Procrustes analysis of a shape of pediatric supracondylar humerus fractures.

Shape of supracondylar fracture of the humeral of pediatric patients is analysed with Procrustes method. XR-images of fractures are considered both in anterio-posterior (AP) view and in a lateral (L) view. Applying Procrustes method for both views mean images are constructed and compared. Variability of shapes is quantified with a shape principal component analysis. Possibility of predictions of typical shape of humeral fracture and its variability using statistical shape analysis offers additional information on injury characteristics important in preoperative planning. Non-parametric tests (permutational and bootstrap) do not indicate statistical difference between Procrustes mean shapes in anterio-posterior and lateral projections. It is shown, however, that AP and L shapes of humeral fractures differ in their variability quantified by shape principal components.

Operative management of sacroiliac joint dislocation in children with unstable pelvic fractures - A STROBE-compliant investigation.

Objective: Injuries involving severe spinal axial loading may be accompanied by sacroiliac joint dislocations. In children, these injuries are relatively rare, and there is little information on their optimal management in young patients. We conducted a multicentre study to investigate the outcome of surgical treatment of unstable pelvic fracture with sacroiliac joint dislocation in children. Patients & methods: We assessed the quality of surgical reduction and functional outcome at follow-up in 7 patients (5 girls, 2 boys) with a median age of 6.4 years (range: 4.2-14.8 years). Patients with pelvic fractures and sacroiliac joint dislocations were treated at four international paediatric level 1 trauma centres between January 2008 and August 2023. We applied the Matta criteria to assess the quality of fracture reduction and graded the functional follow-up results using adjusted Majeed score. Results: At follow-up, 3 patients showed excellent fracture reduction, with 2 patients showing good reduction and 2 patients exhibiting fair fracture reduction according to the Matta criteria. At follow-up visits at a median of 12 months (range: 3-84 months) after the injury, patients achieved a median adjusted Majeed score of 76 (range: 63 to 76). Conclusions: Unstable pelvic injuries with sacroiliac joint dislocation without comminution can be stabilised with a single iliosacral screw in children. Comminuted pelvic fractures with unstable sacroiliac dislocation require stabilisation with lateral compression screws or plates. In case of residual pelvic instability after internal fixation, an additional external fixator or pelvic hammock should be applied to optimize the stability of fixation.

Are menstrual disorders in adolescent girls related to metabolic disorders?

INTRODUCTION: Menstrual disorders in adolescent girls are a common clinical problem. They are often accompanied by lipid and glucose metabolism disturbances. The aim of the study was to investigate to what extent the metabolic profile of adolescent girls relates to the severity of their menstrual disorders. MATERIAL AND METHODS: The study included 165 girls with menstrual disturbances and 49 regularly menstruating girls (REG) without clinical hyperandrogenism, matched for age and BMI. The subjects from the study group were divided into 2 subgroups: OLIGO - 111 girls with oligomenorrhea and SA - 54 girls with secondary amenorrhoea. In all girls, hormonal, lipid, and carbohydrate metabolism profiles were assessed. RESULTS: In the SA subgroup concentrations of total cholesterol (TC) and LDL were significantly higher than in the REG and OLIGO groups. Triglyceride (TG) concentration was also the highest in the SA group and significantly higher than in the REG group. The prevalence of lipid metabolism disorders was higher in the SA group (65%) vs. the REG (40%) and OLIGO (51%) groups. The subgroups did not differ significantly in terms of fasting and OGTT glucose and insulin as well as HOMA-IR. TyG index was significantly higher in the OLIGO and SA groups than in the REG group. BMI z-score correlated with TG, LDL, fasting and 120' OGTT glucose and insulin, HOMA-IR, and TyG and negatively with HDL. No relationship between hormonal concentration and metabolic disturbances was found. CONCLUSIONS: Adolescent girls with menstrual disorders are insulin resistant, regardless of PCOS diagnosis. The severity of menstrual disorders may be related to the incidence of lipid disorders in adolescent girls.

