Elbow Fractures Research Articles

Epidemiologic investigation of pediatric distal humerus fractures: An American insurance claims database study.

Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types: Supracondylar (SC), lateral condyle (LC), and medial epicondyle (ME) fractures. To evaluate the epidemiology of pediatric distal humerus fractures (SC, LC, and ME) from an American insurance claims database. A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC, LC and ME fractures based on the IBM Truven MarketScan® Commercial and IBM Truven MarketScan Medicare Supplemental databases. Patients from 2015 to 2020 were queried for treatments, patient age, sex, length of hospitalization, and comorbidities. A total of 1133 SC, 154 LC, and 124 ME fractures were identified. SC fractures had the highest percentage of operation at 83%, followed by LC (78%) and ME fractures (41%). Male patients were, on average, older than female patients for both SC and ME fractures. In the insurance claims databases used, SC fractures were the most reported, followed by LC fractures, and finally ME fractures. Age was identified to be a factor for how a pediatric distal humerus fractures, with patients with SC and LC fractures being younger than those with ME fractures. The peak age per injury per sex was similar to reported historic central tendencies, despite reported trends for younger physiologic development.

Point-of-Care Ultrasound Screening for an Elbow Fracture in the Pediatric Emergency Department.

Point-of-Care Ultrasound Screening for an Elbow Fracture in the Pediatric Emergency Department.

Trends and projection of forearm fractures including elbow fractures of the Olecranon in Sweden: an analysis of 363 968 fractures using public aggregated data

BackgroundForearm and olecranon fractures are a common orthopaedic injury. This study aimed to analyse whether the incidence of forearm injury is changing and identifying trends in the number of forearm and olecranon fractures using public aggregated data in Sweden.MethodsThe number of forearm and olecranon fractures as defined by the number of registered diagnoses with the ICD-10 code of S52 were collected and normalized per 100,000 inhabitants and stratified per sex, age, and month. Age-adjusted incidence for forearm and olecranon fractures were calculated using the direct method. Poisson regression was used to analyse monthly, seasonal and yearly change in forearm and olecranon fracture incidence. Logistical regression was used to predict future trends of forearm and olecranon fractures.ResultsThe findings revealed a slight decreasing trend in forearm and olecranon fractures. The average incidence rate during the study period was 333 with women having a higher incidence rate than men. More fractures occurred in the winter months. Fluctuations in the number of forearm and olecranon fractures were observed during 2020 which may be influenced by the COVID-19 pandemic. Based on current data, forearm and olecranon fractures are expected to decrease in Sweden by 2035.ConclusionThis study describes the trend of forearm and olecranon fractures among individuals according to sex and age in Sweden using easily obtainable data. Trends in forearm and olecranon fractures are dependent on sex and age but generally show a decreasing trend. More precise studies are needed in order to properly quantify the specific incidence of various subtypes of forearm and olecranon fractures and associated risk factors.

Regional distribution prevalence of heterotopic ossification in the elbow joint: a 3D study of patients after surgery for traumatic elbow injury

