Background: Closed reduction percutaneous pinning of displaced pediatric phalangeal head and neck fractures is preferred to prevent malunion and loss of motion and function. However, open reduction is required for irreducible fractures and open injuries. We hypothesize that osteonecrosis is more common in open injuries than closed injuries that require either open reduction or closed reduction percutaneous pinning. Methods: Retrospective chart review of 165 phalangeal head and neck fractures treated surgically with pin fixation at a single tertiary pediatric trauma center from 2007 to 2017. Fractures were stratified as open injuries (OI), closed injuries undergoing open reduction (COR), or closed injuries treated with closed reduction (CCR). The groups were compared using Pearson χ2 tests and ANOVA. Two group comparisons were made with Student t test. Results: There were 17 OI fractures, 14 COR fractures, and 136 CCR fractures. Crush injury was the predominant mechanism in OI versus COR and CCR groups. The average time from injury to surgery was 1.6 days for OI, 20.4 days for COR, and 10.4 days for CCR. The average follow-up was 86.5 days (range, 0 to 1204). The osteonecrosis rate differed between the OI versus COR and OI versus CCR groups (71% for OI, 7.1% for COR, and 1.5% for CCR). Rates of coronal malangulation >15 degrees differed between the OI and COR or CCR groups, but the 2 closed groups did not differ. Outcomes were defined using Al-Qattan’s system; CCR had the most excellent and fewest poor outcomes. One OI patient underwent partial finger amputation. One CCR patient had rotational malunion but declined derotational osteotomy. Conclusions: Open phalangeal head and neck fractures have more concomitant digital injuries and postoperative complications compared with injuries closed on presentation, regardless of whether the fracture underwent open or closed reduction. Although osteonecrosis occurred in all 3 cohorts, it was most frequent in open injuries. This study allows surgeons to discuss rates of osteonecrosis and resultant complications with families whose child presents with phalangeal head and neck fractures that are indicated for surgical treatment. Level of Evidence: Therapeutic, Level III.
There is no financial information to disclose. Hypothesis: Pediatric PROMIS tools are validated patient-or parent-reported measures of health-related quality of life for children and adolescents with chronic conditions. We hypothesized that children with upper-limb malformations would rate their health-related quality of life lower than the standardized reference population, and that those with malformations involving the entire upper limb (UL) would rate themselves lower than those with hand plate malformations. Methods: Four PROMIS domains (Mobility, Upper Extremity [UE] Function, Pain Interference, and Peer Relationships) were administered to 82 children (age 5e17 years) with UL malformations and hand plate malformations, which were classified according to the Oberg-Manske-Tonkin (OMT) classification of congenital malformations. Responses are converted to a T-score, which rescales the raw score for each domain to a mean of 50 (representing the mean of the reference population) and a standard deviation (SD) of 10.Results: Forty-one children (Group A) had OMT type IA malformations (abnormal axis formation/differentiation: entire upper limb), including radial longitudinal deficiency, ulnar longitudinal deficiency, and transverse deficiency. Forty-one children (Group B) had OMT type IB malformations (abnormal axis formation/differentiation: hand plate), including radial polydactyly, syndactyly, symbrachydactyly, and thumb hypoplasia.In Group A, mean Mobility, UE, Pain Interference, and UE Function Tscores were all within the normal range (average T-score ¼ 51, 44, 45, and 5,344, respectively).In Group B, Mobility and Pain Interference T-scores were within the normal range (T-scores ¼ 49 and 44, respectively), and Peer Relationships were greater than 1 SD above the mean (T-score ¼ 55). UE Function scores, however, were 1 SD below the mean (T-score ¼ 39), indicating mildly decreased function compared with the reference population. Summary Points:Children with abnormal axis formation of the entire upper limb and of the hand plate report normal or better-than-normal function for Mobility, Peer Relationships, and Pain Interference. Children with hand plate malformations, report impairment in UE Function. Since the questions included in the PROMIS UE Function domain may be more sensitive to hand function than overall UE function, comparison of UE Function PROMIS scores with objective hand function tests is indicated to determine if this domain has a ceiling effect for children with OMT IA malformations. Furthermore, comparison of PROMIS scores for children with specific diagnoses would help clinicians better understand and treat the challenges that this population faces with regard to mobility, pain interference, peer relationships, and UE function. BIBLIOGRAPHY 1. DeWalt DA, Gross HE, Gipson DS, et al. PROMIS(â) pediatric self-report scales distinguish subgroups of children within and across six common pediatric chronic health conditions.
Introduction: Septic arthritis of a native hip is a relatively uncommon condition in adults. Prompt diagnosis and treatment of septic hip arthritis are imperative to preserve joint integrity, as failure to quickly intervene can allow rapid degenerative changes. Case Report: This is a case report of a 50-year-old male that presented with right septic hip arthritis in the acute setting. He complained of pain with attempted range of motion and log-roll. Laboratory workup demonstrated no leukocytosis, but elevated inflammatory markers. A hip aspiration under fluoroscopy was performed, revealing a cell count of 100,600/cm3 with 91% neutrophils. His right hip underwent irrigation and debridement with a muscle-sparing anterolateral approach (Rottinger). Conclusion: This case report describes the successful use of the anterior based muscle-sparing approach for incision and drainage of septic arthritis of the native hip joint in an adult patient. Advantages to this strategy include lower rate of nerve injury compared to classical anterior and lateral approaches, less muscle damage than the posterior approach, and no requirement for special skills or equipment as in the case of hip arthroscopy. Keywords: Septic arthritis, anterior based muscle sparing and anterolateral
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