Higher Soong grade predicts flexor tendon issues after volar plating of distal radius fractures - a retrospective cohort study.

BACKGROUND AND PURPOSE: Soong classification is used to estimate volar locking plate prominence and evaluate the risk for flexor tendon ruptures after surgical treatment of distal radius fractures (DRFs). However, the scientific community has questioned the Soong classification due to lacking evidence. Therefore, this study aimed to evaluate the accuracy of Soong grading as a predictor for flexor tendon issues and plate removal. PATIENTS AND METHODS: We performed a retrospective single-center review of adult distal radius fracture patients treated with a volar locking plate between 2009 and 2019. In total, 2779 patients were included in the study. The primary outcome was a flexor tendon issue (flexor tendon rupture, tendinitis, or flexor irritation), whereas plate removal was a secondary outcome. Using Soong grade 0 as a reference, we used univariable and multivariable logistic regression to calculate odds ratios (OR) with 95% confidence intervals (CI) for flexor tendon issues and plate removal. RESULTS: In total, 756 (27%) patients were graded as Soong 0, 1679 (60%) Soong 1, and 344 (12%) Soong 2, respectively. There were 32 (1.2%) patients with flexor tendon issues, of which 4 were flexor tendon ruptures, 8 tendinitises, and 20 flexor irritations. The adjusted OR for flexor tendon issues was 4.4 (CI 1.1-39.7) for Soong grade 1 and 9.7 (CI 2.2-91.1) for Soong grade 2. The plate was removed from 167 (6.0%) patients. Soong grade 1 had a univariable OR of 1.8 (CI 1.2-2.8) for plate removal, and Soong grade 2 had an OR of 3.5. (CI 2.1-5.8), respectively. CONCLUSION: Flexor tendon ruptures are rare complications after the volar plating of DRFs. A higher Soong grade is a risk factor for flexor tendon issues and plate removal. TRIAL REGISTRATION: The trial was retrospectively registered.

Epidemiology and risk factors for premature physeal closure in distal femur fractures.

BACKGROUND AND PURPOSE: Premature physeal closure (PPC) is a common and concerning complication to distal femoral fractures as the distal growth plate accounts for 70% of the growth of the femur. The literature is not unanimous in determining the risk factors of PPC, and the epidemiological characterization of these fractures is limited. Our aim was to calculate the population-based incidence and investigate risk factors for PPC in these fractures. PATIENTS AND METHODS: In this register-based study, between 2014 and 2021, 70 children with distal femoral physeal fractures presented to our hospital. Demographic data, and fracture- and treatment-related details were collected using the Kids' Fracture Tool. A directed acyclic graph (DAG) was constructed to determine confounding factors used in the risk analysis. RESULTS: Physeal fractures of the distal femur occurred with an annual incidence of 6/105 children, and a resulting PPC occurred in 16/70 (23%) with an annual incidence of 1.3/105 children. In multivariable analysis, dislocation exceeding 10 mm was a risk factor for PPC (OR 6.3, CI 1.4-22). CONCLUSION: One-fourth of distal femoral physeal fractures developed PPC. Greater dislocation and higher injury energy were significant risk factors, whereas choice of fracture treatment was not an independent risk factor. All patients with PPC belonged in the age group 11-16 years.

Peri-implant fracture: a rare complication after intramedullary fixation of trochanteric femoral fracture.

INTRODUCTION: Trochanteric femoral fractures are among the most common operatively treated fractures. Intramedullary fixation has become the treatment of choice in many centers around the world. Nevertheless, the knowledge of rare complications of these fractures is limited. In this study, the incidence and treatment strategies for peri-implant fractures (PIF) were assessed. MATERIALS AND METHODS: A single-center retrospective cohort study was done on 987 consecutive operatively treated trochanteric fractures. PFNA cephalomedullary nail was used as a fixation method. All patients were followed up from patient records for peri-implant fractures. Plain radiographs as well as different salvage methods were analyzed and compared. RESULTS: The total rate of peri-implant fractures was 1.4% (n = 14). The rate of PIF for patients treated with short (200 mm) nails, intermediate-length (240 mm) nails, and long nails was 2.7% (n = 2), 1.5% (n = 11), and 0.7% (n = 1), respectively (ns, p > 0.05 for difference). Treatment of choice for PIF was either ORIF with locking plate (57%, n = 8) or exchange nailing (43%, n = 6). None of the PIF patients needed additional surgeries for non-union, malunion, or delayed union. CONCLUSIONS: A PIF is a rare complication of intramedullary fixation of trochanteric fractures. It can be treated with either locking plates or exchange nailing with sufficient results. There are no grounds for favoring long nails to avoid PIFs.

