Case: We describe an anterior and posterior pelvic ring construct, with emphasis on the posterior construct, to treat a vertical displacement fracture in a 2-year-old girl who was struck by a motor vehicle. Eighteen months after her injury, radiographs showed intact sacroiliac joints and symmetrical pubic symphysis. Conclusion: Although commonly performed in adults, pelvic fixation is challenging in children because of the small size of the child’s pelvis and osseous fixation pathways. However, this approach enabled successful vertical stabilization of the pelvis, complete resolution of symphyseal diastasis, and recovery of function and mobility.

Background: Pediatric olecranon fractures can be treated with several methods of fixation. Though postoperative outcomes of various fixation techniques, including cannulated intramedullary screws, have been described in adults, functional and radiographic outcomes of screw fixation in pediatric patients are unclear. In this study, we assessed clinical, radiographic, functional, and patient-reported outcomes of pediatric olecranon fractures treated with compression screw fixation. Methods: We retrospectively identified 37 patients aged 16 years or younger with a total of 40 olecranon fractures treated with screw fixation at our level-1 trauma center between April 2005 and April 2022. From medical records, we extracted data on demographic characteristics, time to radiographic union, range of elbow motion at final follow-up, and complications during the follow-up period. Patient-reported outcomes were evaluated using the Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Reported Outcomes Measurement Information System Pediatric Upper Extremity Short Form 8a measures. Results: There were no malunions or nonunions at the final mean follow-up of 140 days (range, 26 to 614 d). Four patients had implant failure (11%), of whom 3 experienced fracture union with no loss of fixation or need for revision surgery. One patient underwent a revision for fracture malreduction. Screw prominence was documented in 1 patient. Instrumentation was removed at our institution for 33 of 40 fractures. Mean time to radiographic union was 53 days (range, 20 to 168 d). Postoperative range of motion at the most recent follow-up visit showed a mean extension deficit of 6 degrees (range, 0–30 degrees) and mean flexion of 134 degrees (range, 60–150 degrees). At the final follow-up, the mean (±SD) Quick Disabilities of the Arm, Shoulder, and Hand score was 4.2±8.0, and the mean Patient-Reported Outcomes Measurement Information System score was 37±1.5, indicating good function and patient satisfaction. Conclusions: All 37 patients in our series had excellent radiographic, functional, and patient-reported outcomes after screw fixation. We observed no cases of nonunion or malunion, growth disturbance, or refracture. These results suggest that screw fixation is a safe and effective option for pediatric olecranon fractures. Level of Evidence: Level IV, case series.

Introduction: Flexible intramedullary nail fixation (FIN) has become the preferred mode of treatment for femur fractures in elementary school aged children. One clear limitation of FIN is the inability to control length unstable femur fractures. This case series evaluates radiographic union rates, fracture alignment, and postoperative complications for a novel technique of FIN and adjunct external fixation in length unstable femur fractures. Materials and Methods: A retrospective chart review was performed using current procedural terminology coding to identify 10 pediatric femur fractures utilizing flexible nail fixation with supplemental external fixation in length unstable femur fractures. Electronic medical records were used to obtain demographic information and length of operative time. A picture archiving and communication system was utilized to review radiographs. Results: Combined FIN fixation and supplemental external fixation were used in ten pediatric patients with length unstable femur fractures. The average age at time of injury was 6.4 years (range: 3 to 8 years). The average duration of external fixation was 30 days with no pin site complications including infection or refracture. Average time to union was 54 days with no radiographic loss of reduction. There were no documented intraoperative or postoperative complications. Conclusions: The cases reviewed in this study support that in addition to FIN fixation for unstable pediatric femur fractures, a supplemental external fixator provides a viable option with all fractures obtaining union, acceptable alignment, no loss of reduction, and no postoperative complications. This technique may provide another tool in the orthopedist armamentarium and possibly as an alternative to submuscular plating.

Case: Iliotibial band (ITB) autograft is used for anterior cruciate ligament (ACL) reconstruction in prepubescent patients. No reports have described ITB salvage techniques for failed reconstruction. We describe a 13-year-old boy who sustained a multiligamentous knee injury, experienced a failed primary reconstruction, and required a revision ITB ACL, lateral collateral ligament, and posterior lateral corner reconstruction with reuse of his ITB autograft. At the 2-year follow-up, he returned to playing competitive sports. Conclusion: This case shows that salvage of an ITB ACL autograft can be an option in early reconstruction failure.