Comparison of treatment outcomes of stable and unstable developmental dysplasia of the hip with the Tübingen splint.

Background: The Tübingen splint was initially developed for the treatment of stable developmental hip dysplasia (DDH). Later on, some authors expanded its include for the treatment of unstable DDH, but there remain some controversies in the literature. This study aims to compare the outcome between stable and unstable DDH treated with a Tübingen splint. Methods: Epidemiological data and ultrasonographic data of all infants diagnosed with DDH and initially treated with a Tübingen splint at our institution between May 2017 and February 2020 were assessed retrospectively. We divided the population into stable and unstable hips using the Graf classification. Age at treatment initiation, duration of treatment, complications, and radiological outcome between 12 and 24 months were investigated. Results: We included a total of 45 patients (57 hips) affected by DDH treated with the Tübingen splint. Treatment has been successful in 93% of stable hips and only 40% of unstable hips. Radiological outcome at 1-year follow-up significantly correlated with initial Graf classification (p < 0.001). Conclusion: The Tübingen splint is a safe and effective treatment for stable hips, nevertheless, for unstable hips, closed reduction, and spica cast remains the gold standard.

Epidemiology of paediatric lower extremity fractures in a tertiary care center in Switzerland.

PURPOSE: About 20% of all fractures in children occur at the lower extremity. This study aims to investigate the epidemiology and injury pattern of lower extremity fractures within the pediatric population consulting a tertiary referral hospital in Switzerland. METHODS: Study population included all patients up to 16 years presenting with a lower extremity fracture over a period of one year. Recorded data were age, gender, side, season of the year, mechanism, type of fracture and applied treatment. RESULTS: Fractures of the lower extremity represent 23% of all fractures with a mean age of 9 years and 6 months. The tibia, with 94 fractures (38%), represents the most frequently injured bone. Peak incidence is seen in winter and 24% of tibia shaft fractures were due to board sports. Overall, 82% of fractures were treated by cast with or without closed reduction, and only 18% requested surgery. CONCLUSION: Board sports seems to be a leading cause of tibial shaft fracture in our region. Nevertheless, only 18% of fractures had recourse to an orthopedic surgeon, hence the importance of the teaching quality of pediatric residents for conservative fracture treatment.

Epidemiology of Pediatric Upper Extremity Fractures in a Tertiary Care Center in Switzerland.

OBJECTIVE: Fractures in children are common and account for 10% to 25% of injuries in children with considerable effects on activity restriction and subsequent high socioeconomically impact. Eighty percent of all fractures in children occur at the upper extremity. The article investigates the epidemiology and fracture pattern of the upper extremity within a pediatric population consulting a tertiary referral hospital in Switzerland. METHODS: Study population included all patients younger than 18 years presenting with an upper extremity fracture. Recorded data were age, sex, side, season of the year, mechanism, type of fracture, and applied treatment. RESULTS: Fractures of the upper extremities represented 76% with a mean age of 9 years and 7 months. Compared with girls, boys had a risk ratio of 1.35 (1.14-1.6) of having a traumatic injury. The radius, with 298 fractures (37%), was the most injured bone. Overall simple fall from his or her height and soccer represented the main injury mechanisms accounting for 26% and 9%, respectively. Eighty-six percent of fractures were treated by cast with or without closed reduction, 11% (92) by closed reduction and pinning or elastic stable intramedullary, and only 3% of fractures were treated by open reduction and internal fixation. CONCLUSIONS: Eighty-six percent of all fractures could be treated by conservative methods. Only 17% need surgical treatments by orthopedic surgeons. This shows how important it is to train residents in pediatrics for the treatment of upper limb fractures in children.