Dimensions of the anterior cruciate ligament and thickness of the distal femoral growth plate in children: a MRI-based study.

BACKGROUND: When determining the dimensions of an anterior cruciate ligament (ACL) graft in children, bone age should be considered in addition to the patient's age, gender, and body height. OBJECTIVES: We aimed to determine the relationship between age, gender, and ACL dimensions as well as thickness of growth plate cartilage of the distal femur during puberty. METHODS: We retrospectively analyzed MRI scans of the knee in 131 children (82 girls, 49 boys) aged 6-18 years (mean age: 14.9 ± 2.6 years). ACL length and width as well as thickness of the growth plate cartilage at the distal femoral epiphysis were measured. RESULTS: Mean ACL length increased linearly up to the age of 12 years in females and 14 years in males; thereafter, mean ACL length remained constant. Mean ACL length was largest at the age of 12 to < 13 years (38.18 mm) in females and at 15 to < 16 years (39.38 mm) in males. Mean ACL width increased up to the age of 12 years in girls and 13 years in boys. After the age of 12 years, both the ACL length and width were significantly larger in boys than girls (p = 0.002 and p = 0.045, respectively). Mean thickness of the growth plate cartilage of the distal femur remained stable up to the age of 12 years in girls and 14 years in boys. Thickness of the growth plate cartilage changed most markedly between the age intervals of 11 to < 12 years and 12 to < 13 years in girls and between the age intervals of 13 to < 14 years and 14 to < 15 years in boys. CONCLUSIONS: ACL dimensions depended on both age and gender during the growth period. Measurement of cartilage thickness of the femoral distal growth plate proved to be an objective parameter to assess the maturation stage of local bone. This may be useful for the planning and timing of orthopedic ACL procedures. LEVEL OF EVIDENCE: III-retrospective cohort study.

Case Report: The unique case of flexible intramedullary nailing of pediatric radius complicated with temporary radial nerve's motor branch damage.

This study reported a case of radius flexible intramedullary nailing complicated by temporary paralysis of the posterior interosseous nerve due to compression of the ESIN on the nerve in an 8-year-old boy. The nerve damage resulted from an essential misconception at the surgery. Despite bad decisions made during qualifications and the procedure undertaken, restoring the nerve function, and gaining satisfactory functional fracture recovery was possible. Although it is generally acknowledged to perform retrograde flexible intramedullary nailing from the level of the distal radial metaphysis, the presentation of our case aims to emphasize the real risk of damage to the motor branch of the radial nerve when approaching the proximal metaphysis.

Results of Anterior Cruciate Ligament Avulsion Fracture by Treatment Using Bioabsorbable Nails in Children and Adolescents.

(1) Background: Anterior cruciate ligament avulsion fractures are characteristic for skeletally immature patients, and appropriate treatment is currently debated in the literature. The study aimed to evaluate the clinical and functional outcomes in patients with tibial eminence fractures treated with bioabsorbable nails in one orthopedic clinic. (2) Methods: After retrospective evaluation, we found 17 patients with tibial eminence fractures treated in orthopedic departments between January 2013 and July 2022 using bioabsorbable fixation nails. The study group comprised 12 boys and five girls aged 5 to 15.2 (average 10.1). The mean follow-up was 28 months. We diagnosed five type II fractures, ten type III fractures, and two type IV fractures according to Meyers-McKeever classification. (3) Results: We obtained a high healing rate-17 patients with the complete union on the control radiographs. We diagnosed two cases of malunion, of which one required revision surgery. Only one patient showed a slight anterior knee laxity. The treatment effect at follow-up was assessed using the Lysholm Knee Score and IKDC Score. The median Lysholm Score was 96.64 (SD 4.54), and the median IKDC Score was 84.64 (SD 3.10), which were both excellent results. (4) Conclusions: Based on our results, surgery using bioabsorbable devices for type II, III, and IV tibial eminence fractures in young individuals is an effective alternative, allowing good outcomes and restoring proper knee stability. The crucial factor for a good effect is a stable fracture fixation. Arthroscopic surgery gives good outcomes with minimal invasion. It is important not to prolong the attempts of arthroscopic reduction and to perform the open reduction to shorten the procedure's time and avoid complications.

