Arm Cast Research Articles

A Single Education Session of Orthopaedic Residents Does Not Reduce The Rate of Failed Nonoperative Management or Improve Radiographic Outcomes in Pediatric Distal Radius Fractures.

Introduction:The primary objective was to evaluate whether a single educational session on casting is sufficient to reduce the rate of loss of reduction in pediatric distal radius fractures.Methods:A retrospective review was conducted of pediatric patients with distal radius fractures casted between November 2016 and February 2019. Patients were divided into two groups: those casted by a resident who participated in a targeted education session on short arm casting and those who had not.Results:A total of 137 patients were included (education cohort: 61 patients and noneducation cohort: 76 patients). The two groups demonstrated similar ages and pre/post-reduction radiographic measurements. In the education cohort, 11.5% required repeat casting, wedging, or surgical intervention versus 17.1% of patients in the noneducation cohort (P = 0.47). Patients casted by residents doing one of their first three independent casts trended toward being more likely to place a cast with poor cast index and to lose reduction (P = 0.12 and P = 0.43, respectively).Discussion:A one hour education session did not reduce the need for intervention or loss of reduction. For educating residents on the skill of casting to be effective, one may consider formal feedback and evaluation throughout multiple education sessions and in early episodes of clinical care.Level of Evidence:A Level III, Retrospective Comparative Study

Clinical outcomes comparison of distal radius fractures between two conservative treatment methods: Below-arm cast versus reverse sugar tong splint

BackgroundThe purpose of this prospective randomized study was to compare a new reverse sugar tong splint technique with a below-arm cast, in terms of patient radiological and clinical outcomes. MethodsOne hundred and forty patients who presented to our clinic between April 2017 and March 2019 were randomly divided into two groups: 70 received reverse sugar tong (RST group) and 70 received below arm cast (BAC group). Clinical and radiological follow-up was performed 7–10 days, three weeks, 5 or 6 weeks, 12 weeks and one year after the treatment. Clinical outcomes including wrist range of motion, complication rates, Health Assessment Questionnaire (HAQ) score at end of treatment, Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaire and Mayo Elbow Performance score (MEPS) score at 12 weeks and last follow-up. ResultsFinally, sixty-five patients were treated with BAC, and their average age was 58.2 years and sixty-two patients with an average age of 57.4 years were treated with RST were completed the radiological and clinical one-year follow-up. There were no significant differences in range of motion, radiological parameters, the Q-DASH and MEPS scores between the groups the 12th week and last visit; however, the HAQ score was significantly higher in the cast group during the 6th visit (p < 0.001). The BAC group had a higher complication rate (40%) than the RST group (19.3%) (p = 0.01). ConclusionPatient treated with RST had a higher functional status at end of treatment and lower complications when comparing traditional below arm cast. Level of evidenceLevel I prognostic randomized controlled trial.

A comparison of sugar-tong and volar-dorsal splints for provisional immobilization of distal radius fractures in the adult population.

Distal radius fractures are extremely common injuries affecting a wide range of patient demographics. The purpose of this study was to evaluate the outcomes of distal radius fractures managed initially with closed reduction and immobilization in either a below elbow volar-dorsal splint versus sugar-tong splint prior to conversion into a short arm cast. We performed a retrospective study of patients with distal radius fractures placed in a sugar-tong (n = 45) and volar-dorsal splint (n = 36). Anteroposterior and lateral radiographs were evaluated immediately after closed reduction and placement into either a sugar-tong or volar-dorsal splint. The radial inclination, radial length, volar tilt, and intra-articular displacement were measured. The average age was not significantly different between groups (Diff: 1.1years, P = 0.8766). Initial clinic follow-up radiographs illustrated significantly lower radial inclination in the sugar-tong group than volar-dorsal group (17.1 vs. 19, P = 0.0443). Follow-up mean radial length was not significantly lower in the sugar-tong than volar-dorsal group (8.4 vs. 9.2, P = 0.0858). Palmar tilt and articular step-off was not significantly different between splint types. The loss of reduction was 28.8% for the sugar-tong and 25.0% for the volar-dorsal group (P = 0.696). Our results did not demonstrate a significant difference in loss of reduction rates between the two splint groups. There was no significant difference between the sugar-tong and volar-dorsal groups in terms of loss of radial length and volar tilt. Loss of reduction was similar between groups suggesting no advantage of a volar-dorsal splint compared to a sugar-tong splint. Therapeutic level III.

