Clinical Outcome of Metacarpophalangeal Joint Dislocation of the Thumb in Children: Case Series of 10 Patients.

OBJECTIVES: Dislocation of the metacarpophalangeal joint of the thumb in children is an uncommon entity. The aim of this study was to evaluate the clinical outcome of pediatric patients with metacarpophalangeal joint dislocation of the thumb. PATIENTS AND METHODS: Ten pediatric patients with metacarpophalangeal joint dislocation of the thumb were evaluated. Patients were studied prospectively over a period of 3 years. Parameters studied included patient demographics, type of dislocation, management, and any complications. RESULTS: Mean age of patients was 6.8 years (range: 3-12 years). Seven patients underwent closed reduction and three patients were managed by open reduction. Of the total 10 patients, excellent results were obtained in 9 patients. One of the patients who reported on the fourth day of trauma and was managed by open reduction had mild joint stiffness with a range of motion of 10 to 40 degrees at final follow-up. None of these patients had infection or instability. CONCLUSION: After thorough clinical and radiological examination, closed reduction can be done in incomplete and simple complete dislocations of metacarpophalangeal joint of the thumb. Repeated closed reduction should be avoided in complex complete injuries. Early mobilization is advised to prevent joint stiffness.

Use of external fixator versus flexible intramedullary nailing in closed pediatric femur fractures: comparing results using data from two cohort studies.

PURPOSE: Although external fixation and flexible intramedullary nailing have been extensively used in the management of pediatric femur fractures, there are very few studies, which have compared the results. The purpose of the study was to compare the results of external fixation and flexible intramedullary nailing in pediatric femur fractures. METHODS: Two groups of patients were treated by external fixator (EF) and flexible intramedullary nailing (FIN) over two different but successive time periods and results compared. The first group (EF) consisted of 45 patients, and the second group had 50 patients. RESULTS: The age in EF group ranged from 6 to 14 years (average 9.93 years), and the age in FIN group ranged from 6 to 11 years (average 7.66 years). In the EF group, fixator was removed at an average of 12.23 weeks. In the FIN group, radiographic union was evident at an average time of 10.06 weeks. Pin-site infection was common in EF group. One patient had a re-fracture in EF group, and one patient had to be re-operated in FIN group after he developed anterior angulation of more than 30°. CONCLUSION: We believe that it is the discretion of the surgeon to operate on the femur fracture using either of the treatment modalities. Further randomized studies need to be conducted between these two treatment modalities.

Minimally invasive percutaneous plate osteosynthesis for closed distal tibial fractures: a consecutive study based on 25 patients.

We studied the outcome of minimally invasive percutaneous plate osteosynthesis (MIPPO) using locking plate for closed fractures of distal tibia in a consecutive study consisting of 25 patients. Preoperative variables were age of patient, mode of trauma, type of fracture, and soft tissue status. Postoperative variables included wound status, time to union, return to activity, and AO foot and ankle score. After 1 year, all the fractures had united. The average time to union was 16.8 weeks. There were two cases of superficial infection. We also had two cases of deep infection, which required removal of hardware after the fracture was united. The average AO foot and ankle score was 83.6 in our study. We concluded that using MIPPO is a safe and effective method for the treatment for distal tibial fractures in properly selected patients.