Comparative risk of ulnar nerve injury in pediatric supracondylar humeral fractures: a multicenter evaluation of Kirschner wire fixation techniques.

PURPOSE: This multicenter, retrospective cohort study aimed to compare the risk of ulnar nerve injury in pediatric supracondylar humeral fractures treated with percutaneous lateral-pins, blinded-crossed-pins, and crossed-pins with a mini-incision. METHODS: Data were collected from 1705 children treated between January 2010 and December 2023 at four orthopedic centers in Colombia. The incidence of postoperative ulnar nerve injury was compared among three fixation techniques: lateral-pin, blinded-crossed-pin, and crossed-pin with a mini-incision. RESULTS: A statistically significant difference in nerve injury rates was observed between the lateral-pin and both blinded-crossed-pin and mini-incision crossed-pin techniques (p < 0.001), with the lateral-pin technique demonstrating a significantly lower risk of injury. No significant difference was found between the blinded-crossed-pin and mini-incision crossed-pin techniques (p = 0.67). CONCLUSION: Crossed-pin fixation was associated with a higher incidence of ulnar nerve injury, regardless of the use of a mini-incision. The lateral-pin technique remains the safest option for minimizing iatrogenic nerve injury. There is insufficient evidence to support the mini-incision as a safer alternative to traditional crossed-pin fixation.

Terminal nerve entry points' locations to muscles of the thigh for selective peripheral neurectomy in the adult population: a cadaveric study.

PURPOSE: Spasticity is the result of a variety of lesions to the central nervous system and one of the most common causes of disability worldwide. Selective peripheral neurectomy (SPN) is a surgical procedure that permanently decreases focal spasticity. The authors' objective is to provide recommendations, in terms of probabilities, for locating terminal motor entry points to muscles of the thigh, as alternatives for proximal incision sites to SPN. METHODS: The femoral, obturator, and sciatic nerves, and its corresponding motor rami, were systematically dissected on cadaveric specimens, and terminal motor entry points to each muscle of the thigh were located and carefully measured, relative to the length of the thigh. Measurement distributions were obtained and normal transformations were used when necessary. RESULTS: In 23 adult cadaveric specimens, 779 motor rami were dissected. Entry points' locations are presented as a percentage of the length of the thigh in means and standard deviations, which roughly corresponds to 64 and 95% probability of finding a motor entry point. CONCLUSION: Alternative incisions directly over the motor entry points, for the muscles of the thigh, may be helpful when considering SPN as treatment for focal spasticity. A prior degree of certainty of the location of the nerve to be severed may simplify surgical approach.

Measurement properties of the Boston Carpal Tunnel Questionnaire in subjects with neurophysiological confirmation of carpal tunnel syndrome: a Rasch analysis perspective.

PURPOSE: To perform a comprehensive psychometric analysis of the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) by means of factor and Rasch analyses in subjects with neurophysiologic confirmation of carpal tunnel syndrome (CTS). Relationship between clinical severity assessed with the log-linear version of the BCTQ and neurophysiologic severity assessed with nerve conduction studies was further examined. METHODS: Five hundred and twenty-eight individuals completed the questionnaire. Confirmatory and exploratory factor analyses were used to determine the latent structure of the BCTQ. Through Rasch methodology, a log-linear version was proposed given the latent structure of the questionnaire. Linear relationship between the proposed questionnaire and neurophysiologic findings was established. RESULTS: The BCTQ underlying structure comprises, at least, three factors that may be represented by Functionality, Paresthesia and Pain domains. Two log-linear subscales may be proposed: subscale 1 comprised of the Functionality factor and subscale 2 which incorporates the Paresthesia and Pain factors under a bifactor solution. Neurophysiologic and clinical severity classification system displays a very weak linear correlation. CONCLUSION: A log-linear version of the BCTQ, useful as an outcome tool in clinical and trial settings, is proposed. Neurophysiological data lack the ability to resemble changes in clinical status of individuals with CTS.

Changes in electromyographic results of patients with lumbar radiculopathy: a follow-up study.

OBJECTIVE: To assess the neurophysiologic changes in a group of patients with lumbar radiculopathy 5 to 12 months after their first electromyographic examination. DESIGN: A prospective group of patients with a case definition of lumbar radiculopathy was reassessed between 5 and 12 months after their first clinical, functional, imaging, and neurophysiologic evaluation. Both the lumbar paraspinals (in which the mini-mapping technique was used) and the same lower limb muscles were explored in every patient. Relevant abnormalities were (1) positive sharp waves/fibrillation potentials, (2) polyphasic motor unit potentials, and (3) large-amplitude/long-duration motor unit potentials. Patients were sorted into 5 groups based on the type and distribution of neurophysiologic abnormalities: from 0 (no abnormalities) to 4 (denervation signs in 2 lower limb muscles and paraspinals). Patients' subjective perception of any improvement or worsening of their condition was also recorded. SETTING: A referral center for neurophysiologic evaluation. PARTICIPANTS: A consecutive sample of patients (N=91) with a clinical definition of lumbar radiculopathy (lumbar pain radiating down the leg and below the knee) referred for neurophysiologic assessment was selected for an initial clinical, functional, and neurophysiologic evaluation. Patients were called for a second evaluation (between 5 and 12mo). Thirty-eight (42% of the initial sample) were willing/eligible for the second evaluation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Changes in (1) electromyographic results; (2) patients' subjective perception of pain; and (3) quality of life, based on the Roland-Morris Questionnaire and Medical Outcomes Study 36-Item Short-Form Health Survey scores. RESULTS: Paraspinal muscles were most frequently affected. Neurophysiologic abnormalities had improved on reassessment. Clinical improvement was more significant for those patients with initially abnormal electromyographic results. CONCLUSIONS: There was clinical as well as electromyographic improvement in patients with lumbar radiculopathy within the first year of the initial diagnosis.

