Ipsilateral femoral neck and shaft fracture in children: a report of two cases and a literature review.

Concomitant ipsilateral fractures of the neck and shaft of the femur in children are rare. The most recent report in this context found a total of only nine reported cases (<12 years of age) following a search of the indexed English literature. These injuries occur in children due to high-velocity trauma, and there is no generally accepted method of treatment. We report three additional cases from the literature and two cases of our own. In our cases, one had a residual 10° varus deformity at the subtrochanteric level in the femur, but this did not affect hip function. Another patient exhibited a limp at final follow-up due to leg length discrepancy, and peroneal nerve palsy at the time of injury. We advocate operative stabilization of the femoral shaft fracture first to reduce the risk of further displacement and simplify the subsequent reduction of the femoral neck. The series shows that these rare injuries have a poor prognosis, with high rates of incidence of avascular necrosis, coxa vara, and leg length discrepancy.

Indirect reduction of the radial head in children with chronic Monteggia lesions.

OBJECTIVE: The purpose of this study was to report the long-term follow-up results of chronic Monteggia fractures treated with angulation-translation osteotomy of ulna and closed reduction of the radial head. DESIGN: Retrospective. SETTING: Level 1 trauma center. PATIENTS: We retrospectively reviewed 10 missed Monteggia fractures in children. The mean age of the patients was 7.5 years (range, 6-10 years), and there were 2 girls and 8 boys. The mean duration of time between initial injury and initial presentation was 1.7 years (range, 6 weeks to 5 years). INTERVENTION: Closed reduction with ulna osteotomy or lengthening was performed in all 10 cases. Annular ligament reconstruction (ALR) was done in 2 cases. Final follow-up ranged from 3 to 20 years (mean 10 years). MAIN OUTCOME MEASUREMENT: We assessed preoperative and postoperative radiographs to evaluate the quality of the radial head reduction. Clinical results were assessed according to the functional elbow score devised by Kim et al. RESULTS: Radial head reduction was achieved and maintained in 8 of 10 cases after primary or secondary surgery. The radial head was mildly subluxated in one case and dislocated in another case at final follow-up. ALR was performed in only 2 cases. Open reduction and ALR is not required in every case, and its need should depend on intraoperative stability of radial head.

Late diagnosis of medial condyle fracture of the humerus with rotational displacement in a child.

For displaced medial condyle fractures in children, open reduction with internal fixation seems to be most popular treatment method. The major complication of this method is failure to make the proper early diagnosis. Corrective supracondylar humeral osteotomy has been preferred to open reduction and internal fixation for managing malunited fragments. We report a case of a child with nonunion of the medial condyle of the humerus who was subsequently treated successfully with open reduction and internal fixation.

Acetabulotrochanteric distance in slipped capital femoral epiphysis.

BACKGROUND: A pathognomonic finding of slipped capital femoral epiphysis (SCFE) is a combination of the decrease in the height of the slipped epiphysis and the position of external rotation and flexion of hip. We believe that decrease in the acetabulotrochanteric distance (ATD) on an anteroposterior (AP) radiograph represents this finding. MATERIAL AND METHODS: In a retrospective study of 25 consecutive cases of unilateral SCFE, we defined ATD as the distance between a line connecting the superolateral margins of the acetabulae with a second line, parallel to the first line, which goes through the tip of the greater trochanter on each hip and acetabulotrochanteric angle (ATA) as the angle between a line connecting the superolateral margins of the acetabulae with a second line connecting the tip of greater trochanter on each side. The difference in ATD and ATA between both hips in each case was evaluated and their correlation was determined using the Pearson correlation coefficient. RESULTS: Nineteen cases (76%) showed difference in ATD of > 2 mm and positive ATA divergence of >1 degree. The average difference in ATD was 6.6 mm (range, 0 to 25 mm); the average ATA divergence was 2.4 degree (range, 0 to 5.3 degree). CONCLUSIONS: Our findings show that the difference in acetabulotrochanteric distance (ATD) between hips is an easy, reliable, and sensitive finding present on an AP radiograph of patients with unilateral SCFE. ATD should be taken into consideration while evaluating AP radiographs of a patient suspected to have SCFE, and further evaluation with lateral hip radiographs should be carried out to confirm the diagnosis. LEVEL OF EVIDENCE: Level IV.