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Objective:To compare the safety and efficacy of medial-lateral pinning (MLP) and lateral pinning (LP) in pediatric supracondylar humeral fractures.Methods:According to PRISMA procedure, the randomized controlled trial (RCT) of pediatric supracondylar humeral fractures in PubMed (Medline), EMBASE, the Cochrane Library databases (Cochrane Controlled Trials Register for RCTs) and Wanfang Data from 1 January, 1990 to 1 January, 2020 were retrieved. Two researchers independently extracted the data and evaluated the quality of the original studies; the random-effects model was used for analysis.Results:A total of 4 679 original literatures were retrieved and 11 literatures were finally included, involving 920 children. Meta analysis results showed that there were no statistical differences in excellent ratio of elbow joint function (Flynn criteria), incidence of iatrogenic nerve injury and incidence of pin tract/ superficial infection between MLP group and LP group: 74.3% (255/343) vs. 72.9% (250/343), 6.1% (16/262) vs. 1.6% (4/246) and 5.3% (14/264) vs. 7.6% (20/262); RR = 0.98, 0.43 and 1.31; 95% CI 0.90 to 1.07, 0.18 to 1.03 and 0.64 to 2.67, P>0.05; the incidence of reduction loss in MLP group was significantly lower than that in LP group: 16.6% (51/307) vs. 23.9% (72/301), and there was statistical difference ( RR = 1.39, 95% CI 1.02 to 1.89, P = 0.04). Conclusions:MLP fixation and LP fixation are equally efficacious for supracondylar humeral fractures in children. MLP fixation may reduce the risk of reduction loss without increasing the risk of iatrogenic nerve injury. Manual reduction and MLP percutaneous Kirschner wire fixation for the treatment of displaced supracondylar humeral fractures in children is recommended.
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Objective To investigate the treatment strategies and clinical effects in treatment of floating knee in children.Methods A retrospective case series study was made on 26 cases of floating knee treated from July 2005 to June 2015.There were 22 males and four females, aged from 2-14 years (mean, 7.6 years).According to the Letts classification of the floating knee, ten cases were with type A, four with type B, two with type C, eight with type D, and two with type E.Closed fractures were noted in 16 cases and open fractures in 10 cases.According to the Gustilo classification of open fractures, one was with type ⅢA, six with type ⅢB, and three with type ⅢC.One case was amputated from the distal of the femur, eight cases were treated by traction and plaster caster, and 17 cases were treated by reduction and fixation of both femoral and tibil fractures.Wound healing, fracture union, Karsstrom criteria for functional outcome and complications were detected.Results All patients were followed up for mean 2.8 years (range, 1-6 years).One case of Gustilo type ⅢA and six cases of Gustilo type ⅢB open fractures had wound healing after one-stage debridement.Two cases of Gustilo type ⅢC showed wound healing after second-stage skin grafting.One case of Gustilo type ⅢC had amputation wound infection and was cured after a second debridement and dress change.Two had delayed union and there was no nonunion.According to the Karlstrom criteria, the excellent and good rate of functional outcome was 25% and 83% respectively in nonoperative and operative population (P<0.05).Malunion was found in four cases, genu vagum in three and overgrowth of 10-20 mm in seven.There was no premature closure of epiphysis.Conclusion Femur and tibia immobilization of floating knee in children is effective for bone union and functional recovery.
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Objective To investigate effect of rotational and shortening osteotomy at the conjoined mass in the treatment of congenital radioulnar synostosis.Methods Fourteen cases of radioulnar synostosis in 13 patients were treated by rotational and shortening osteotomy at the conjoined mass of radius and ulna.There were 10 males and 3 females,aged from 2 to 7 years (average,3.5 years).The pronation deformity of the forearm ranged from 50° to 90° (average,82.1°).The affected limbs could not perform some activities of daily living such as eating by holding a bowl,cleaning genitals and buttocks,turning on the global door knob,turning a key in a keyhole,and accepting objects in the palm.The operation was done through Boyd approach,and the proximal interosseous membrane of forearm was identified and released.The conjoined mass of radius and ulna was cut and shortened about 0.5 cm,then the distal part of forearm was rotated to neutral position or 10° to 20° of supination.Finally two parts of osteotomy were closed and fixed by crossing Kirschner wires which were removed 8 to 16 weeks after operation when reunion had been achieved.Results The average correction of pronation deformity of the forearm was 90.7°.No ischemic contracture of the forearm and incision infection occurred.And bone union was achieved in all patients.The parents and children were satisfied with improvement of deformity and function of the affected limbs.All patients were followed up for 14 to 88 months (average,35.7 months),and there was no loss of correction.Conclusion Rotational and shortening osteotomy at the conjoined mass of radius and ulna is an effective method for treating congenital radioulnar synostosis,which can significantly improve deformity and function of the affected limbs,and decrease risk of ischemic contracture of the forearm after operation.