Supracondylar humeral fractures and lateral elbow condyle fractures in children: association between body weight, clinical signs, and fracture severity.

BACKGROUND: The objective of our study was to investigate the association between body weight, clinical signs and surgical time, and the severity of elbow fractures sustained exclusively by a ground-level fall in children. METHODS: Patients aged 2-11 years with elbow fracture caused exclusively by a ground-level fall were included. BMI was plotted on the sex-specific BMI-for-age percentile growth chart to obtain the BMI percentile. The elbow fractures were classified according to Gartland Classification for supracondylar fractures and the Song Classification for lateral humeral condyle fracture. Our main outcome measurement was Body Mass Index and fracture severity according Gartland or Song classifications. RESULTS: A total of 175 patients with elbow fractures were included in this study. The mean age of total population was 5.4 years (±2.4). The majority of our patients were male (61.7%), nearly of 48% were overweight or obese patients. The ecchymosis and puckering were the clinical sign more frequent in more severe fractures. CONCLUSIONS: Our data presented did not observe a direct relation between obesity and the severity of elbow humeral fractures in the pediatric population with a ground-level fall.

Compartment Syndrome in Children With a Supracondylar Fracture: Not Everyone has Risk Factors.

OBJECTIVES: To clarify the incidence, associated conditions, and timing of fasciotomy for compartment syndrome (CS) in children with a supracondylar (SC) fracture of the humerus. DESIGN: A retrospective trauma system database study. SETTING: Accredited trauma centers in Pennsylvania. PATIENTS: A statewide trauma database was searched for children 2-13 years of age admitted with a SC fracture between January 2001 and December 2015. Four thousand three hundred eight children met inclusion criteria. INTERVENTION: Treatment of a SC fracture. MAIN OUTCOME MEASUREMENT: Diagnosis of CS/performance of a fasciotomy. RESULTS: During the study period, 21 (0.49%) children admitted with a SC fracture of the humerus were treated with fasciotomy. CS/fasciotomy was more likely in males (P = 0.031), those with a nerve injury (P = 0.049), and/or ipsilateral forearm fracture (P < 0.001). Vascular procedure, performed in 18 (0.42%) children, was strongly associated with CS/fasciotomy (P < 0.001). Closed reduction and fixation of a forearm fracture was associated with CS (P = 0.007). Timing of SC fracture treatment did not influence outcome. Fasciotomy was performed subsequent to reduction in 13 subjects; mean interval between procedures was 23.4 hours (r = 4.5-51.3). CONCLUSIONS: Risk factors for CS exist; however, they are not required for the condition to develop. CS may develop subsequent to admission and/or SC fracture treatment. In timing of operative management and hospitalization, the results support contemporary practice. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Demographics and clinical features of humeral shaft fractures: The Latin American multicentre prospective study (HSF-LAMPS).

PURPOSE: To present transversal data (demographic and clinical) on isolated humeral shaft fractures (HSFs) in Latin American countries. METHODS: Patients were enrolled between December 2015 and April 2017 at 11 medical institutions from six Latin America countries. INCLUSION CRITERIA: Age ≥18 years and a closed, isolated 12A, 12B, or 12C fracture (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification). The patients' demographic, comorbidity, and other baseline data were recorded. The outcome measures included the basal results of the research and the associations among the demographic factors, fracture features, and type of treatment applied. RESULTS: A total of 123 patients were included. There was a preponderance of men (61.8%), whose mean age was significantly lower than that of the women (31.48 vs. 60.55). Overweight or obesity was present in 61.0% of women; 56.1% of patients were sedentary, 75.6% were nonsmokers, and 74.0% had no chronic disease. The type or treatment (operative/nonoperative) was not significantly associated with the patient's or fracture's characteristics. Falls and traffic accidents were the main causes of HSFs. Intramedullary nailing treatment was performed significantly more often in women, elderly patients, patients who did not participate in sports, and patients participating in only home activities. Minimally invasive plate osteosynthesis was performed significantly more frequently in men and in those who were self-employed. Open reduction internal fixation was performed significantly more often when the cause of the fracture was a traffic accident and when radial nerve palsy was present. CONCLUSION: The demographics and etiological differences observed in comparison to the current literature show the importance of regional studies for both preventive measures and educational guidance.

