Analysis of the factors affecting school attendance in pediatric fractures.

OBJECTIVE: This study aimed to examine the average duration of school absence according to the type of fracture and the factors affecting the duration of absence in children who had difficulty going to school after an acute orthopedic injury. METHODS: Patients between the ages of 6 and 17 who applied to the emergency department of our hospital and were treated for orthopedic trauma during a teaching period between September 2022 and December 2022 were examined. This study was designed prospectively. All school-aged patients with upper or lower extremity fractures requiring hospitalization or outpatient treatment were included in this study. Information about school absences and school starting dates were recorded at the outpatient clinical presentations of these patients. RESULTS: A total of 126 patients were included in this study. The mean age of the patients was 11.7 (range=6-17) years. The gender ratio was determined as F/M=20/106. The average time absent from school was 14.7 (range=2-61) days. Distal radius fractures were the most common upper extremity fractures; the mean time away from school was 7.9 days. In lower extremity fractures, lateral malleolar fracture was the most common complaint, and the mean duration of absence was calculated as 21.8 days. The periods of absence were mainly determined by the family or the child. CONCLUSION: One of the critical findings in this study was that rest periods were primarily determined by the parents and/or the child and not by the physician. The need to use crutches and/or transportation difficulties were other reasons for the absence. For these reasons, teachers and school management should be sensitive to the adverse effects of absenteeism on the child's success and provide facilitating support and home education opportunities when necessary. LEVEL OF EVIDENCE: Level II, Prognostic study.

Analysis of the Intra- and Inter-observer Reliabilities of Delbet Classification: Is Simplification Required.

Objective: This study aims to investigate the intra- and inter-reliabilities of Delbet classification and whether simplifying the classification improves reliability. Method: The Radiographs of 58 patients under 16 years old diagnosed with pediatric hip fractures between January 2012 and January 2020 were evaluated. Two separate Microsoft® PowerPoint (PPT) presentations consisting of 58 slides for Delbet's classification and its simplified form were prepared in which the order of cases was randomized and blinded. Then five orthopedic surgeons with different years of experience (more than 15 years of surgical experience were accepted experienced group) in pediatric trauma surgery evaluated the presentations two times one month apart. Results: In the inter-observer reliability analysis, a moderate agreement for the classical Delbet classification and a substantial agreement for the simplified Delbet classification was found in both evaluations. As a result of the intra-observer reliability analysis, there was substantial agreement in four observers, moderate agreement in one observer for the classical Delbet classification and substantial agreement in two observers, very good agreement in three observers for the simplified Delbet classification. The experience was not effective on agreement levels in the intra-observer reliability analysis of the classical Delbet classification system. The inter-reliability values of the less experienced group in the simplified classification were much higher than the classical Delbet classification. Conclusion: The simplification of the Delbet classification provides a significant increase in inter-observer reliability levels, especially in less experienced orthopedics and traumatology specialists, and a significant increase in intra-observer reliability levels. Level of Evidence: Level III, diagnostic study.

The clinical results of lower trapezius tendon transfer with the peroneus longus allograft augmentation combined with interpositional repair with fascia lata in massive irreparable rotator cuff tears.

OBJECTIVES: To investigate the clinical results of lower trapezius (LT) tendon transfer and interpositional repair that were performed simultaneously in patients with massive irreparable rotator cuff tears. METHODS: Between 2018 and 2020 years, 16 patients with massive irreparable rotator cuff tears that were treated with LT tendon transfer and interpositional repair at the same time were included in this study. The mean follow-up period was 29±3 months (24-39 months) and the mean age of patients was 62±9 years (42-73 years). The acromio-humeral distance, active range of motions, Visual Analog Scale (VAS) scores, University of California-Los Angeles (UCLA) scores and Constant-Murley scores were made preoperatively and at the final follow-up. RESULTS: At the final follow-up, forward flexion was increased from 109˚±24.7 to 144˚±22.21 (p=0.005), abduction from 60˚±16.33 to 135˚±16.33 (p=0.005) and external rotation from 12˚±16.87 to 35˚±14.34 (p=0.005). Total UCLA scores were 5.9±2.13 to 22.7±5.29 (p=0.005), Constant-Murley scores were 24±9.43 to 50.2±14.28 (p=0.008), VAS scores were 6.1±1.1 to 2.4±1.35 (p=0.007), mean acromio-humeral distances were 4.64±0.85 mm (3.42-6.23 mm) to 6.58 mm (5.25-8.21 mm) (p=0.005) preoperatively and at the final follow-up. Except one patient who had a frozen shoulder any significant complication was detected. CONCLUSION: Adding interpositional repair to the LT tendon transfer in patients with posterior superior irreparable rotator cuff tear seems to have satisfactory short to mid-term clinical outcomes without an increase in complications.

Can a coracoclavicular screw added to the clavicular hook plate reduce subacromial stress? A finite element analysis.

