Risk Factors for Upper Extremity Refractures in Children.

Background: Multiple descriptive studies have been published on refracture patterns, particularly for forearm fractures. However, few large cohorts have been analyzed quantitatively including the odds of refracture, and with a comprehensive assessment of the possible predictive factors associated with refracture. This study aimed to assess the frequency and timing of upper extremity refracture in a large pediatric orthopaedics practice, and to evaluate the strength of association of various patient-level and fracture-related factors with refracture.

Improved Diagnosis and Treatment of Bone and Joint Infections Using an Evidence-based Treatment Guideline.

Background: Our institution created a multidisciplinary guideline for treatment of acute hematogenous osteomyelitis (AHO) and septic arthritis (SA) in response to updates in evidence-based literature in the field and existing provider variability in treatment. This guideline aims to improve the care of these patients by standardizing diagnosis and treatment and incorporating up to date evidence-based research into practice. The primary objective of this study is to compare cases before versus after the implementation of the guideline to determine concrete effects the guideline has had in the care of patients with AHO and SA.

Carpal Coalitions and Metacarpal Synostoses: A Review.

Carpal coalition and metacarpal synostosis are uncommon congenital anomalies of the carpus and hand. A comprehensive review of the literature was performed to help guide surgical and non-surgical treatment of carpal coalition and metacarpal synostosis. The embryology, epidemiology, medical and surgical management, and associated outcomes are detailed.

Juvenile Dermatomyositis: A Case of Calcinosis Cutis of the Elbow and Review of the Literature.

Juvenile dermatomyositis is a rare, chronic autoimmune disorder commonly associated with calcinosis cutis. Although great advances have been made in the treatment of juvenile dermatomyositis, little progress has been made in the treatment of calcinosis cutis. It remains resistant to medical treatment and surgical intervention has long been avoided due to early reports of poor wound healing and sinus track formation associated with the surgical excision of calcinosis cutis.

Improving diagnostic efficiency: analysis of pelvic MRI versus emergency hip aspiration for suspected hip sepsis.

Background: Accurately diagnosing and treating childhood hip sepsis is challenging. Adjacent bone and soft-tissue infections are common and can lead to delayed and inappropriate treatment. This study evaluated the effect of early advanced imaging (bone scan, magnetic resonance imaging) in the management of suspected hip sepsis.

Reliability of internal oblique elbow radiographs for measuring displacement of medial epicondyle humerus fractures: a cadaveric study.

Background: Standard elbow radiographs (AP and lateral views) are not accurate enough to measure true displacement of medial epicondyle fractures of the humerus. The amount of perceived displacement has been used to determine treatment options. This study assesses the utility of internal oblique radiographs for measurement of true displacement in these fractures.

Tibial tubercle fractures in children with intra-articular involvement: surgical tips for technical ease.

Background: Tibial tubercle fractures often occur in athletic adolescents close to skeletal maturity. These fractures can present with marked displacement of the apophysis, intra-articular extension, and associated soft tissue injuries, such as tibial meniscal ligament tears. Here, we present our surgical technique which focuses on recreating the meniscal-articular relationship (using suture anchors) in severely displaced fractures.

Focal fibrocartilaginous dysplasia in the ulna: report on 3 cases.

Focal fibrocartilaginous dysplasia is an uncommon, benign bone lesion that causes deformity in young children. It is most commonly encountered in the proximal tibia, with few cases documented in the upper extremity. We report 3 cases affecting the ulna.

Effect of osteochondroma location on forearm deformity in patients with multiple hereditary osteochondromatosis.

Purpose: Multiple hereditary osteochondromatosis (MHO) is an autosomal-dominant skeletal dysplasia that may result in forearm deformity. The purpose of this study was 2-fold: to describe the natural history of forearm deformity in patients with MHO, with particular attention to those who develop radial head dislocation, and to determine predictors of deformity.

Methods: We retrospectively reviewed charts of all patients with MHO evaluated at our institution.

Late reconstruction of ulnar nerve palsy.

Ulnar nerve palsy results in significant loss of sensation and profound weakness, leading to a dysfunctional hand. Typical clinical findings include loss of key pinch, clawing, loss of normal flexion sequence of the digits, loss of the metacarpal arch, and abduction of the small finger. Further deficits in hand/wrist function are seen in high-level ulnar nerve palsy, including loss of ring- and small-finger distal interphalangeal flexion, decreased wrist flexion, and loss of dorsal sensory innervation.

Metacarpal synostosis: treatment with a longitudinal osteotomy and bone graft substitute interposition.

Purpose: To describe a case series of congenital metacarpal synostosis treated with longitudinal osteotomy and bone graft substitute interposition.

Methods: We retrospectively reviewed charts of all patients with metacarpal synostosis treated with a longitudinal osteotomy and bone graft substitute interposition at 2 institutions. Radiographic and clinical appearances were analyzed at initial diagnosis, intraoperatively, and at last follow-up.

Biomechanical analysis of pin placement for pediatric supracondylar humerus fractures: does starting point, pin size, and number matter?

Background: Several studies have examined the biomechanical stability of smooth wire fixation constructs used to stabilize pediatric supracondylar humerus fractures. An analysis of varying pin size, number, and lateral starting points has not been performed previously.

Methods: Twenty synthetic humeri were sectioned in the midolecranon fossa to simulate a supracondylar humerus fracture.

Medial epicondyle fractures in the pediatric population.

Humeral medial epicondyle fractures in the pediatric population account for up to 20% of elbow fractures, 60% of which are associated with elbow dislocation. Isolated injuries can occur from either direct trauma or avulsion. Medial epicondyle fractures also occur in combination with elbow dislocations.

Open clavicle fractures: patterns of trauma and associated injuries.

Objectives: To describe the demographic distribution, mechanism of injury, and associated injuries of patients sustaining open clavicle fractures.

Design: Retrospective case series.

Setting: Level I trauma center.

Shoulder girdle: patterns of trauma and associated injuries.

Objectives: To develop a system of quantification of shoulder girdle injuries that stratifies their severity and to assess the association between shoulder girdle injuries and associated nonbony injuries to the head, thorax, and great vessels.

Design: Retrospective review.

Setting: Level I trauma center.

Gait analysis of children treated for moderate clubfoot with physical therapy versus the Ponseti cast technique.

Background: Nonoperative methods for clubfoot treatment include the Ponseti technique and French functional method. The purpose of this study was to compare the gait of children presenting with moderate clubfeet who were treated successfully with these techniques. We hypothesized: (1) no difference in gait parameters of moderate clubfeet treated with either of these nonsurgical techniques and (2) gait parameters after treatment for less severe feet would more closely approximate normal gait.