Complications associated with Pediatric Supracondylar Humeral Fractures.

OBJECTIVE: To measure pediatric supracondylar fracture epidemiology, fracture rate, and complications in the island's pediatric population. The study aims to compare our results to the national rates reported in the literature. METHODS: In this retrospective record review we examined 330 patients who underwent open reduction internal fixation or closed reduction percutaneous pinning in pediatric supracondylar fractures at the University Pediatric Hospital of Puerto Rico Medical Center (HOPU). The study evaluated patients from January 2008 to January 2011 that had completed at least a 1 year follow-up. Measurement of type of fracture, and complications were recorded. Statistical significance was set at a p-valuevalue<0.05. RESULTS: Of the 330 patients, 206 (62%) were male and 127 (38%) were female. The average age was 5.49 years (± 2.43). The vast majority had extension-type fractures (98.2%) and 1.8% had flexion-type fractures. The neurological complication rates were 10% (33 patients). Neurologic complications after distal fragment displacement were 13.5% for posteromedial displacement versus 11.8% for posterolateral displacement, with a p-value of 0.71. CONCLUSION: Our results in terms of female-to-male ratio, fracture type and complications (e.g., infection, vascular and neurologic complications) were similar to those reported in the literature. Because significant differences in the rates of posteromedial and posterolateral supracondylar fractures were found, we recommend further research on this subject. Overall, both our findings regarding complications and our results are similar to what has been reported in the literature. We can therefore affirm that our institution provides adequate care and management for this kind of fracture.

Ewing sarcoma superimposed on a previous osteochondroma in multiple osteochondromatosis.

It has been reported that patients with hereditary multiple exostoses (called multiple osteochondromatosis by the World Health Organization) are at increased risk for malignant transformation of osteochondromas to secondary chondrosarcomas. A review of the literature found 14 cases showing transformation of osteochondromas into osteosarcomas; however, Ewing sarcoma has never been reported superimposed on an osteochondroma. This article presents the case of a boy who underwent biopsy of a previously existent osteochondroma for which the pathology report showed cytologic and immunohistochemical properties consistent with Ewing sarcoma. A 13-year-old boy with hereditary multiple exostoses (multiple osteochondromatosis) presented to an orthopedic clinic because of waxing and waning pain superficial to a previous osteochondroma on the lateral aspect of the right leg, below the knee, of 1 month's duration. On examination, inflammation was noted over a bony mass associated with tenderness to palpation of the affected area. There was no evidence of penetrating injury or trauma, and the patient reported no constitutional symptoms, including fever. Radiographs showed marked osteolysis and signs of periosteal reaction. Magnetic resonance imaging showed evidence of cortical bone erosion and extension of the mass into soft tissue. Malignant transformation was suspected, and the patient underwent biopsy. The pathology findings were consistent with Ewing sarcoma. The highly uncommon presentation of this malignancy must serve as a red flag to other physicians who treat patients with hereditary multiple exostoses. Ewing sarcoma tends to be of higher grade and have a worse prognosis than other malignancies that are more commonly seen in these patients.

FINGERTIP RECONSTRUCTION WITH THE "SHARK MOUTH" INCISION THENAR FLAP: ANALYSIS OF OUTCOMES IN PEDIATRIC PATIENTS.

UNLABELLED: The thenar flap technique is a time-tested method of fingertip reconstruction that has been criticized due to possible finger flexion contractures and unsightly donor site scars. Functional outcome data on thenar flaps on the pediatric population is poor in the medical literature. METHOD: In this retrospective chart review we acquired information from sixteen patients who underwent a "Shark Bite" incision thenar flap reconstruction. RESULTS: Patients ranged in age from 0-17 years. Time to division ranged from 16-30 days. All 16 patients' affected finger ROM were measured in DIP, PIP and MCP joints and compared with corresponding finger on contralateral hand. A questionnaire measured subjective satisfaction in: sensibility, appearance, and function. Fingertip sensation was preserved in both affected finger and donor site. The most persistent patient complaint involved fingertip contour, were most patients rated it as "Fair"(43%) and "Good" (56%). After statistical analysis of the data we found no statistical difference in range of motion (ROM) between affected finger and the same finger on the contralateral hand on both PIP and MCP joints (p=0.08, 0.06 respectively). CONCLUSIONS: The "Shark Mouth" incision thenar flap is an effective strategy for fingertip reconstruction. The results demonstrate this technique has excellent functional and aesthetic results and is not associated with flexion contractures, excessive sensibility or pain in the pediatric population.

THE USE OF A FIBULAR STRUT ALLOGRAFT WITH DBM, CANCELLOUS CHIPS AND BMP FOR A 10 CM HUMERAL SHAFT INFECTED NON-UNION: A CASE REPORT.

Humeral shaft non-unions occur in 2-10% of all fracture cases. Increased incidence of these non-unions can be associated with ORIF, comminution, high impact injuries, bone loss or fracture gaping. Treatment guidelines for fracture non-union state that fractures with gaps greater than 4 cm should be treated with vascularized fibular autografts or transportation with an external fixator. Unfortunately these modalities carry considerable donor site morbidity and patient will experience considerable discomfort, especially when dealing with an external fixator. This report demonstrates how the use of a nonvascularized fibular strut can be effectively utilized as an alternate treatment modality for large humeral shaft non-union gaps. Further studies should be conducted to support this method as a viable treatment option for non-union gaps greater than 4 cm.