Precision Neuroimaging Opens a New Chapter of Neuroplasticity Experimentation

Characterizing the brain's ability to adapt to changing environments has been at the forefront of neuroscience for decades. In this issue of Neuron, Newbold et al. build on this neuroplasticity work using precision neuroimaging and arm casting to unmask previously unknown pulses of spontaneous activity.

One-Year Follow-Up Of Isolated Trapezoid Fracture From Occult Trauma: A Case Report

Background&#x0D; Herein we present a rare case of isolated trapezoid fracture from occult trauma and review this type of fracture as related to sports injuries. The common presentation of occult trauma is important and proper imaging will lead to accurate diagnosis and consequent treatment with excellent results.&#x0D; &#x0D; Case presentation &#x0D; A 28-year-old right hand-dominant female presented with pain in her right hand for 1 week following a boxing class in fitness training. She was diagnosed as isolated trapezoid fracture. She was successfully treated with short arm cast immobilization for 3 weeks and a moveable wrist splint for 3 weeks with activity modification. A one year follow up confirmed excellent clinical results.&#x0D; &#x0D; Conclusion&#x0D; Isolated sports-related trapezoid fractures are rare and the diagnosis is usually missed. Advanced imaging can be helpful. Following conservative treatment our patient was able to return to normal activities and continued to have no problems at the 1 year follow up.&#x0D;

Diagnosis and Treatment of Scaphoid Waist Fractures: A Literature Review

Scaphoid fracture can cause serious complications and its diagnosis and treatment approaches are still contentious. Tenderness of anatomical snuffbox (ASB), longitudinal compression (LC) of the thumb, and scaphoid tubercle (ST) tenderness are very sensitive tests for clinical diagnosis of scaphoid factures all together. Previous studies recommend taking four standard views of the wrist for non-displaced scaphoid fractures diagnosis. Magnetic resonance imaging (MRI), computed tomography scan (CT scan), bone scintigraphy, and ultrasound are used for triage of suspected scaphoid fractures. MRI has the highest sensitivity and specificity. CT scan images captured in planes by the long axis of the scaphoid guide the diagnosis of nondisplaced scaphoid fracture. Displaced fractures need surgical treatment, but the best way of treating a nondisplaced fracture is controversial. Same results have been determined using a short arm or long arm cast for treatment of nondisplaced scaphoid fractures as well as similar outcomes with or without a thumb-spica component to the cast. Wrist position immobilization did not affect the rate of nonunion, wrist flexion, pain, or grip strength. Percutaneous screw fixation can shorten return to work time. CT scan and MRI both can be applied for assessment of union of fracture during follow-up period. This study aims to review the literature on challenges about clinical and radiologic diagnosis of nondisplaced scaphoid fractures and also present concepts about definite management of nondisplaced and minimally-displaced scaphoid waist fractures.

Extraphyseal distal radius fracture in children: is the cast always needed? A retrospective analysis comparing Epibloc system and K-wire pinning.

