Pin Fixation Research Articles

Facial bone fracture repair using ultrasound‐aided pin fixation of resorbable plates in two horses

SummaryThis report describes the application of a resorbable implant (Resorb‐Vet) made of poly‐(DL) lactide (PDLLA) for the repair of a maxillary fracture in one horse and a nasal bone fracture in another. The horses were positioned in lateral recumbency and the fracture was reduced. An absorbable plate was moulded to the bone and fixed with PDLLA pins, which were attached to an ultrasonic device and inserted into predrilled holes by ultrasonic vibrations. Once the pins contacted the bone, the ultrasonic vibrations caused liquefication of the PDLLA, which infiltrated the bone and solidified after the ultrasonic vibrations ceased. Immediate primary stability was achieved with this technique. Both horses recovered well, were discharged without complications and returned to their previous level of activity.

Dorgan’s lateral cross pinning for displaced pediatric supracondylar fractures of the distal humerus

Background: Supracondylar humeral fractures are the most common elbow fracturesseen in children. Although closed reduction and percutaneous pin fixation is the treatment of choice for displaced supracondylar fractures of the humerus in children, controversy about which pin configuration is best in treating these fractures is ongoing. Some advocate lateral entry pins only while others advocate medial and lateral entry pins. In this study I utilized Dorgan’s cross lateral technique to fix such fractures which is believed to have the advantages of both the conventional pinning techniques. Objectives:To evaluate the functional and cosmetic outcome and complications of cross lateral pinning. Methods: Thirty cases of supracondylar humeral fractures were treated by closed or open reduction with cross lateral pin fixation under fluoroscopic guidance. The elbow was immobilized for a period of 4 weeks after which the pins were removed and physiotherapy initiated. At the end of 12 weeks the patients were evaluated clinically and radiologically and final results were assessed as per Flynn’s criteria. Results: According to Flynn’s criteria, the cosmetic result in my study was evaluated as excellent in 25 cases (83%) and good in 5 cases (17%) and functional result was evaluated as excellent cases in 23 (77%) and good in 7cases (23%). There were no cases of post operative loss of reduction of fractures. Six cases (20%) had pin tract infection while 24 patients (80%) had no complications at all. Conclusions: Cross lateral method of pinning for treating supracondylar fractures is a useful method of fixation as it gives stabilization like medio-lateral pinning and minimizes the risk of injuring the ulnar nerve like lateral pinning.

The Impact of a Resident, Fellow, or Physician Assistant on Operative Time and Complication Rate in Closed Reduction and Percutaneous Pin Fixation of Pediatric Distal Humerus Supracondylar Fractures

We sought to compare operative times and complications for attending surgeons operating alone or with an assistant including an orthopedic resident, fellow, or physician assistant (PA) for closed reduction and percutaneous pinning (CRPP) of pediatric supracondylar humerus fractures (SCH), an archetypal procedure integral to the education of orthopedic trainees. Using a retrospective database collected following institutional review board approval, a 1-way ANOVA (non-parametric) was used to assess the effect of assistant absence or presence by type of assistant on mean operative time. We analyzed the association between the attending surgeon assistant categories and the complication rate using Fisher's Exact Test. The study was performed at Gillette Children's Specialty Healthcare, St. Paul, Minnesota, and Children's Minnesota in St. Paul and Minneapolis. These three affiliated metropolitan hospitals, the last of which is a level 1 trauma facility, all share the same group of orthopedic surgeons, trainees, and physician assistants. All patients under 14 years of age treated with CRPP for Gartland type 2, 3, 4 and flexion type closed supracondylar fractures between April 2006 and September 2016 were analyzed. Of 1053 patients identified by Current Procedure Terminology code 24358, data was available for 888 patients. Out of the 888 patients, 44.1% were operated on by a surgeon alone, 48.4% with a resident, 4.8% with a fellow and 2.6% with a physician assistant. The ANOVA revealed a statistically significant increase (p < 0.001) in operative times when a resident participated compared to the other categories. The shortest mean surgery time (34.7 minutes) occurred when an attending surgeon and PA were present. The longest mean time (44.3 minutes) occurred with a surgeon and resident. This difference, at 9.6 minutes, constituted 28% more time. There were 40 patients with a complication, a rate of 4.5%. The rate for each of the assistant categories was surgeon alone 5.6%, with a resident 3.3%, with a fellow 4.7%, with a PA 8.7%. The Fisher's Exact Test results showed no statistically significant association between the type or absence of assistant and the complication rate. Differences in operative times were observed across assistant categories although the mean time difference was statistically insignificant between the surgeon unassisted versus assisted by the fellow or a PA. The finding of statistically increased operative times with resident participation in this study for this specific procedure is consistent with results for most other reported orthopedic surgeries. Complication rates did not vary based on the participating personnel.