BackgroundHeterotopic ossification (HO) is a common complication after elbow fracture surgery and can lead to severe upper extremity disability. The radiographic localization of postoperative HO has been reported previously. However, there is no literature examining the distribution of postoperative HO at the three-dimensional (3D) level. This study aimed to investigate 1) the distribution characteristics of postoperative HO and 2) the possible risk factors affecting the severity of postoperative HO at a 3D level. MethodsA retrospective review was conducted of patients who presented to our institution with HO secondary to elbow fracture between 13 January 2020 and 16 February 2023. CT scans of 56 elbows before elbow release surgery were reconstructed in three dimensions (3D). HO was identified using density thresholds combined with manual identification and segmentation. The elbow joint and HO were divided into six regions according to three planes: the transepicondylar plane (TEP), the lateral ridge of the trochlear plane (LTP), and the radiocapitellar joint and coronoid facet plane (RCP). The differences in the volume of regional HO associated with different initial injuries were analyzed. ResultsPostoperative HO was predominantly present in the medial aspect of the capsule in 52 patients (93%), in the lateral aspect of the capsule in 45 patients (80%), in the medial supracondylar in 32 patients (57%), and in the lateral supracondylar, radial head, and ulnar region in the same number of 28 patients (50%). The median and interquartile range (IQR) volume of total postoperative HO was 1683 (777∼4894) mm3. The median and IQR volume of regional postoperative HO were: 584 (121∼1454) mm3 at medial aspect of capsule, 207 (5∼568) mm3 at lateral aspect of capsule, 25 (0∼449) mm3 at medial supracondylar, 1 (0∼288) at lateral supracondylar, 2 (0∼478) at proximal radius and 7 (0∼203) mm3 at the proximal ulna. In the subgroups with Injury Severity Score (ISS) >or= 16, Gustilo–Anderson II, normal uric acid levels, elevated alkaline phosphatase (ALP), and Body Mass Index (BMI) >or= 24, the median HO volume exceeds that of the respective control groups. ConclusionThe medial aspect of the capsule was the area with the highest frequency and median volume of postoperative HO among all initial elbow injury types. Patients with higher Gustilo-Anderson grade, ISS, ALP or BMI had higher median volume of postoperative HO.

Fixation of Terrible Triad Fracture in Young Adult through Anterior Approach – A Case Report

Introduction: The terrible triad of the elbow is defined as the combination of fractures of the radial head and ulnar coronoid process and dislocation of the elbow joint, and is often associated with collateral ligaments injuries. Objective: The objective is to report the clinical outcomes of an anterior surgical approach for coronoid fracture with plate fixation in the management of a case of terrible triad fracture with undisplaced radial head. Case Details: A 23 years old male presented with complaints of pain and swelling in right wrist and left elbow region since 1 day. He had a history of fall from height 1 day back with no known comorbidities or DNVD. Conclusion: Terrible triad fracture can be treated successfully with plate fixation through an anterior surgical approach in cases of undisplaced radial head with physiological range of motion at elbow which allows for accurate reduction and rigid internal fixation and early functional exercise, resulting in a favourable outcome.

Artificial neural networks outperform linear regression in estimating 9-month patient-reported outcomes after upper extremity fractures with increasing number of variables.

To compare performance between linear regression (LR) and artificial neural network (ANN) models in estimating 9-month patient-reported outcomes (PROs) after upper extremity fractures using various subsets of early mental, social, and physical health variables. We studied 734 patients with isolated shoulder, elbow, or wrist fracture who completed demographics, mental and social health measures, and PROs at baseline, 2-4 weeks, and 6-9 months postinjury. PROs included 3 measures of capability (QuickDASH, PROMIS-UE-PF, PROMIS-PI) and one of pain intensity. We developed ANN and LR models with various selections of variables (20, 23, 29, 34, and 54) to estimate 9-month PROs using a training subset (70%) and internally validated them using another subset (15%). We assessed the accuracy of the estimated value being within one MCID of the actual 9-month PRO value in a test subset (15%). ANNs outperformed LR in estimating 9-month outcomes in all models except the 20-variable model for capability measures and 20-variable and 23-variable models for pain intensity. The accuracy of ANN versus LR in the primary model (29-variable) was 83% versus 73% (Quick-DASH), 68% versus 65% (PROMIS-UE-PF), 66% versus 62% (PROMIS-PI), and 78% versus 65% (pain intensity). Mental and social health factors contributed most to the estimations. ANNs outperform LR in estimating 9-month PROs, particularly with a larger number of variables. Given the otherwise relatively comparable performance, aspects such as practicality of collecting greater sets of variables, nonparametric distribution, and presence of nonlinear correlations should be considered when deciding between these statistical methods.

