Supracondylar Fractures of the Humerus: Association of Neurovascular Lesions with Degree of Fracture Displacement in Children-A Retrospective Study.

Supracondylar humerus fractures (ScHF) account for 60% of fractures of the elbow region in children. We assessed the relationship between neurovascular complications and the degree of fracture displacement as rated on the basis of modified Gartland classification. Moreover, we aimed to evaluate predisposing factors, e.g., age and gender, and outcomes of neurovascular complications in ScHF. Between 2004 and 2019, we treated 329 patients with ScHF at the Department of Traumatology and Orthopedics of the Upper Silesian Child Centre, Katowice, Poland. Mean age of patients (189 boys and 140 girls) was 7.2 years (Confidence interval: 6.89, 7.45). Undisplaced fractures were treated conservatively with a cast. Displaced fractures were managed by closed reduction and percutaneous Kirschner wire fixation using two pins inserted laterally. We retrospectively assessed the number of neurovascular lesions at baseline and recorded any iatrogenic injury resulting from the surgical intervention. Acute neurovascular lesions occurred in 44 of 329 ScHF patients (13.4%). The incidence of accompanying neurovascular injuries was positively associated with the severity of fracture displacement characterized by Gartland score. Vascular injuries occurred mainly in Gartland type IV ScHF, while nerve lesions occurred in both Gartland type III and IV ScHF. We noted a significantly higher mean Gartland score and mean age at injury in the group of children suffering from neurovascular injuries when compared to those in the group without such injuries (p = 0.045 and p = 0.04, respectively). We observed no secondary nerve lesions after surgical treatment. For the treatment of ScHF in children, we recommend closed reduction and stabilization of displaced fractures with K-wires inserted percutaneously from the lateral aspect of the upper arm. We advocate vessel exploration in case of absent distal pulses after closed reduction but do not consider primary nerve exploration necessary, unless a complete primary sensomotoric nerve lesion is present.

Evaluation of using the Anderson-Montesano and the Tuli classifications in pediatric patients with occipital condyle fractures.

BACKGROUND: Occipital condyle fractures (OCFs) in patients before 18 years of age are rare. Classifications of OCF are based on the CT images of the cranio-cervical junction (CCJ) and MRI. The Anderson-Montesano and Tuli classifications are the types which are most commonly used in these cases. Classification of OCFs allows the implementation of OCF treatment. The aim of this study was to evaluate the effectiveness of using the OCF classification in pediatric patients based on the analysis of our own cases. METHODS: During the years 2013-2020, 6 pediatric patients with OCFs, aged 14-18, have been treated. Two patients with unstable fracture III according to Anderson-Montesano and IIB according to Tuli were treated with the halo-vest. Additionally, one patient presenting neurological symptoms and with an associated C1 fracture was qualified for the halo-vest stabilization as well. The other patients were treated with a Minerva collar. We evaluated the results 6 months after completing the OCF treatment using the Neck Disability Index (NDI) and SF-36 questionnaires. Confidence intervals for the mean values were verified using the MeanCI function (from the R library DescTools) for both classical and bootstrap methods. RESULTS: Based on NDI results, we have obtained in our patients an average of 4.33/45 points (2-11) and 9.62% (4.4-24.4). Based on the SF-36 questionnaire, we obtained an average of 88.62% (47.41-99.44). CONCLUSION: The Anderson-Montesano and Tuli's classifications of OCF can be used to assess the stability of OCF in adolescents, but both classifications should be used simultaneously. CT and MR imaging should be used in diagnosing OCFs, whereas CT allows assessing therapeutic outcomes in OCF.

Treatment of acetabular fractures in paediatric patients.

BACKGROUND: Acetabular fractures are rare in children, constituting approximately 1-4.6% of all paediatric fractures. MATERIAL AND METHODS: Nine patients (4 girls and 5 boys) with a mean age of 14.5 years (range, 12-16.5 years) were treated due to acetabular fractures between 2000 and 2020. Most of the fractures were caused by road accidents. Before the patients were qualified for treatment, they underwent a CT scan (all patients) and an MRI scan (8 patients) of the hip. Surgical treatment was used in 6 patients while the other 2 were managed conservatively. RESULTS: Mean follow-up period was 6.2 years (range, 2-10 years). Bone union was achieved in all patients after 76 days on average (range, 65-90 days). The mean Merle d'Aubigne score at 12 months after treatment was 17.1 points (range, 13-18 points). CONCLUSIONS: The treatment of acetabular fractures in paediatric patients during or after puberty may be the same as in adults. An MRI scan of the hip joint is recommended for assessing the fracture, particularly the triradiate cartilage.