Treatment of Radial Nerve Palsy in Paediatric Humeral Shaft Fractures. STROBE-Compliant Investigation.

Background and Objectives:Due to the rarity of radial nerve palsy in humeral shaft fractures in the paediatric population and the lack of data in the literature, the purpose of our study was to report the treatment results of six children who sustained a radial nerve injury following a humeral shaft fracture. Materials and Methods: We treated six paediatric patients with radial nerve palsy caused by a humeral shaft fracture in our department from January 2011 to June 2022. The study group consisted of four boys and one girl aged 8.6 to 17.2 (average 13.6). The mean follow-up was 18.4 months. To present our results, we have used the STROBE protocol designed for retrospective observational studies. Results:We diagnosed two open and four closed humeral shaft fractures. Two simple transverse AO 12A3c; one simple oblique AO 12A2c; two simple spiral AO 12A1b/AO 12A1c and one intact wedge AO 12B2c were recognized. The humeral shaft was affected in the distal third five times and in the middle third one time. In our study group, we found two cases of neurotmesis; two entrapped nerves within the fracture; one stretched nerve over the bone fragments and one case of neuropraxia. We found restitution of the motor function in all cases. For all patients, extensor muscle strength was assessed on the grade M4 according to the BMRC scale (except for a patient with neuropraxia-M5). The differences in patients concerned the incomplete extension at the radiocarpal and metacarpophalangeal (MCP) joints. Conclusions: In our small case series, humeral shaft fractures complicated with radial nerve palsy are always challenging medical issues. In paediatric patients, we highly recommend an US examination where it is possible to be carried out to improve the system of decision making. Expectant observation with no nerve exploration is reasonable only in close fractures caused by low-energy trauma. Early surgical nerve exploration related with fracture stabilisation is highly recommended in fractures after high-energy trauma, especially in open fractures and where symptoms of nerve palsy appear at any stage of conservative treatment.

Evaluation of Osteochondritis Dissecans Treatment with Bioabsorbable Implants in Children and Adolescents.

(1) Background: This is the first systematic review concerning the treatment of osteochondritis dissecans with the use of bioabsorbable implants. The study was done as a comprehensive review to identify important factors affecting the results of OCD treatment in children and adolescents; (2) Methods: We searched electronic bibliographic databases including PubMed, Cochrane Library, Scopus, and Web of Knowledge until May 2022. This systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PICO (Patients, Interventions, Comparisons, Outcomes) guidelines; (3) Results: We identified 2662 original papers of which 11 were found to be eligible for further analysis. The study group included a total of 164 OCD lesions in 158 patients. In 94.86% of postoperative cases, there was complete healing or local improvement on follow-up CT or MRI scans. The great majority of patients achieved a good clinical effect. Out of 164 OCD lesions, 10 did not heal (6.09%); (4) Conclusions: Surgical treatment of stable and unstable OCD in children with the use of bioabsorbable implants facilitates a high rate of healing and a good clinical outcome; treatment of juvenile OCD is associated with a better outcome compared to adult OCD; the use of bioabsorbable implants for the treatment of humeral capitellum OCD is associated with a more frequent incidence of synovitis (18.2%).

Humeral Capitellum Fractures in Adolescents: A Study of 6 Cases Treated by Open Reduction and Internal Fixation with Bioabsorbable Nails.