Surgical Treatment of the Terrible Triad of the Elbow

Summary. The so called “terrible triad” injury of the elbow, which includes a combination of posterolateral dislocation of the forearm with fractures of the radial head and coronoid process, accounts for 10%-11% of all elbow fractures in adults. This type of elbow injury remains difficult to treat and is often accompanied by a high level of complications: instability, contractures, deformable arthrosis, and pain syndrome.
 Objective: to assess the effectiveness of surgical treatment of patients with the terrible triad of the elbow, depending on the duration of the injury and the features of osteosynthesis of the coronoid process using certain approaches.
 Material and Methods. The surgical treatment of 87 patients with the terrible triad of the elbow was analyzed. The age of the patients was 40.9±2.6 years. The average term of admission to treatment was 5.5±4.1 months after the injury. 59 patients were admitted in less than 30 days and 28 patients were admitted after 30 days. The preoperative examination included X-ray and CT; sonographic and EMG studies were performed if necessary. Surgical treatment consisted of repositioning and osteosynthesis of the coronoid process, osteosynthesis or prosthetics of the radial head, and restoration of the damaged lateral ligaments of the elbow joint. In cases of consequences of injury, in addition, mobilization of the elbow joint was performed, osteosynthesis was supplemented with bone autograft, and damaged ligaments were restored plastically. After the surgery, the elbow joint was immobilized in the extension position of 30-20 degrees. Postoperative rehabilitation begins on the first day after surgery and involves one cycle of flexion and extension during the day from the extension position of 20-30° to flexion position of 100-120°. Immobilization in the extension position of 20-30° is basic and is used in the evening and at night.
 Results. The results were evaluated according to the MEPS system in 56±6.2 months. In the group of patients who underwent surgery within 30 days, the MEPS function index was 90.3±2.1 points; when surgery was performed more than 30 days after the injury, statistically worse results were achieved (83.5±2.9 points). We also compared the outcomes of treatment depending on the access to osteosynthesis of the coronoid process. When performing an anterior approach to the coronoid process, the MEPS index was 90.1±3.2 points, which was better than in case of other approaches.
 Conclusions. Thus, it has been proven that better results in the surgical treatment of the terrible triad are obtained in the group of patients who underwent surgery up to 30 days after the injury compared to later admission to treatment. The advantages of the anterior approach for grade 2-3 coronoid process fractures have been proven. Our proposed early dosed rehabilitation plays an important role in the treatment of such patients.

Elbow dislocation approach for complex elbow fractures: a cadaveric study

BackgroundApproach need to be considered when surgeons dealt with complex elbow injuries and the choice of the approach is a challenge for surgeons due to the complex anatomy. On the basis of releasing the lateral collateral ligament, we modified the dislocation technique to pursue the superior exposure including not only the distal humeral surface but also the anterior facet of the coronoid process.MethodsA total of 4 cadaver specimens and 8 elbows were included in the study. Each cadaver provided one elbow for either the elbow dislocation approach or the posterior olecranon approach. The exposed distal articular surface of humerus, humeral capitulum, humeral trochlea, anterior trochlea of distal humerus, posterior trochlea of distal humerus and the ulnar coronoid process surface were marked by image J software and calculated for a comparison for each surgical approach.ResultsThe total distal humeral surface was exposed as a median of 98.2 (97.6, 99.6)% and 62.0 (58.3, 64.5)% for the elbow dislocation approach and the olecranon osteotomy approach (P < 0.001), the capitulum 100% and 32.4 (28.0, 39.2)% (P < 0.001), the trochlea 93.2(90.1, 96.9)% and 72.5 (65.2, 78.8)% (P < 0.001), the anterior trochlear articular surface 96.0(93.0, 97.4)% and 50.3 (43.6, 59.1)% (P < 0.001), the posterior trochlear articular surface 95.4 (93, 100)% and 100% (P = 0.76) and the articular surface of the coronoid process of ulna 71.3 (66.0, 74.2)% and 0% (P < 0.001).ConclusionFor complex elbow fractures, the technique of elbow dislocation provides complete exposure of the distal humerus surface and a significant portion of the coronoid process surface, facilitating direct visualization for reduction and fixation.Level of evidence Anatomy Study; Cadaver Dissection.

