Fractures In Children Research Articles

Closed Reduction Technique for Severely Displaced Radial Neck Fractures in Children.

The described technique is useful for achieving closed reduction of severely displaced (i.e., Judet Type-III and IV) pediatric radial neck fractures. It is widely agreed that radial neck fractures with angulation of >30° should be reduced. Various maneuvers have been described, but none uniformly achieves complete reduction in severely displaced radial neck fractures (Types III and IV)1-4. The aim of the present technique is to achieve closed reduction in these severely displaced radial neck fractures without surgical instrumentation. A stepwise approach is described. First, the radial head is viewed in profile under an image intensifier so that it appears rectangular. Varus stress is applied at the medial aspect of the elbow by the assistant, and thumb pressure is applied at the radial head along the posterolateral aspect of the elbow. This results in partial reduction of the radial head. The elbow is then simultaneously flexed and pronated with continuous pressure over the radial head. This final step anatomically reduces the radial head, and hyperpronating the forearm locks it in the corrected position. Operative alternatives to this technique include intra-focal pin-assisted reduction to achieve closed reduction, the Métaizeau technique of achieving indirect closed reduction of the fracture with the aid of a TENS (Titanium Elastic Nailing System) nail, and open reduction5. Nonoperative techniques have also been described for use with Judet Type-II and III fractures, but not with the severely displaced types described in the present article. This technique takes into consideration the anatomy of the capsule and lateral collateral ligament complex. The biomechanical ligamentotaxis helps in achieving anatomic reduction of the radial head. Placing the forearm in pronation tightens the annular and lateral collateral ligaments and prevents redisplacement. There are potential complications with operative treatment, including the risk of nerve injury with percutaneous reduction techniques and the risks of osteonecrosis, premature epiphyseal fusion, and heterotopic ossification with open reduction. These complications can be avoided by the use of the presently described technique. This technique provided satisfactory clinical outcomes in our previous study6, with none of the 10 patients showing signs of growth disturbance, loss of reduction, or reported complications at 12 months. Terminal restriction of supination was observed in 1 patient. No patient had osteonecrosis or elbow deformity. No patient required conversion to an implant-assisted or open reduction procedure. The steps need to be followed sequentially as described in order to achieve an anatomical reduction.After achieving the reduction, it is necessary to keep the forearm in pronation to maintain the reduction with the aid of the lateral ligament complex.This technique may not work in complex fractures with elbow dislocation because of the lack of ligamentous integrity.In the final step, the elbow is pronated and flexed simultaneously, with sustained pressure over the radial head in order to obtain further correction. This is the most critical step of the technique because anatomic reduction of the partially reduced fracture is achieved at this time. Percut. = percutaneousAP = anteroposteriorCR = closed reductionORIF = open reduction and internal fixation.

Results of Antegrade Intramedullary Elastic Wires for Severely Displaced Distal Radial Fractures in Children

Objective: The objective of this study is to present a new method of Antegrade elastic wires, which is a minimally invasive surgical approach to treat displaced fractures in the distal radial metaphyseal and dia-metaphyseal fractures in children. Materials and Methods: We conducted a retrospective analysis of 18 patients who received antegrade elastic wires treatment for distal radial fractures from January 2019 to January 2023. The surgical indications encompassed closed, significantly displaced, and unstable fractures located in the metaphysis or diaphyseo-metaphyseal region of the radius. The fractures were stabilized using two prebent short elastic nails that were introduced from the diaphysis to the metaphysis. In instances when an ulnar fracture was present, a traditional anterograde nailing procedure was also carried out. A long or short arm plaster cast was administered for a duration of 3 weeks. Results: The group consisted of 15 boys and 3 girls, with an average age of 10.8 years (ranging from 7 to 16 years). The right hand was implicated in 12 instances, whereas the left hand was implicated in 6 instances. The mean duration of follow-up was 7.8 months, with a range of 4 to 28 months. Out of the 18 patients, 2 individuals experienced skin irritations, which were resolved after the removal of the radial nails. All patients had complete restoration of their range of motion and experienced successful bone healing without any problems. Conclusions: An antegrade elastic wire fixation is a very efficient, secure, and readily replicable technique for treating unstable fractures of the distal radius, while also preventing harm to the physeal plate. It successfully attains favorable functional and radiological outcomes and allows early mobilization. Keywords: Distal radius, Metaphyseal fracture, dia-metaphyseal fractures, Elastic wires, Antegrade.