Purpose: The purpose of our study was to evaluate the clinical outcome following open reduction and internal fixation of humeral capitellum fractures in adolescents and to assess the usefulness of bioresorbable implants in that procedure. Due to the rarity of these fractures, there are not many studies dealing with the problem in the literature. Methods: We retrospectively evaluated a group of 6 skeletally immature patients aged 10.6-15.3 treated at our department from January 2015 to December 2021. Four type I and two type IV were diagnosed based on the Bryan and Morrey classification. Our patients underwent an open reduction and internal fixation of coronal shear fractures with the use of SmartNail®. Results: All patients were satisfied with the treatment outcome and had full pronation and flexion after surgery. Two patients presented minor deficits of extension and supination compared with the contralateral elbow. At the one-year follow-up, all patients scored 100 on the Mayo Elbow Performance Score. Conclusions: Correct diagnosis and early surgical intervention in humeral capitellum fractures are crucial. That fractures should be anatomically reduced with no articular cartilage damage in order to prevent osteoarthritis. Based on our experience, SmartNail® implant is accurate for the osteochondral fragment fixation.

Supracondylar Fractures of the Humerus: Association of Neurovascular Lesions with Degree of Fracture Displacement in Children-A Retrospective Study.

Supracondylar humerus fractures (ScHF) account for 60% of fractures of the elbow region in children. We assessed the relationship between neurovascular complications and the degree of fracture displacement as rated on the basis of modified Gartland classification. Moreover, we aimed to evaluate predisposing factors, e.g., age and gender, and outcomes of neurovascular complications in ScHF. Between 2004 and 2019, we treated 329 patients with ScHF at the Department of Traumatology and Orthopedics of the Upper Silesian Child Centre, Katowice, Poland. Mean age of patients (189 boys and 140 girls) was 7.2 years (Confidence interval: 6.89, 7.45). Undisplaced fractures were treated conservatively with a cast. Displaced fractures were managed by closed reduction and percutaneous Kirschner wire fixation using two pins inserted laterally. We retrospectively assessed the number of neurovascular lesions at baseline and recorded any iatrogenic injury resulting from the surgical intervention. Acute neurovascular lesions occurred in 44 of 329 ScHF patients (13.4%). The incidence of accompanying neurovascular injuries was positively associated with the severity of fracture displacement characterized by Gartland score. Vascular injuries occurred mainly in Gartland type IV ScHF, while nerve lesions occurred in both Gartland type III and IV ScHF. We noted a significantly higher mean Gartland score and mean age at injury in the group of children suffering from neurovascular injuries when compared to those in the group without such injuries (p = 0.045 and p = 0.04, respectively). We observed no secondary nerve lesions after surgical treatment. For the treatment of ScHF in children, we recommend closed reduction and stabilization of displaced fractures with K-wires inserted percutaneously from the lateral aspect of the upper arm. We advocate vessel exploration in case of absent distal pulses after closed reduction but do not consider primary nerve exploration necessary, unless a complete primary sensomotoric nerve lesion is present.

The prevalence of autoimmune thyroiditis in adolescent girls with polycystic ovary syndrome.

OBJECTIVES: Both polycystic ovary syndrome (PCOS) and autoimmune thyroiditis (AT) are reported to be common endocrinopathies. In recent years the number of publications assessing the coexistence of these two disease entities in adult women has been growing. There are many suggestions regarding pathophysiological mechanisms that can cause the relationship between AT and PCOS. However, there is still a lack of research among adolescent girls. The aim of the study was to analyze the occurrence of autoimmune thyroiditis in adolescent girls with PCOS. MATERIAL AND METHODS: The study group included 80 girls diagnosed with PCOS (chronological age: 16.54 ± 1.00 years, BMI: 22.80 ± 3.27 kg/m2), and the control group - 64 regularly menstruating girls (chronological age: 16.71 ± 0.63 years, BMI: 24.8 ± 5.2 kg/m2). The thyroid function and morphology were assessed based on the concentration of thyroid stimulating hormone (TSH), free thyroxine (fT4), anti thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG) antibodies and ultrasound scan of the thyroid gland. RESULTS: AT was diagnosed in 18 (22.5%) girls from the study group and nine (14.06%) from the control group (p > 0.05). Positive anti-TPO titer was observed more often in the study group [21 patients (26.25%)] than in the control group [9 girls (14.06%)] (p = 0.054). Moreover, an abnormal ultrasound scan of the thyroid gland characteristic for AT was found in 18 girls from the study group (22.50%) and 8 girls from the control group (12.50%) (p > 0.05). CONCLUSIONS: The results of the analyzed studies do not confirm a significant relationship between PCOS and AT in adolescent girls. However, in the group of girls with PCOS, autoimmune process exponents were more frequent (anti-TPO), reaching the borderline level of statistical significance.