Outcome and Complications Following Medial Patellar Luxation Corrective Surgery with Tibial Tuberosity Transposition Using a Locking Plate and a Pin Fixation: 45 Unilateral and 20 Single-Session Bilateral Procedures.

To evaluate the outcome and complications in dogs with medial patellar luxation (MPL) undergoing tibial tuberosity transposition (TTT) with a locking plate and pin fixation (Plate-Pin). This retrospective multicenter study included 65 consecutive MPL stifle surgeries using tibial tuberosity (TT) fixation with a 5-hole locking plate and a pin. The median weight of the dogs was 6.2 kg. The grade of luxation was 2/4 in 50 stifles and 3/4 in 15 stifles. Outcomes were assessed during follow-up examinations 33 to 648 days after surgery with clinical examination and radiography. Canine Orthopedic Index questionnaires were sent to owners 6 to 39 months after surgery. Complications were reported in 14/65 stifles, of which 8/14 were minor and 6/14 were major. After treatment of the major complications, lameness was resolved in all cases and the MPL was resolved in 64/65 stifles. When the surgery was performed as described in this article, Plate-Pin fixation for TT during MPL surgery is a feasible technique with a lower incidence of luxation recurrence, TT avulsion, and fractures compared with recent retrospective studies with pin and tension band wire TT fixation. Further development of the locking plate TT fixation is indicated to resolve pin-related complications and to determine if fixation including a pin is necessary.

Biomechanical Comparison of Spacer Pin Fixation to Two Established Methods of Tibial Tuberosity Transposition Stabilization in Dogs.

The aim of this cadaveric study was to compare the biomechanical outcomes of three methods of stabilization for tibial tuberosity transposition to treat medial patellar luxation: a complete osteotomy with a two-pin and tension band wire (TBW) fixation (TBW group), a partial osteotomy with a two-pin fixation (2 Pin group), and a partial osteotomy with a spacer pin fixation (Spacer Pin group). Thirty medium to large-sized canine cadaveric tibiae were dissected and randomly assigned to one of three groups: TBW, 2 Pin, and Spacer Pin groups. The patellar ligaments were loaded in tension until ultimate failure. Ultimate failure force and mode of failure were documented, stiffness was calculated, and the results were compared statistically between the three treatment groups. There were not any significant differences in ultimate failure force or stiffness between groups. All groups predominantly failed by patellar ligament failure, with distal tibial crest fracture/displacement being the second-most common mode in the 2 Pin and Spacer Pin groups. The mechanical properties of the spacer pin stabilization were not different from the TBW and 2 Pin groups. The spacer pin technique could be an alternative way to stabilize tibial tuberosity following tibial tuberosity transposition with a partial osteotomy based on this cadaveric load-to-failure model.

Does minimally invasive external fixation of proximal humerus fractures provide adequate stability? A biomechanical in vitro study

IntroductionProximal humerus fractures are usually treated with rigid angle-stable plates or nails. As an alternative, semi-rigid, minimally invasive systems have been developed for supportive fixation. A new system uses this principle with 2.5 mm partially threaded pins and external fixation.AimThis study aimed to compare the fracture stability of the fixator with an angular stable plate about whether the mechanical stability is sufficient for early postoperative mobilisation.Materials and methodsHuman proximal humeri (paired, female, age ≥ 60, n = 8) were cut to a 3-part fracture and treated with an external fixator (Galaxy Shoulder, Orthofix) or an angular stable plate (Philos, DePuy Synthes). A physiological load was simulated in vitro based on a 45° abduction motion. The load level was continuously increased from 10 to 320 N within 10,000 cycles simulating the loads during rehabilitation. This was followed by another 10,000 cycles at 320 N for fatigue testing. Fracture motion was recorded with a 3D camera. Fracture stability was evaluated at a partial load of 160 N and 240 N (simulating loads during early mobilisation).ResultsThe fracture motion at the lateral aspect was significantly (p < 0.034) larger for the fixator compared to the plate both for axial and for shear movements, while at the medial aspects fracture motions were similar. Both fixation systems adequately stabilized the lateral tubercle fragment with no significant differences between fixation techniques. The migration of the fixator pins (1.1 ± 1.0 mm) and valgus rotation of the head fragment were minimal (3.1 ± 2.0°). The maximum load level of 320 N was reached by all plate constructs and 3 fixator constructs.ConclusionOur results suggest that the external fixator system allows early but gentle postoperative mobilisation. More aggressive rehabilitation measures should be postponed after the healing of the fracture.

