Long-term results following intra-articular fractures of the medial malleolus in children and adolescents with special emphasis on MRI.

PURPOSE: Presently, there is no publication combining clinical follow-up with magnetic resonance imaging (MRI) to determine possible post-traumatic alterations following paediatric intra-articular fractures of the medial malleolus. Therefore, the aims of this study were to retrospectively analyze a cohort of patients with Salter-Harris (SH) III and IV fractures of the medial malleolus and to evaluate their long-term outcome. MRI was used to assess possible changes of the articular surface that cannot be diagnosed on native radiographs. PATIENTS AND METHODS: Fifty-four patients with SH III ( n = 38) or IV fractures ( n = 17) of the medial malleolus treated between 2001 and 2011 were invited for a follow-up examination. Clinical outcome was assessed with the Weber score and osteoarthritis with the Kellgren and Lawrence classification. MRI was rated by the Outerbridge classification. Correlations between the clinical and radiological outcomes were calculated. RESULTS: Seventeen patients were recruited for long-term follow-up at a mean of 112 (range, 65-184) months. The Weber score was very good for 5 patients, good for 10 patients and poor for 2 patients; the Kellgren and Lawrence score revealed a favourable grade 0 in 15 patients and grade 1 in 2 patients. The MRI-based Outerbridge classification yielded grade 0 for 12 patients, grade 1 for 1 patient, grade 2 for 2 patients and grade 3 for 1 patient. The Outerbridge score significantly ( p < 0.05) correlated with the Weber score. CONCLUSION: This study shows excellent and good outcome of SH III and IV fractures of the medial malleolus. Worse clinical outcome correlated with post-traumatic changes of the articular cartilage seen on MRI.

Long-term outcome of paediatric flexor tendon injuries of the hand.

The ideal rehabilitation regimen of paediatric flexor tendon injuries of the hand is discussed controversially. In this study, the clinical outcome of paediatric patients with flexor tendon injuries treated with a dynamic postoperative protocol was assessed. All children with flexor tendon injuries of the hand who were treated by a dynamic postoperative protocol between 1999 and 2011 were included. Patients were invited for a follow-up examination consisting of clinical examination, the TAM and Buck-Gramcko scores, and the linear measurement system. In total, 144 patients (mean age 9.1 years, range 1-17 years) with 267 flexor tendon injuries (128 flexor digitorum superficialis (FDS), 126 flexor digitorum profundus (FDP) and 13 flexor pollicis longus (FPL)) of 191 digits were treated. Of them, 43% (n = 62; 49 male, 13 female) with 88 digits (thumb n = 4, index finger n = 17, middle finger n = 25, ring finger n = 20, small finger n = 22) with 123 injured tendons (FDS n = 62, FDP n = 57, FPL n = 4) were included in the follow-up at a mean post-operative interval of 7.2 years (range 1-13 years). Using the Total Active Motion (TAM) score, an excellent and good outcome could be achieved in 41% and 48% of the patients, respectively. The zone of injury did not influence the objective outcome measures. Subjective and objective outcomes were not statistically different between young children (≤6 years) and older children (>6 years). The present study demonstrates good to excellent outcome in a large cohort of paediatric patients with flexor tendon injuries of the hand treated with a dynamic mobilisation protocol irrespective of patient age.