Compared outcomes after percutaneous pinning versus open reduction in paediatric supracondylar elbow fractures.

BACKGROUND: Supracondylar fractures of the elbow are common in children. Their treatment is controversial when displacement has occurred, although percutaneous pinning is usually advocated. HYPOTHESIS: In paediatric extension-type supracondylar fractures of the elbow, percutaneous pinning and crossed K-wire fixation after open reduction via the medial approach produce similar functional outcomes and complication rates. MATERIALS AND METHODS: We retrospectively reviewed the medical charts of 58 children aged 2 to 15 years who underwent surgery for extension-type supracondylar elbow fractures between 2004 and 2008. Closed reduction and percutaneous pinning was used in 33 patients with a mean age of 7 years and 11 months; open reduction with cross-wiring in 25 patients with a mean age of 7 years. Functional outcomes were assessed using Flynn's criteria. Baumann's angle was determined and postoperative complications and sequelae were recorded. RESULTS: Outcomes were satisfactory in 30 (90.9%) patients treated with percutaneous pinning and in 23 (92%) patients treated with open reduction and cross-wiring. Mean Baumann's angle at last follow-up was 73.9±5.74° after percutaneous pinning and 74.76±4.07° after open reduction and cross-wiring. Postoperative complications consisted of reoperation in six (10.3%) patients and iatrogenic nerve injury in two (3.4%) patients. Cubitus varus occurred in two (6.06%) patients after closed treatment and in one (4%) patient after open treatment. In each group, three (5.1%) patients had greater than 15° of motion range limitation. DISCUSSION: In children with extension-type supracondylar elbow fractures, outcomes are similar with percutaneous pinning and with open reduction via the medial approach followed by cross-wiring. LEVEL OF EVIDENCE: Level IV, retrospective study.

[Prolapse of the urethral mucosa in young girls from the Ivory Coast]. / Le prolapsus muqueux de l'urètre de la fillette en Côte-d'Ivoire.

In this retrospective study covering a nine-year period, 65 cases have been analyzed of prolapse of the urethral mucosa in young girls (aged between six weeks and 14 years) from the Ivory Coast. The aim of this study was to describe the etiology of this disorder, and to demonstrate the utility of ambulatory surgery. The main reason for the detection of this disorder was mild genital hemorrhage in 37 cases, which was related to rape in eight instances and to other types of trauma in nine cases, thereby raising serious medico-legal problems. Various forms of treatment were used (medical and/or surgical). The medical approach consisted of antibiotic and antiinflammatory treatment, combined with a local antiseptic. Two surgical approaches were adopted, either the Doria method in which the necrosed tissue is spontaneously eliminated after three to five days, or surgical excision under general anesthesia of the prolapsed mucosa followed by seromucosal stitching. The results were satisfactory in all cases, and in the surgically operated cases no complications or recurrence were noted at one-year follow-up.