Do not Miss a Pediatric Lateral Condyle Fracture- A Case Based Description of Neglected Case Managed with Good Outcome

Background: Lateral Condyle Fractures are the second most common fracture amongst the pediatric elbow fractures, which is usually neglected commonly due to parents not seeking timely medical help or clinician missing the diagnosis with lack of knowledge or understanding. Case Presentation: A 3-year-old female was presented in the outpatient department with outward bowing of the right elbow following a history of FOOSH injury more than a month back. Clinical examination showed gross valgus deformity with an increased carrying angle with thickened and irregular lateral condyle on examination. Adiograph of the elbow showed nonunion of the lateral humeral condyle with lateral displacement and malrotation of the fracture fragment. The carrying angle of the affected side was 50º and Baumann’s angle on affected side was 40º. A CT scan also showed displaced fracture of lateral epicondyle of right humerus. Patient was treated successfully with Open Reduction and Internal Fixation (ORIF) with Kirschner (k) wires. On follow up, the patient had significant improvement with the correction of valgus deformity and overall improvement in the elbow range of movements.

Systematic review of paediatric pulseless pink humerus supracondylar fractures.

The supracondylar humeral fracture (SCHF) is the most common fracture seen in children, forming up to 70% of all pediatric elbow fractures. The decision to surgically explore the brachial artery in a well-perfused, pulseless arm remains a controversial one among vascular and orthopedic surgeons and is something we seek to explore in this article. We reviewed the literature from electronic databases such as PubMed and Embase for studies focusing on the management of the pink pulseless hand (PPH) following SCHF. We gathered a total of 23 articles to be analyzed in this review. We found 336 PPH postreduction and evaluated the management as well as the follow-up and complications of the PPH involved. Most recent articles have cited the close observation strategy as the most reliable strategy. It is clear that the management of a SCHF requires immediate reduction and fixation. In the management of a postoperatively pulseless pink humerus, we do agree with the latest conclusion of Delionitis et al . who advocate the traditional dogma of watchful waiting in the case of a PPH postreduction and fixation as long as no signs of vascular deterioration appear. However, the outcome of this study also advocates for the monitoring of up to 24-48 h postreduction and the use of noninvasive tools such as ultrasound Doppler, Color flow duplex Ultrasound and pulse oximetry to monitor perfusion as they all have had good outcomes in the articles cited in this review. Still, in the event of vascular deterioration or development of complications of the hand, immediate vascular exploration is still indicated.

WORK-LIMITING INJURIES SUSTAINED BY ATHLETES IN THE WORLD'S HARDEST RACE

IntroductionThe Tour de France, commonly recognised and the hardest physical endurance event on the planet, is an iconic cycling competition with a history of ever impressive performances and increasingly notable injuries. This study aims to methodologically catalogue and analyse injuries sustained by professional riders over a span of six years and understand the operative workload created by this prestigious race. (2018–2023).MethodsData was gathered from multiple publicly available sources, including pro-cycling stats, news articles, team press releases and independent medical reports. Each injury was categorized by year, rider, and injury type.ResultsFrom 2018–2023, there was a significant diversity in both injured body part and mechanism of injury. Of the 124 recorded race ending incidents clavicle fractures accounted 19.4%, laceration/contusions 12.1%, patella fractures 10.5% and elbow fractures 7.3%. Othernotable other body areas undergoing surgical intervention were hand fractures 5.6%, pelvic fractures 2.4% and femoral fracture 1.6%. At a mean of 20.67 injuries per tour, this accounts for almost exactly one race ending injury per day where an athlete finishes the day on the operating table, rather than the team bus.DiscussionThe Tour de France's rigorous challenges are mirrored in its injury statistics. Over six years, clavicle fractures were most prevalent, likely due to cyclists' instinct to brace during crashes. Lacerations, contusions, and patella fractures also featured prominently. Alarmingly, each race stage averaged an injury severe enough for surgical intervention. This data highlights the imperative need for enhanced protective measures, race regulations, and medical preparedness to protect these elite athletes.