Hemodynamic Instability of Femur with Closed Fractures in Children

Hemodynamic Instability of Femur with Closed Fractures in Children

Clinical and Radiographical Evaluation of Displaced Supracondylar Humerus Fractures in Children with Open Reduction and Internal Fixation from Lateral Approach at Dr. Soedirman Hospital in Kebumen

ABSTRACT Supracondylar humerus fracture is the most common elbow fractur in children. This fracture requires proper diagnosis and treatment, otherwise it can cause functional impairment and complications. This study aims to assess outcome of displaced supracondylar humerus fracture in children by open reduction and pining from lateral approach. This research was descriptive quantitative using a retrospective method. All cases Gartland type III of supracondylar humerus fractures in children at Dr. Soedirman Hospital in Kebumen for 2015-2020, treated with open reduction and internal fixation from lateral approach. Outcomes were assessed according to the Flynn’s criteria and Mayo Elbow Performance Score. There were 59 patients, the age 3-15 years and the mean age 6.8 years. More cases were found in boys (59.3%) than girls (40.7%). The most common type of fracture was extension (98.3%). The side of fracture was more the left and was the non-dominant extremity (56%). No infection, vascular and nerve injuries. According to Flynn's criteria, cosmetic outcome in 55 of the 59 patients (93.2%) was excellent, in 4 patients (6.8%) good (P=0.051). Also, the functional outcome in 59 patiens (100%) were excellent. According to MEPS scoring, functional outcome in 58 patients (98.3%) was excellent and 1 patient (1.7%) had good. Overall, all cases were judged satisfactory (P=0.043). Treatment of supracondylar humerus fractures in children with open reduction and internal fixation from lateral approach is a safe with good clinical and radiographic results and can be applied. Keywords: Supracondylar Fractures, Open Reduction, Lateral Approach, Children.

Diagnostic Accuracy of Ultrasonography for Identification of Elbow Fractures in Children; a Systematic Review and Meta-analysis.

In spite of the results of previous studies regarding the benefits of ultrasonography for diagnosis of elbow fractures in children, the exact accuracy of this imaging modality is still under debate. Therefore, in this diagnostic systematic review and meta-analysis, we aimed to investigate the accuracy of ultrasonography in this regard. Two independent reviewers performed systematic search in Web of Science, Embase, PubMed, Cochrane, and Scopus for studies published from inception of these databases to May 2023. Quality assessment of the included studies was performed using Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). Meta-Disc software version 1.4 and Stata statistical software package version 17.0 were used for statistical analysis. A total of 648 studies with 1000 patients were included in the meta-analysis. The pooled sensitivity and specificity were 0.95 (95% CI: 0.93-0.97) and 0.87 (95% CI: 0.84-0.90), respectively. Pooled positive likelihood ratio (PLR) was 6.71 (95% CI: 3.86-11.67), negative likelihood ratio (NLR) was 0.09 (95% CI: 0.03-0.22), and pooled diagnostic odds ratio (DOR) of ultrasonography in detection of elbow fracture in children was 89.85 (95% CI: 31.56-255.8). The area under the summary receiver operating characteristic (ROC) curve for accuracy of ultrasonography in this regard was 0.93. Egger'sand Begg'sanalyses showed that there is no significant publication bias (P=0.11 and P=0.29, respectively). Our meta-analysis revealed that ultrasonography is a relatively promising diagnostic imaging modality for identification of elbow fractures in children. However, clinicians employing ultrasonography for diagnosis of elbow fractures should be aware that studies included in this meta-analysis had limitations regarding methodological quality and are subject to risk of bias. Future high-quality studies with standardization of ultrasonography examination protocol are required to thoroughly validate ultrasonography for elbow fractures.