Evaluation of the surgical treatment of humeral shaft fractures and comparison between surgical fixation methods / Avaliação das fraturas diafisárias do úmero tratadas cirurgicamente e comparação entre os métodos de fixação cirúrgica

ABSTRACT Objective: The objective of this study is to analyze the surgical results of humeral shaft fracture treatment and describe its epidemiology. Methods: Retrospective study that identified all patients treated with surgical fixation of humeral shaft fractures between December of 2014 and June of 2016 in a trauma reference center. All medical records were reviewed in search of epidemiological data referent to the trauma and post-operative results, including radiographic healing of the fracture and related complications. Results: Fifty-one patients were included, mostly male (78.4%), with an average age of 35.02 years. The most common trauma mechanism was a traffic accident (56.9%) followed by same-level falls (17.6%). No statistically significant difference was found between healing time comparing surgical fixation techniques, including open reduction and internal fixation, minimally invasive technique, intramedullary nailing, and external fixation. Conclusion: Although each technique has inherent advantages and disadvantages, all fixation methods proved to be adequate options for the surgical treatment of humeral shaft fractures with high rates of healing and low rates of post-operative complications.

RESUMO Objetivo: Descrever o perfil dos pacientes com fraturas diafisárias do úmero, bem como analisar os resultados das diferentes modalidades cirúrgicas. Método: Estudo retrospectivo baseado na identificação de todos os casos de fraturas diafisárias de úmero submetidas a tratamento cirúrgico entre dezembro de 2014 e junho de 2016 em um serviço de referência em trauma, bem como na análise dos respectivos prontuários, e que buscou dados epidemiológicos referentes ao trauma e resultados pós-operatórios, inclusive tempo de consolidação e complicações relacionadas. Resultados: Foram incluídos 51 pacientes, dos quais a maioria do sexo masculino (78,4%), com média de 35,02 anos. O mecanismo de trauma mais prevalente foram acidentes de trânsito (56,9%), seguidos de quedas de mesmo nível (17,6%). Não foi encontrada diferença significante entre o tempo de consolidação dos diferentes métodos, inclusive redução aberta e fixação interna com placa e parafusos, técnica minimamente invasiva com placa em ponte, haste intramedular e fixação externa. Conclusões: Todos os métodos cirúrgicos avaliados mostraram-se adequadas opções para o tratamento cirúrgico das fraturas da diáfise do úmero, ainda que tenham vantagens e desvantagens inerentes a cada técnica, com altas taxas de consolidação e poucas complicações relatadas.

Humerus shaft fracture associated with traumatic radial nerve palsy: An international survey among orthopedic trauma surgeons from Latin America and Asia/Pacific.

PURPOSE: The purpose of this article is to explore the real-life practice of clinical management of humeral shaft fracture associated with traumatic radial nerve palsy among orthopedic trauma surgeons. METHODS: Two hundred seventy-nine orthopedic surgeons worldwide reviewed 10 real cases of a humeral shaft fracture associated with traumatic radial nerve palsy answering two questions: (1) What treatment would you choose/recommend: nonoperative or operative? (2) What are the reasons for your decision-making? The survey was developed in an online survey tool. All participants were active members from AOTrauma International. RESULTS: Two hundred sixty-six (95.3%) participants were from Latin America and Asia/Pacific. One hundred sixty-two participants (58.1%) had more than 10 years in practice and 178 (63.8%) of them did trauma as the main area of interest. One hundred fifty-one (54.1%) participants treated less than three humeral shaft fractures a month. Traumatic radial nerve palsy was the main reason (88.4%) for surgeons to recommend surgical treatment. Open reduction and internal fixation (ORIF) or percutaneous fixation of the fracture associated with acutely explore of radial nerve was the first option in 62.0% of the cases. A combination of morphology and level of the fracture and the presence of the radial nerve palsy was the most suggested reason to surgically treat the humerus fracture. The main isolated factor was the morphology of the fracture. CONCLUSION: Our survey highlight the tendency for a more aggressive management of any humeral shaft fracture associated with a traumatic radial nerve palsy, with surgeons preferring to use ORIF with acute exploration of the radial nerve. Nonsurgical management was the less chosen option among the 279 respondents. Fracture morphology, level of the fracture, and the presence of the radial nerve palsy were most influential for guiding their treatment.