Comparison of complications and results of early vs. delayed surgery for pediatric supracondylar humeral fractures.

Pediatric supracondylar humerus fracture (SCHF) is one of the most common elbow fractures in children aged 5-7 years. There is a continuous discussion regarding the optimal timing for conducting surgery for fractures of this nature. Therefore, we aimed to determine whether the timing of surgery in pediatric SCHFs has an impact on the frequency of early postoperative complications. Between January 2018 and March 2020, pediatric SCHF patients who underwent surgery at our hospital were retrospectively reviewed. Patients operated on within 12 hours after the fracture and those operated on later were respectively included in the early and late groups. Early postoperative complications, including neurological deficits, iatrogenic ulnar nerve injury, vascular injury, compartment syndrome, K-wire migration, and unexpected returns to the operating room, were compared between the two groups. We investigated surgical duration, reduction, and perioperative radiographic data. For modified Gartland type II or type III fractures, there was no significant difference in the incidence of early complications between the early and delayed groups. Additionally, there were no noticeable differences between the two groups in terms of perioperative radiographic data, reduction procedure, or surgical duration. Delayed surgery in type II or type III supracondylar humerus fractures was not associated with an increased incidence of early postoperative complications. The difficulty or effectiveness of reduction is not influenced by the timing of surgery.

The Boyd approach: a valuable alternative to treating simple to complex elbow fractures and dislocations.

The Boyd approach is a single-incision posterior approach to the proximal radius and ulna based on a lateral anconeus muscle reflection and release of the lateral collateral ligamentous complex. This approach remains a lesser-used technique following early reports of proximal radioulnar synostosis and postoperative elbow instability. Although limited by small case series, recent literature does not support these early reported complications. This study presents a single surgeon's outcomes using the Boyd approach for the treatment of simple to complex elbow injuries. Following institutional review board approval, a retrospective review of all patients with simple to complex elbow injuries treated consecutively using a Boyd approach by a shoulder and elbow surgeon was conducted from 2016 to 2020. All patients with at least 1 postoperative clinic visit were included. Data collected included patient demographics, injury description, postoperative complications, elbow range of motion, and radiographic findings including heterotopic ossification and proximal radioulnar synostosis. Categorical and continuous variables were reported using descriptive statistics. A total of 44 patients were included with an average age of 49 years (range 13-82 years). The most commonly treated injuries were Monteggia fracture-dislocations (32%) and terrible triad injuries (18%). Average follow-up was 8 months (range 1-24 months). Final average elbow active arc of motion was from 20° (range 0°-70°) of extension to 124° (range 75°-150°) of flexion. Final supination and pronation were 53° (range 0°-80°) and 66° (range 0°-90°), respectively. There were no cases of proximal radioulnar synostosis. Heterotopic ossification contributing to less than functional elbow range of motion occurred in 2 (5%) patients who elected conservative management. There was 1 (2%) case of early postoperative posterolateral instability due to repair failure of injured ligaments that required revision using a ligament augmentation procedure. Five (11%) patients experienced postoperative neuropathy, including 4 (9%) with ulnar neuropathy. Of these, 1 underwent ulnar nerve transposition, 2 were improving, and 1 had persistent symptoms at final follow-up. This is the largest case series available demonstrating the safe utilization of the Boyd approach for the treatment of simple to complex elbow injuries. Postoperative complications including synostosis and elbow instability may not be as common as previously understood.

Navigating a Rare Type IV Capitellar fracture: A Case Report and Comprehensive Literature Review.

