Incidence of flexion-type supracondylar fractures at a single Australian level one Paediatric Trauma Centre.

BACKGROUND: Supracondylar fractures are the most common elbow fracture. There have been no studies published analysing flexion-type fractures in the Australian paediatric population. This paper aims to investigate flexion-type supracondylar fractures in an Australian paediatric population. Eight hundred and three paediatric supracondylar elbow fractures were retrospectively reviewed at one hospital over a 5 year time period. The focus was on flexion-type fractures. METHODS: Supracondylar fractures that presented to the Women's and Children's Hospital Emergency Department between 2015 and 2020 were retrospectively reviewed. Fractures were classified on plain radiographs according to the Modified Gartland Classification System. Injury and treatment data were collected for flexion-type fractures. RESULTS: Twenty-one (2.6%) of fractures were flexion-type. The average age of injury was 6.8 years old. Flexion-type fractures were more common in females (62%) and with high energy mechanisms (81%). Ulnar nerve palsies occurred in five cases (24%). Two ulna nerve palsies did completely resolve at 3 months follow up. One open fracture occurred. No vascular injuries occurred. Ten of the 21 flexion-type fractures (48%) were treated surgically. CONCLUSIONS: The authors conclude that: flexion fractures are uncommon, they occur more often after high energy mechanisms such as falls from monkey bars, swings, or trampolines. Flexion-type fractures occur more often in slightly older females. The ulnar nerve is most frequently injured and in the current study-exclusively injured. At 3 month follow up, spontaneous nerve recovery had occurred in three of the five cases (60%).

The distal radius palmar cortical angle in adolescent versus adult populations.

PURPOSE: Volar distal radius plates are pre-contoured to aid restoration of anatomy during open reduction internal fixation of distal radius fractures. Incorrectly contoured plates can result in malreduction, leading to malunion, pain, and loss of function. The purpose of this study was to investigate whether adolescent distal radius anatomy on the palmar cortical surface differs from that in adults, in order to determine whether adult plates are suitable for use in adolescents. METHODS: Lateral wrist radiographs were used to measure the distal radius palmar cortical angle (PCA) in adolescent age groups (12-13, 14-15, and 16-17 years old) and compared to a skeletally mature control group (30-50 years old). Two assessors measured 423 PCAs twice. RESULTS: There was a statistically significant ( p = <0.05) difference in the PCA of the control group compared to each adolescent group. The mean PCA for both males and females decreased as age increased (increasing curvature of the volar distal radius with age). The mean PCA (male/female) was 164.38°/163.00° in ages 12-13, 162.14°/160.92° in ages 14-15, 157.52°/158.18° in ages 16-17, and 149.65°/154.03° in the control group aged 30-50 years. Agreement between assessors was high with an Interclass correlation coefficient (ICC) of 0.97. CONCLUSION: There is a statistically significant and potentially clinically important difference in the curvature of the distal radius volar cortex between adolescents and adults. This difference persists even in the 16-17 age group. As the PCA curvature is significantly greater in adults compared to adolescents, plates pre-contoured for adults may lead to malreduction of distal radius fractures into flexion in adolescent patients.

A new method of fixation in osteoporotic bone. A preliminary report.

Over-tightening of cortical bone screws in osteoporotic bone results in weak fixation. Once a screw is over-tightened and the bone thread form is stripped, there are limited means at the surgeon's disposal to rescue the situation, none of them entirely satisfactory. We describe a simple device that is specifically designed to resolve this problem. It consists of a nylon cavity plug and applicator. The plug is inserted into the stripped hole and the screw re-applied and tightened in the normal manner. The plug expands and forms a load-bearing region on the inner face of the bone. Tests on osteoporotic cadavaric bone have shown that the plug effectively re-establishes screw fixation. When compared to an over-tightened screw, the plug is at least twice as resistant to loads acting to pull the screw out of the surrounding bone.