Complications associated with Pediatric Supracondylar Humeral Fractures.

OBJECTIVE: To measure pediatric supracondylar fracture epidemiology, fracture rate, and complications in the island's pediatric population. The study aims to compare our results to the national rates reported in the literature. METHODS: In this retrospective record review we examined 330 patients who underwent open reduction internal fixation or closed reduction percutaneous pinning in pediatric supracondylar fractures at the University Pediatric Hospital of Puerto Rico Medical Center (HOPU). The study evaluated patients from January 2008 to January 2011 that had completed at least a 1 year follow-up. Measurement of type of fracture, and complications were recorded. Statistical significance was set at a p-valuevalue<0.05. RESULTS: Of the 330 patients, 206 (62%) were male and 127 (38%) were female. The average age was 5.49 years (± 2.43). The vast majority had extension-type fractures (98.2%) and 1.8% had flexion-type fractures. The neurological complication rates were 10% (33 patients). Neurologic complications after distal fragment displacement were 13.5% for posteromedial displacement versus 11.8% for posterolateral displacement, with a p-value of 0.71. CONCLUSION: Our results in terms of female-to-male ratio, fracture type and complications (e.g., infection, vascular and neurologic complications) were similar to those reported in the literature. Because significant differences in the rates of posteromedial and posterolateral supracondylar fractures were found, we recommend further research on this subject. Overall, both our findings regarding complications and our results are similar to what has been reported in the literature. We can therefore affirm that our institution provides adequate care and management for this kind of fracture.

Increased risk of humerus and lower leg fractures in postmenopausal women with self-reported premenopausal hirsutism and/or oligomenorrhea.

OBJECTIVE: The aim of this study was to investigate the prevalence of fracture in women aged >55 years with self-reported premenopausal hirsutism and/or oligomenorrhea. STUDY DESIGN: A cross-sectional study including 1057 post-menopausal women aged >55 years who were treated in a primary care facility in Santa Maria, South Brazil, from March 2013 through August 2013. Data were collected using a standardized questionnaire for characteristics including fracture history, medication use, and reproductive history (oligomenorrhea, hirsutism, miscarriage, the diagnosis or treatment of hypothyroidism, hyperprolactinemia, or infertility). RESULTS: A non-significant trend towards an increased prevalence of all fragility fractures was observed in women with premenopausal hirsutism and/or oligomenorrhea when compared to those without (20.4% vs. 15.7%). After correction for age, falls, and comorbidities, fracture prevalence was significantly higher in the lower leg (OR 3.1 [CI 1.1-8.6]; P=0.029), and humerus (OR 2.6 [CI 1.2-5.4]; P=0.015) in the women with hirsutism and/or oligomenorrhea. CONCLUSION: This is a hypothesis-generating study which evaluated the association between hirsutism and/or oligomenorrhea and fractures in postmenopausal women. Our results suggest that premenopausal hirsutism and/or oligomenorrhea may be associated with an increased risk of fracture postmenopause, particularly in the humerus and lower leg.

Fracturas de tratamiento quirúrgico alrededor del codo en niños: descripción epidemiológica en Hospital Clínico San Borja Arriarán / Surgical treatment fractures around the elbow in children: epidemiological description in Clinical Hospital San Borja Arriaran

Introducción: los traumatismos de codo tienen una alta incidencia en la población infantil, la fractura de esta zona corresponde al 5 a 10 por ciento del total de fracturas en niños. El objetivo de nuestro trabajo es hacer una descripción epidemiológica de las fracturas de codo en niños operadas en el Hospital Clínico San Borja Arriaran. Materiales y métodos: Estudio retrospectivo, descriptivo. Se realizó revisión de fichas electrónicas de pacientes de edad pediátrica operados de fracturas alrededor del codo en el HCSBA desde el 1 de junio al 31 de 2014. Resultados: Se estudiaron 25 pacientes, 64 por ciento de sexo masculino y 36 por ciento de sexo femenino. La edad promedio fue de 5,5 años. Fracturas supracondilea de humero correspondieron a 64 por ciento, epicondilo de humero 24 por ciento, epitróclea de humero 8 por ciento y olecranon y cúpula radial 4 por ciento. Discusión: Las fracturas supracondileas de humero son la lesión más frecuente de codo en los niños. Las fracturas de epicondilo son la segunda en frecuencia. Las fracturas de epictroclea representan aproximadamente 10 por ciento, mientras que las fracturas del olécranon son relativamente poco comunes en los niños. Conclusiones: nuestro centro tiene una epidemiologia similar a la descrita por la literatura internacional en cuanto a frecuencia, complicaciones asociadas y presentación clínica.