Distribution of fractured bones among children: Experience with the Comprehensive Pediatric AO classification in a children's orthopedic hospital in Bogotá-Colombia.

INTRODUCTION: Fractures in children and adolescents are a public health issue. However, reliable epidemiological descriptions of the South American population must be improved. This study aims to present epidemiological data on fractures from a children's orthopedic hospital in one of the five largest cities in Latin America. PATIENTS AND METHODS: Descriptive epidemiological data from 2015 to 2019 were used to characterize children's fractures. Demographic variables, the number of fractured bones, high-energy trauma findings, fracture characteristics, fingertip injuries, and associated complications discriminated by the type of treatment are presented. Long bone fractures were classified according to the AO classification. All children less than 18 years of age were included. RESULTS: In a population of 3,616 children, 4,596 fractures were identified. More boys than girls sustain a fractured bone, with ratios as high as 6:1 around 15 years old. Distal forearm fractures were the most common (31.9%), followed by distal humerus (20.2%). Most of the complications were related to these two sites of fractures. The OR of complications between surgical and conservative management was 2.86. CONCLUSION: Epidemiological data of fractures from the authors' institution display the usual trending reported in most populations. Gender-related and age-related differences were relevant. Most fractures and complications are related to upper limb low-energy trauma. The most frequent are loss of ROM and loss of reduction. LEVEL OF EVIDENCE: Level III - retrospective cohort study.

Casting Without Reduction Versus Closed Reduction With or Without Fixation in the Treatment of Distal Radius Fractures in Children: Protocol for a Randomized Noninferiority Trial.

BACKGROUND: Acute treatment for distal radius fractures, the most frequent fractures in the pediatric population, represents a challenge to the orthopedic surgeon. Deciding on surgical restoration of the alignment or cast immobilization without reducing the fracture is a complex concern given the remodeling potential of bones in children. In addition, the lack of evidence-based safe boundaries of shortening and angulation, that will not jeopardize upper-extremity functionality in the future, further complicates this decision. OBJECTIVE: The authors aim to measure functional outcomes, assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Physical Function v2.0 instrument. The authors hypothesize that outcomes will not be worse in children treated with cast immobilization in situ compared with those treated with closed reduction with or without percutaneous fixation. The authors also aim to compare the following as secondary outcomes: ulnar variance and fracture alignment in the sagittal and coronal planes, range of motion, pressure ulcers, pain control, radius osteotomy due to deformity, pseudoarthrosis cure, and remanipulation. METHODS: This is the protocol of a randomized noninferiority trial comparing upper-extremity functionality in children aged 5 to 10 years, after sustaining a distal radius fracture, treated with either cast immobilization in situ or closed reduction with or without fixation in a single orthopedic hospital. Functional follow-up is projected at 6 months, while clinical and radiographic follow-up will occur at 2 weeks, 3 months, and 9 months. RESULTS: Recruitment commenced in July 2021. As of January 2022, 23 children have been randomized. Authors expect an average of 5 patients to be recruited monthly; therefore, recruitment and analysis should be complete by October 2024. CONCLUSIONS: This experimental design that addresses upper-extremity functionality after cast immobilization in situ in children who have sustained a distal fracture of the radius may yield compelling information that could aid the clinician in deciding on the most suitable orthopedic treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT05008029; https://clinicaltrials.gov/ct2/show/NCT05008029. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34576.

Reliability of home-based, motor function measure in hereditary neuromuscular diseases.

Objective To evaluate the reliability of the motor function measure (MFM) scale in the assessment of disease severity and progression when administered at home and clinic and assess its correlation with the Paediatric Outcomes Data Collection Instrument (PODCI). Methods In this prospective study, two assessors rated children with hereditary neuromuscular diseases (HNMDs) using the MFM at the clinic and then 2 weeks later at the patients' home. Intraclass correlation coefficient (ICC) was calculated for the reliability of the MFM and its domains. The reliability of each item was assessed and the correlation between MFM and three domains of PODCI was evaluated. Results A total of 48 children (5-17 years of age) were assessed in both locations and the MFM scale demonstrated excellent inter-rater reliability (ICC, 0.98). Weighted kappa ranged from excellent to poor. Correlation of the home-based MFM with the PODCI domain 'basic mobility and transfers' was excellent, with the 'upper extremity' domain was moderate, but there was no correlation with the 'happiness' domain. Conclusion The MFM is a reliable tool for assessing patients with HNMD when used in a home-based setting.

