Background The internal joint stabilizer of the elbow (IJS-E) adds to techniques for maintaining reduction of elbow fracture-dislocations while allowing early motion. Literature on this device is limited to small case series. Methods Retrospective comparison of function, motion and complications in patients who sustained elbow fracture-dislocations reconstructed with (30 patients) and without (34 patients) an IJS-E by a single surgeon. The minimum follow up was 10 weeks. Results The mean follow up was 16 ± 17 months. The mean final flexion arc did not differ between the two groups, however patients without an IJS achieved greater pronation. There were no differences in mean Mayo Elbow Performance, Quick-DASH and pain scores. Five patients (17%) underwent IJS-E removal. The rates of capsular releases for stiffness after 12 weeks and recurrent instability were similar. Conclusions The use of an IJS-E to supplement traditional repair of elbow fracture-dislocations does not appear to affect final function or motion, and appears to be effective in reducing the risk of recurrent instability in a group of patients deemed high risk. However, its use is weighed against a 17% rate of removal at early follow up and possibly inferior forearm rotation. Level of Evidence Retrospective Cohort study, Level 3
Background: Neuromuscular scoliosis in Rett syndrome (RS) is common, progressive, and often requires posterior spinal fusion (PSF). While PSF is associated with improved overall outcomes, there is a paucity of information describing complications. We aimed to report the postoperative complications, readmissions, and reoperations for patients with RS undergoing PSF. Methods: Female pediatric patients with RS treated by PSF with segmental instrumentation, with or without concurrent pelvis fixation, during January 2012 to August 2022 were included. Preoperative patient characteristics, intraoperative data (estimated blood loss, cell saver, packed red blood cells transfused), postoperative complications according to the Modified Clavien-Dindo-Sink classification within 90 days, unplanned readmissions within 30 days, and unplanned reoperations within 90 days were recorded. Results: A total of 25 females were included. The mean (SD) age at surgery was 12.9 (1.8) years and the mean follow-up of 38.6 (24.9) months. The mean preoperative major coronal curve was 79 degrees (23 degrees) which decreased to 32 degrees (15 degrees) by the last follow-up (P<0.001). The median estimated blood loss was 600 mL and length of stay was 7 days. There were 81 total postoperative complications (3.2 complications/patient). Eight (32%) had grade IVa complications (disseminated intravascular coagulopathy, hypotensive shock, respiratory failure, chronic urosepsis). Five (20%) patients experienced seizures, 48% had pulmonary complications, and 56% had gastrointestinal complications. There were 3 readmissions (12%) within 30 days for pneumonia and 2 (8%) reoperations (an incision and drainage and C2-T2 fusion for significant kyphosis) within 90 days. One patient also had their fusion extended to the pelvis 1 year later. There were more nonambulatory patients in the group fused to the pelvis, but otherwise no differences between those fused and unfused to the pelvis. Conclusions: This is the largest review of early postoperative complications for patients with RS who underwent PSF. PSF effectively reduced the major coronal curve, but surgeons and families should be aware of a high postoperative seizure and respiratory complication rate, as well as 8% having reoperations within 90 days and 12% being readmitted within 30 days. Level of Evidence: Level IV—therapeutic study.
Background: Lateral humeral condyle fractures (LHCF) are the second most frequent type of pediatric elbow fracture. The purpose of this study is to characterize infections and nonunions of LHCF treated at a single institution. This is the largest series on infections and nonunions of LHCF to date. Methods: Pediatric patients undergoing surgical treatment for a LHCF from 2012 to 2022 at a single children’s hospital were identified for a retrospective review. Patients who were diagnosed with an active infection or nonunion after surgery were included. Data collected included demographics, original treatment course, presentation, effective treatments, outcomes, and timing of events. Results: Out of 863 surgical patients, 12 (1.4%) patients developed 13 infections: 8 were diagnosed with superficial cellulitis, 3 with soft tissue infections, and 2 with osteomyelitis. Eleven fractures were stabilized with percutaneous pins and 1 with buried pins. The average time to infection diagnosis was 29 days and the most common presenting symptom was increased or new onset of pain. All 12 patients received antibiotics for an average 18 days, 6 required hospital admission, 3 required surgical incision and drainage, and 2 required intravenous antibiotics without admission. One patient that developed osteomyelitis developed a nonunion. Ten (1.2%) surgical patients developed nonunion. There were 3 Weiss type II fractures and 7 type III fractures. On average, nonunions were diagnosed 12 weeks after initial treatment. Nine patients underwent nonunion surgery, and all went on to union. Patient’s elbows were immobilized for an average 16 weeks and at least 5 patients required an average of 10 physical therapy sessions to regain their range of motion. Conclusion: Infection and nonunion are rare complications of LHCF, but greatly change the timeline and number of healthcare interactions required for healing. Infectious complications typically require admission, additional surgery, or emergency department visits. Nonunions require extensive cast time, additional surgery, and rehabilitation. Level of Evidence: Level IV – case series.
Background: Pediatric patients with leg length discrepancies and complex deformities may require multiplanar external fixators for correction. We have encountered 4 cases of half-pin breakage with the Orthex hexapod frame. The purpose of this study is to report factors associated with half-pin breakage and compare various deformity correction characteristics between 2 hexapod frames – Taylor Spatial Frame (TSF) and Orthex. Methods: Pediatric patients with lower extremity deformities treated with an Orthex or TSF at a single tertiary children’s hospital between 2012 and 2022 were included for retrospective review. Variables compared between frame groups include frame configuration, half-pin/wire fixation, length achieved, angular correction, and frame time. Results: There were 23 Orthex frames (23 patients) and 36 TSF (33 patients) included. Four Orthex and zero TSF had proximal half-pin breakage. The Orthex group was younger on average (10 vs. 12 y, P=.04*) at the time of frame placement. The majority (52%) of Orthex frames were used for simultaneous lengthening and angular correction, while the majority (61%) of TSF was used for only angular correction. Orthex had more half-pins used for proximal fixation (median 3 vs. 2, P<0.0001*) and more frames with nonstandard configuration (7 (30%) vs. 1 (3%), P=0.004*). Orthex group had a longer total frame time (median 189 vs. 146 days, P=0.012*) and longer time required for regenerate healing (117 vs. 89 d, P=0.02*). There were no significant differences in length gained, angular correction, or healing index between Orthex and TSF. Nonstandard configuration, increased number of proximal half-pins, younger age at index surgery, and increased lengthening were associated with pin breakage. Conclusions: This is the first study to report half-pin breakage while using multiplanar frames in pediatric lower extremity deformity correction. The Orthex and TSF groups consisted of significantly different patients and frame configurations, making it difficult to identify any specific cause for pin breakage. This study shows that pin breakage is likely caused by multiple factors and is associated with the increased complexity of deformity correction. Level of Evidence: Level III—Retrospective Comparison Study.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.