Introduction: elbow injuries have a high incidence among children, breaking this area corresponds to 5-10 percent of all fractures in children. The aim of our work is to make an epidemiological description of the elbow fractures in children operated in the Hospital Clinico San Borja Arriaran. Materials and methods: Retrospective, descriptive study. Review of electronic records of pediatric patients operated on fractures around the elbow in the HCSBA from 1 June 31, 2014 was performed. Results: 25 patients, 64 percent male and 36 percent female, were studied. The average age was 5.5 years. Supracondylar humerus fractures accounted for 64 percent, 24 percent epicondyle of the humerus, 8 percent medial epicondyle of the humerus, olecranon and radial head 4 percent. Discussion: Supracondylar humerus fractures are the most common elbow injury in children. Epicondyle fractures are the second in frequency. Epictroclea fractures represent approximately 10 percent, while the olecranon fractures are relatively uncommon in children. Conclusions: our center is similar to that described by the international literature in frequency, associated complications epidemiology and clinical presentation.

Opioid Use and Risk of Nonvertebral Fractures in Adults With Rheumatoid Arthritis: A Nested Case-Control Study Using Administrative Databases.

OBJECTIVE: To assess the risk of nonvertebral fractures in patients with rheumatoid arthritis (RA) who were exposed to opioids. METHODS: A population-based, nested case-control study was conducted using health services administrative databases (Quebec, Canada) from 1997 to 2012. Among RA patients, cases of nonvertebral fractures from 2007 to 2012 were identified using a validated algorithm. The date of the first fracture was the index date for the case and his/her matched control. Controls were selected using incidence density sampling and were matched 5:1 to cases for age, sex, and date of RA diagnosis. Opioid exposure was classified as current use, recent past use, remote past use, and nonuse. Conditional logistic regression was used to assess the association of nonvertebral fractures with opioid exposure, adjusting for comorbidity, indicators of RA severity, drugs influencing fracture risk, and health care utilization. RESULTS: In total, 1,723 cases and 8,046 controls were identified. Among these patients, 2,595 (722 cases and 1,873 controls) had been exposed to opioids. Current use (versus nonuse) increased the risk of nonvertebral fracture. Cumulative current use of opioids according to the quartile distribution was also associated with the risk of nonvertebral fracture: for continuous use for 1-20 days before the index date, odds ratio (OR) 11.49 (95% confidence interval [95% CI] 8.81-14.99); for 21-155 days, OR 1.75 (95% CI 1.31-2.33); for 156-355 days, OR 1.54 (95% CI 1.17-2.04); and for ≥356 days, OR 1.73 (95% CI 1.31-2.30). No association between the risk of nonvertebral fractures and recent past use or remote past use of opioids was observed. CONCLUSION: Among RA patients, the risk of nonvertebral fracture is increased in those treated with opioids.

Medial Epicondyle Fractures in Children and Adolescents: Shifting Care from General Hospitals to Children's Hospitals?

OBJECTIVES: To determine if there is a shift in the treatment of children with medial epicondyle fractures toward children's hospitals, and to explore potential confounders of any observed effect. STUDY DESIGN: The Healthcare Cost and Utilization Project Kids' Inpatient Database was used to examine the epidemiology of medial epicondyle fractures, particularly with attention to whether they were admitted to a general hospital or a children's hospital (defined as free-standing children's hospitals, specialty children's hospitals, and children's units within general hospitals). Age and insurance payer status were also collected and evaluated as potential confounders. RESULTS: The proportion of medial epicondyle hospital discharges from children's hospitals increased (from 29%-46%; P < .001), and the proportion of discharges from general hospitals declined over the study period (from 71%-42%; P < .001). Age and insurance payer status both remained consistent throughout the study period and did not contribute to this finding. CONCLUSIONS: This study demonstrates an increase in the proportion of discharges for pediatric medial epicondyle fractures from children's hospitals. Although this finding is likely multifactorial, it may represent increasing subspecialization and increasing medical liability when treating children. Children's hospitals should identify those conditions which will continue to increase in number and consider constructing clinical pathways in order to optimize delivery of care and resource utilization.