Radial Nerve Palsy in Paediatric Humeral Shaft Fractures: Incidence and Management.

BACKGROUND: Humeral shaft fractures are relatively rare in the paediatric population. The purpose of our study was to retrospectively evaluate all humeral shaft fractures treated at a children's trauma centre and assess cases involving radial nerve injury. MATERIAL AND METHODS: We retrospectively evaluated a group of 5 skeletally immature patients with radial nerve palsy out of a total of 104 patients with humeral shaft fractures treated in our hospital between January 2011 and December 2021. RESULTS: The study group consisted of four boys and one girl aged 8.6 to 17.2 years (average age 13.6). Mean follow-up duration was 18.4 months. We diagnosed two open and three closed fractures. There were two cases of neurotmesis, two cases of nerve entrapment within the fracture site and one case of neuropraxia. Bone union and functional recovery was achieved in all five patients. CONCLUSIONS: 1. Humeral shaft fractures complicated with radial nerve palsy are a challenging medical problem; 2. The incidence of radial nerve injury in the paediatric population is significantly lower than in adults; in our study, it accounted for 4.8% of all humeral shaft fractures; 3. Expectant observation without nerve exploration is reasonable in fractures caused by a low-energy trauma; 4. Early surgical nerve exploration combined with fracture stabilisation is highly recommended in fractures due to a high-energy trauma.

Surgical treatment of benign lesions and pathologic fractures of the proximal femur in children.

PURPOSE: Benign lesions of the proximal femur region, such as simple bone cysts, aneurysmal bone cysts, and fibrous dysplasia, are common in children. Benign lesions may cause pathologic fractures, limb length inequities, and growth disturbances. Differential diagnoses, e.g., malignant bone tumors and osteomyelitis, are sometimes difficult to rule out. OBJECTIVE: We aimed to evaluate outcomes in children with benign lesions of the proximal femur treated with curettage, bone grafting, and plate fixation. METHODS: In this retrospective study, we included 30 children (median age 10.5 years; range 1.1-17.8 years) suffering from bone cysts and tumor-like lesions of the proximal femur region treated between 2002 and 2018. We analyzed plain X-ray images and CT scans in all children and obtained MRI scans in a selected group of children (63.3%). We examined histopathologic biopsy results for all bone lesions before initiating treatment. Surgical management comprised tumor curettage with adjuvant high-speed drilling and allogenic bone grafting supplemented by bone graft substitutes before plate fixation. Median follow-up interval was 87 months (range 24-156 months). We evaluated the healing of lesions according to Capanna's classification and rated functional outcomes according to Merle d'Aubigné and Postel score. RESULTS: Overall, 25 of 30 (83.3%) patients were admitted to hospital because of a pathologic fracture. We diagnosed simple bone cysts in 15 (50.0%) patients, aneurysmal bone cysts in 7 (23.5%) patients, and fibrous dysplasia in 8 (26.5%) patients. Bone consolidation was achieved in 22 of 30 (73.3%) patients after a mean of 5 months (range 3-7 months). The main complication was recurrence of the lesion in 4 of 30 (13.3%) patients. With respect to the Merle d'Aubigné and Postel scores, 17 of 30 (56.7%) patients obtained an excellent result (18 points), while 12 (40.0%) patients had a good result (15-17 points) and only 1 (3.3%) patient had a fair result (14 points). CONCLUSION: Surgical treatment of bone cysts and tumor-like lesions of the proximal femur by local resection or destruction of the lesion, followed by filling the defect with bone graft material and internal stabilization represents a safe and effective treatment option in children. LEVEL OF EVIDENCE: Therapeutic, retrospective comparative study-Level III.