Epidemiology and management of proximal tibia fractures in children and adolescents: a population-based study based on the Kids' Fracture Tool.

BACKGROUND AND PURPOSE: Proximal tibial fractures are infrequent injuries in children, and the literature on epidemiology, associated injuries, and management is limited. We calculated a population-based incidence and described the characteristics of proximal tibial fractures in children in terms of complications and management. PATIENTS AND METHODS: This is a retrospective study over a 6-year-period during including 241 children with proximal tibial fractures who presented to our university hospital. Demographic and fracture-related data was collected from the Kids' Fracture Tool. The number of children during the study period was collected from statistical yearbooks of the City of Helsinki to estimate annual incidence. RESULTS: Extra-articular fractures (129/241) peaked at the age of 3 and tibial tubercle (42/241) and intra-articular fractures (70/241) peaked at the age of 15. Annual incidences were estimated to be 3.4/100,000 children and 22/100,000 children in the age group of 13-16 years for ACL avulsions, and 3.8/100,000 children and 21/100,000 children in the age group of 13-16 years for tibial tubercle fractures. The incidence of vascular compromise (0%) and compartment syndrome was low (0.4 %, 1/241). CONCLUSION: Proximal tibial fractures present with a bimodal distribution, with extra-articular fractures peaking at the age of 3 years and fractures of the tibial tuberosity and intra-articular fractures peaking at the age of 15 years. Additionally, associated compartment syndrome and vascular compromise was not as common as previously reported.

Physeal Fractures of Distal Tibia: A Systematic Review and Meta-analysis.

BACKGROUND: Fractures involving the distal tibia growth plate are common in children. Injury or treatment that damages the growth plate may result in progressive angular deformity or leg length discrepancy. There is no consensus on treatment and follow-up of these injuries. This study aims to describe which factors increase the risk of premature physeal closure (PPC). MATERIAL AND METHODS: A systematic review and meta-analysis were performed. Altogether 395 articles were reviewed, and ultimately 12 of them were found eligible, comprising 1997 patients. The most usual type of fracture was Salter-Harris (SH) II (n=855, 49%) followed by SH III (n=296, 17%) and SH I (n=261, 15%). The risk of PPC according to number of reduction attempts, method of treatment, and residual displacement was the primary outcome. RESULTS: The total rate of PPC was 13% (n=245). The PPC rate varied from 0.2% to 42% across the studies. Patients with SH IV fractures were most likely to develop PPC (20%), followed by those with SH II (12%) (P<0.05) and repeated (>2) reduction maneuvers were associated with a higher risk of PPC (pooled odds ratio, 8.5; 95% confidence interval, 6.3-12.17; P<0.05). Open reduction was associated with a lower risk of PPC when analyzing only displaced fractures (odds ratio, 0.63; 95% confidence interval, 0.38-0.91; P<0.05). INTERPRETATION: This meta-analysis implies that residual displacement after reduction is the most significant factor in predicting PPC. It seems that open reduction might reduce the PPC rate among patients with dislocated fractures. In addition, there is some evidence that a higher number of reduction attempts correlates positively with the risk of PPC.

Most surgeons still prefer to reduce overriding distal radius fractures in children.