Closed reduction and internal fixation are a widespread surgical treatment for pediatrics displaced extraphyseal distal radius fractures. Post-surgical cast immobilization is usually needed. Epibloc system (ES) is a device used to fix Colles fractures in adults, not requiring post-surgical immobilization. The aim of the study is to investigate the effectiveness of ES in a pediatric population suffering from displaced extraphyseal distal radius fractures. We retrospectively analyzed 52 patients (age 8-12years) who underwent CRIF. Patients were divided into two groups. Group A (25 patients): ES osteosynthesis. Group B (27 patients): K-wires and short arm cast osteosynthesis. The primary outcome is the maintenance of reduction in radiographs (displacement on frontal and lateral view). The secondary outcome is the reaching of the complete active range of motion recovery (compared with the contralateral side) and the time needed to obtain it. The need of further additional treatment (physiotherapy) and the presence of complication were also assessed. Reduction was equally maintained in both groups (p > 0.05). Physiotherapy was mandatory for 11 patients in group B; only for 3 patients in group A, the difference was statistically significant (p = 0.03) according to Fisher test. Otherwise, the difference was not statistically significant regarding complications. (p > 0.05). At the last follow-up, complete functional recovery was reached in all patients. Functional recovery is faster, and postoperative physiotherapy is rarely required with ES. This device allows us to go beyond the traditional concept of mandatory postoperative immobilization after pediatric wrist fractures surgery.

Effect of casting speed on dendrite arm spacing of Mn13 steel continuous casting slab

The dendrite arm spacing in the continuous casting slab of Mn13 steel under different casting speeds was measured using the metallographic microscope. Meanwhile, a heat transfer model was established by the Pro-cast software. The relationship between the dendrite arm spacing and casting speed in continuous casting slab of Mn13 steel was studied and described by a function expression. The results provide an important theoretical basis for the development and optimization of continuous casting production process of high-manganese steel and help to improve the quality of continuous casting slab of high-manganese steel. Under the experimental conditions, the suitable casting speed is about 0.9 m/min. The secondary dendrite spacing maintains a relatively stable low-amplitude increase trend, and it is beneficial to obtain a higher proportion of equiaxed crystals.

Simultaneous dislocation of the radial head and distal radio-ulnar joint without fracture in an adult patient: a case report and review of literature

BackgroundSimultaneous dislocation of the radial head and distal radio-ulnar joint without fracture (Criss-Cross Injury) in an adult patient is rarely reported in previous studies. The pathological changes and injury patterns have not been clearly demonstrated.Case presentationA 26-year-old woman presented with acute pain of the right wrist and elbow after a fall from cycling. Physical examination revealed an unstable elbow and wrist joint. Plain radiographs showed volar dislocation of the radial head and dorsal dislocation of the distal radius without associated fracture, forming a criss-cross appearance of the ulna and radius on the lateral radiograph. MRI images confirmed partial rupture of the proximal interosseous membrane from its dorsal attachment on the radius, as well as partial rupture of the medial collateral ligament. Conservative treatment failed because the radiocapitellar joint and distal radio-ulnar joint could not be simultaneously reduced. Surgical exploration revealed a highly unstable radial head, but the annular ligament was found to be intact. Manual force was applied to reduce the radial head and a percutaneous K-wire was used to stabilize the proximal radioulnar joint with the forearm in full supination. After surgery, the elbow was immobilized in 90° flexion by a long arm cast for 4 weeks. The K-wire was removed at 6 weeks postoperatively. At 18 months postoperatively, the patient had regained a full range of flexion and extension, with normal supination and a slight limitation in pronation.ConclusionsThe proximal IOM, especially the dorsal band, was injured in Criss-Cross injuries, while the central part of the IOM remained intact. This injury pattern distinguished itself from Essex-Lopresti injury, which mainly involves rupture of the central band of the IOM.