Case Report: Postoperative Complication Epidural Haematoma after Brain Tumor Resection

Postoperative intracranial haemorrhage is one of the most dangerous complications in cranial surgery, especially epidural haematoma although it is very rare with an incidence of 1.0%. The exact mechanism of occurrence is still unknown and with appropriate treatment can result in a good outcome. A 34-year-old female, 63 kg, who lost consciousness after extubation following resection of a meningioma in the parietooccipital region. In the recovery room, the patient regained consciousness and was transferred to the ICU for observation. The patient suddenly lost consciousness after 30 minutes in the ICU, reintubation was performed and a CT scan of the head showed an epidural hematoma after tumour resection. An emergency decompressive craniotomy was performed, with total intravenous anaesthesia (TIVA) combination of remifentanil 0.1 mcg/kg/min and thiopental 2 mg/kg/h, The operation lasted for one hour. The patient was admitted to the intensive care unit (ICU) for seven days under mechanical ventilation. The patient was extubated on the eighth day and transferred to the ward on the following day. There are several causes of epidural hematoma after brain tumour resection, namely sudden decrease in ICP, massive CSF drainage, uneven ICP distribution, coagulopathy factors, and excessive pin fixation. Excessive loss of CSF during surgery causes displacement of the brain and creates negative pressure in the remote area. In this case, it is suspected that the sudden decrease in ICP caused traction on the meningeal blood vessels, so that the negative pressure made the dura pulled and caused extradural haematoma. Conclusion: Postoperative epidural haematoma is a serious and relatively rare complication but if treated promptly, will result in a favourable outcome.

Improving external fixator pin site care through user involvement: A quality improvement project

IntroductionExternal fixation is widely used in treating complex fractures and limb reconstruction. Pin site infections remain a significant complication, impacting on patients' physical and psychosocial wellbeing. This clinical improvement project at a University Hospital in Denmark aimed to enhance pin site care by involving patients and caregivers throughout the treatment pathway. BackgroundAt our hospital, approximately 55 trauma patients are annually treated with lower limb external fixators. Pin site care is crucial for preventing serious infections/osteomyelitis and involves collaboration between hospital and municipal caregivers. Traditional pin site care in our unit was complex and time-consuming, causing patient anxiety and frequent unplanned clinic visits. MethodsInspired by the Participatory Design research methodology, a quality improvement project was conducted in three phases: (1) identifying users’ needs, (2) developing solutions collaboratively, and (3) testing/evaluating these solutions. Iterative cycles of planning, acting, observing, and reflecting were employed, facilitating mutual learning among participants. Interviews with patients, families and healthcare professionals and field observations both at the hospital and in the municipality were conducted. Inspiration was sought from international literature. ResultsPhase 1 identified the need for improved education about infection recognition, a less painful and time-consuming dressing method, and an assessment tool for pin site infection. Phase 2 involved extensive user input to develop and implement a new dressing procedure using PolyMem™ along with an assessment tool. Phase 3 evaluated the new methods, revealing reduced patient pain, fewer clinic visits, and stable infection rates as well as less time-consuming pin site care. ConclusionThe project successfully enhanced pin site care, involving users in developing a new care process, thus improving patient satisfaction and care efficiency. Implications for future practiceIncorporating patient perspectives and collaborative methods can significantly improve clinical care pathways. Future efforts should focus on further integrating patient centered and participatory approaches in healthcare improvements.

A Comparison of Nerve Injury in Cross Versus Lateral Pinning Fixation of Displaced Supracondylar Humerus Fracture.

