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INTRODUCTION: Proximal femur fractures are common in older patients and typically require surgical treatment, with cephalomedullary nails being the gold standard device for this approach. This study aimed to identify the factors associated with the failure of cephalomedullary nailing. MATERIALS AND METHODS: We retrospectively evaluated 380 patients treated with a cephalomedullary nail between August 2021 and August 2022 in a trauma referral center in Brazil. A total of 221 (58.1%) patients were included in the study after applying specific eligibility criteria. Data were collected and rates were determined by reviewing patients' medical records and radiographs. RESULTS: Of 221 patients, 14 (6.3%) had nail failures A significant association was found between post-fixation cervico-diaphyseal angle and the occurrence of nail failure (p<0.001). Furthermore, calcar-referenced tip-apex distance (CalTAD) and tip-apex distance (TAD) values were higher in cases with nail failure than in those without nail failure. Cutoff points were established for TAD and CalTAD to measure the correspondence with nail failures. CONCLUSION: The present study supports previous evidence that varus reduction potentially causes collapse and nail failure in pertrochanteric fractures treated with cephalomedullary nailing and that high TAD and CalTAD values contribute to the incidence of cut-out.
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Subungual lesions are very common in clinical practice. We present the clinical case of a 10-year-old female patient who presented with progressive nail deformity. The onset of the condition was approximately five years prior to presentation with an injury in the left hallux, according to the mother. She denied pain or change in the color of the area from the onset of the injury to the day of consultation. There was no previous trauma. Examination revealed subungual bone injury to the distal extremity (distal phalanx of the left hallux), and imaging tests (X-ray and soft tissue ultrasound) found bone injury. Subungual exostosis was considered as a possible diagnosis, thus prompting the indication for exeresis of the tumoral process. After surgical removal, the resected specimen was sent for pathological assessment, which found that an intraosseous hemangiolymphangioma was the origin of the tumor. A subungual exostosis is a slow-growth benign osseous tumor mainly located in the distal phalanx of the hallux that especially affects young adults, being less frequent in children. This condition results from a process of bone neoformation involving different stages, the clinical symptoms of which depend on its size and associated processes. Hemangiolymphangiomas are angiomatous lesions of the blood and lymphatic vessels that have a controversial etiology and present slow, painless, and progressive growth; these lesions are mostly benign. It is worth emphasizing that subungual injuries are not always caused by an underlying bone; therefore, potential differential diagnoses, both benign and malignant, should be considered, based on the location of the injury.
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Introduction Supracondylar fractures are the predominant type of pediatric elbow fractures. The usual mechanism of injury is falling over the hand with the elbow extended and the hand open. The management of these fractures encompasses a range of treatment options, and their goal is to recover the anatomy and achieve a stable contact area between them. There are some controversies on the management of these injuries mainly focused on those that present some degree of displacement. A review and analysis of the current treatment at our institution and a comparison with the guidelines suggested by the American Academy of Orthopaedic Surgeons (AAOS) for the treatment of these fractures in the pediatric population were performed. Materials and methods This was an observational, analytical, retrospective study of consecutive pediatric patients with displaced supracondylar humeral fracture treated at Hospital de Trauma "Manuel Giagni" in Asunción, Paraguay, from January 2016 to December 2021. Demographic and clinical data were assessed, and patients were clinically and radiologically followed for at least 12 months. The management of supracondylar humeral fractures at our hospital was compared with the guidelines suggested by the American Academy of Orthopaedic Surgeons (AAOS) by analyzing whether these guidelines were applied in each case. The mechanism of injury was divided into three groups, initial X-rays were measured, extension-type fractures were categorized into three groups, and the type of treatment was divided into two groups: non-operative and operative. Furthermore, trauma-related preoperative complications and postoperative complications were reported. Outpatient follow-up was performed for at least 12 months in all cases. Results Of the 843 patients analyzed, 71.5% were male, with a mean age of 5.6 years. It was observed that 57.5% of injuries were caused by falls on the same level. The most frequent type of injury was Gartland type III, accounting for 55% of the cases, and associated injuries were found in 4% of the cases. With regard to the type of treatment, 91.8% of patients were treated with closed reduction and percutaneous pin fixation. Complications on admission were found in 12% of the cases and late complications in 12% of the cases. Most patients (82%) had excellent Mayo Elbow Performance Score. Conclusion Supracondylar fractures were more frequent in males and in schoolchildren. Garland type III fractures were the most common type of injury. The treatment of choice was predominantly closed reduction and percutaneous pin fixation. The Mayo Elbow Performance Score was excellent in most patients. Our service, a referral center of a public hospital in a developing country, complies with the guidelines recommended by the AAOS.