Radial head anterior dislocation and ulna bowing in a children

A 11 year old boy is examined three days after going to the emergency room, in consultation with orthopaedic surgery for right elbow pain after a fall on the hand. The clinical examination revealed oedema of the external part of the elbow with a deficit in flexion and supination. X-rays revealed anterior dislocation of the head radial associated with plastic deformation of the ulna (A). It´s about an equivalent type 1 Monteggia lesion according to the Bado classification. The line of Mubarak highlights the deformation plastic of the ulna on x-rays of profile. The treatment consisted of a closed orthopaedic reduction under sedation by external maneuvers directed in the opposite direction of the plastic deformation of the ulna and dislocation of the radial head under scopic control which was satisfactory. Patient was immobilized in a long arm cast in 90 degrees of flexion and supination and followed closely radiographically for 2 weeks to ensure maintenance of radial head reduction (B). After four weeks the patient begins functional rehabilitation. The two-month check showed a painless stable elbow with symmetrical supination and flexion. Evolution is pejorative in the absence of a early reduction. A Radial neuropathy can also occur in the longer term by compression, hence the importance of early diagnosis.

Prospective Evaluation of a Treatment Protocol Based on Fracture Displacement for Pediatric Lateral Condyle Humerus Fractures: A Preliminary Study.

To prospectively evaluate a displacement-based classification system and an outcome-derived algorithm in the treatment of children with lateral condyle fractures. All children with a lateral condyle fracture were prospectively enrolled at our institution between 2013 and 2016. Fractures were classified and treated on the basis of the following classification system: type 1: <2 mm; treated with long arm casting, type II: 2 to 4 mm; treated with closed reduction and percutaneous pinning (CRPP), and type III: >4 mm; open reduction and percutaneous pinning (ORPP). Functional outcomes were assessed at 6 to 12 weeks and at 1-year follow-ups using the Pediatric Outcomes Data Collection Instrument (PODCI). A total of 55 patients (mean age, 6 y; range 2 to 12 y) were prospectively enrolled. There were 17 (31%) type I fractures treated with a long arm cast, 8 (15%) type II treated with CRPP, and 30 (54%) type III treated with ORPP. Postoperative complications included delayed union (N=5) and pin site infection (N=3). Delayed unions on the basis of fracture type was type I (1/17, 6%), type II (1/8, 13%), and type III (3/30, 10%) (P=0.85). The rate of delayed unions in type II and III fractures fixed with k-wires was 11% (4/38). Four patients required a second operation with screw fixation. No significant differences were found across PODCI domains at 1-year follow-up when comparing our study population with normative data. This is the first prospective study of a treatment protocol for pediatric lateral condyle fractures and validates the use of displacement as a guide for best evidence-based treatment. Children with a lateral condyle fracture can achieve excellent functional outcomes in all classification types with comparable complication rates when radiographic fracture displacement is used to guide surgical and clinical decision making. Level II.

Reconstruction of the deep fibers of the distal radioulnar ligaments facilitating atendon graft-Adams' procedure

Anatomical reconstruction of the deep fibers of the distal radioulnar ligaments to stabilise the distal radioulnar joint. Multidirectional instability of the distal radioulnar joint without the possibility for anatomic refixation of the distal radioulnar ligaments. General operative contraindications, infection, insufficient soft tissue coverage, osteoarthritis of the distal radioulnar joint, excessive ulna impaction syndrome, osseous deformation. Dorsal approach to the distal radioulnar joint, preparation of the ulna head, transosseous transfer of tendon graft through the distal ulnar corner of the radius at the sigmoid notch, transfer through the ulnar fovea and transosseous fixation within the ulna head using aninterference screw. Long arm cast for 4-6weeks, then Bowers splint for further 4weeks; optional long arm orthosis without limiting elbow flexion and extension for 4-6weeks, then Bowers splint for further 4weeks; starting exercises after 12weeks. Reconstruction of the distal radioulnar ligaments using tendon grafts stabilises the distal radioulnar joint with restoration of joint kinematics.

Comparison of distal third forearm fractures in children treated with above elbow verses below elbow cast.

