Associated Factor and Long-Term Clinical Outcomes for Patients with Postoperative Rotational Malreduction in Pediatric Supracondylar Humeral Fractures.

Background and Objectives: Long-term outcomes of immediately postoperative rotational malreduction in the axial plane after operative treatment of supracondylar humeral fractures (SCHF) are unknown. This study aimed to investigate the long-term clinical outcomes and associated factors for immediately postoperative rotational malreduction of SCHF. Materials and methods: In this retrospective case-control study, 88 patients who underwent surgery for Gratland type III SCHF were enrolled between January 2012 and January 2020. Among them, 49 patients had immediately postoperative malrotational reduction (rotational malreduction group) and 39 patients had no rotational deformity (control group). To evaluate the associated factors for immediately postoperative rotational malreduction, demographic data, fracture patterns, physical examination signs, and preoperative radiological parameters were analyzed. To compare the clinical outcomes, operation time, range of motion of the elbow, time from operation to full range of motion, and Flynn criteria were evaluated. The Oxford elbow score was used to investigate long-term clinical outcomes for patients five years after operation. Results: The mean age was 5.7 ± 2.3 years and mean follow-up period was 15.7 ± 4.0 months. The rotational malreduction group had significantly more patients with oblique fracture pattern (p = 0.031) and Pucker sign (p = 0.016) and showed a significantly longer operative time (p = 0.029) than the control group. Although there was no significant difference in the range of elbow motion and the Flynn criteria, the Kaplan-Meier survival curve showed a longer time to recover the full range of elbow motion in the rotational malreduction group (p = 0.040). There were no significant differences in the long-term clinical outcomes assessed using the Oxford elbow score (p = 0.684). Conclusions: Oblique fracture pattern and Pucker sign may be associated with immediately postoperative rotational malreduction in the axial plane. Although patients with immediately postoperative rotational malreduction showed favorable results of long-term clinical outcomes, they required more weeks to recover the full range of elbow motion.

Tension band wiring versus suture anchor technique in patellar inferior pole fracture: Novel double row suture anchor technique.

Introduction: Patellar inferior pole fractures are challenging to obtain sufficient fixation. The purpose of this retrospective, case-controlled study was to compare the clinical and radiological outcomes between tension band wiring (TBW) and our novel double-row suture anchor (SA) technique in patellar inferior pole fractures. Materials and methods: This retrospective study included patients who underwent TBW or SA fixation for patellar inferior pole fractures from 2015 to 2019. A total of 63 patients were divided into two groups according to the surgical procedure: the TBW group (n = 35) and the SA fixation group (n = 28). The visual analog scale score, range of motion of the knee, Lysholm score, Kujala patellofemoral score, and patient satisfaction score were evaluated for clinical and functional outcomes. Radiological outcomes included the time to radiological union, loss of reduction, and the Insall-Salvati (IS) ratio. Results: Significant improvements in clinical outcomes were observed in both groups with no significant differences. Bone union was achieved in all patients, and there was no significant difference in the time to radiological union and the IS ratio between the two groups. All patients in the TBW group underwent additional surgeries for implant removal. However, none of the patients in the SA group underwent implant removal or experienced skin irritation. Conclusion: Our novel double-row SA technique could provide comparable fixation strength and good clinical outcomes, with fewer complications in patellar inferior pole fractures. This novel SA technique is a satisfactory alternative treatment for patellar inferior pole fractures.