[Validating and standardizing children's box and block test normal values]. / Validación y estandarización de valores normales de la prueba de caja y cubos en niños.

OBJECTIVE: Evaluating gross motor skills forms part of a child's functional examination. The box and block test is a simple, useful method for evaluating upper limb functionality. This study was aimed at validating and standardising the test's normal values in 6 to 11 year-old Colombian children. METHODS: The test was used on 411 children from two schools in Bogotá catering for children different socioeconomic classes. A questionnaire directed towards parents and teachers was used for evaluating the children's performance on every-day life and school-related activities for validating the construct; correlation with the test was established. RESULTS: Data related to 386 children (55.4% male) was analysed; 67.9% of these children were attending a public school and 90.2% had right dominance. Average test score with the right hand was 60.9 and 57.8 with the left hand. DISCUSSION: Girls' average test scores were significantly higher. A table was constructed from (and showing) the average values, standard deviation and range of normality. A positive correlation was found regarding test result with age and every-day life activities and the teachers' appreciation of children's scholastic abilities. The test was reliable, having 0.84 intraclass correlation for the right hand and 0.83 for the left hand.

Factor analysis of carpal tunnel syndrome questionnaire in relation to nerve conduction studies.

OBJECTIVE: This study aims to assess the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) structure and its relation to nerve conduction studies (NCS). METHODS: A total of 403 patients with clinical and/or electrophysiological definition of CTS were evaluated with the instrument. The structure of the questionnaire was assessed by means of factor analysis. Factors obtained were compared with NCS. RESULTS: Factor analysis showed that three factors represented nearly 60% of the variance of the instrument. Factor one is related to all the function domain questions and to the weakness and difficulty in grasping questions of the symptom domain; factor two to questions that assess numbness and tingling, and to the pain-awakening question of the symptom domain; and factor three, to pain questions of the symptom domain. Factor two had a stronger correlation with latencies of NCS and with the neurophysiological scale than the other two factors. CONCLUSIONS: BCTQ assesses function and symptoms in patients with CTS by means of questions related to numbness and tingling sensation, pain and functional status. Questions related to numbness and tingling (factor two) better reflected the pathophysiology of the median nerve. SIGNIFICANCE: Factor-2 sensory-related questions of BCTQ may be more useful in diagnosis, follow-up and assessing therapeutic outcome in CTS.

Validación y estandarización de valores normales de la prueba de caja y cubos en niños / Validating and standardizing children's box and block test normal values

Objetivo La evaluación de las destrezas motoras gruesas forma parte del examen funcional del niño. La prueba de caja y cubos es un método sencillo y útil en la valoración de la funcionalidad del miembro superior. El objetivo del estudio fue validar y estandarizar los valores normales de la prueba en niños de 6 a 11 años. Métodos Se aplicó la prueba a 411 niños de dos colegios de diferentes clases socioeconómicas en Bogotá. Para la validación de constructo se utilizó un cuestionario dirigido a padres y profesores evaluando el desempeño en actividades de la vida diaria y actividades escolares relacionadas y se estableció la correlación con la prueba. Resultados En total se analizaron los datos de 386 niños (55.4% de género masculino), de los cuales 67.9 % pertenecían a colegio público. 90.2% tenían dominancia derecha. La puntuación promedio de la prueba con la mano derecha fue 60.9 y con la mano izquierda 57.8. Discusión Los valores de las puntuaciones promedio de las niñas fueron significativamente más altos. Se construyó una tabla con los valores promedio, desviación estándar y rango de normalidad. Se encontró una correlación positiva del resultado de la prueba con la edad y con las actividades de la vida diaria y la apreciación de las habilidades escolares del niño por parte del profesor. La prueba fue confiable con una correlación intraclase de 0.84 y 0.83 para la mano derecha e izquierda, respectivamente.

Objective Evaluating gross motor skills forms part of a child's functional examination. The box and block test is a simple, useful method for evaluating upper limb functionality. This study was aimed at validating and standardising the test's normal values in 6 to 11 year-old Colombian children. Methods The test was used on 411 children from two schools in Bogotá catering for children different socioeconomic classes. A questionnaire directed towards parents and teachers was used for evaluating the children's performance on every-day life and school-related activities for validating the construct; correlation with the test was established. Results Data related to 386 children (55.4% male) was analysed; 67.9% of these children were attending a public school and 90.2% had right dominance. Average test score with the right hand was 60.9 and 57.8 with the left hand. Discussion Girls' average test scores were significantly higher. A table was constructed from (and showing) the average values, standard deviation and range of normality. A positive correlation was found regarding test result with age and every-day life activities and the teachers' appreciation of children's scholastic abilities. The test was reliable, having 0.84 intraclass correlation for the right hand and 0.83 for the left hand.