Outcomes of Adolescent T-condylar Fractures: Kids Do Not Always Make You Look Good.

BACKGROUND: Optimal treatment for pediatric and adolescent T-condylar fractures remains poorly understood. We sought to assess how functional outcomes and range of motion (ROM) after surgical fixation of T-condylar fractures are affected by patient and surgical factors. METHODS: This is a retrospective cohort study of 52 patients with operatively treated T-condylar fractures at a single tertiary pediatric referral center between 2003 and 2021. All patients younger than 18 at the time of injury with a radiographically confirmed diagnosis were included. RESULTS: Fifty-two T-condylar fractures were included, with a mean patient age of 12.9 years (SD, 2.8). The cohort was 65% male. Nine (19%) fractures were open, 46% (24/52) were AO type C2, and 33% (17/52) occurred in skeletally mature individuals. The surgical approach was through olecranon osteotomy in 29% (15/52) of patients, and fixation included anatomically specific plates and screws in 42% (22/52) of patients. In our cohort, 46% (24/52) achieved good outcomes based on Jarvis ROM criteria and 42% (22/52) achieved good to excellent results based on Roberts functional criteria. The median loss of ROM was 58 degrees at 6 weeks, 20 degrees at 3 and 6 months, and 8 degrees at 1 year postoperatively. We observed a complication rate of 54% (28/52). Patients undergoing adult-type plate fixation had better postoperative range of motion at 6 weeks (ROM loss 52 vs. 80 degrees, P =0.03) and 3 months (10 vs. 35 degrees P =0.004) compared with pediatric-type fixation and trended towards better functional outcomes. We did not identify significant differences in functional outcome scores or complication rates with respect to surgical approach or skeletal maturity. CONCLUSIONS: Surgical fixation of pediatric and adolescent T-condylar fractures achieved a good to excellent functional outcome in only a minority of patients (46% Jarvis / 42% Roberts) with a high rate of postoperative complications (54%). Future work is needed to elucidate optimal treatment to minimize complications and achieve the best functional outcomes in these challenging fractures. LEVEL OF EVIDENCE: Level-IV.

Peer Leader Reflections on Promoting Discussion in Peer Group-Learning Sessions: Reflective and Practiced Advice through Collaborative Annual Peer-Advice Books.

As research has shown, collaborative peer learning is effective for improving student learning. Peer-led team learning (PLTL) is one well-known collaborative-group approach in which groups are facilitated by trained undergraduate peer leaders. This paper contributes to the literature on peer-leader training by examining how peer leaders for a large introductory science course translate their training into practice during their sessions. By conducting qualitative analysis on annual advice books written by emergent peer leaders, we examined the practiced advice and strategies of these peer leaders as they facilitate PLTL groups in a university-level general chemistry course. These advice books are passed on to future peer instructors, creating a community of practice between new and more experienced peer leaders. From the analysis, we discovered that peer leaders focus on developing robust student-student discussion during complex problem solving by 1) creating a community-oriented social and intellectual environment, 2) adapting their tactics and the collaborative-learning strategies to balance different personalities and promote equal participation among all students, and 3) modifying collaborative group approaches when facilitating their sessions. Also, in their correspondence across cohorts, peer leaders provided near-peer support to one another. These annual books disseminate practiced advice between peer-leader generations and are used during new peer-leader training.