Radial Nerve Palsy Associated with Humeral Shaft Fractures in Children

Background. This is the first systematic review of the relationship between humeral shaft fractures and radial nerve palsy in children. The present comprehensive review is aimed at identifying important clinical findings between humeral diaphysis fractures and radial nerve injuries and assessing the effects of treatment. Methods. We searched electronic bibliographic databases, including PubMed, the Cochrane Library, Scopus, and Web of Knowledge, until March 2022. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses and the patients, interventions, comparisons, outcomes guidelines. Results. We identified 23 original papers, of which 10 were eligible for further analysis. Cases of 32 young patients with radial nerve palsy were identified and analyzed. The prevalence of radial nerve palsy was 4.34% (eight cases out of 184 patients with humeral shaft fractures). The radial nerve was most often associated with a simple transverse fracture (12A3, 17 cases (65.4%)). Conclusions. Radial nerve injury in humeral shaft fractures in children is rare, with a frequency of 4.34%. We highly recommend early surgical nerve exploration with transverse fractures in the distal third segment combined with primary radial palsy. Furthermore, we recommend making thoughtful decisions regarding early nerve exploration in the Holstein–Lewis fractures. In addition, consideration of early surgical nerve exploration in fractures resulting from high‐energy trauma and open fractures despite their morphology is recommended.

Retracted: Clinical Application of Remifentanil Combined with Sevoflurane in Manual Reduction of Humeral Supracondylar Fracture in Children.

[This retracts the article DOI: 10.1155/2022/2410433.].

Epidemiological and characteristic features of childhood fractures

Childhood fractures are becoming an important public health problem around the world due to the increasing incidence. Fractures in children are more than twice as common as in adults. The incidence of pediatric fractures is affected by many factors such as the age and sex of the child and seasonal and sociocultural factors. One of the leading causes of childhood fractures is simple falls and approximately 50% of childhood fractures were reported to occur after a simple fall. On the other hand, childhood fractures are also very common at home or school and after traffic accidents. A child’s bone has a lower density and more porous structure than an adult’s bone. The periosteum of bone in children is thicker and stimulates new bone formation more strongly. As a result, new bone formation is completed in less time. The remodeling potential of a child’s bone is also an advantage that differentiates pediatric treatment from adult treatment. Complications like delayed union, nonunion, re-fracture, myositis ossificans, and joint stiffness are also very rare in children. But physeal damage may cause serious complications like growth arrest or angular deformities. Despite the advancement in technology and increasing options for minimally invasive surgeries, closed reduction and conservative treatment methods are still the mainstay of treatment in children.

Анализ осложнений интрамедуллярного остеосинтеза титановыми гибкими стержнями при переломах костей нижних конечностей у детей

INTRODUCTION: The introduction of minimally invasive methods in clinical practice has significantly expanded the indications for surgical treatment of bone fractures in children. The method of osteosynthesis with titanium elastic nails is widely used at the age of 7 to 14 years and has many advantages. At the same time, the elastic-stable osteosynthesis has a number of probable complications and limitations. AIM: To analyze probable complications of the method of intramedullary osteosynthesis with titanium elastic nails in children of different age categories. MATERIALS AND METHODS: The results of treatment of 98 children with fractures of the long bones of the lower extremities were analyzed. All the patients underwent osteosynthesis with titanium elastic nails. The patients were divided to three age groups: 2 to 6 years, 7 to 13 and 14 to 16 years. Clinical and X-ray examinations of the patients were conducted. RESULTS: In young children, excellent results of treatment were obtained in 82.6% and satisfactory results in 17.4% of cases, no poor results were noted. In patients of the group 7 to 13 years, the results of treatment were considered excellent in 82.3%, and satisfactory in 17.7% of cases. In older children, outcomes of treatment were excellent in 62.5%, satisfactory in 29.2%, and poor outcomes that required repeated surgical interventions, were observed in 8.3% of cases. CONCLUSION: The most preferable age for osteosynthesis with titanium elastic nails was found to be from 6 to 14 years. There exist technical difficulties in use of this method in children of 2 to 4 years of age with "unstable in length" femoral bone fractures, nevertheless, the displacement of bone fragments was leveled out in all the observed cases. The greatest number of complications are associated with the use of TEN in the treatment of adolescents of 15 to 16 years due to insufficient rigidity of fracture fixation.