Supracondylar fracture of the humerus (SCFH) is a common pediatric fracture encountered in orthopedic surgery. The most frequently used pinning methods include cross pinning or lateral pinning with two or three pins. However, complications such as ulnar nerve injury can occur, particularly during medial pinning, which necessitates careful isolation of the ulnar nerve and expert surgical intervention. The objective of this study is to compare nerve injury in cross versus lateral pinning fixation of the SCFH. The observational study was conducted at Sheikh Zayed Hospital, Rahim Yar Khan, PAK. Patients in group L (n=55) underwent lateral pinning, while those in group C (n=55) received cross pinning. The patients were followed retrospectively postoperatively until radiological union was achieved. The outcomes were assessed using the Flynn criteria, and nerve injury was evaluated in both groups. The study aimed to compare the postoperative results between the two groups based on the specified criteria. The mean age was 7.28±2.03 years in group L and 8.20±2.21 years in group C. The majority of patients in both groups were male. The left side was more commonly involved, and among the 110 patients enrolled, most sustained the injury while playing. The mean follow-up period was 21.3±1.4 months for group L and 23.5±0.2 weeks for group C. Nerve injuries were reported in six (5.45%) patients in group C, while no nerve injuries were reported in group L. For type III SCFH, lateral pinning fixation has demonstrated itself to be an effective alternative, yielding excellent functional outcomes. This method not only minimizes the risk of iatrogenic nerve injury, particularly to the ulnar nerve but also provides sufficient stability for the fracture. The results from this study suggest that lateral pinning is a reliable option for treating unstable supracondylar fractures, with a favorable safety profile and outcomes comparable to, if not better than, those achieved with cross pinning. This makes it a valuable technique, especially in settings where the risk of nerve injury is a significant concern.

Outcomes of Non-Operative and Operative Treatment of Proximal Humerus Fractures: Current Concepts

Proximal Humerus Fractures (PHF) account for 5-6% of all adult fractures and have a bimodal distribution involving young patients with high-energy trauma or, more commonly, older patients with low-energy falls. Whenever possible, particularly with non- or minimally displaced fractures, PHFs can be treated non-operatively. Many recent studies have demonstrated no outcome difference between non-operative treatment and any common operative option. Operative treatment options for PHFs include percutaneous pinning, open reduction and internal fixation (ORIF), intramedullary nails (IMN), hemiarthroplasty (HA), and reverse shoulder arthroplasty (rTSA). Generally displaced three or four-part fractures are indicated for operative fixation. However, the ProFHER (Proximal Fracture of the Humerus: Evaluation by Randomization) trial demonstrated satisfactory results may be achieved when PHFs are managed non-operatively. This review will focus on the latest evidence and outcomes following non-operative and operative treatment of proximal humerus fractures (PHF).

Pin fixation is an effective method for fixation of bunion osteotomy with various procedures: a retrospective cohort study

BackgroundVarious fixation devices are available for bunion osteotomy. In this study, we evaluated the radiographic outcomes, postoperative complications, and recurrence rate in a series of hallux valgus deformities treated with various osteotomy procedures using a pin for the fixation of the osteotomy.MethodsTwo-hundred forty-seven patients with hallux valgus deformity managed with a Simple, Effective, Rapid and Inexpensive (SERI) osteotomy, distal chevron osteotomy, or proximal crescentic osteotomy and K-wire fixation were included. The mean follow-up of the patients was 53.9 ± 8.9 months. Radiographic evaluations included the assessment of the Hallux valgus angle (HVA), intermetatarsal angle (IMA), and union. Clinical evaluations included the assessment of the range of motion, pain in the first metatarsophalangeal joint, and patient satisfaction.ResultsIn the last visit, the mean improvement of HVA was 23.9 ± 9.1º (P < 0.001). The mean IMA improvement was 6.1 ± 6º (P < 0.001). The mean metatarsophalangeal flexion and extension were 33 ± 10.7º and 34.6 ± 9.2º, respectively. Postoperative complications included pin tract infection in eight (3.2%) patients, deep infection in five (2%) patients, and early pin complication in four (1.6%) patients. Recurrence was observed in five (2%) patients. Twenty-three (9.3%) patients had slight pain in the last follow-up. The mean surgical time was smaller in the SERI osteotomy (P < 0.001). The mean hospitalization period was longer in the proximal osteotomy group (P = 0.039). The mean metatarsophalangeal flexion and extension were significantly smaller in the distal chevron osteotomy (P = 0.046 and P = 0.037, respectively). 90% of patients were satisfied or very satisfied with the surgical outcomes.ConclusionK-wire fixation is a safe and effective device for the fixation of bunion osteotomy, and this effectiveness is even higher with SERI and proximal crescentic osteotomy.

