Pediatric aseptic lower leg fracture nonunion

Abstract

Purpose Lower leg nonunion in pediatric patients is a rarity. Therefore, eight European pediatric trauma units retrospectively analyzed all patients younger than 18 years suffering lower leg fractures resulting in aseptic nonunion. Methods Thirteen children and adolescents less than 18 years old (2 girls and 11 boys) diagnosed with aseptic nonunion of the tibia and/or fibula were evaluated. In all patients, epidemiological data, mechanism of injury, fracture configuration, and the initial treatment concept were assessed, and the entire medical case documentation was observed. Furthermore, potential causes of nonunion development were evaluated. Results The mean age of patients was 12.3 years with the youngest patient being seven and the oldest being 17 years old. Open fractures were found in six out of thirteen patients (46%). Nonunion was hypertrophic in ten and oligotrophic in three patients. Mean range of time to nonunion occurrence was 7.3 ± 4.6 months. Nonunion healing resulting in complete metal removal was found in 12 out of 13 patients (92%), only in one case of a misinterpreted CPT type II osseous consolidation could not be found during the observation period. Mean range of time between surgical nonunion revision and osseous healing was 7.3 months as well. Conclusion If treatment principles of the growing skeleton are followed consistently, aseptic nonunion of the lower leg remains a rare complication in children and adolescents. Factors influencing the risk of fracture nonunion development include patient’s age, extended soft tissue damage, relevant bone loss, and inadequate initial treatment.

Analysis of Efficacy, Complications, and Inflammatory Reactions of Bridge Combined Internal Fixation System for Periarticular Fractures of the Shoulder

“…As a kind of fractures, periarticular fractures of the shoulder joint include clavicle and scapula fractures, fractures of the upper end of the humerus and of the outer clavicle with coracoclavicular ligament rupture, displaced fractures of the outer 1/3 of the clavicle, open fractures, and fractures combined with vascular and nerve injuries, usually requiring surgical treatment [ 2 ]. However, fracture healing, a complex process that takes time, is affected by the blood supply, bone stability, and inflammation at the fracture site [ 3 ]. Besides, improper fixation material selection or inadequate fixation adversely influences functional recovery and fracture healing of the affected limb [ 4 ].…”