Clavicle shaft fractures in childhood and adolescence : Consensus report of the Pediatric Traumatology Section of the German Society for Trauma Surgery

Clavicle shaft fractures are among the most common fractures in childhood and adolescence. In the past they were almost exclusively treated conservatively but in recent years there has been an increase in surgical treatment. Nevertheless, exact recommendations for the choice of diagnostics and for the treatment regimen do not yet exist. Therefore, our aim was to develop aconsensus within the 7th scientific working meeting of the section for pediatric traumatology in the German Society for Trauma Surgery based on expert opinion. Single-plane radiographic imaging is considered the gold standard diagnostic tool. Children younger than 10years are primarily treated conservatively, and the type of immobilization is secondary. In girls older than 12years and boys older than 14years, fractures dislocated by more than the shaft width and shortened by > 2 cm should be treated by open reduction and stabilized by osteosynthesis, followed by free-functional follow-up treatment. In addition to X‑rays, diagnostics using ultrasound must be further established. Treatment continues to be primarily conservative, but surgical treatment is also important, especially in adolescents. If the indications are correct, agood outcome can be expected regardless of the choice of treatment.

Diaphyseal Femur Fractures in Children and Adolescents-Opportunities and Limitations of the ESIN Technique.

Background: Elastic stable intramedullary nailing (ESIN) is the gold standard for non-overweight children aged 6−12 years. However, the complication rate using elastic stable intramedullary nailing is considerably high. Nevertheless, the question arises of whether the indication for elastic stable intramedullary nailing therapy can be extended and which factors must be taken into account when determining the indication. Methods: A retrospective chart review of patients <18 years admitted with diaphyseal femur fracture at a Level I Trauma Center in Germany between 2005 and 2017 was performed. In total, 118 patients were included. For the classification of femur fractures in children, the AO Pediatric Comprehensive Classification of Long-Bone Fractures (AO-PCCF) was applied. Results: Simple oblique fractures (32-D/5.1) occurred in most of the patients. Patients with simple oblique fractures were significantly younger compared to patients with simple transverse (32-D/4.1) or multifragmentary (32-D/5.2) fracture type according to the AO Pediatric Comprehensive Classification of Long-Bone Fractures. Most patients were treated with elastic stable intramedullary nailing (68 patients, 58%). Although children treated with elastic stable intramedullary nailing were older than those treated conservatively (25%, n = 29, mean age 1.5, median age 1.0), the children in the elastic stable intramedullary nailing group were comparatively young (range 1−12 years, mean age 5.4, median age 5). A total of 32 children below the age of 6 years were treated with elastic stable intramedullary nailing. Complications were more frequent in patients with overhead extension (50%) compared to conservative treatment with a spica cast (17%) or elastic stable intramedullary nailing (15%). Conclusions: Elastic stable intramedullary nailing therapy was associated with a low complication rate and was, therefore, a safe and frequently used treatment strategy in diaphyseal femur fractures with satisfactory results, even though the age groups were expanded in favor of younger patients.

Length Unstable Femoral Shaft Fractures in Children: It's Time for a New Definition.

Length Unstable Femoral Shaft Fractures in Children: It's Time for a New Definition.