Background and purpose - Traditionally, overriding distal radius fractures in children have been reduced and immobilized with a cast or treated with percutaneous pin fixation. There is recent evidence that these fractures heal well if immobilized in the bayonet position without reduction. We evaluated the present treatment of these fractures.Methods - A questionnaire including AP and lateral radiographs of overriding distal radius fractures in 3 pre-pubertal children was answered by 213 surgeons from 28 countries. The surgeons were asked to choose their preferred method of treatment (no reduction, reduction, reduction and osteosynthesis), type and length of cast immobilization, and the number of clinical and radiographic follow-ups.Results - Of the 213 participating surgeons, 176 (83%) would have reduced all 3 presented fractures, whereas 4 (2%) would have treated all 3 children with cast immobilization without reduction. Most reductions (77%) would have been done under general anesthesia. Over half (54%) of the surgeons who preferred anesthesia would have fixed (pins 99%, plate 1%) the fractures. An above-elbow splint or circular cast was chosen in 84% of responses, and the most popular (44%) length of immobilization was 4 weeks. Surgeons from the Nordic countries were more eager to fix the fractures (54% vs. 31%, p < 0.001) and preferred shorter immobilization and follow-up times and less frequent clinical and radiological follow-ups compared with their colleagues from the USA.Interpretation - Most of the participating surgeons prefer to reduce overriding distal radius fractures in children under anesthesia. There is substantial lack of agreement on the indications for osteosynthesis, type of cast, length of immobilization, and follow-up protocol.

Routine radiographic follow-up is not necessary after physeal fractures of the distal tibia in children.

Background and purpose - Unnecessary radiographic and clinical follow-ups are common in treatment of pediatric fractures. We hypothesized that follow-up radiographs are unnecessary to monitor union of physeal fractures of the distal tibia.Patients and methods - All 224 (147 boys) children under 16 years old treated for a physeal fracture of the distal tibia during a 5-year period (2010-14) in Helsinki Children's Hospital were included in this study. Peterson type II fractures comprised 55% and transitional fractures (Tillaux and Triplane) 20% of all injuries. Fracture displacement and alignment was measured. Type and place of treatment was recorded. Number of follow-up radiographs and outpatient visits was calculated and their clinical significance was assessed.Results - 109 children had fractures with < 2 mm displacement and no angulation. The other 115 children's mean fracture displacement was 6 mm (2-28). 54% of all children were treated by casting in situ in the emergency room, 20% with manipulation under anesthesia and 26% with surgery (internal 57, external fixation 2). Median 3 (1-7) follow-up appointments and median 3 (0-6) radiographs were taken. Follow-up radiographs at or before cast removal did not alter treatment in any of the patients. 223 patients' fractures healed within 4-9 weeks in good alignment (≤ 5° angulation).Interpretation - Routine radiographic follow-up is unnecessary to monitor alignment and union of physeal fractures of the distal tibia.

Traumatic hip dislocation in pediatric patients.

Traumatic hip dislocations constitute approximately 5% of all pediatric dislocations and typically result from high-energy trauma. However, pediatric hip dislocations can also occur as a result of minor energy due to flexibility of the joint structures of the immature hip. Children with a posteriorly dislocated hip present with the injured hip in flexion, adduction and internal rotation. Spontaneous relocation of hip dislocation is frequent and a thorough physical examination of the whole lower extremity is always required to reduce the chance of missing hip dislocation/subluxation. Dislocated hips should be emergently repositioned under general anesthesia. MRI is indicated after reduction and in patients after spontaneous relocation if labral interposition is suspected in plain radiographs.

Heel pain in young athletes - not always Sever's Disease: A Narrative Review.

Heel pain is a prevalent issue in young athletes, often arising from overuse and increased sporting demands. While Sever's Disease is the predominant cause, various other entities, including stress-related injuries and pathologies like tumors and bone lesions, contribute to this condition. The complex hind foot anatomy, encompassing ossicles, physis, and soft tissues, may lead to heel pain. This study aims to provide physicians with a clinically oriented narrative review of adolescent heel pain, supported by illustrative cases. CONCLUSION: This study aims to offer physicians a comprehensive understanding of the concepts surrounding heel pain in adolescents. By presenting clinically relevant information and illustrated cases, it seeks to enhance medical practitioners' ability to diagnose and manage heel pain effectively in this specific demographic.