ABSTRACT: In childhood most common fractures are closed fracture of the distal third of the forearm in children, after closed reduction of the forearm fractures of distal third were immobilized with long arm cast and by some orthopedic surgeon with short arm cast. Objectives: To compare the result of above elbow cast with below elbow cast in the treatment of distal third forearm fractures in children. Study Design: Randomized study. Setting: Department of orthopedics, Allied Hospital, Faisalabad. Period: One year 14-Sep, 2015 to 15-Aug, 2016. Results: 180 Cases fulfilling the inclusion / exclusion criteria were included in the study. In group A38.89% (%35) in our study and group B 45.56% (n=41) were between 1-6 years of age while. In group A 61.11% (n=55) and group B 54.44% (n=49) were 7-12 years of age of the children mean + sd 7.66 + 2.54 and 7.38 + 2.46 years respectively, In group A 58.89 % (n=53) in group B 62.22% (n=56) were male while group –A 41-11% (N37) and in group B 37.78% were females below elbow cast compared with above elbow cast in treating distal one third forearm fracture in children shows that group A 23.33% (n+21) and group B 30% (n=27) and re displacement shows no significant difference between their two groups. Conclusion: We concluded there is no significant difference in outcome of above elbow cast with below elbow cast after reduction treating the fracture of children in distal on third forearm fractures.

Does a Hand Strength-Focused Exercise Program Improve Grip Strength in Older Patients With Wrist Fractures Managed Nonoperatively?: A Randomized Controlled Trial.

Distal radius fractures in the older population significantly impair grip strength. The aim of the study was to investigate whether a hand strength focused exercise program during the period of immobilization for nonoperatively managed distal radius fractures in this population improved grip strength and quality of life. This is a single-center randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Fifty-two patients older than 60 yrs who experienced distal radius fractures managed nonoperatively with cast immobilization. The intervention group (n = 26) received a home hand strength-focused exercise program from 2 and 6 wks after injury while immobilized in a full short arm cast. The control group (n = 26) performed finger range of motion exercises as per protocol. Primary outcome was grip strength ratio of injured arm compared with uninjured arm. Secondary outcome included functional scores of the 11-item shortened version of the Disabilities of the Arm, Shoulder and Hand. Outcomes were measured at 2, 6, and 12 wks after injury. The intervention group significantly improved grip strength ratio at both 6 and 12 wks (6 wks: 40% vs 25%, P = 0.0044, and 12 wks: 81% vs 51%, P = 0.0035). The intervention group improved the 11-item Disabilities of the Arm, Shoulder and Hand score at 12 wks; however, this was not statistically significant (25 vs 40, P = 0.066). A hand strength-focused exercise program for elderly patients with distal radius fractures while immobilized significantly improved grip strength.

The Effect of Long Arm Cast and Thumb Spica Arm Cast in the Treatment of Patients with Distal Radius Fractures: A Randomized Clinical Trial

Background: Distal radius fracture is among the most common fractures of the long bones that are seen in all age groups. Treatment of these fractures in simple cases with displacement or intra-articular fractures is immobilizatgion, and if the fracture has dislocation, surgery may be required.Objectives: The aim of the study is a comparison of treatment efficacy and satisfaction in the methods of a long cast and thumb Spica cast in the patients with distal radius fractures without displacement.Methods: This study is a randomized clinical trial with a non blinded parallel design. Eighty patients with distal radius fractures without displacement were randomly assigned to long cast and thumb Spica cast groups. Patients were randomly using a random number table assigned to one of two long cast and thumb Spica castmethods. Both groupswere examined atweeks 4 and 5 and after six weeks plaster was opened and after one week they were evaluated by DASH questionnaire. Performance (limitation of motion, grip strength) and patients’ satisfaction was assessed in the two groups.Results: Themean age of patientswas 49.87±13.81 years. Therewere no significant differences between two groups regarding age(P= 0.84). In thumb Spica group 60% and in the long cast group 55% were male. There was no significant difference in sex distribution between treatment groups. The DASH scores in all subjectswere 11.68±5.53. Average total DASH score in thumb Spica cast group was 7.19 ± 6.80 and in the long cast was 16.02 ± 6.23. The mean of total DASH score in thumb Spica cast group was significantly higher than long cast group that presented better performance (limitation of motion, grip strength) in thumb Spica cast group respect to long cast group (P < 0.001). Satisfaction was similar between two groups (P = 0.40).Conclusions: Regarding better performance and treatment, thumb Spica cast is recommended as the preferred treatment for distal radius fractures without displacement.