Comparative Outcome of Three Different Approaches for Supracondylar Humeral Fractures in Children in Khyber Pakhtunkhwa, Pakistan

Background: The closed reduction and percutaneous pinning are the min treatment approaches tested in pediatric humerus supracondylar fractures but the treatment approach preferred in fractures without closed reduction is remains unclear. Objectives: The purpose of this study was to compare three common orthopaedic procedures for treating children with supracondylar humerus fractures of the displaced extension type. Methods: The current retrospective analytical study was started in the Department of Orthopedic at Khyber Teaching Medical College from 2015 to 2020, with the approval of the clinical research ethics committee. This analysis was conducted on 64 patients between the ages of 1 and 12 years who underwent hospital surgery for Gartland IIb, Gartland IIb, and Gartland III supracondylar humerus fracture. Results: A total of 64, 22 patients were from group A, in which 18 (81.81%) were male and only 4 (18.18%) were female, while in group B and C were 21 (80.76%), 5 (19.23%) and 14 (87.5%), 2 (12.50%) male and female, respectively. The injury on left elbow and right elbow in group A was recorded 68.18 and 31.81%, respectively. Among the total injured children, the left elbow was fractured in 47 (73.43%) case and the right one in 7 (10.93%). Approximately the duration of injury to therapeutic procedure was recorded 7.53±3.03 hours in the study. When compared to the group of displaced supracondylar humeral fractures that were conservatively handled, the functional and aesthetic treatment outcomes between the closed and open reduction with K-wire fixation groups were significantly different. According to this system, excellent, fair, good and poor functional outcomes were recorded in 10 (45.45%), 6 (27.27%), 4 (18.18%) and 2 (9.09%) patients of A group, respectively, while 13 (50%), 5 (19.23%), 5 (19.235), and 3 (11.50%) patients in group B, respectively. The poor and fair functional outcome was noted in 1 (6.25%) and 3 (18.75%) patients, respectively in group C. Practical implication: This is a critical surgical condition in children and they should be provided with the appropriate treatment to acquire the child's ability of movement. According to our findings among three management techniques, the most favorable was open reduction with K-wire fixation, and therefore was recommended with good success rate. Conclusion: It was thus concluded that open reduction with K-wire fixation is a good alternative to closed reduction with percutaneous pinning for treating displaced pediatric supracondylar humeral fracture. Keywords: Children; Supracondylar humerus fracture; Surgical treatment; Pediatric fractures; Pakistan

Evaluation of Radiological and Functional Results of Long Bone Diaphyseal Fractures in Children Aged 5-15 Years Who Underwent Titanium Elastic Nail

Objective: In this study, we aimed to evaluate the radiological and functional results of titanium elastic nail (TEN), which was used as a surgical method in pediatric long bone diaphyseal fractures between 5-15 years of age, by comparing it with the clinical features of the patient and the fracture.Methods: In this study, 44 patients (11 girls, 33 boys) aged 5-15 years (mean 9.86 ±2.84) were included. The clinical features of the patient, family satisfaction, evaluation of the fracture according to Flynn Criteria, time to bone union, stay in the hospital, and school absence was examined.Results: TEN was applied mostly to the femur (n;18), tibia (n;14), and forearm (n;12) diaphysis fractures, respectively. Most of the fractures were seen as a result of high energy and closed middle diaphysis, the transverse fracture pattern was the most. Most of the fracture surgeries were performed with the closed method. The family satisfaction of the patients was at a high level. In the evaluation of fractures according to Flynn Criteria, most of the results were excellent, but no poor results were observed. Bone union time was higher in patients aged ten years and older and undergoing open surgery, and less in transverse fracture shape (p&amp;lt;0.05). The time not to attend school was highest in open fracture type, tibia fractures, and open surgery patients (p&amp;lt;0.05). Ulna union time was 13.1 ± 1.8 weeks, which was higher than forearm fractures (p&amp;lt;0.05). The hospital stay was 3.50 ± 0.79 / 4.29 ± 1.54 / 3.33 ± 0.49 days in femur/tibia/forearm fractures, respectively, and was the highest in tibia fractures (p&amp;lt;0.05).Conclusions: TEN is an effective and safe method for long bone diaphyseal fractures in children aged 5-15 years, with low complication rates and positive effects on the patient and the health system.