Primary Closure of External Fixator Pin Sites Is Safe After Orthopaedic Trauma Surgery.

To determine if rates of pin site infection and surgical site infection among patients managed with primary closure after external fixator removal were similar to those allowed to heal secondarily. Retrospective cohort. Urban/Suburban Academic Level I Trauma Center. Patients who had received a lower extremity external fixator for provisional management before definitive fixation of lower extremity fractures were included with pin site wounds closed primarily or allowed to heal by secondary intention. The rate of pin tract infection and surgical site infection following primary closure of external fixator pin sites relative to patients whose pin sites were allowed to heal through secondary intention. In total, 256 patients were evaluated: 143 patients (406 pin sites) in the primary closure group and 113 patients (340 in sites) in the secondary closure group. The average age was 49 ± 16 years. Sixty-five percent of included patients were male. There was no difference in pin tract infections between cohorts (primary = 0.5%, secondary = 1.5%, P = 0.26). External fixator duration in the primary closure group was 11.5 ± 8.4 days and 13.0 ± 8.1 days in the secondary closure group (P = 0.15). There was a greater rate of surgical site infections in the secondary intention cohort (15.9% vs. 7.7%, P = 0.047). There was no difference in pin site infection rate after primary pin site closure relative to patients who were allowed to heal through secondary intention. Furthermore, there was a lower rate of surgical site infection after primary closure. These results challenge the dogma of secondary closure for ex fix pin sites, suggesting that debridement and primary closure is a safe option for management of external fixator pin sites and may impart benefit in decreasing infection risk. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Solving Challenges in Static Computer-Assisted Guided Surgery for Posterior Open-End Situations.

This technical note presents a technical note on optimizing static computer-assisted implant surgery (sCAIS) in distal open-end scenarios. Five methods are introduced for enhancing surgical guide stabilization and improving the accuracy of implant placements in situations lacking stabilizing adjacent teeth. Techniques include the use of keratinized soft tissues, implant-borne stabilizers, lateral fixation pins, transitional implants, and digital bone segmentation for guide support. Each method is evaluated for its potential to address the specific challenges faced in sCAIS, aiming to contribute to the field through practical solutions for clinicians.

Transmediastinale migratie van een Kirschner-pin na fixatie van een proximale humerusfractuur: een casus

Transmediastinal migration of a Kirschner pin after fixation of a proximal humeral fracture: a case report Fractures of the proximal humerus are common lesions in the elderly population. In some cases, they are surgically stabilized via a minimally invasive technique, namely percutaneous osteosynthesis with fixation pins. Intrathoracic migration of these pins or wire is a rare complication after percutaneous osteosynthesis of a proximal humeral fracture. In this article, the authors describe an extremely rare transmediastinal migration of a Kirschner pin from the humeral head. The purpose of this case report is to call for awareness and to open a debate in which appropriate prevention can be freely discussed. The consideration of a conservative management, the choice of alternative osteosynthesis techniques, the use of a sling bandage to restrict the shoulder movement, the use of fixation pins with a threaded tip, bending of the external free end of the pin and an appropriate time to remove the pin are possible recommendations from the literature. Furthermore, it is important to provide additional information and awareness to health care providers in rehabilitation centers, geriatricians and orthopedists concerning the possibility of such a life-threatening postoperative complication. Thus, specific policies for clinical and radiographic monitoring of the position of fixation pins should be developed in hospitals and rehabilitation centers with the aim of prevention, early detection and prompt action when this life-threatening complication is suspected.