Results of Femoral Elongation Treatment Using Electromagnetic Intramedullary Nail. Preliminary Report.

BACKGROUND: Surgical correction of lower limb discrepancy in children poses a significant clinical problem. The aim of this paper is to present our experience with the PRECICE electromagnetic intramedullary nail. MATERIALS AND METHODS: The study group consisted of 5 patients (2 girls; 3 boys) aged 11.5 to 18 years (mean age 16.3) treated for lower limb discrepancy by femoral lengthening using the PRECICE nail intramedullary system. Average discrepancy was 63 mm (range: 45-74.5 mm). RESULTS: Femoral lengthening was successful in all patients. The femur was lengthened by a mean of 49 mm (range: 40-58 mm). A knee flexion contracture of about 10° occurred in one patient. CONCLUSIONS: 1. Femoral lengthening in children poses a therapeutic challenge. 2. The PRECICE intrame-dullary nail system helps reduce complications and increases patient comfort.

[Surgical treatment of pertrochanteric femoral benign tumors in children]. / Leczenie operacyjne lagodnych guzów okolicy miedzykretarzowej kosci udowej u dzieci.

INTRODUCTION: Disclosure of the tumor area intertrochanteric femur occurs mostly at the time of pathological fracture. Detection of changes can also be made in conjunction with x-ray of the hip joint such as the hip injury. The purpose of this study was to present the treatment of benign tumors of the intertrochanteric area in children and adolescents. MATERIALS AND METHODS: From 1. 01. 2002 to 31. 12. 2009 13 patients were treated with benign tumors of the femur intertrochanteric area, including 10 with pathological fractures in the background. Average age was 9.8 years (5-13 years). There were 11 boys and 2 girls. The procedure was performed with resection of the tumor,histopathology, allogenic bone grafting, the femur was fixed using locked plate (10 patients) or angular plate (3 patients). RESULTS: The mean observation time was 62 months (24-94 months). Histopathology examination showed a simple cyst in 7 patients, aneurysmal cyst in 2 patients, and fibrous dysplasia of bone in 4 patients. Bone consolidation was achieved in 10 patients after an average of 4 months (3-5 months) after surgery, as determined by X-ray examination and clinical examination. In 3 cases there was a recurrence of the tumor, 2 patients with fibrous dysplasia after 4 months and 6 months after surgery were found in X-ray partial resorption of bone graft >25%, and 1 patient after 4 months presented fatigue fracture at Adams angle. After re-treatment complete bone consolidation was achieved in this group after an average of 4 months (2.5-5 months) from the second surgery. 1 patient with aneurysmal cyst in 11 month after surgery, presented femoral infection, sequestrum and plate were surgically removed, antibiotic therapy was used and the inflammatory process was stopped. CONCLUSION: Surgical treatment of benign tumors of the intertrochanteric area of the femur gives good results if it is carried out by a complex surgery (resection of the tumor - bone graft - osteosynthesis).

[Salter pelvic osteotomy in operative treatment in patients with bladder extrophy]. / Obustronna osteotomia miednicy typu Saltera w leczeniu operacyjnym pacjentów z wynicowanym pecherzem moczowym.

BACKGROUND: Bladder extrophy malformation includes outward rotation of the innominate bones, pubic symphysis diastasis and acetabular retrovertion. We have corrected the pelvic deformation during the reconstruction of the bladder neck and the urethra in older children. METHODS: From 1/01/2002 to 1/01/2006 in the Department of Pediatric Urology and the Department of Pediatric Orthopedics in Katowice 4 children were operated on for bladder extrophy. The age of the patients ranged from 2.3 to 4.1 years; an average of 3.6 years. In the patients with bladder extrophy we performed the urological reconstruction and simultaneously the bilateral Salter's osteotomy was done. RESULTS: The follow up was 52 months (48-84).The consolidation of the osteotomy was obtained in all patients after 62 days (48-72) with the correction of the retroversion of the hips and symphysis to 2.4 cm (0.9-5.8). CONCLUSION: The innominate Salter's osteotomy is helpful in the bladder neck reconstruction and allows to achieve the proper anatomy of the pelvic ring.

[Surgical treatment of adolescent's hallux valgus using Scarf's osteotomy]. / Operacyjne leczenie mlodzienczych paluchów koslawych za pomoca osteotomii wedlug Scarfa.

14 patients were operated for hallux valgus using the Scarf technique. The mean age of patients was 15.5 years, in 7 the deformation was bilateral. The hallux valgus was medium in 18 cases and the mean angle of the valgus was 35 degrees. The patients were examined 1 year after surgical procedure and 18 results were good and 3 satisfactory.