Adverse Events After Surgical Treatment of Adult Diaphyseal Forearm Fractures: a Retrospective Analysis of 470 Patients.

Background: The incidence of and risk factors for adverse events after internal fixation of diaphyseal forearm fractures have not been well defined in the current literature. The objective of this study was to estimate the incidence of adverse events after diaphyseal forearm fracture surgery in adults and explore potential risk factors for adverse events. Methods: We conducted a retrospective, multicenter, cohort study in which we evaluated all diaphyseal forearm fractures between 2009 and 2019 in patients presenting to 4 trauma hospitals in southern Finland. Patients <16 years of age and fracture-dislocations were excluded. There were 470 patients included in this study. Patient records were evaluated to identify and analyze adverse events. Results: There were 202 patients with both-bone fractures, 164 patients with isolated ulnar fractures, and 104 patients with isolated radial fractures. In total, 146 patients (31%) experienced an adverse event; 83 (18%) had major adverse events (persistent or requiring surgical intervention). The patients underwent procedures performed by 185 different surgeons. The median number of operations for a single surgeon was 2 (range, 1 to 12). The most common major adverse events were plate and screw-related issues (6%), nonunion (5%), persistent nerve injuries (4%), and refractures (4%). Higher body mass index, Gustilo-Anderson type-II open fractures, both-bone fractures, isolated radial fractures, and operations performed by junior residents were found to be risk factors for adverse events in the multivariable analysis. Conclusions: Adverse events after diaphyseal forearm fracture surgery are common. We recommend concentrating these operations in a limited team of surgeons and restricting inexperienced surgeons from operating on these fractures without supervision. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Factors affecting hand cosmesis and the aesthetic impact of surgery on congenital hand differences in Finland.

We assessed the appearance and cosmetic impact of surgery in congenitally different hands in Finland. A questionnaire was sent to 1165 respondents (786 female) with a mean age of 33 years (range 3-84). Participants were shown nine image pairs and seven pairs of pre- and postoperative images twice in a random order and asked to choose the more cosmetically pleasing one. We found that the appearance and number of fingers had an important aesthetic role, with higher number and more normal appearing digits consistently scoring higher than its counterpart (range 59-99%). Postoperative appearances were perceived as better than preoperative ones in syndactyly (98%), thumb duplication (92%), cleft hand (93%) and radial dysplasia (99%). Toe transfer and pollicization had little impact on cosmesis. This study demonstrated that surgery could improve cosmesis in congenitally different hands and overall, most respondents prefer an appearance that is as close as possible to normality. Level of evidence: IV.

Intramedullary Fixation of Trochanteric Fractures Can Be Safely Performed by Senior Residents Without Immediate Consultant Supervision.

OBJECTIVE: To assess the safety of senior residents performing trochanteric hip fracture surgery without immediate consultant supervision DESIGN: A retrospective chart review of trochanteric hip fractures (AO-OTA 31-A) operated in a single center between years 2011 and 2016 (inclusive). Operations were divided into three groups: Group 1 - surgeon was a senior resident without any immediate supervision; Group 2 - surgeon was a consultant and Group 3 - surgeon was a senior resident supervised by a consultant. The follow-up period was a minimum of 2 years or until death. All re-operations and surgical related mortality were assessed. SETTING: Helsinki University Hospital, Finland. A tertiary level trauma center. PARTICIPANTS: 987 consecutive trochanteric fractures on 966 patients treated by operative fixation of an intertrochanteric fracture with an intramedullary nail between 2011and 2016 (inclusive). RESULTS: The total number of reoperations was smaller in Group 1 where the surgeon was a senior resident without any immediate supervision compared to Group 2 where the surgeon was a consultant (5.5 % vs 8.8 %, p < 0.05). There were no significant differences in mortality or length of surgery. The total rate of mechanical complications was 2.0 %, with no significant differences between groups. The observed blade cut-out rate was low: 1.3 %, suggesting a good overall quality of surgery. CONCLUSIONS: Senior residents can safely perform intramedullary nailing of trochanteric fractures without immediate supervision.