How long does treated supracondylar humerus fracture in children take to recover elbow range?

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Our goal was to address requirement of physiotherapy after treatment of supracondylar humerus fractures in children and evaluate result of casting on elbow without injury using control group of distal forearm fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 57 cases of supracondylar fractures were included in this retrospective study and compared with group of 54 children with distal forearm fractures treated with long arm casting for 28 days. Passive elbow ROM was checked with goniometer on day of cast removal, 2 weeks later, and then every month until the elbow ROM returned to 95% ROM (ROM-95) of uninjured side. No physiotherapy was given.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Average time in cast for supracondylar fracture group was 31.8 days and distal forearm fracture group was 32.4 days. The elbow total flexion angle reached a plateau of 139 degrees at 1month after cast removal whereas forearm group required less than 2 weeks. Total rotation ROM required half the time to reach 139 degrees in forearm group. From the paired t test it took more time for pronation to recover than supination in supracondylar fractures. In supracondylar group there was positive correlation between casting period and recovery period of ROM-95 elbow extension (p=0.021) and days of casting (p=0.021) and ROM-95 flexion recovery period. There was no statistically significant impact between casting and recovery period in other directions and recovery of ROM-95 &amp;amp; F-ROM and the subclassification and type of treatment of individual fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Lessons learned: thorough assessment of elbow function post cast removal, lack of need of physiotherapy in management protocol and elbow stiffness is related to initial injury and associated treatment not merely immobilisation.&lt;/p&gt;

What’s New in Orthopaedic Trauma

What’s New in Orthopaedic Trauma

Unusual Wrist Injury Presentation in a Football Player

HISTORY: 17-year-old high school football player presented for sideline evaluation with right wrist pain. The injury occurred when he was tackled and had his wrist twisted and caught under another player. His coach kept him in the game and after one more play, his teammates called out for medical attention. He had diffuse swelling and pain along the ulnar aspect of the distal forearm and wrist. He was placed in a volar splint and sent to the emergency department where x-ray imaging of the wrist was read by radiologist as normal. The athlete followed up in clinic four days later. He continued to have pain, restricted range of motion, and decreased strength. Review of systems was otherwise normal. Past medical history was unremarkable. PHYSICAL EXAMINATION: Wrist examination showed moderate diffuse swelling but no ecchymosis or deformity. He had tenderness along the ulnar aspect of the distal wrist. There was no tenderness at the anatomic snuff box or scaphoid tubercle. Range of motion was limited in all directions, especially in supination. Strength was 4+/5 in all motions except for supination, which was 3+/5. Special tests including triangular-fibrocartilage complex grind, Watson’s, and Finkelstein’s were equivocal. Sensation to light touch was intact. Radial pulses were equally palpable bilaterally. DIFFERENTIAL DIAGNOSIS: 1) Ulnar styloid or hook of hamate fracture. 2) Distal radioulnar joint injury. 3) TFCC injury. 4) Scapholunate or lunotriquetral dissociation. TESTS AND RESULTS: Initial x-rays at ED were read as normal. Repeat x-rays were concerning for volar ulna dislocation. MRI without contrast showed volar dislocation of the ulna. FINAL/WORKING DIAGNOSIS: Radioulnar joint dislocation with volar displacement of ulna. TREATMENT AND OUTCOMES: 1. Orthopedic hand surgery referral. Given the length of time since initial injury, closed reduction was performed under general anesthesia. 2. Long arm cast with the forearm in supination position for 4 weeks. Repeat x-rays demonstrated maintenance of reduction. After cast removal, the patient returned to football with a removal wrist splint.

