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Objective:To investigate the clinical effect of arthroscopic reduction of tibial intercondylar ridge fractures in children using a 2.0 mm perforated Kirschner wire to establish bone tunnels and the Krackow-" 8" suture.Methods:From January 2018 to December 2020, 24 children (14 males and 10 females, aged 6-15 years) with tibial intercondylar ridge fractures admitted to Children′s Hospital of Nanjing Medical University were retrospectively recruited for analyses.All patients were treated with arthroscopic reduction, non-absorbable Krackow-" 8" suture for the base of the anterior cruciate ligament, and establishment of bone tunnels by 2.0 mm perforated Kirschner wire from the proximal tibial epiphysis for inserting a suture to fix the fractures.The affected limb was immobilized with a cast for 4 weeks, followed by active exercises postoperatively.Knee function was assessed using the Lysholm score and IKDC 2000 subjective score.Knee stability was evaluated using the Lachman test.X-rays were taken at 3 and 6 months postoperatively to evaluate fracture healing.Growth retardation of epiphyseal plate at 2 years of follow-up was assessed by bilateral knee X-rays.Results:All the 24 cases were successfully operated, with the operation time of (63.1±20.2) (40-115) min.All children were followed up for 24-36 months[(28.7±3.4) months]. All children achieved an anatomical reduction of the fracture postoperatively.No complications like fracture displacement, suture rupture, or infection were reported.All fractures healed completely at 3 months postoperatively.At the last follow-up, the Lysholm score and IKDC 2000 subjective score were (94.4±4.8) points and (93.8±5.6) points, respectively.The positive Lachman test was detected in 2 patients.No inhibition of proximal tibial epiphyseal growth was observed.Conclusions:Arthroscopic reduction with non-absorbable Krackow-" 8" suture and establishment of bone tunnels using a 2.0 mm perforated Kirschner wire for the treatment of tibial intercondylar ridge fractures in children has the advantages of simple surgical procedures, minimal invasiveness, which is an effective treatment method.
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Objective To evaluate the clinical efficacy of percutaneous haemostat stroke-poking reduction and elastic intramedullary nailing for pediatric radial neck fractures of O'Brien types Ⅱ & Ⅲ.Methods From January 2014 to June 2016,38 children (23 boys and 15 girls) with radial neck fracture of O'Brien type u or Ⅲ were treated by percutaneous haemostat stroke-poking reduction and elastic intramedullary nailing in our department.We had 26 left and 12 right sides.Their ages ranged from 5 to 14 years,averaging 8.6 years.All fractures were fresh.According to O'Brien classification,22 cases were type Ⅱ and 16 type Ⅲ.The operation time,frequency of intraoperative C-arm fluoroscopy,frequency of percutaneous haemostat stroke-poking reduction,and union time were recorded.The elbow function was assessed one day before removal of internal implants according to the Métaizeau scoring system.Results All operations succeeded,lasting from 12 to 25 min (average,16.4 min).The frequency of intraoperative fluoroscopy ranged from 3 to 11 times (average,6.4 times);the frequency of intraoperative percutaneous reduction ranged from 1 to 4 times (average,2.3 times).The patients were followed up for 6 to 22 months (average,1 1.2 months).Postoperative X-ray films showed satisfactory alignment of the fracture ends.All fractures demonstrated clinical and radiographic evidence of complete healing after a mean time of 58 days (from 38 to 72 days).The Métaizeau scoring showed 33 excellent,4 good and one fair cases,yielding an excellent to good rate of 97.4％.Follow-ups revealed no infection,implants breakage,nonunion,fracture redisplacement,or iatrogenic radial nerve injury.Conclusions As percutaneous haemostat stroke-poking reduction can increase the probability of successful reduction at first attempt,reduce frequency of close reduction and X-ray exposure for both children and medical staff,and shorten operation time,the procedure is effective,simple,reliable and minimally invasive,leading to fewer complications.
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Objective To discuss the clinical effect of three different approaches of elastic stable intramedullary nail for treatment of humeral shaft fractures in older children.Methods From January 2011 to December 2015,54 older children(31 males and 23 females) aged 8-14 years(average 11.4 years old) of humeral shaft fractures were treated in Children's Hospital of Nanjing Medical University with elastic stable intramedullary nail.The left side involved 24 cases and right involved 30 cases.Patients were divided into 3 groups according to different approaches:bilateral retrograde group (31 cases),radial retrograde group (15 cases) and anterograde group (8 cases).Abduction brace was carried out postoperatively for about 6 weeks.Implant removal took place about 3-4 months later,when the X-ray showed fracture line disappeared and continuous trabecular bone was formed.A retrospective study was performed to compare the operation time,imaging findings after the surgery,fracture healing time and recent complications among the 3 groups.Results Bilateral retrograde nailing operation lasted for an average of (51 ±25) min and residual angle in X-ray films postoperative was (5.4 ± 1.8) °.The radial retrograde nailing average operating time was(46 ± 12)min and average residual angle in X-ray films postoperative was (12.8 ±2.9)°,while anterograde nailing was (44 ±16) min and (13.0 ± 3.6)°.The angle of the fracture after operation in the bilateral retrograde group was significantly less than those of the radial retrograde group and the anterograde group,and the difference was statistically significant (F =19.340,P ＜ 0.01).Children were followed up for 6 to 18 months (averaged 11 months).Each fracture was healed successfully.The excellent rates of Constant scores of postoperative shoulder joints 6 months after surgery were 96.8％ (30/31 cases),93.3％ (14/15 cases),87.5％ (7/8 cases).The excellent rates of Mayo scores of elbow joints 6 months after surgery were 93.5％ (29/31 cases),100.0％ (15/15 cases),100.0％ (8/8 cases).All fractures were healed without abnormal appearance or decreased range of motion.In terms of their complications,in the bilateral retrograde group,there was 1 case of iatrogenic ulnar nerve palsy and 5 cases with skin irritation.One case of skin irritation occurred in the radial retrograde group.Conclusions In treatment of humeral shaft fractures in older children,functional outcomes are similar in 3 groups.The technique of bilateral retrograde insertion is effective and has extensive applicability.