Capitellar fractures are rare, it accounts 1% of elbow fractures, and can be challenging to diagnose initially. Distinctive "double arc sign" on lateral elbow radiograph is pathogonomic. 3D CT scans is . ORIF is the preferred treatment, but the choice of fixation methods lacks consensus, although headless compression screws are commonly used. This case report presents a Type IV capitellar fracture in a 14-year-old boy resulting from a fall. The patient underwent successful ORIF using 4.0mm cannulated screws inserted posterior to anterior without penetrating joint surface, leading to complete functional recovery. At the 6-month follow-up, the patient exhibited robust healing without signs of capitellar avascular necrosis (AVN).The case underscores the significance of clinical suspicion and meticulous radiographic evaluation to avoid overlooking capitellar fractures. Moreover, it showcases the effectiveness of cannulated screws as a viable alternative in the absence of headless compression screws, offering comparable stability and excellent functional outcomes.

Comparison of the midterm result between Lag-Screw fixation and K-wires treating displaced medial epicondyle fractures in children.

Medial epicondyle fractures a prevalent injury, constituting 11% to 20% of all elbow fractures in children and adolescents. Common fixation strategies for displaced medial epicondylar fractures involve the use of K-wires and Lag-Screw fixation. The aim of this retrospective study was to compare 2 methods for treating medial epicondylar fractures in children. In this retrospective study, 26 children with displaced medial epicondyle fractures were included. Patients were divided into 2 groups after reduction: Lag-Screw (LS) group and K-wires group. We compared the operation time, range of motion (ROM), range of rotation (ROR), and Mayo elbow performance score (MEPS). A total of 26 patients were available for a long-term follow-up, with a mean age of 11.6 ± 2.5 years, follow up by 35.7 ± 5.7 months. The average operation time in K-wires group was shorter than the Lag-Screw group. The average ROM, ROR, and MEPS of the 2 groups are excellent in 3 months follow up after operation and maintained excellent results during the final follow-up. Regarding MEPS, ROM, and ROR, there was no significant difference between LS group and KW group. However, the LS group experienced fewer complications than the KW group. Both Lag-Screw and K-wires fixation for medial epicondyle fractures in pediatric patients yield favorable mid-term results when assessed in terms of ROM,ROR, MEPS. K-wires fixation, while having a shorter operation time and saving an additional anesthesia and surgery to remove the implants compare to fixed by Lag-Screw fixation, does come with a higher complication rate.

Arthroscopic-Assisted Fracture Fixation About the Elbow.

Arthroscopic-assisted fracture fixation can be used for some adult elbow fractures. In particular, for articular fractures of the anterior elbow (coronoid/capitellum), elbow arthroscopy can provide excellent visualization of fracture fragments using a less invasive surgical exposure. Meticulous adherence to safe techniques and utilization of specialized equipment can help maximize safety and facilitate reproducible surgical results.

A Comparative Study of the Modified Baumann's Angle Between the Dominant and Non-Dominant Sides in a North Indian Pediatric Population.

Background The literature points towards the fact that paediatric elbow fractures happen more frequently and have greater variability when contrasted with adults. Between 65%-75% of pediatric fractures involve the upper extremity, and supracondylar humerus is the most common of them all. To know the exact site of injury and to estimate the degree of reduction after manipulation, the modified Baumann's angle, the Baumann's angle, the Humero-condylar angle, the Anterior humeral line, and the Radio-capitellar line are the parameters most commonly used. This study was carried out to compare the modified Baumann's angle between both upper limbs in the paediatric population. Methodology This cross-sectional study was conducted in a tertiary health care centre in Northern India for one year from September 1, 2021, to August 31, 2022. We included pediatric patients in the age group of 3-16 years. Age, sex, weight, height, BMI, secondary sexual characters, and handedness were noted in all the children enrolled in our study. In both the dominant and non-dominant sides, the mean arm length, the forearm length, the inter-epicondylar distance, the clinical carrying angle, the radiological carrying angle, and the modified Baumann's angle were calculated. Results A total of 113 children were enrolled in the study. The majority of children (71.7%) had dominance on the right side. In both the dominant side and non-dominant side, mean arm length, forearm length, inter-epicondylar distance, clinical carrying angle, radiological carrying angle, and modified Baumann's angle values were calculated. On evaluating the data statistically, a significant difference between the two sides was observed for all the parameters (p<0.05), except forearm length (p-value -0.954). Multivariate analysis showed that only BMI was significantly negatively associated with modified Baumann's angle (p=0.016), and only age (0.019) and BMI (<0.001) were found to be significantly associated with the difference in modified Baumann's angle. Conclusions The findings of this study will be helpful in the management of elbow disorders and their reconstruction following trauma. A significant difference was found in the modified Baumann's angle between dominant and non-dominant sides, and it also showed a negative significant correlation with arm length, forearm length,and the presence of secondary sexual characteristics. The equations derived in this study will be helpful in the simple derivation of the modified Baumann's angle and its differencefrom simple measurements of the upper limb parameters.