Humeral Shaft Fractures in Children Incidence, Management and Treatment Effects.

BACKGROUND: Humeral shaft fractures are relatively rare in children, with incidence between 0.4% and 3% of all fractures in children and between 10% and 20% of all humeral fractures. The purpose of our study was to retrospectively evaluate all humeral shaft fractures treated at children's trauma center from january 2012 till december 2021. MATERIAL AND METHODS: We retrospectively evaluated the group of 104 skeletally immature patients with humeral shaft fracture treated in our hospital. We have analyzed: age; sex; fracture type, management; time of bone healing; final effect and complications. RESULTS: The non-surgical group consisted of 73 patients (27 girls and 46 boys) with an average age of 8.03 (0.6 - 17.7), while the surgical group consisted of 31 patients (16 girls and 15 boys) with an average age of 12.47 (5,7- 17.8). The mean follow-up was 7.65 months (4-12) in non-surgical group, and 13.38 months (4-24) in surgical group. We have analyzed the results statistically, confirming increase the frequency of the above-mentioned fractures and increase the number of patients treated with surgery. We achieved good effect in all patients. CONCLUSIONS: 1. Humeral shaft fractures in children are relatively rare. Although in recent years, we have observed an increase of their frequency; 2. The vast majority of humeral shaft fractures are treated non-surgically with good clinical results; 3. Increase of number of patients treated surgically has been noticeable in the last decade; 4. Surgery is associated with a relatively low risk of complications and allows for cast withdrawal, which significantly improves the patients comfort.

Treatment of acetabular fractures in paediatric patients.

BACKGROUND: Acetabular fractures are rare in children, constituting approximately 1-4.6% of all paediatric fractures. MATERIAL AND METHODS: Nine patients (4 girls and 5 boys) with a mean age of 14.5 years (range, 12-16.5 years) were treated due to acetabular fractures between 2000 and 2020. Most of the fractures were caused by road accidents. Before the patients were qualified for treatment, they underwent a CT scan (all patients) and an MRI scan (8 patients) of the hip. Surgical treatment was used in 6 patients while the other 2 were managed conservatively. RESULTS: Mean follow-up period was 6.2 years (range, 2-10 years). Bone union was achieved in all patients after 76 days on average (range, 65-90 days). The mean Merle d'Aubigne score at 12 months after treatment was 17.1 points (range, 13-18 points). CONCLUSIONS: The treatment of acetabular fractures in paediatric patients during or after puberty may be the same as in adults. An MRI scan of the hip joint is recommended for assessing the fracture, particularly the triradiate cartilage.

Changes in the avascular area of the meniscus using mesenchymal stem cells and growth plate chondrocytes in a pig model.

