Late diagnosis of a McFarland fracture: imaging and treatment.

McFarland fractures represent a type of oblique medial malleolar fracture in children that can be challenging to diagnose and treat. A 14-year-old junior league soccer player with a Salter Harris type IV McFarland fracture presented late, as the initial routine two views radiological assessment failed to reveal a clear fracture line. The addition of a mortise ankle view led to the correct diagnosis and subsequent MRI findings guided nonsurgical treatment with an excellent outcome. The debate between obtaining two or three views in closed pediatric ankle injuries according to the so-called Ottawa rules and the usefulness of magnetic resonance imaging (MRI) in the decision making for the choice of treatment of McFarland fractures are discussed in this case report.

Late results of absorbable pin fixation in the treatment of radial head fractures.

The use of bioabsorbable pins with prolonged degradation periods for fracture fixation has raised concerns about adverse soft tissue reactions, including seromas, discharging sinuses, or osteolytic changes. We asked whether bioabsorbable pins of self-reinforced polylactic acid polymer used in radial head fractures resulted in such reactions. We retrospectively reviewed 21 patients followed a minimum of 36 months (mean, 81 months; range, 36-136 months). There were nine Mason II, 10 Mason III, and two Mason IV fractures, which were evaluated clinically and radiographically. All fractures healed well with no radiographic signs of osteolysis. The mean Mayo Elbow Performance score was 93.8 (range, 20-100), which is comparable to the outcome of historical groups with radial head arthroplasty. The mean range of flexion of the elbow was 9 degrees to 132 degrees , with 79 degrees pronation and 77 degrees supination. The grip strength of the operated arm was not affected in comparison to the contralateral arm (mean range, 38.6 versus 40.9 kg). No material-related adverse effects were observed during and beyond the degradation period. Our data suggest concerns about soft tissue or bony reactions from these materials in radial head fractures are not justified.