Abstract:PurposeOpen reduction and internal fixation with a tension band construct is the standard treatment for displaced transverse intra-articular olecranon fractures. The purpose of this study is to describe the outcomes of tension band fixation of olecranon fractures in children, specifically assessing the need for revision fixation and hardware removal.MethodsPatients less than 18 years of age diagnosed with a displaced transverse intra-articular olecranon fracture and treated with tension band fixation between 2008 and 2017 were retrospectively enrolled. Operative treatment was with tension band wire (TBW) or tension band suture (TBS) constructs.ResultsA total of 46 patients, 36 male and ten female with a mean age of 12.3 years (6 to 17), were included. Surgical fixation was with TBW in 17 patients and TBS in 29 patients. Revision fixation due to failure and fracture displacement was required in 6% of the TBW group and 14% of the TBS group (p = 0.19). The patients who required revision fixation in the TBS group were older (14.7 years versus 11.6 years, p = 0.05) and heavier (70.5 kg versus 48.5 kg, p = 0.05) than those in the same group who did not require revision fixation.ConclusionPaediatric olecranon fractures treated with TBW or TBS fixation unite in the majority of patients with similar need for hardware removal due to prominence and/or pain between fixation techniques. In a select group of older patients weighing greater than 50 kg, TBS constructs demonstrate increased failure rates, requiring revision fixation, and should be avoided in this population group.Level of Evidence:IV

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Purpose: Osteogenesis Imperfecta (OI) is a rare genetic disorder caused by a mutation in type I collagen, characterized by bone fragility and deformity. Current treatment methods aim to decrease fracture rates and improve bone density and mobility. Recent orthopaedic surgery research has focused primarily on fracture fixation and outcomes of intramedullary rodding procedures. While surgical techniques continue to evolve, recent trends are focusing on patient-reported outcomes measures (PROMs). Methods: The authors created a 12-question survey in conjunction with the OI Foundation (OIF). The survey was titled, “O.I. Wish Orthopaedic Surgeons Had Better Strategies to Help with . . .” and sought to gather information regarding the aspects of orthopaedic care OI patients and families would most like to see improved. The survey was electronically administrated to members of the OIF and the OI Federation Europe (OIFE). 341 individuals completed the survey. The final question of the survey indicated, “Please include any comments you would like to pass along.” To report on the responses for this question, the answers were grouped into themes. Results: Many of the survey questions we asked were related to childhood orthopaedic surgical interventions. However, 75% of the respondents who answered the age question (254/335) were adults. Regarding surgical intervention for long bones, 16% of respondents recall that they have been told that they could not have surgery because they were too young. Of the 16%, 37.8% were told that <5 years was too young, 13.4% <4 years was too young, and 48.8% <3 years of age was too young for surgical intervention for fractures or deformity. Nearly 22% of respondents were told that their bones were too small to have intramedullary fixation. For the free text response, the most frequent comments were to focus future research on OI adults (14.9%), focus on pain management (11.8%), and focus on improving rodding surgery techniques (11.3%). Conclusion: The information collected helps reveal trends of the typical orthopaedic advice patients and families with OI are receiving. The patient and family responses help elucidate the topics requiring focus for the improvement of OI orthopaedic care. Patient concerns and insights most powerfully drive the research questions we should ask to advance the orthopaedic care of OI patients. Significance: This survey highlights variability in OI treatment for patients of all ages. The responses guide future OI research with a focus on patient-reported areas for improvement of care.

The use of telescopic intramedullary rods for the treatment of lower extremity deformity in children with osteogenesis imperfecta has been well described. The reinforcement of these weakened weightbearing bones with intramedullary devices leads to improvements in mobility that progress into adulthood. Although the current telescopic intramedullary rod systems are an upgrade from earlier systems, they are still associated with high rates of reoperation and complication. We describe a unique complication encountered during a revision which involved the male retriever system for the Fassier–Duval rod (FDR) (Pega Medical, Quebec, CA) experienced intraoperatively. To our knowledge, this mechanism of failure has not been previously described in the literature.

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Osteogenesis Imperfecta (OI) is a rare genetic disorder in Type I collagen characterized by bone fractures, fragility, and deformity. Current treatments are focused on decreasing fracture rates, improving bone strength, and improving overall global function. Recent research has focused primarily on fracture fixation and outcomes of intramedullary rodding of long bones. While surgical techniques continue to evolve, recent trends in OI research are focusing on patient quality of life and patient-reported outcomes. We created a 12-question survey seeking information regarding aspects of orthopedic care that OI patients and families feel are the most pressing to improve. The survey was electronically administered, and 341 individuals participated. A total of 75% of respondents who answered the age question (254/335) were adults. Regarding surgical intervention for long bones, only 16% of respondents recall being told they could not have surgery because they were too young. Of the 16%, 37.8% were told that <5 years was too young, 13.4% <4 years was too young, and 48.8% <3 years of age was too young for surgical intervention for fractures or deformities. Nearly 22% of respondents were told that their bones were too small for intramedullary fixation. The patient and family responses help elucidate the topics requiring focus for the improvement of OI orthopedic care. Patient concerns and insights should drive the research questions we ask to advance the orthopedic care of OI patients.