[Clinical and epidemiological characteristics of humeral supracondylar fractures in pediatric patients in a Regional General Hospital]. / Perfil clínico-epidemiológico de las fracturas supracondíleas de húmero en pacientes pediátricos en un hospital general regional.

BACKGROUND: Supracondylar humerus fractures are common in children between 5-7 years of age and more frequent in the males, 90-95% of these fractures are in extension mechanism, the urgency of immediate attention is to prevent complications and sequelae. OBJECTIVE: To establish the clinical and epidemiological profile of supracondylar humerus fractures, in a General Regional Hospital from the Instituto Mexicano del Seguro Social in Yucatan Mexico, during 2011-2013. MATERIAL AND METHODS: A cross-sectional study. Strength association was measured by odds ratios and statistical significance with chi(2) test, p value was considered in < 0.05 RESULTS: 56 cases were analyzed, the mean age was 2.6 ± 5.33 years, the mechanism of injury was falling over at home, male gender is associated with extent injure mechanism (OR 5.6, 95% CI 1.0-30.1, p = 0.03), we observed that at most time elapsed between injury and medical means more hospital days (r = 0.40; p = 0.002), surgical treatment was established in 44 cases (78.6%), 18 (40.9%) with closed technique and placement of cloves and 26 (59.1%) with open reduction, in 100% cross configuration was used, ten complications were reported. CONCLUSIONS: Supracondylar humerus fractures are a common injury in children, males are more likely to be injured by extension, and the speed in medical treatment is an important issue.

Fracturas supracondíleas de húmero en niños (1975-2001) / Humeral supracondylar fractures in children (1975-2001)

Estudio retrospectivo con objeto de establecer las características epidemiológicas de los 110 pacientes pediátricos quienes acudieron a la emergencia del Hospital José María Benítez, Edo. Aragua, con diagnóstico de fractura supracondílea del húmero, desde 1975 hasta 2001. La mayor incidencia se presentó en niños varones, con edad media de 6,33 años, 38,18 por ciento recibieron tratamiento con reducción cerrada y fijación percutánea, evolucionando satisfactoriamente sin ningún tipo de complicación

Fracturas supracondileas de codo en ninos / Supracondyleal elbow fractures in children

Se estudiaron los diferentes metodos empleados para tratamiento de las fracturas supracondileas para determinar con cual de ellos se obtenian mejores resultados. Se revisaron 750 casos de fracturas tratadas en el Hospital Infantil y en la Clinica San Rafael desde 1970 hasta 1983. Se incluyeron en el estudio 169 pacientes con un seguimiento que permitia obtener datos clinicos y radiologicos para hacer una evaluacion adecuada. 116 eran hombres (68.6%) y 53 mujeres (31.4%), el codo izquierdo se vio afectado mas que el derecho. La edad promedio fue de 6 anos con rango de 7 meses -14.6 anos. Hubo 7 fracturas abiertas (42.2%), 12 grado I(7.1%), 14 grado II (8.2%), 29 grado III (17.1%), 114 grado IV (67.4%). El 82%consulto durante las primeras 24 hs despues del trauma con un promedio de 4.8 hs y un rango de 9-40 dias. El edema y la deformidad fueron evidentes en el 70%de los casos. El 70%de las fracturas se redujeron en las primeras 6 hs y se realizaron los siguientes procedimientos: inmovilizacion en yeso BMC inmediata en 12 casos (7.1%) todos grado I. Traccion esqueletica tipo Lymann-Smith o Dunlop en 42 casos (24.8%) estando entraccion en promedio 9 dias y posteriormente un yeso BMC. Reduccion cerrada mas fijacion percutanea en 82 casos (48.5%); reduccion cerrada mas inmovilizacion en flexion maxima en 33 casos (19.5%), el tiempo promedio de hospitalizacion fue de 5.3 dias. El yeso o los clavos se retiraron en promedio a las 3 semanas. Como complicaciones se presentaron infeccion superficial (3), migracion de los clavos (2), neuropraxia pasajera (13), cubito varo (20), cubito valgo (4), lesion nerviosa definitiva (2) ...