OBJECTIVES: The aim of this study was to investigate the stresses on the plate and the clavicle in the standard clavicular hook plate model and the clavicular hook plate models with a coracoclavicular (CC) screw by finite element analysis (FEA). MATERIALS AND METHODS: The FEA models were created with the combination of acromion, clavicle, coracoid process, 8-hole clavicular hook plate and screw components. Model 1 was created as a standard clavicular hook plate model and plates were implanted to the clavicle and the acromion by six locking screws. Model 2 was created by a cortical screw placed in the coracoid process through the third hole of the plate (CC screw) and fixation of hook plate by five locking screws. The upward-pull force was applied to clavicle at the insertion of sternocleidomastoid muscle with three axes. The stress exerted by acromion on the hook of the plate, stresses on the plate, clavicle, and CC screw were analyzed. RESULTS: When the screw holes were compared, in Model 1, the highest stress was found in the last hole of the plate. In Model 2, the highest stress was detected on the CC screw. The stress on the clavicle was found to be 0.14 Mpa in Model 1 and 0.21 Mpa in Model 2. In Model 1 and Model 2, the stress exerted by acromion on the subacromial part of the plate was found to be 2.05 KPa and 1.66x10-6 KPa, respectively. CONCLUSION: The results of this study show that addition of CC screw to the standard clavicular hook plate shares the loading and reduces the stress on the hook of the plate.

Flexion type supracondylar humerus fractures: 12 year experience of a pediatric orthopedics clinic.

OBJECTIVES: This study aims to review flexion type supracondylar humerus fractures in children and treatment options. PATIENTS AND METHODS: Forty-seven patients (26 males, 21 females; mean age 8.6±3.2 years; range 4 to 15 years) who admitted to and were hospitalized in a pediatric orthopedics clinic between January 2002 and January 2014 due to flexion type supracondylar humerus fracture were included in this retrospective study. Fractures were classified according to Wilkins modification of Gartland system. Closed reduction and percutaneous pinning (CRPP) were administered in all patients with type 2 and 3 fractures. An overhead traction or open reduction was applied when closed reduction could not be achieved with three manipulations. Patients were evaluated clinically and radiologically. The results were graded according to Flynn criteria. RESULTS: Four patients with type 1 fracture were treated conservatively. Of the remaining patients, we were able to perform CRPP successfully in 36 (83.7%). While six patients (14%) were treated with open reduction and internal fixation, one patient (2.1%) was treated with overhead traction. The results were excellent or good in 44 patients (93.7%). CONCLUSION: Compared with extension type fractures, these fractures are seen in older children and are rarer. One should be prepared to perform open reduction especially for type 3 fractures. In our study, results of patients with type 3 fractures treated with CRPP were superior.

How are outcomes affected by performing a one-stage combined procedure simultaneously in bilateral developmental hip dysplasia?

PURPOSE: The aim of this study was to compare the outcomes of one-stage combined surgical treatment in children of unilateral and bilateral developmental hip dysplasia diagnosed after walking age. METHODS: We reviewed 24 patients who underwent one-stage combined surgery for DDH diagnosed after walking age. Group I consisted of 12 patients with bilateral disease who underwent bilateral operation at one operative setting. Group II consisted of 12 patients with unilateral disease. Pre-operatively the hips were classified according to Tönnis classification. Acetabular dysplasia was evaluated by measuring acetabular index (AI) angles pre-operatively. The acetabular improvements with time regarding AI was noted immediately postoperatively, every six months, and at the final follow-up examination. RESULTS: Mean follow up of the bilateral group I and group II were 54.8 months (range 20-84 months) and 52.6 months (24-80), respectively. There were no statistically significant differences between immediate postoperative and final follow up acetabular index improvement rates in both groups. Also there was no significant difference when both hips were compared in group I. The clinical final outcome of both groups and within group I was similar. CONCLUSIONS: Simultaneous combined surgery is a challenging but worthwhile procedure for late diagnosed patients with bilateral DDH. The short-mid term outcomes of the procedure are encouraging.

Bilateral calcaneal stress fractures: a case report.

The majority of plantar heel pain is diagnosed as plantar fasciitis or heel spur syndrome. When history or physical findings are unusual or when routine treatment proves ineffective, one should consider an atypical cause of heel pain. Stress fractures of the calcaneus are a frequently unrecognized source of heel pain. In a normal population, the possibility of calcaneal stress fractures must be borne in mind with patients who have bilateral heel pain. When a stress fracture is considered, clinicans have different imaging options. First of all, x-rays must be used to evaluate for any visible osseous pathology. If plain films are inconclusive, the clinician can proceed with a bone scan or Magnetic Resonance Imaging. In the literature, calcaneal stress fractures are mostly reported in soldiers or athletes, but our case is one of a 44-year-old housewife with bilateral heel pain treated as Achilles tendinitis and plantar faciitis for a long time. Her final diagnosis was bilateral calcaneal fracture by Magnetic Resonance Imaging.