Is casting of displaced paediatric distal forearm fractures non-inferior to reduction under general anaesthesia? Study protocol for a pragmatic, randomized, controlled non-inferiority multicentre trial (the casting trial)

BackgroundTreatment of displaced distal forearm fractures in children has traditionally been closed reduction and pin fixation, although they might heal and remodel without surgery with no functional impairment. No randomized controlled trials have been published comparing the patient-reported functional outcome following non-surgical or surgical treatment of displaced paediatric distal forearm fractures.MethodsA multicentre non-inferiority randomized controlled trial. Children aged 4–10 years with a displaced distal forearm fracture will be offered inclusion, if the on-duty orthopaedic surgeon finds indication for surgical intervention. They will be allocated equally to non-surgical treatment (intervention) or surgical treatment of surgeon’s choice (comparator). Follow-up will be 4 weeks and 3, 6, and 12 months. The primary outcome is the between-group difference in 12 months QuickDASH score. We will need a sample of 40 patients to show a 15-point difference with 80% power.DiscussionThe results of this trial may change our understanding of the healing potential of paediatric distal forearm fractures. If non-inferiority of non-surgical treatment is shown, the results may contribute to a reduction in future surgeries on children, who in turn can be treated without the risks and psychological burdens associated with surgery.Trial registrationwww.clinicaltrials.gov (ID: NCT05736068). Date of registry: 17 February 2023.

3D virtual patient-Magnetically retained printed stackable system for implant guided placement: Case report.

The aim of this report is to present the complete workflow of 3D virtual patient for planning and performing implant surgery with magnetically retained 3D-printed stackable guides. A 3D-printed stackable system was proposed based on bone, dental, and facial references. Initially, a 66-year-old male patient was digitalized through photographs, cone beam computed tomography, and intraoral scans (Virtuo Vivo, Straumann). All files were merged to create a 3D virtual patient in the planning software (coDiagnostiX, Straumann). Sequential stackable guides were designed, printed, and cured. Magnets were inserted into connectors, and the interim protheses received color characterization. Four mounted guides were produced for the specific purposes of pin fixation, bone reduction, implant placement, and immediate provisionalization. After surgery and healing period, patient digital data were updated. Final implantpositions were compared to planned values and inconsistencies were clinically acceptable. The mean angular deviation was 5.4° (3.2-7.3) and mean 3D discrepancies were of 0.90 mm (0.46-1.12) at the entry point and 1.68 mm (1.00-2.20) at implant apex. Case follow-up revealed stability, patient's comfort, and no intercurrences. Magnetically retained stackable guides provide treatment accuracy and reduce surgical and prosthetic complications. The projected virtual patient enhances decision-making and communication between the multidisciplinary team and the patient, while decreases time and costs. Bidimensional diagnosis and freehand implant placement have limitations and outcomes often rely on professionals' expertise. Performing facially driven virtual planning improves treatment predictability. This approach promotes function, esthetic harmony, and patient satisfaction. Implant guided surgery and 3D printed prostheses constitute a reproducible digital workflow that can be implemented into clinical practice to optimize dental care.

Physeal and metaphyseal fractures of the distal radius in pediatric patients

Background: This article aims to summarize the available information and present treatment recommendations. The scope of this discussion is limited to physeal and metaphyseal fractures of the pediatric distal radius.Current Concepts: Pediatric distal radial fractures are common among children and adolescents. The mechanism of injury is usually a fall on an outstretched hand, and fractures typically occur during sports-related activities. Children with distal radial fractures initially present with pain, swelling, and distal forearm deformities. Plain radiographs are essential for evaluating the fracture type and degree of displacement. Complete wrist, forearm, and elbow views should also be assessed, especially for high-energy injuries, to identify ipsilateral fractures. Fractures typically involve the distal radial metaphysis or physis. Metaphyseal fractures are classified as torus, buckle, and bicortical fractures. Most displaced Salter-Harris types I and II and non-displaced metaphyseal fractures can be treated with closed reduction and casting. Operative treatment is recommended if irreducibility or soft-tissue neurovascular compromise is suspected. Operative options include closed reduction, percutaneous pinning, or open reduction, followed by pin or plate fixation. Malunion, nonunion, physeal arrest, ulnocarpal impaction, and nerve injury are possible complications of distal radial fractures in pediatric patients.Discussion and Conclusion: Metaphyseal and physeal fractures of the distal radius are common in children. Most cases are best treated with closed reduction and cast immobilization. Clinicians should be aware of delayed complications and understand how to manage them to ensure successful long-term outcomes.