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Introduction An ipsilateral fracture of the femur and tibia (also known as floating knee) is a rare injury in pediatric patients. Recent advances rapidly made the use of intramedullary elastic nails the standard of care in the management of long bone fractures, including floating knee injuries, in patients with immature skeletons. Currently, we have observed a trend of fixing both fractured bones, thus improving functional outcomes, and reducing sequelae. The aim of this study was to report our experience in the management and functional outcomes of floating knee injuries in a single trauma-I level center. Materials and methods This is a retrospective study of consecutive cases from June 1, 2018, to March 31, 2022, from a single trauma center. Preoperative and postoperative records and radiographs were assessed, including the epidemiological data and characteristics of the fractures type of treatment, mechanism of injury, complications, and functional evaluation at the last follow-up, which was performed according to the criteria described by Karlstrom and Olerud. Results Twenty-five patients were included during the four years of study, of which 18 were male (72%), and the mean age was 9.6 years. Overall, 96% of the cases were related to traffic accidents. An analysis of the provided treatment showed that 19 cases (76%) were resolved with surgery on at least of the bones, and six cases were managed with simultaneous orthopedic treatments in both injuries. Excellent outcomes were achieved in 15 cases (60%), good outcomes in three, fair outcomes in five, and poor outcomes in one. Concerning the classification of injuries according to the criteria developed by Letts and Vincent,it was observed that type D was the most frequent one. With regard to exposed bone injuries, 15 cases presented with open fractures. Complications were found in eight (32%) cases, of which five were related to limb discrepancy and three with functional limitations of the knee, with changes in its range of motion. There was also one case of nonunion of the distal tibia. Conclusion Traffic accidents are the main cause of floating knees. Surgical management of the fractures brought satisfactory outcomes and reduced complications. Thus, fixation of injuries is recommended for early return to daily activities and for a reduction in residual complications.
ABSTRACT
Objetivos: Mostrar los resultados obtenidos, describiendo el manejo y experiencia, sabiendo que el tiempo de demora quirúrgica está muy alegado de lo recomendado en las guías actuales. Materiales y Método: Estudio retrospectivo de casos consecutivos de fracturas de cadera en el rango de 0 a 16 años, con seguimiento mínimo de 12 meses. Donde se analizaron variables epidemiológicas, demora en la llegada al Hospital, demora en el tratamiento quirúrgico, complicaciones y funcionalidad según los criterios de Ratliff. Resultados: Veintiún casos de fracturas de cadera. Promedio de edad de 9 años, 71% de afectación del lado izquierdo, un caso de presentación bilateral. El mecanismo de trauma fue en un 42,8% relacionado con accidente de tránsito. Hubo lesiones asociadas en 33,3%. Predominio de tipo IV y tipo III según la clasificación de Delbet. Tratamiento quirúrgico en 95% de los casos. El tiempo de demora de llegada al hospital fue de 1,6 días en promedio, con un retraso en el tratamiento de 5,45 días. Seguimiento promedio de 29 meses (12 a 54 meses). Se obtuvieron resultados funcionales excelentes en el 66,6% de los casos, regular en el 23,8% y 9,5 de malos resultados. Las complicaciones se presentaron en 7 casos, siendo la NOA 19% pacientes, coxa vara en 8,5% y 4% de discrepancia de longitud (4%). Conclusiones: Son fracturas raras. Debemos, como ortopedistas infantiles, estar actualizados en el manejo de cada tipo de lesiones, para ofrecer el tratamiento adecuado que disminuya las secuelas que potencialmente puedan existir. La meta debe ser la obtención de reducciones anatómicas y fijaciones estables. Y la demora quirúrgica no es sinónimo de malos resultados.
Objectives: Show the results obtained, describing the management and experience, knowing that the surgical delay time is very close to what is recommended in current guidelines. Materials and Method: Retrospective study of consecutive cases of hip fractures in the range of 0 to 16 years, with a minimum follow-up of 12 months. Where epidemiological variables, delay in arrival at the Hospital, delay in surgical treatment, complications and functionality were analyzed according to Ratliff criteria. Results: Twenty-one cases of hip fractures. Average age 9 years, 71% left side involvement, one case of bilateral presentation. The mechanism of trauma was 42.8% related to a traffic accident. There were associated injuries in 33.3%. Prevalence of type IV and type III according to the Delbet classification. Surgical treatment in 95% of cases. The delay time to arrival at the hospital was 1.6 days on average, with a delay in treatment of 5.45 days. Average follow-up of 29 months (12 to 54 months). Excellent functional results were obtained in 66.6% of the cases, fair in 23.8% and poor results in 9.5%. Complications occurred in 7 cases, with NOA in 19% patients, coxa vara in 8.5% and length discrepancy in 4%. Conclusions: These are rare fractures. We must, as children's orthopedists, be up to date in the management of each type of injury, to offer the appropriate treatment that reduces the sequelae that may potentially exist. The goal should be to obtain anatomical reductions and stable fixations. And surgical delay is not synonymous with bad results.
