Incidence, treatment techniques, and results of distal humeral coronal shear fractures in children and adolescents-a multicenter study of the German Section of Pediatric Traumatology (SKT).

PURPOSE: Distal humeral coronal shear fractures (CSF) are uncommon and may be challenging to treat due to their size, location, and intraarticular nature. The purpose of this study was to analyze treatment concepts of this rare entity in the growing age. METHODS: Based on a multi-center data analysis we retrospectively reviewed patients below 16 years of age with CSF treated at 13 high-volume pediatric trauma centers. RESULTS: Data from 51 patients with a CSF treated between 01/2012 and 12/2021 were analyzed. The mean age was 12.9 years (10-15), and there was a trend towards male patients (30: 21). The initial diagnostic approach was conventional X-ray in all cases. In addition, a CT scan (n = 33), MRI scan (n = 9), or both (n = 3) were performed. All fractures except two showed relevant displacement. Consequently, only two cases received conservative treatment consisting of plaster immobilization. Surgical treatment was performed in 49 cases consisting of open or mini-open reduction and metal/resorbable screw osteosynthesis (n = 39), plates (n = 4), K-wire pinning (n = 6), and others (n = 6), as well as combinations. In 1 case open reduction without osteosynthesis was performed. Postoperative additional plaster immobilization was performed in 40 cases (for a mean of 19 days (2-42)), physiotherapy was initiated in 29 cases, and metal removal was performed in 28 cases (after a mean of 18.1 weeks (4-44)). After a mean follow-up of 9.9 months (2-25), elbow axial deviation (5° valgus) was observed in one case and mild loss of elbow ROM in six cases (11.7%). Complications included revision of the osteosynthesis because of insufficient articular reconstruction (n = 4), removal of a free joint body (n = 1), an osteonecrosis (n = 1), and a cartilage defect (n = 1). CONCLUSION: In pediatric patients CSFs start to occur at the age of 10, but are typically observed at the age of 13 and older. Because of their intraarticular nature and predilection toward displacement, these fractures are frequently treated operatively. The surgical strategy requires open reduction and anatomic reconstruction of the articular surface. Stable internal fixation, most often achieved by screws, permits early mobilization and leads to good outcomes in most cases. This is presumably due to the fact that mostly simple fractures occur in children and mostly complex injuries in older adults. LEVEL OF EVIDENCE: III, retrospective analysis.

Identifying children and adolescents with cognitive dysfunction following mild traumatic brain injury--preliminary findings on abbreviated neuropsychological testing.

OBJECTIVE: Studies on cognitive function in paediatric patients suffering head trauma suggest neuropsychological impairment even after mild traumatic brain injury (MTBI). The present study examined the feasibility of abbreviated neuropsychological testing in different settings in children and adolescents following MTBI. METHODS: Within the scope of two prospective studies on psychosocial and cognitive outcome, 71 school-aged children with mild, moderate or severe TBI were assessed. In addition, 15 healthy children were included in the study. The abbreviated instrument comprises three standardized tests measuring attention and memory functions (Digit Symbol, Digit Span, learning trials of the German Auditory Verbal Learning Test). Impairment rates were calculated according to a defined cut-off score for clinically significant cognitive impairment. RESULTS: Abbreviated testing could easily be implemented both in the acute and post-acute clinical setting. Out of the children with MTBI, 12% (shortly after injury) and 30% (2 months after injury), respectively, were classified as cognitively impaired. Following moderate or severe TBI, impairment occurred in 50% of the patients. Healthy children showed the best performance, while children with severe TBI performed worst. CONCLUSION: Results suggest that abbreviated testing allows detection of MTBI-related cognitive dysfunction. Identified children should be referred to a clinical neuropsychologist for comprehensive assessment.

[Arthroscopically assisted internal fixation of avulsion fractures of the anterior cruciate ligament during childhood and adolescence]. / Die arthroskopisch assistierte Refixation bei knöchernen Ausrissen des vorderen Kreuzbands im Kindes- und Jugendalter.

OBJECTIVE: Minimally invasive reduction and internal fixation of anterior tibial spine and anterior cruciate ligament (ACL) without harming knee joint cartilage and physis of the proximal tibia. INDICATIONS: Anterior tibial spine fractures type II-IV according to Meyers/McKeever. CONTRAINDICATIONS: ACL tears. Fractures of the tibial plateau. Fractures involving the growth plate (Aitken I-III). SURGICAL TECHNIQUE: 1. Diagnostic arthroscopy and drainage of the knee joint. Search for additional injuries (menisci, knee joint cartilage, collateral ligaments, posterior cruciate ligament). 2. Arthroscopy-assisted reduction of anterior tibial spine fragment. 3. Epiphyseal internal fixation with Kirschner wires or cannulated screws according to fragment size. POSTOPERATIVE MANAGEMENT: Full weight bearing as tolerated after wound healing (day 7 after surgery) in 20 degrees of knee flexion (orthesis or ankle-sparing cast tutor). X-rays postoperatively and after 3 and 6 weeks. Passive and active physiotherapy (extension and flexion without weight bearing) 3-4 weeks postoperatively according to patient's age, weight and compliance. Weight bearing in knee flexion (stairs) 6-8 weeks postoperatively. RESULTS: 19 patients were treated from 2001 to 2005 at an age of 7-14 years. All patients achieved free range of motion without pain or growth disturbances. Three patients developed slight joint laxity (anterior drawer test) which did not affect mobility, sports performance, joint surface or menisci on clinical evaluations conducted at least 1 year postoperatively. One patient had bony healing of the tibial spine in slight dislocation without impingement or decrease of range of motion within the knee joint.

Proline-rich transcript of the brain (prtb) is a serum-responsive gene in osteoblasts and upregulated during adhesion.

To characterize the temporal expression of genes that play a functional role during the process of osteoblast adhesion, we used differential display (DD-PCR) on mRNA isolated from attached vs. suspended osteoblasts. A 200-bp fragment displaying upregulated expression after 30 and 60 min adhesion was isolated, sequenced, and showed 97% homology to prtb, previously showed to be expressed in mouse brain. Northern analysis confirmed a two-fold increase in prtb message during adhesion to tissue culture polystyrene, both in the presence or absence of surface-adsorbed serum proteins. Serum stimulation alone was also able to induce prtb expression, although to a lesser extent, in suspension cells. Strong prtb expression was also detected in both brain and bone of adult rats. Furthermore, prtb expression analysis during MC3T3-E1 cell differentiation revealed high expression levels independent of proliferation (day 0-7), matrix maturation (day 7-14), and mineralization (day 14-31). Time course analysis of prtb expression during adhesion of sensitized osteoblasts to serum-protein coated surfaces showed robust mRNA expression at 5 min post-plating and a peak at 10 min. The two known serum-inducible immediate early genes c-fos and c-jun showed similar expression kinetics, with c-jun mRNA levels peaking at 15 min and c-fos at 20 min. Based on these data, we hypothesize that prtb may function as an immediate early, serum-responsive, and adhesion-inducible gene with possible involvement in processes such as cell cycle control, adhesion, and proliferation.