Management of Unstable Pediatric Distal Radius Fractures With a 2-Pin External Fixator and a Short Arm Cast: Technique and Case Series

Introduction: Pediatric distal radius fractures that are unacceptably aligned and undergo closed reduction are often redisplaced when immobilized in a cast alone without additional fixation. Percutaneous pinning, plate and screw fixation, and 4-pin wrist joint and physis-spanning external fixation constructs have previously been described to achieve and maintain reduction. Technique and Results: We successfully treated and followed 12 consecutive pediatric patients presenting with malaligned, nonphyseal distal radius fractures that were reduced and held with a 2-pin external fixation construct that did not extend distal to the physis, supplemented by a short arm cast. No complications were encountered in this series of patients. Conclusion: Two-pin external fixation is an alternative solution for completely displaced or markedly angulated pediatric distal radius fractures.

Serious injuries of Lisfranc joint: A retrospective multicenter study of 141 patients

IntroductionLisfranc joint injuries are common and often underdiagnosed. They occur during trauma of various mechanisms, high or low energy. Their management is difficult because of the wide spectrum of lesions and the management of associated lesions, particularly in the emergency stage. Their surgical treatment remains controversial. Therefore, the objective of this study was to evaluate and compare the management of Lisfranc injuries and to study their clinical, functional and radiologic evolution. We also wanted to assess the consequences of these lesions on the patient's quality of life. Material and methodsThis was a retrospective multicenter study of 141 patients over 16 years at the time of the trauma. The patients included had presented a Lisfranc injury from January 2010 to June 2018. The epidemiological characteristics, the type of osteosynthesis, and the immediate and radiographic results at the last follow-up were collected. Functional assessment was analyzed by telephone review using the SF12, FAAM and AOFAS scores. ResultsAn associated M2 base fracture was found in almost 50 % of cases. A closed reduction and fixation was made in 25 % of cases. There was 69 % pins fixation. The reduction was not anatomical in 1/3 of the cases and was more difficult to achieve with an associated fracture. The FAAM score was statistically superior in the patients with internal fixation by screws compared to the treatment by pins. We found 18 % early complications. At least 1 year after the injury, C2M2 osteoarthritis was found in 45 % of patients. DiscussionContrary to what is recommended in the literature, this study reported a high rate of osteosynthesis by pins whereas screws and plates were more recommended. Open reduction was also recommended and was the strategy of choice in this study. An M2 fracture was often associated with Lisfranc dislocations. The quality of reduction was essential and was better with open reduction and screw fixation.

Analysis of risk factors for failed closed reduction in pediatric Gartland Type III supracondylar humerus fracture

PurposeGartland Type III supracondylar humerus fractures are commonly treated using closed reduction followed by percutaneous pin fixation. However, conversion to open reduction may be necessary if closed reduction fails. This study aimed to identify risk factors associated with failed closed reduction and provide a theoretical basis for clinical decision-making in the treatment of Gartland Type III fractures. MethodsA retrospective analysis was conducted on children with Gartland Type III supracondylar humerus fracture who underwent surgical treatment between April 2017 and June 2018. Based on whether or not the closed reduction was successful, patients were split into the open reduction group and the closed reduction group. Within the closed reduction group, subgroup analysis based on surgery duration was carried out. Data were collected from medical records and X-ray images. Univariate and multivariate regression analyses were utilized to evaluate the relationship between variables and failed closed reduction. ResultsThe study included 36 patients in the open reduction group and 135 patients in the closed reduction group. Multivariate analysis revealed that the presence of angle (P=0.024, OR=3.199), rotation (P=0.000, OR=6.359), skin creases (P=0.013, OR=4.077), anterior-posterior displacement ratio (P=0.011, OR=4.337), fracture angle in the anteroposterior view (P=0.014, OR=0.939), and fracture distal displacement direction (P=0.002, OR=5.384) were independent risk factors for failed closed reduction. Subgroup analysis showed that fracture distal displacement direction (P=0.013), skin folds (P=0.013), lateral displacement ratio (P=0.016), and anterior-posterior displacement value (P=0.005) significantly influenced the duration of closed reduction surgery. ConclusionThe presence of sharp angle or rotation at the fracture ends, skin folds on the anterior elbow, minor anterior-posterior displacement of the fracture, higher medial inclination of the fracture plane, and distal fracture displacement towards the radial side are independent risk factors for failed closed reduction in pediatric Gartland Type III supracondylar humerus fracture.