Orthotic hip brace as an alternative for treatment of femoral fractures in children under the age of 3 years: a retrospective study.

Femoral fractures are among the most common reasons for orthopedic-related hospital admissions in children. While spica cast is recommended for most children younger than 5 years, in the last decades, Pavlik harness was proven to be a safe alternative for young children. The objective is to assess the safety, outcomes and complications of a hip abduction brace (HAB) for the treatment of femoral fractures in children under the age of 3 years. This 7-year retrospective study was conducted in a single tertiary hospital. Children aged 6-36 months diagnosed with a femoral fracture, which did not necessitate operative treatment, were included. HAB has been used as the treatment of choice for nondisplaced or minimally displaced fractures of the proximal femur as well as for both displaced and nondisplaced femoral shaft fractures. The database was composed of a total of 102 children under the age of 3 with femoral fractures. Twenty-nine (28.4%) patients were treated with HAB and the others with a spica cast. The average age (±SD) at presentation was 21.5 ± 6.1 months. The length of stay was 0.96 ± 1 day. The complication rate was 6.9%. A satisfactory outcome in terms of fracture alignment and union was reported in 100% of the patients treated with HAB. When compared with patients treated with a spica cast, the HAB group were younger, had less severe injuries, shorter lengths of stay, lower complication rates and no need for surgical intervention. HAB can be considered a safe and comfortable alternative in selected children aged 6-36 months with nondisplaced/mildly displaced proximal and diaphyseal femoral fractures.

Hemiepiphysiodesis for coronal angular knee deformities: tension-band plate versus percutaneous transphyseal screw.

INTRODUCTION: Pediatric coronal plane knee deformities can be treated surgically using hemiepiphysiodesis. The two leading techniques used for hemiepiphysiodesis are: tension-band plates (TBP) and percutaneous transphyseal screws (PETS). We hypothesized that PETS would lead to faster guided correction of angular knee deformities than TBP. MATERIALS AND METHODS: A retrospective cohort of 35 patients treated with either TBP or PETS in one medical institution was established. The cohort included both genu varum and genu valgum of both primary and secondary etiologies. We first compared the treatment groups for differences in demographic and malalignment characteristics. Then, we compared the treatment groups for differences in operation-related outcomes, radiological mechanical correction and complication rates. RESULTS: We found that the use of PETS, compared to TBP, was associated with a faster implantation surgery and a shorter interval between implantation and removal, i.e., faster correction. Furthermore, PETS were associated with faster correction rates of the mechanical axis deviation, lateral distal femoral angle and medial proximal tibial angle. No significant differences in complication rates were found between the two treatments. CONCLUSION: PETS provided a faster correction of angular knee deformities compared to TBP at similar complication rates. Hence, PETS could be considered a superior technique for hemiepiphysiodesis.