Menisci are wedge-shaped cartilage discs that are divided into two parts: the avascular and vascular regions. They are formed by fibrocartilage tissue, which contains round cartilage-like cells and extracellular matrix. Meniscus injury in animals is a common orthopedic problem, but data on the natural healing process mainly deals with the vascular zone. The healing processes in the avascular zone of the meniscus are significantly limited. Thus, this study aimed to evaluate autologous growth plate chondrocytes' impact on the healing process of a damaged meniscus in the avascular zone based on a growing animal model. The study group consisted of 10 pigs at about three months of age. From each animal, chondrocytes from the iliac growth plate and from concentrated bone marrow were taken. Knee joints were divided into right (R) and left (L). The medial meniscus of the R knee joint was treated with a hyaluronic acid based scaffold incubated with bone marrow cells from marrow aspirates (nCHON). The medial meniscus of the L knee joint was treated with a hyaluronic acid based scaffold incubated with bone marrow cells from marrow aspirates supplemented with immature chondrocytes isolated from growth plates (wCHON). The meniscus was damaged in the avascular zone in both knee joints. Followingly, the damaged part of the meniscus was filled with a scaffold with cells from the concentrated bone marrow and from growth plate chondrocytes. In the control group, a scaffold with concentrated bone marrow cells was used. After three months the animals were euthanized and preparations (microscopic slides) were made from the meniscus' damaged part. A qualitative and quantitative analysis have been prepared. The wCHON group in comparison with the nCHON group showed a statistically significantly higher number of fusiform cells on the surface of the graft as well as better healing of the graft. In addition, the degree of vascularization was higher in specimens from the wCHON group than in the nCHON group. The results of our research on immature pig knees revealed that mesenchymal stem cell and growth plate chondrocytes could be treated as the cell source for meniscus reconstruction, and growth plate chondrocytes enhance healing processes in the avascular zone of the injured meniscus.

Evaluation of using the Anderson-Montesano and the Tuli classifications in pediatric patients with occipital condyle fractures.

BACKGROUND: Occipital condyle fractures (OCFs) in patients before 18 years of age are rare. Classifications of OCF are based on the CT images of the cranio-cervical junction (CCJ) and MRI. The Anderson-Montesano and Tuli classifications are the types which are most commonly used in these cases. Classification of OCFs allows the implementation of OCF treatment. The aim of this study was to evaluate the effectiveness of using the OCF classification in pediatric patients based on the analysis of our own cases. METHODS: During the years 2013-2020, 6 pediatric patients with OCFs, aged 14-18, have been treated. Two patients with unstable fracture III according to Anderson-Montesano and IIB according to Tuli were treated with the halo-vest. Additionally, one patient presenting neurological symptoms and with an associated C1 fracture was qualified for the halo-vest stabilization as well. The other patients were treated with a Minerva collar. We evaluated the results 6 months after completing the OCF treatment using the Neck Disability Index (NDI) and SF-36 questionnaires. Confidence intervals for the mean values were verified using the MeanCI function (from the R library DescTools) for both classical and bootstrap methods. RESULTS: Based on NDI results, we have obtained in our patients an average of 4.33/45 points (2-11) and 9.62% (4.4-24.4). Based on the SF-36 questionnaire, we obtained an average of 88.62% (47.41-99.44). CONCLUSION: The Anderson-Montesano and Tuli's classifications of OCF can be used to assess the stability of OCF in adolescents, but both classifications should be used simultaneously. CT and MR imaging should be used in diagnosing OCFs, whereas CT allows assessing therapeutic outcomes in OCF.

Treatment of Unstable Occipital Condylar Fractures in Children-A STROBE-Compliant Investigation.