Introducing and Prospective Efficacy Comparison of an Innovative and Affordable Technique for the Treatment of Distal Radius Fractures

BackgroundThere are different treatments as well as controversies surrounding the adequate treatment for Distal Radius Fractures (DRF). In the absence of enough evidence[HYPHEN]base data regarding clinical effectiveness of available treatments, cost should be considered as an essential factor in selecting the surgical technique for DRF treatment. The goal of this study is introducing an improved and modified pin[HYPHEN]and[HYPHEN]plaster (MP&P) technique as an affordable alternative for treatment of DRF. This study also assesses and compares the outcomes of DRF treatment by using the introduced method versus external fixation (EF) technique. MethodsIn this clinical cohort study, 98 patients presenting with closed DRF Types III or IV, randomly were classified into two modified P&P (50 patients) and EF (48 patients) groups and assessed for functional, clinical, radiographic and overall outcome at the time, 2, 10 and 22 months after surgery. They were also followed[HYPHEN]up for up to 3 years to determine the rate of complications. ResultsEighty one percent of EF and 86% of MP&P group were female. The average ages in the EF and MP&P groups were 44.9 ± 12.4 and 46.1 ± 5.4, respectively. Around 70% of the patients in each group had a Type III fracture, and 30% had Type IV. The rate of complications was higher among EF group patients (seven major and seven minor complications) compared to the MP&P (only 4 minor complications), however the difference between two groups regarding the complications and treatment outcome were insignificant, except in extension ROM and the quick[HYPHEN]dash score (only in two and four months follow up visits) and also returning to work (only in two month follow up visit). ConclusionThis study introduces a modified P&P technique that protects the transverse palmar curvature, prevents the collapse of the distal radius, and simplifies casting, thereby obviating a full arm cast and mitigating elbow stiffness in patient outcomes. This modified technique could be considered as a more cost[HYPHEN]conscious alternative to external fixation for patients with distal radius fractures.

Frequency of Secondary Dislocations of Initially non Displaced and Minimally Displaced Fractures of the Lateral Humeral Condyle in Children - Surveillance of a Treatment Algorithm.

The treatment of undisplaced fractures of the lateral humeral condyle is conservative. However, it is problematic that it is not possible to differentiate between a stable and an unstable, non-displaced fracture. A pragmatic approach is to X-ray the elbow without a cast 5 days after trauma and to compare those images with the initial ones. If there is a central increase of dislocation, then there is an indication of an unstable fracture. The dislocation can also be indicated by a translational movement, which is best observed in the border area. The aim of the study was to retrospectively determine the incidence of secondary dislocations of initially undisplaced and minimally dislocated fractures of the lateral humeral condyle in infants between 2010 and 2015. We performed a retrospective, non-randomized analysis of 75 children with initially undisplaced and minimally displaced fractures of the lateral humeral condyle between 2010 and 2015. The strategy for the evaluation of a stable and an unstable fracture of the lateral humeral condyle was carried out by means of an X-ray without a cast 5 days after trauma. Further radiological controls were performed after 14 days, 4 weeks and after 10 to 12 weeks in operated children. Seven initially undisplaced and minimally dislocated fractures (9,3%) showed a secondary dislocation 5 days after trauma when a radiological control without a cast was performed. At the control 14 days after trauma there was no further secondary dislocation. The immobilization took place in an upper arm cast for a period of 4 weeks. 90% of all non-dislocated fractures of the lateral humeral condyle can be treated conservatively. It is important to find out which about 10% of children will experience a secondary dislocation safely and effectively. It has been shown that the strategy for the evaluation of a stable and an unstable fracture of the lateral humeral condyle by means of a radiological control after 5 days without a cast can be effective and cost-saving. With a high degree of certainty, the unstable fracture can be detected at the radiological control 5 days after trauma. If, after 5 days, the radiological control reveals unsure finding regarding the dislocation, it is advisable to recheck the fracture in the second radiological control after 14 days.