Open Elbow Fracture Dislocation with Ipsilateral Shoulder Fracture Dislocation: A Case Report and Literature Review

Open Elbow Fracture Dislocation with Ipsilateral Shoulder Fracture Dislocation: A Case Report and Literature Review

Prospective review of open reduction and internal fixation with Kirschner wires (K-wires left exposed) fixation in displaced and rotated (Song V) lateral humerus condyle fractures in children

Background: Fractures of the lateral condyle of the humerus account for 10-15% of all elbow fractures in children. These include Salter Harris type 2 and type 4 growth plate injuries in which the fracture crosses the distal humeral growth plate and enter the elbow joint. Open reduction and internal fixation with K wire is treatment of choice for the displaced as well as minimally displaced lateral condyle fractures of children to prevent malunion, nonunion and further displacement. Methods: This was prospective analytical study conducted in Rajendra Institute of Medical Sciences, Ranchi from December 2020 to December 2022 which consisted of 30 patients (of whom only 27 were present for follow ups) who were treated by ORIF with K-wires fixation. We followed the classification pattern given by Song et al. Results were evaluated according to the criteria given by the Hardacre et al. Results: Major culprit for injuries was fall from height (44.4%), followed by playing indoor games (25.9%). RTA and sports each constituted of (14.8%). Functional outcomes based on Hardacre criteria are excellent (85.1%), good in 11.1% cases and fair in 3.7% cases. Conclusions: Our findings demonstrate that open reduction and internal fixation with 2 or 3 K-wires (which were left exposed) and immobilization with casting for 3-4 weeks is sufficient for most of displaced and rotated fractures of the lateral condyle of the humerus.

External validation of an artificial intelligence solution for the detection of elbow fractures and joint effusions in children

PurposeThe purpose of this study was to conduct an external validation of an artificial intelligence (AI) solution for the detection of elbow fractures and joint effusions using radiographs from a real-life cohort of children. Materials and methodsThis single-center retrospective study was conducted on 758 radiographic sets (1637 images) obtained from consecutive emergency room visits of 712 children (mean age, 7.27 ± 3.97 [standard deviation] years; age range, 7 months and 10 days to 15 years and 10 months), referred for a trauma of the elbow. For each set, fracture and/or effusion detection by eleven senior radiologists (reference standard) and AI solution was recorded. Diagnostic performance of the AI solution was measured via four different approaches: fracture detection (presence/absence of fracture as binary variable), fracture enumeration, fracture localization and lesion detection (fracture and/or a joint effusion used as constructed binary variable). ResultsThe sensitivity of the AI solution for each of the four approaches was >89%. Greatest sensitivity of the AI solution was obtained for lesion detection (95.0%; 95% confidence interval: 92.1–96.9). The specificity of the AI solution ranged between 63% (for lesion detection) and 77% (for fracture detection). For all four approaches, the negative predictive values were >92% and the positive predictive values ranged between 54% (for fracture enumeration and localization) and 73% (for lesion detection). Specificity was lower for plastered children for all approaches (P < 0.001). ConclusionThe AI solution demonstrates high performances for detecting elbow's fracture and/or joint effusion in children. However, in our context of use, 8% of the radiographic sets ruled-out by the algorithm concerned children with a genuine traumatic elbow lesion.