Effect of Weather Conditions on the Pediatric Supracondylar Humerus Fracture Incidence.

Some environmental factors pose as risk factors for children's supracondylar humerus fractures. This study aimed to evaluatethe relationship between weather conditions and pediatric supracondylar humerus fracture incidence. A total of 310 patients aged <16 years, admitted to our hospital with supracondylar humerus fractures,were evaluated. We evaluated patients' age, and also, season, day, and weather conditions. The Turkish State Meteorological Service database was used for meteorological data and data was analysed statistically. Most cases occurred in the spring (28.1%, n=87) and summer (27.1%, n=84). Cases of older children (aged six years and older) with supracondylar humerus fractures were recorded in the summer season, while fracture cases in preschool-aged(younger than six years old) children were seen in the winter season. We found that the overall incidence of pediatric supracondylar humerus fractures increased inspring and summer seasons. In addition, the fracture incidence in preschool- and school-aged children differed according to the season and temperature. Hence, the management of these fractures could also include the significance of weather conditions, making preventive measures more critical in the spring and summer seasons.

The Outcome of Placing the Medial K-wire First and Then the Lateral K-wire in Treating Supracondylar Humerus Fractures in Children Treated by Closed Reduction.

Background Displaced Gartland type III and IV supracondylar fractures are difficult to reduce and invariably require closed pining. After closed reduction, taking the anteroposterior (AP) view does not present any problem but when the elbow is placed in flexion and the limb is rotated internally to take a lateral view, the reduction is invariably lost. However, the reduction stays when the arm is rotated outwards, keeping the medial condyle up. This stimulates the idea of whether the medial pin can be placed first and then the two lateral pins to stabilize the fracture. It is very frustrating for young orthopedic surgeons to see reduction getting lost during internal rotation after first doing lateral pinning. There is no clear guideline on which side should be fixed first. Hypothesis We hypothesized that placing the medial pin first maintains the reduction and facilitates the subsequent placing of lateral pins without the loss of reduction. Materials and methods A total of 170 children with displaced supracondylar humerus fractures were included in the study. A total of 120 children were grouped in the medial wire first group, and 50 were placed in the lateral wire first group, which was the control group. The mean age of the children was 7.5 years (range 2-13 years). The gender ratio (M: F) was 5:3; the left elbow was involved in 68% of the injuries, whereas the right elbow was involved in 32% of the injuries. All 170 children had an extension-type injury, with 91 (53.5%) fractures being Gartland type III and 79 (46.45%) fractures being type IV. Results Results were recorded as per Flynn's criteria. At the end of two years of follow-up, the children in the medial wire first group 117 (97.5%) showed excellent resultsand three (2.5%) children showed good results, whereas, in the lateral wire first group, 48 (96%) children showed excellent results and two (3.8%) children showed good results. There was a significant difference in the mean surgical time of 20.11±15.43 minutes in the medial wire first group vs 41.23±19.65 minutes in the lateral first group (p = 0.0021). None of the children developed permanent ulnar nerve palsy. Conclusions Placing the medial K-wire first rather than the conventional placing of the lateral wire first helps in maintaining the reduction and allows for the subsequent placement of lateral K-wires without losing the reduction, thus minimizing fixation time and producing good results.

