Journal of pediatric orthopedics
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Comparative Study
Changing patterns of pediatric pelvic fractures with skeletal maturation: implications for classification and management.
Orthopaedic traumatologists have recognized the unique fracture patterns and injury constellations of pediatric pelvic fractures. However, an understanding of the effect of advancing skeletal maturation is needed to avoid applying adult classifications and management. The authors determined how pelvic fracture patterns and management change with advancing skeletal maturity. ⋯ The incidences of specific pelvic fracture patterns between the two groups were statistically different. Management of fractures to the immature pelvis should focus on associated injuries. Once the triradiate cartilage has closed, adult pelvic fracture classifications and management principles should be used.
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A retrospective study of 21 medial condylar fractures revealed that the complication rate for these rare fractures was 33%. Most of the minimally displaced fractures healed uneventfully with immobilization; however, one patient developed avascular necrosis of the trochlea, and one patient developed a nonunion. Operative treatment was performed if there was >2 mm of displacement at the fracture site. ⋯ Medial condylar fractures may be difficult to diagnose in younger children and should be considered when there is a history of trauma and medial-sided elbow pain. Oblique views, arthrography, or magnetic resonance imaging can be helpful in confirming the diagnosis. Management of this rare fracture must include adequate stabilization of the fracture and immobilization until there is radiographic evidence of healing.
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This study investigates the hypothesis that the integrity of the cartilage hinge at the distal humeral epiphysis determines the stability of fractures of the lateral humeral condyle. Sixteen patients with lateral humeral condyle fractures were studied with radiographs and magnetic resonance imaging (MRI). The clinical course of each patient was compared using these imaging studies to determine whether initial fracture displacement and the integrity of the cartilage hinge correlated with fracture stability. ⋯ None of these displaced during treatment. Two patients had radiographically stable fractures and complete fractures on MRI. One of these fractures displaced, confirming the hypothesis that the stability of lateral humeral condyle fractures is related to the integrity of the cartilage hinge.
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The authors present an original fixation technique for olecranon fractures in children, achievable without opening the fracture site. The standard method of Kirschner wire fixation with tension band wiring is replaced by a threaded pin stabilization with adjustable lock effect. An olecranon fracture model was used to compare the mechanical properties of this new system with the tension band wiring technique, and with a simple pin fixation. No significant difference was found between the two first techniques, whereas the simple pin fixation had much poorer mechanical properties.