Flexor Tendon Injuries in the Pediatric Population.

Flexor tendon injuries are rare in children, posing specific diagnostic and therapeutic challenges. This study aims to describe epidemiologic characteristics of flexor tendon injuries in children and evaluate the outcomes of surgical treatment. We conducted a retrospective study of patients with acute traumatic flexor tendon injuries treated between 2012 and 2019. We analyzed demographics, lesion mechanism, surgical technique, clinical results, complications, and secondary surgical procedures. Functional results were assessed through the Total Active Mobilization score. Twenty patients were included (n=34 tendons), with median follow-up of 7 months (range, 3-34 months) and median age at time of surgery of 13 years (range, 1-17 years). Male sex was predominant (n=16). The most prevalent injury mechanism was a cut (n=17), mostly affecting the 4th digit (n=10) and Verdan's zone II (n=13). Modified Kessler was the suture technique most commonly used (n=31), and polypropylene was the preferred suture material (n=19). All patients were immobilized with a splint for a median time of 4 weeks (range, 1-7 weeks). According to the Total Active Mobilization score, 15 patients reached a score greater than 75%, independently of age (P>.05). Stiffness was the main complication observed. Complications were identified in 37% of patients and were most common in those older than age 10 years (P>.05) and those with zone II lesions (P>.05). Four patients (20%) needed a second surgical intervention. Flexor tendon injuries in children are relatively uncommon and prevail in the male sex, similarly to the adult population. The principal complication observed was stiffness, which was more prevalent in children older than age 10 years, although without relevant functional implications, as surgical treatment enabled good or excellent outcomes in 75% of patients. [Orthopedics. 2023;46(2):82-85.].

Tibial tubercle avulsion fractures in adolescents: impact on function and quality of life.

The objective of the study was to assess functional outcomes and quality of life of patients treated for tibial tubercle avulsion fractures (TTAFs). Retrospective study of patients under 18 years of age treated from June 2011 to May 2018. Demographic data included age, gender, mechanism of injury, side, fracture classification, associated injuries, predisposing factors, and type of treatment. Clinical results included knee range of motion, pain, return to sports, overall satisfaction, functional outcomes, and complications. At final follow-up, Tegner Lysholm Knee Scoring Scale, and Kidscreen-10 were applied. Ten patients were included, all males, with a median age of 15 years. Mechanism of injury: football (three patients), basketball (two patients), running (two patients), handball (one patient), gymnastics (one patient), and fall (one patient). Nine were treated surgically with reduction and fixation with cannulated screws or Kirschner wires, plus treatment of associated injuries (three patellar tendon avulsions, one contralateral proximal tibia epiphyseal fracture, and two prophylactic fasciotomies). One patient developed mild recurvatum and two presented minor decreased knee flexion. Eight patients returned to their previous level of sports activity. Median Tegner Lysholm Knee Score was 100/100 and Kidscreen-10 was 50/50. With appropriate treatment, nearly 100% of TTAFs have good functional outcomes and low impact on quality of life.

Operative Pediatric Hand Trauma.

This study aims to describe the epidemiology of hand injuries in pediatric patients undergoing surgical treatment. A retrospective analysis of patients with traumatic hand injuries surgically treated over a 7-year period. A total of 155 patients were included. Fracture was the most common injury type (74.8%), most of which were open (54.3%). Incidence of articular fractures increased with age. The predominant mechanism of injury before age 10 was crush. In toddlers, only central digits were affected. Good functional results were achieved (Quick-DASH 1.37 ± 4.90). The incidence of hand injuries requiring surgery increased with age. The mechanism and segment affected varied with age groups. Although good functional results are expected, complications may occur 33% and secondary surgical procedures in 7.7%.

Fixação transpedicular da coluna toraco-lombo-sagrada: análise de 124 parafusos / Transpedicular fixation of the thoraco-lumbar-sacral spine: analysis of 124 screws / Fijación transpedicular de la columna toracolumbosacra: análisis de 124 tornillos

OBJECTIVO: Avaliar a técnica free hand de colocação de parafusos transpediculares na coluna torácica, lombar e sagrada. MÉTODOS: Avaliação clínica e imagiológica (tomografia computorizada) de 25 pacientes (13 mulheres e 12 homens) submetidos a instrumentação vertebral num total de 124 parafusos transpediculares aplicados, utilizando a técnica free hand. Os parafusos foram inseridos de T11 a S1, e a maioria destes foram colocados nos níveis L4, L5 e S1. RESULTADOS: 94% dos parafusos transpediculares estavam correctamente colocados no pedículo. Verificou-se que 6% (7 parafusos) estavam mal colocados e destes apenas dois violavam a cortical inferomedial, um destes apresentava uma perfuração inferior a 2 mm e o outro entre 2 e 4 mm. Nenhum dos pacientes seguidos apresentou complicações associadas ao incorrecto posicionamento dos parafusos. CONCLUSÃO: A técnica free hand é segura na instrumentação da coluna torácica e lombo-sagrada.

OBJECTIVE: To evaluate the correct placement of transpedicular screws in the thoracic, lumbar and sacral spine using the free hand technique. METHODS: Clinical and imaging (CT scan) evaluation of 25 patients (13 female and 12 male) undergoing spinal instrumentation for a total of 124 transpedicular screws applied using the free hand technique. The screws were inserted from T11 to S1, most of which were placed at levels L4, L5 and S1. RESULTS: 94% of transpedicular screws were placed correctly in the pedicle. It was found that 6% (seven screws) were misplaced and among those, only two violated the inferomedial wall, one less than 2 mm and the other between 2 and 4 mm. None of the patients had complications associated with incorrect positioning of the screws. CONCLUSION: The free hand technique is safe to be used in the instrumentation of the thoracic, lumbar and sacral spine.

OBJETIVO: Evaluar la colocación de tornillos transpediculares utilizados en las vértebras de la columna torácica, lumbar y sacra, introducidos mediante la técnica free hand. MÉTODOS: Evaluación clínica y radiológica (Tomografía Computadorizada) de 25 pacientes (13 mujeres y 12 hombres) sometidos a la instrumentación espinal para un total de 124 tornillos transpediculares aplicados mediante la técnica free hand. Los tornillos se insertaron desde T11 a S1, la mayoría de los cuales fueron colocados en los niveles L4, L5 y S1. RESULTADOS: 94% de los tornillos transpediculares se colocaron correctamente en el pedículo. Se encontró que 6% (siete tornillos) se colocaron mal; de estos, solamente dos habían sobrepasado la cortical inferomedial, uno presentaba una perforación inferior a 2 mm y el otro entre 2 y 4 mm. Ninguno de los pacientes acompañados tuvo complicaciones asociadas con la colocación incorrecta de los tornillos. CONCLUSIÓN: La técnica free hand es segura en la instrumentación de la columna torácica y, lumbosacra.