children. Suboptimal management of these fractures can lead to the development of long-term complications such as stiffness and flexion contracture. METHODS: MEDLINE (PubMed), Scopus, Embase, Google Scholar, and Cochrane CENTRAL databases were systematically searched, and additional studies were found through reference of articles up to June 15, 2023. Identified articles were assessed using predetermined inclusion/exclusion criteria. RESULTS: Twenty-five articles were included, involving 268 patients with ages from 3 to 17 years. Fractures with less than 30% joint involvement, classified as Eaton type I or II, or designated as "Stable" in the Keifhaber-Stern classification, were treated through nonsurgical means. Surgical interventions, encompassing open reduction and internal fixation, were reserved for fractures with more than 30% joint involvement and/or meeting criteria such as Eaton type IIIa or IIIb and Keifhaber-Stern "Tenuous" or "Unstable." Positive outcomes were seen in 99.5% of patients receiving nonsurgical treatment, compared with 85.7% in the surgical cohort. CONCLUSIONS: The literature demonstrated positive outcomes for fractures presenting with less than 30% joint involvement that were managed nonsurgically. In fractures with more than 30% joint involvement, surgical interventions yielded positive results. To further substantiate these findings, larger prospective studies with uniform measures are needed to validate the results of this study.
ABSTRACT
Ganglion cysts are the most common soft tissue tumor of the hand and wrist, affecting pediatric and adult populations. Despite their frequency, there is no consensus within the literature regarding the best management of pediatric wrist ganglia, and there are few recent publications examining this topic. We provide an up-to-date literature review examining the current issues and controversies in the management of pediatric wrist ganglia.
Subject(s)
Ganglion Cysts , Soft Tissue Neoplasms , Adult , Humans , Child , Ganglion Cysts/surgery , Wrist/pathology , Hand/surgery , Hand/pathology , Wrist Joint/pathology , Soft Tissue Neoplasms/pathologySubject(s)
Polydactyly/surgery , Toes/surgery , Child , Fingers/surgery , Humans , Infant , Infant, NewbornSubject(s)
Klippel-Feil Syndrome , Pierre Robin Syndrome , Humans , Mandible , Osteogenesis, DistractionABSTRACT
Giant omphalocele is a rare, large abdominal wall defect in which the intra-abdominal organs herniate through the umbilical cord and are covered by a sac. Surgical management of giant omphalocele is challenging, and optimal treatment remains controversial. Two generally accepted treatment options are staged closure and delayed closure. Delayed closure takes place after a period of conservative treatment promoting omphalocele sac epithelialization. We present 3 patients treated by a delayed closure technique for ventral hernia repair. In this technique, the epithelialized omphalocele sac and peritoneum are elevated as flaps, which are used to reconstruct the abdominal wall in multiple layers.
Subject(s)
Hernia, Umbilical/surgery , Herniorrhaphy/methods , Surgical Flaps , Child, Preschool , Combined Modality Therapy , Conservative Treatment , Female , Hernia, Umbilical/therapy , Humans , Infant , Male , Time FactorsABSTRACT
A patient with Klippel-Feil syndrome, which was associated with Pierre Robin sequence, bilateral mandibular duplication, and occipital clefts, is described. The management, surgery, and possible etiology are discussed in relation to the relevant literature.
Subject(s)
Klippel-Feil Syndrome/surgery , Mandible/abnormalities , Mandible/surgery , Pierre Robin Syndrome/surgery , Cervical Vertebrae/abnormalities , Child, Preschool , Cleft Palate/complications , Cleft Palate/surgery , Humans , Klippel-Feil Syndrome/complications , Male , Palate, Soft/abnormalities , Pierre Robin Syndrome/complications , Speech Disorders/complicationsABSTRACT
We present findings of anomalous musculotendinous anatomy in a patient having exploration of an acute volar wrist laceration. Surgical dissection demonstrated supernumerary flexor carpi radialis brevis and flexor carpi ulnaris brevis muscle bellies crossing the radiocarpal and ulnocarpal joints, in addition to injuries to several normal tendons and nerves. Postoperative magnetic resonance imaging confirmed the presence of a bilateral supernumerary flexor carpi radialis brevis but contralateral absence of flexor carpi ulnaris brevis.
Subject(s)
Muscle, Skeletal/abnormalities , Muscle, Skeletal/injuries , Tendon Injuries/surgery , Tendons/abnormalities , Wounds, Penetrating/surgery , Wrist Injuries/surgery , Humans , Magnetic Resonance Imaging , Male , Median Nerve/injuries , Median Nerve/surgery , Muscle, Skeletal/pathology , Muscle, Skeletal/surgery , Suture Techniques , Tendons/pathology , Tendons/surgery , Young AdultABSTRACT
A unilateral upper lateral orbital cleft, fitting the description of the extremely rare Tessier cleft number 9 is reported. The management and surgery of this patient are discussed, and the relevant literature is reviewed. The usefulness of three-dimensional computed tomography reconstructions and plastic models in planning the surgery is discussed.
