Incidence and risk factors for redisplacement after closed reduction and instant rigid cast immobilization for paediatric distal radius fractures: a case control study.

BACKGROUND: The aim of this study is to record the incidence of redisplacement after closed reduction and instant rigid cast immobilization and to identify possible risk factors that may be associated with the redisplacement. METHODS: We retrospectively reviewed paediatric patients who underwent closed reduction and instant rigid cast immobilization for simple distal radius fractures from 2014 to 2018. Patients were followed up at 1 week, 2 weeks, 3 weeks, and 6 weeks after casting. Redisplacement was diagnosed on the basis of image findings. Risk factors for redisplacement were evaluated in three aspects, which included patient-related, fracture-related, and cast-related factors. RESULTS: A total of 123 children were included in this study. During follow-up, 31 patients (25.2%) showed redisplacement after closed reduction and cast immobilization. Twenty-two redisplacements happened within 1 week after treatment, 8 redisplacements happened between 1 and 2 weeks, and only one redisplacement happened after 2 weeks. In the multivariate analysis, associated ulna fracture (OR, 4.278; 95% CI, 1.773-10.320), initial translation ≥ 50% (OR, 9.148; 95% CI, 3.587-23.332), and 3-point index ≥ 0.40 (OR, 1.280; 95% CI, 1.159-1.401) were three independent factors that correlated with the incidence of redisplacement during follow-up. CONCLUSIONS: About a quarter of paediatric patients would develop redisplacement after reduction and immobilization with instant rigid cast. Patients with associated ulna fracture, severe initial translation, and high 3-point index have a higher risk to develop redisplacement.

Hoverboard injuries in children and adolescents: results of a multicenter study.

With the increasing popularity of hoverboards in recent years, multiple centers have noted associated orthopaedic injuries of riders. We report the results of a multi-center study regarding hoverboard injuries in children and adolescents. who presented with extremity fractures while riding hoverboards to 12 paediatric orthopaedic centers during a 2-month period were included in the study. Circumstances of the injury, location, severity, associated injuries, and the required treatment were recorded and analysed using descriptive analysis to report the most common injuries. Between-group differences in injury location were examined using chi-squared statistics among (1) children versus adolescents and (2) males versus females. Seventy-eight patients (M/F ratio: 1.8) with average age of 11 ± 2.4 years were included in the study. Of the 78 documented injuries, upper extremity fractures were the most common (84.6%) and the most frequent fracture location overall was at the distal radius and ulna (52.6%), while ankle fractures comprised most of the lower extremity fractures (66.6%). Majority of the distal radius fractures (58.3%) and ankle fractures (62.5%) were treated with immobilization only. Seventeen displaced distal radius fractures and three displaced ankle fractures were treated with closed reduction in the majority of cases (94.1% versus 66.7%, respectively). The distal radius and ulna are the most common fracture location. Use of appropriate protective gear such as wrist guards, as well as adult supervision, may help mitigate the injuries associated with the use of this device; however, further studies are necessary to demonstrate the real effectiveness of these preventions.

Suboptimal outcomes after closed reduction and internal fixation of displaced femoral neck fractures in middle-aged patients: is internal fixation adequate in this age group?

BACKGROUND: There have been many studies regarding nongeriatric femoral neck fractures (FNFs), which included patients of a wide age range (between 20 and 60 years old). We aimed to determine whether internal fixation provided acceptable outcomes for middle-aged patients with displaced FNFs, and identify predictors of successful internal fixation. METHODS: A total of 117 patients, aged 50-60 years and who underwent closed reduction and unilateral internal fixation using cannulated screws, were included. The outcomes were classified as either "complications" (varus malunion, femoral neck shortening, non-union/early collapse, avascular necrosis, or arthroplasty during the follow-up) or "optimal outcomes" (no complications). Patients with displaced FNFs (Garden stages III-IV, n = 69) were categorized according to whether they experienced acceptable or unacceptable reduction. We evaluated whether patients' clinical characteristics could predict optimal outcomes. RESULTS: Patients with displaced FNFs generally experienced complications (84.1%). Twenty-two percent of patients experienced optimal outcomes when acceptable reduction was achieved. Patients with unacceptable reductions experienced complications. Optimal outcomes were positively associated with Pauwels' type II fracture (OR: 8.67, p = 0.025) and negatively associated with excessive alcohol consumption (p = 0.045). CONCLUSIONS: Compared with the younger age group, complication rates are higher in middle-aged patients with displaced FNFs treated using cannulated screws. If internal fixation is to be used for a displaced FNF, patient selection is essential. Care must be taken to avoid selecting patients with excessive alcohol consumption, while successful internal fixation may be more likely for patients with Pauwels' type II fracture.

Hip Dislocations in the Emergency Department: A Review of Reduction Techniques.

BACKGROUND: Hip dislocations are a common presentation in the Emergency Department (ED) and require urgent reduction to reduce the risk of avascular necrosis. Over 90% of all dislocations can successfully be reduced in the ED and there is evidence that cases awaiting operative reduction result in significant delays. DISCUSSION: While there is limited data comparing specific techniques, the individual success rates of most maneuvers range from 60-90%. Additionally, each technique has distinct advantages and limitations associated with its use. CONCLUSIONS: It is important for Emergency Physicians to be familiar with several different reduction techniques in case the initial reduction attempt is unsuccessful or patient characteristics limit the use of certain maneuvers. This article reviews a number of reduction techniques for hip dislocations, variations on these techniques, and advantages and disadvantages for each approach.