Incidence of inpatient surgeries in children and young adults with childhood orthopaedic diagnoses.

The incidence of orthopaedic surgery for young people with childhood onset of orthopaedic disabilities is not well documented. This study tabulated that incidence in the past two decades in California. Trauma, tumors, and hand surgery were not included in the study. Common pediatric orthopaedic diagnoses by ICD-9 code requiring CPT orthopaedic surgical procedures were tabulated in three years: 1983, 1990, and 1999. The most common procedures in each of these years studied were, in order of incidence, scoliosis, congenital hip problems, slipped femoral capital epiphyses, and clubfeet. The incidence of surgery for scoliosis and slipped femoral capital epiphyses increased over the past two decades. These data should be helpful in planning for future inpatient services for orthopaedically handicapped children.

Medial condyle fractures of the humerus in children.

A retrospective study of 21 medial condylar fractures revealed that the complication rate for these rare fractures was 33%. Most of the minimally displaced fractures healed uneventfully with immobilization; however, one patient developed avascular necrosis of the trochlea, and one patient developed a nonunion. Operative treatment was performed if there was >2 mm of displacement at the fracture site. Two of three fracture-dislocations lost reduction in the early postoperative period, requiring revision with more stable fixation. Medial condylar fractures may be difficult to diagnose in younger children and should be considered when there is a history of trauma and medial-sided elbow pain. Oblique views, arthrography, or magnetic resonance imaging can be helpful in confirming the diagnosis. Management of this rare fracture must include adequate stabilization of the fracture and immobilization until there is radiographic evidence of healing.