A systematic review of surgical intervention in the treatment of hamstring tendon ruptures: current evidence on the impact on patient outcomes.

Hamstring injuries are among the most common muscle injuries. They have been reported in many different sports, such as running, soccer, track and field, rugby, and waterskiing. However, they are also present among the general population. Most hamstring injuries are mild strains, but also moderate and severe injuries occur. Hamstring injuries usually occur in rapid movements involving eccentric demands of the posterior thigh. Sprinting has been found to mainly affect the isolated proximal biceps femoris, whereas stretching-type injuries most often involve an isolated proximal injury of the semimembranosus muscle. The main cause of severe 2- or 3-tendon avulsion is a rapid forceful hip flexion with the ipsilateral knee extended. Most hamstring injuries are treated non-surgically with good results. However, there are also clear indications for surgical treatment, such as severe 2- or 3-tendon avulsions. In athletes, more aggressive recommendations concerning surgical treatment can be found. For a professional athlete, a proximal isolated tendon avulsion with clear retraction should be treated operatively regardless of the injured tendon. Surgical treatment has been found to have good results in severe injuries, especially if the avulsion injury is repaired in acute phase. In chronic hamstring injuries and recurring ruptures, the anatomical apposition of the retracted muscles is more difficult to be achieved. This review article analyses the outcomes of surgical treatment of hamstring ruptures. The present study confirms the previous knowledge that surgical treatment of hamstring tendon injuries causes good results with high satisfaction rates, both in complete and partial avulsions. Early surgical repair leads to better functional results with lower complication rates, especially in complete avulsions.KEY MESSAGEsSurgical treatment of hamstring tendon ruptures leads to high satisfaction and return to sport rates.Both complete and partial hamstring tendon ruptures have better results after acute surgical repair, when compared to cases treated surgically later.Athletes with hamstring tendon ruptures should be treated more aggressively with operative methods.

Enchondromas of the Hand: Curettage With Autogenous Bone vs. Bioactive Glass S53P4 for Void Augmentation.

Background/Aim Enchondroma is the most common primary bone tumour of the hand. When surgery is indicated, curettage with or without void augmentation has been described. However, only few comparative studies exist. The aim of this study was to compare the outcomes of hand enchondromas treated with autologous bone graft (AG) and bioactive glass S53P4 (BAG). PATIENTS AND METHODS: A retrospective comparative analysis was conducted among patients surgically treated for hand enchondromas at a tertiary referral centre during a 17-year period. RESULTS: A total of 190 patients (116 AG vs. 74 BAG) with 205 enchondromas were included. No statistically significant differences in outcome measures were observed. A reoperation was performed in five patients in the autologous bone-graft group; one patient presented a rare malignant transformation from enchondroma to chondrosarcoma after the primary operation. No reoperations were performed in the BAG group. CONCLUSION: Although AG is the gold standard for filling bony cavities, bone-graft retrieval can cause complications and postoperative pain. Our results suggest that S53P4 BAG is a safe and effective bone-graft material alternative for filling of enchondroma-evacuated cavities.

Epidemiology, Treatment, and Treatment Quality of Overriding Distal Metaphyseal Radial Fractures in Children and Adolescents.