Background and objectives: Occipital condyle fractures (OCF) occur rarely in children. The choice of treatment is based on the Anderson-Montesano and Tuli classification systems. We evaluated the outcome of unstable OCF in children and adolescents after halo-vest therapy. Materials and Methods: We treated 6 pediatric patients for OCF, including 3 patients (2 girls, 1 boy) with unstable OCF. Among the 3 patients with unstable OCF, 2 patients presented with an Anderson-Montesano type III and Tuli type IIB injury, while 1 patient had an Anderson-Montesano type I fracture (Tuli type IIB) accompanied by a C1 fracture. On admission, the children underwent computed tomography (CT) of the head and cervical spine as well as magnetic resonance imaging (MRI) of the cervical spine. We treated the children diagnosed with unstable OCF with halo-vest immobilization. Before removing the halo vest at the end of therapy, we applied the CT and MRI to confirm OCF consolidation. At follow-up, we rated functionality of the craniocervical junction (CCJ) based on the Neck Disability Index (NDI) and Questionnaire Short Form 36 Health Survey (SF-36). Results: All children achieved OCF consolidation after halo-vest therapy for a median of 13.0 weeks (range: 12.5-14.0 weeks). CT and MRI at the end of halo-vest therapy showed no signs of C0/C1 subluxation and confirmed the correct consolidation of OCF. The only complication associated with halo-vest therapy was a superficial infection caused by a halo-vest pin. At follow-up, all children exhibited favorable functionality of the CCJ as documented by the NDI score (median: 3 points; range: 3-11 points) and SF-36 score (median: 91 points; range: 64-96 points). Conclusions: In our small case series, halo-vest therapy resulted in good mid-term outcome in terms of OCF consolidation and CCJ functionality. In pediatric patients with suspected cervical spine injuries, we recommend CT and MRI of the CCJ to establish the diagnosis of OCF and confirm stable fracture consolidation before removing the halo vest.

Statistical image analysis and escort histograms in characterization of articular cartilage repair in a skeleton animal model.

Statistical image analysis of an ensemble of digital images of histological samples is performed as an auxiliary investigation a result of the recently proposed method of articular cartilage repair utilizing growth plate chondrocytes in a skeleton animal model. A fixed-shift model of maximal likelihood estimates of image histograms applied for monochromatic (grayscale) images or their RGB components confirms the statistically significant effect of the previously proposed medical treatment. The type of staining used to prepare images of histological samples is related to the visibility of the effectiveness of medical treatment. Hellinger distance of escort distributions for maximal likelihood estimates of image histograms of medically treated and control samples is investigated to identify grayscale (or RGB) intensities responsible for statistically significant difference of the estimates. A difference of Shannon entropy quantifying informational content of the histograms allows one to identify staining and image colors which are most suitable to visualize cluster formation typical for articular cartilage repair processes.

Conservative treatment and outcome of upper cervical spine fractures in young children: A STROBE-compliant case series.

ABSTRACT: Cervical spine (C-spine) fractures in young children are very rare, and little information on treatment modalities and functional, radiographic, and patient-reported outcome exists. In this 2-center, retrospective case series, we assessed subjective and functional mid-term outcomes in children aged ≤5 years whose C-spine fractures were treated nonoperatively.Between 2000 and 2018, 6 children (median age at injury: 23.5 months; range: 16-31 months) with C1 or C2 injuries were treated with Minerva cast/brace or soft collar brace at 1 of the 2 study centers. Two patients suffered C1 fractures, and 4 patients had lysis of the odontoid synchondrosis. Overall, 3 children had sustained polytrauma. One child died due to the consequences of massive head injury.For the primary outcome parameter, we recorded subjective symptoms such as pain and functional restrictions due to the sequelae of C-spine injuries at follow-up.Based on medical records, we also assessed the causes of injury, diagnostic procedures, treatments and complications, and time to fracture consolidation.Median follow-up of the 5 surviving children was 51 months (range: 36-160 months). At the latest follow-up, 4 of 5 children did not complain of any pain. One child who sustained an open head injury in combination with a subluxation of the odontoid and undisplaced fracture of the massa lateralis reported occasional headache. All patients experienced complete fracture healing and normal range of motion of the cervical spine.Median duration of cast/brace treatment was 8.5 weeks. Fracture healing was confirmed by computed tomography in all patients.All C-spine injuries were managed with either Minerva cast/Halo brace or soft collar brace without complications.In our retrospective case series, nonoperative treatment of atlas fractures and dislocations or subluxations of the odontoid in young children using Minerva casts or prefabricated Halo braces resulted in good subjective and functional outcomes at mid-term. We observed no complications of conservative treatment of C1 and C2 injuries in young children.