13 Quantifying the Intensity of Adverse Events in Children Receiving Ibuprofen and Oxycodone Following Acute Fracture

Abstract Background Treatment of pain is an essential component of optimizing an injured child’s quality of life and experience. Ibuprofen and oxycodone are widely used for treating childhood fracture pain. While oxycodone is generally associated with increased frequency of adverse events (AEs), little is known on the comparative intensity of AEs associated with these medications. Objectives Our primary objective was to quantify the frequency and intensity of AE's associated with ibuprofen and oxycodone in children following acute fracture. Our secondary objective was to assess functional outcome impairment in children taking ibuprofen and oxycodone, specifically their ability to eat, sleep, play, and attend school. Design/Methods Patients aged 4-16 years diagnosed with a fracture in the Stollery emergency department who were prescribed either ibuprofen or oxycodone were recruited from 2010-2014. Patient characteristics were collected using a structured chart review. Families were called for the first three days after discharge and asked to report the frequency and intensity of AEs, as well as whether their child’s ability to eat, sleep, play or attend school was impaired. Results A total of 240 children were recruited (ibuprofen n=176, oxycodone n=59). Children using oxycodone were more likely to report any AE (p&amp;lt;0.001), nausea (p&amp;lt;0.001), vomiting (p&amp;lt;0.001), drowsiness (p&amp;lt;0.001), constipation (p=0.003), and dizziness (p&amp;lt;0.001), compared to ibuprofen. Using an 11-point rating scale, children receiving oxycodone reported more severe abdominal pain (oxycodone: mean 5.4 SD 3.1; ibuprofen mean 2.5 SD 1.4) on Day 1 (p=0.02) and worse constipation (oxycodone: mean 4.9 SD 2.1; ibuprofen mean 3.2 SD 2.2) over all three days (p=0.04). Children with upper limb fractures experienced more impairment in playing (oxycodone 93.8%, ibuprofen 65.7%, p&amp;lt;0.001) and attending school (oxycodone 80.9%, ibuprofen 57.6%, p=0.004) when prescribed oxycodone, while children with lower limb fractures experienced similar impairments regardless of medication used. Conclusion Oxycodone is associated with more frequent overall, gastrointestinal, and neurologic AEs and higher intensity gastrointestinal AEs compared to ibuprofen. Function with upper limb fractures is worse in children prescribed oxycodone, over ibuprofen. Clinicians should be aware of differences in AE profiles when caring for children in pain.

Functional Orthodontic Treatment of Mandibular Condyle Fractures in Children and Adolescent Patients: An MRI Follow-Up.

Background: The purpose of this study was to retrospectively evaluate and follow up a conservative treatment approach with functional orthodontic appliances for the management of mandibular condyle fractures in children and adolescent patients. Methods: Between 2020 and 2022, the treatment records of patients with mandibular condyle fractures receiving a functional orthodontic treatment (FOT) were evaluated. In addition to the clinical and functional findings, magnetic resonance images of the mandibular condyles and surrounding structures were assessed. Results: Out of 61 patients, 8 met the inclusion criteria. The follow-up examination records showed no functional limitations. In 75% of cases, mild midline deviations persisted (mean 1.1 mm) without significant alterations to the occlusal relationships. Magnetic resonance imaging (MRI) showed the remodeling of the condyles and the restitution of the ramus heights, even in dislocated and displaced fractures. In three cases, a partial displacement of the articular disc was observed at the follow-up. No differences in the remodeling patterns were noted depending on age, sex, or fracture location. Conclusions: A FOT led to favorable functional and morphologic outcomes, supporting the concept of a conservative functional approach in children and adolescent patients. Functional adjunctive therapy should be considered in the conservative treatment of mandibular condyle fractures in growing patients.

Three-Dimensional-Printed Splint for Use in Pediatric Mandibular Fracture.

Mandibular fractures are the most common type, accounting for about 71% of facial fractures in children. The mandible is the only movable bone in the craniomaxillofacial region. The injury of the mandible has a serious impact on the functions of children's mouth opening, chewing, pronunciation, and occlusion. Therefore, the treatment of children's mandibular fractures is particularly important. Because of the characteristics of children with permanent tooth germ blocking and strong skeletal development, the treatment methods of adults cannot simply be used in children with mandibular fractures. Here, we demonstrate the simple, reliable method using 3-dimensional-printing splint for stability of the fracture segments in pediatric patients.

Operative Treatment of Displaced Both Bone Forearm Diaphyseal Fractures in Children by Elastic Intramedullary Nail

Operative Treatment of Displaced Both Bone Forearm Diaphyseal Fractures in Children by Elastic Intramedullary Nail