BACKGROUND: The incidence of completely displaced overriding distal metaphyseal radial fractures in children is unknown, and the optimal treatment is controversial. METHODS: All completely displaced distal metaphyseal radial fractures in patients <16 years old treated in our tertiary-level institution from 2014 to 2019 were identified with use of the Kids' Fracture Tool Helsinki. Etiology, fracture characteristics, management, and quality of treatment were assessed. A telephone interview with the guardian of the patient was performed for 100 (89%) of 112 patients at 1.5 to 7.2 years (median, 4.6 years) after the injury. Pain during the last month and forearm function were recorded. Treatment satisfaction was assessed with use of a 7-point Likert scale. RESULTS: A total of 113 completely displaced overriding distal metaphyseal radial fractures in 112 patients (81 of whom were residents of Helsinki) were treated during the 6-year-long study period. The mean annual incidence was 1.42 per 10,000 population. Most (73%) of these fractures occurred in children <11 years old, and most fractures were dorsally displaced and located nearly as far proximally from the distal radial physis as the maximum width of the distal metaphysis. Closed manipulation was attempted in two-thirds of cases in the emergency department, with a failure rate of 46%. Strong opioids were administered in 70 of 112 patients. None of the 26 patients whose fractures were immobilized in an overriding position had secondary interventions, pain, or functional disability. The mean satisfaction with treatment on the Likert scale was 6.2. CONCLUSIONS: The annual incidence of overriding distal metaphyseal radial fractures patients <16 years old was shown to vary between 0.72 and 2.01 per 10,000 population. Opioids, local and general anesthesia, hospital admission, and secondary interventions can be avoided in prepubescent patients by casting these fractures in an overriding position while the patient is in the emergency department. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Infections after intramedullary fixation of trochanteric fractures are uncommon and implant removal is not usually needed.

BACKGROUND AND PURPOSE: Infections after intramedullary fixation of trochanteric femoral fractures are rare, but potentially life-threatening complications. There are limited data available to support decision making in these cases. PATIENTS AND METHODS: A retrospective study of 995 consecutive operatively treated trochanteric fractures was made to find out different risk factors for infection and to describe the results of treatment. RESULTS: 28 patients developed a surgical site infection (2.8%) after intramedullary fixation of trochanteric fracture. 15 patients (1.5%) had a deep and 13 patients (1.3%) a superficial surgical site infection. Cigarette smoking (p<0.05) and prolonged operative time (p<0.05) were significant risk factors for an infection. 15 of 28 patients needed revision surgeries. Implant removal or exchange was needed only for 4 of 28 patients: 1 exchange of the blade, 1 removal of additional cable used to assist reduction and 2 removals of distal locking screws. None of the patients needed additional surgeries for problems with fracture healing. Mortality was not increased among patients with an infection. INTERPRETATION: Infection after intramedullary fixation of trochanteric fractures can be successfully treated without removal or exchange of the fixation material.

Risk of premature physeal closure in fractures of distal tibia.

The reported incidence of premature physeal closure (PPC) in fractures of the distal tibia has varied between 5 and 36%, but there is no consensus on the cause. We wanted to determine incidence and predictors of PPC in distal tibia physeal fractures in a population-based patient cohort. Two hundred forty-one patients (195 Peterson type I-V fractures and 46 transitional fractures) treated for a physeal fracture of the distal tibia during a 5-year period in two tertiary-level teaching hospitals. Odds ratios (OR) for developing PPC for different parameters (Peterson fracture type, associated fibula fracture, primary and postreduction displacement, number of reductions and the method of treatment) were calculated by binary logistic regression analysis. In 195 children with Peterson type I-V fractures PPC was diagnosed in 21 children (11%), of which 11 (6%) had surgery at mean 14 months from the fracture to correct either angular deformity or leg length discrepancy. The incidence of distal tibia PPC is at least 0.05/1000 children. More than one reduction attempt was the most significant risk factor (OR 7.0) for PPC. Peterson fracture type, associated fibula fracture, initial or post-reduction displacement or type of treatment did not correlate with PPC. The incidence of distal tibia PPC is at least 0.05/1000 children. The number of reductions correlates positively with the risk of PPC.

Casting in finger trap traction without reduction versus closed reduction and percutaneous pin fixation of dorsally displaced, over-riding distal metaphyseal radius fractures in children under 11 years old: a study protocol of a randomised controlled trial.

