Atypical use of pediatric flexible nails in the treatment of diaphyseal fractures in adults.

BACKGROUND AND AIM OF THE WORK: Elastic intramedullary nails are commonly used for the treatment of diaphyseal fractures in adolescents and children. The major advantages are the minimally invasive nature of the technique, the short operation time, and the preservation of the growth plate and periosteum thus allowing bone healing within a closed and intact biological environment. Elastic nails are rarely applied to the adult fractures. METHODS: Five selected adult patients affected by diaphyseal fractures were treated using paediatric flexible nails T2 Kids (Stryker®, Mahwah, NJ, USA) as consequence of their poor clinical conditions, high risk of neurovascular injuries and skin/soft tissues problems. All patients were monthly clinically and radiographically evaluated after surgery until fracture healing. RESULTS: Radiological and clinical outcomes were satisfying. All fractures healed after a mean period of 3 months. No losses of reduction as well as mobilization/breakage of implant were observed. CONCLUSIONS: Use of pediatric elastic nails is a valid surgical option in treatment of diaphyseal fractures in selected adult patients who request fast and minimally invasive surgery as consequence of precarious clinical or soft tissues conditions.

Distal radius nonunion after epiphyseal plate fracture in a 15 years old young rider.

BACKGROUND AND AIM OF THE WORK: Radius and ulna fractures are the most common long bone fractures in children and adolescents. The majority of these injuries involve the distal metaphyseal portion of the radius associated or not to physeal plate injuries. Because of the high remodelling potential of the distal radius in growing children most injuries heal without complication after closed reduction and immobilization in a long arm cast. Nonunions of closed distal radius fracture are an extremely rare occurrence especially in paediatric population. Methods: In this report, we describe a rare case of distal radius fracture nonunion in a 15-years old male rider treated conservatively with cast immobilization. Eight months later he underwent surgical closed reduction and fixation with kirschner wire and cannulated screw. Results: Follow-up at 2 years showed satisfying radiological and functional outcomes. The patient ultimately returned to ride 3 months following surgery. Conclusions: Nonunion is rarely seen in distal radius fractures in healthy children and adolescents, and there are few studies in the literature. Treatment of the nonunion must be individualized and the results are not entirely predictable.

Pectoralis major tendon rupture in a weight lifter: a rare case.

Pectoralis major tendon (PMT) rupture is a rare event, and it was originally described by Patisser in 1822. The PMT is a thick lamina, which has two origins, one from the clavicle and the other from the ribcage sternum. PMT lesions are classified according to 3 levels of severity: Type 1 is contusions and strains, Type 2 is a partial tear and Type 3 is a complete tear. Diagnosis is made through a clinical examination which comprises a positive response to pain upon pressure over the axilla recess, the presence of bruising and limited motion, and is completed with an MRI. Type 3 injuries are treated exclusively through surgery, while Type 1 and 2 lesions are treated conservatively. In this article, we describe a rare case of PMT rupture in a 39-year-old weight lifter, the surgical treatment that was carried out through an open access at the Pectoralis and Deltoid junction and anchor suture, the post-surgical rehabilitation program and a 1-year follow-up assessment at which point return to sport was achieved.