INTRODUCTION: Distal radius is the most common site of fracture in children, comprising 23%-31% of all paediatric fractures. Approximately one-fifth of these fractures are displaced. Completely displaced distal metaphyseal radius fractures in children have traditionally been treated with closed reduction. Recent evidence suggests that correcting the shortening in over-riding distal metaphyseal radius fractures is not necessary in prepubertal children. To date, no published randomised controlled trial (RCT) has compared treatment of these fractures in children by casting the fracture in bayonet position to reduction and pin fixation. METHODS AND ANALYSIS: We will conduct an RCT to compare the outcomes of casting the fracture in bayonet position in children under 11 years of age to reduction and percutaneous pin fixation. 60 patients will be randomly assigned to casting or surgery groups. We have two primary outcomes. The first is ratio (injured side/non-injured side) in the total active forearm rotation and the second is ratio (injured side/non-injured side) in total active range of motion of the wrist in the flexion-extension plane at 6 months. The secondary outcomes will include axial radiographic alignment, passive extension of the wrists, grip strength and length of forearms and hands, patient-reported outcome QuickDASH and pain questionnaire PedsQL. Patients not willing to participate in the RCT will be asked to participate in a prospective cohort. Patients not eligible for randomisation will be asked to participate in a non-eligible cohort. These cohorts are included to enhance the external validity of the results of the RCT. Our null hypothesis is that the results of the primary outcome measures in the casting group are non-inferior to surgery group. ETHICS AND DISSEMINATION: The institutional review board of the Helsinki and Uusimaa Hospital District has approved the protocol. We will disseminate the findings through peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT04323410. PROTOCOL: V.1.1, 29 September 2020.

Cast immobilization in bayonet position versus reduction and pin fixation of overriding distal metaphyseal radius fractures in children under ten years of age: a case control study.

PURPOSE: Completely displaced distal radius fractures in children have been traditionally reduced and immobilized with a cast or pin fixed. Cast immobilization leaving the fracture displaced in the bayonet position has been recently suggested as a non-invasive and effective treatment alternative. This is a pilot comparative study between reduction and no reduction. METHODS: We assessed subjective, functional and radiographic outcome after a minimum 2.5-year follow-up in 12 children under ten years of age who had sustained a completely displaced metaphyseal radius fracture, which had been immobilized leaving the fracture in an overriding position (shortening 3 mm to 9 mm). A total of 12 age-matched patients, whose similar fractures were reduced and pin fixed, were chosen for controls. RESULTS: At follow-up none of the 24 patients had visible forearm deformity and the maximal angulation in radiographs was 5° Forearm and wrist movement was restored (< 10° of discrepancy) in all 24 patients. Grip strength ratio was normal in all but three surgically treated patients. All patients had returned to their previous activities. One operatively treated boy who was re-operated on reported of pain (visual analogue scale 2). CONCLUSION: The results of this study do not demonstrate the superiority of reduction and pin fixation over cast immobilization in the bayonet position of closed overriding distal metaphyseal radius fractures in children under ten years with normal neurovascular findings. LEVEL OF EVIDENCE: III.

Achilles Tendon Reconstruction with Semitendinous Tendon Grafts Is Associated with a High Complication Rate.

BACKGROUND: In the presence of a large gap where end-to-end repair of the torn Achilles tendon is difficult and V-Y advancement would likely be insufficient, augmentation is sometimes required. At our institute we have used primarily the hamstring autograft augmentation technique for the past two decades. The aim of this study was to analyze the complications after surgical treatment of Achilles tendon rupture with semitendinous tendon augmentation. METHODS: We retrospectively analyzed 58 consecutive patients treated with semitendinous tendon autograft augmentation at the Helsinki University Hospital between January 1, 2006, and January 1, 2016. RESULTS: During the study period, 58 patients were operated on by six different surgeons. Of 14 observed complications (24%), seven were major and seven were minor. Most of the complications were infections (n = 10 [71%]) The infections were noted within a mean of 62 days postoperatively (range, 22-180 days). Seven patients with a complication underwent repeated operation because of skin edge necrosis and deep infection (five patients), hematoma formation (one patient), and a repeated rupture (one patient). CONCLUSIONS: In light of the experience we have had with autologous semitendinous tendon graft augmentation, we cannot recommend this technique, and, hence, we should abandon reconstruction of Achilles tendon ruptures with autologous semitendinous tendon grafts at our institute. Instead, other augmentation techniques, such as flexor hallucis longus tendon transfer, should be used.