Indications of Arthroscopy in the Treatment of Patellar Instability in Children.

Purpose Understanding the relevant risk factors for patellar instability and the clinical and radiographic tests necessary to determine optimal treatment. This case series intends to evaluate arthroscopic indications in the treatment of patellar instability in children. Methods From 2013 to 2021, 33 patients (seven to 16 years of age) with 35 knees sustaining first-time dislocation with loose bodies, recurrent dislocation or subluxation, and habitual dislocation were arthroscopically operated on according to the flow chart. Periods of follow-up were two to 10 years (avg. 5.5 years). Follow-up assessment included the recurrence, complications (joint stiffness and excessive reduction), and the final function outcomes by using the Kujala score. Results Among 35 knees, there were two (5.7%) first dislocations, 30 (85.7%) recurrent dislocations, and three (8.6%) habitual dislocations, lateral release 27/35 (77.1%), medial reefing 23/35 (65.7%), reconstruction of the medial patellofemoral ligament (MPFL) 12/35 (34.3%). The major complication was a knee of extensive stiffness after medial reefing and lateral release. Recurrence was in 4/35 (11.4%) of knees, not correlated to lateral release (p=0.21), medial reefing, or reconstruction of MPFL (p=0.07); in about 23 knees of medial reefing, recurrence was significantly correlated to number of knots (p=0.045). The final functional results according to Kujala were 88-100 (avg. 95.5). Conclusions This study showed the role of arthroscopy in both medial reefing and reconstruction of MPFL in children by low recurrence rate and high Kujala score at final follow-up. There was no significant correlation between recurrence and the procedures as arthroscopic indications counted on the flow chart.

Management of Pediatric Supracondylar Humerus Fractures Using Lateral Cross-Wiring Technique Under Fluoroscopic Guidance.

BACKGROUND:  Supracondylar humeral fractures are the most prevalent elbow fractures in pediatric patients. Current treatment modalities typically involve closed reduction and fixation using percutaneous Kirschner wires. The lateral cross-wiring technique has demonstrated favorable functional and cosmetic outcomes, thereby reducing the incidence of ulnar nerve injury. OBJECTIVES:  This study aimed to assess the efficacy of the lateral cross-wiring technique in achieving optimal functional and cosmetic recovery while mitigating the risk of ulnar nerve injury in pediatric patients with displaced supracondylar humeral fractures. MATERIALS AND METHODS: A prospective analysis was conducted on 48 patients who underwent lateral cross-wiring for displaced supracondylar fractures (Gartland type III, including extension and flexion types) of the humerus. Follow-up assessments were performed over a minimum period of eight months post-surgery. RESULTS: Among the 48 patients, all demonstrated satisfactory restoration of the carrying angle and functional ability postoperatively. Notably, no iatrogenic cases of radial or ulnar nerve injury were observed during the follow-up period. CONCLUSION:  The lateral cross-wiring technique emerges as an effective treatment option for displaced supracondylar fractures of the humerus in pediatric patients. It facilitates both functional and cosmetic recovery while concurrently reducing the risk of ulnar nerve injury, thus warranting consideration in the management of such fractures.

Mid-term results of Ponseti management for an idiopathic congenital clubfoot at a single center in Vietnam.

Despite the increasing popularity of the Ponseti method for the treatment of idiopathic congenital clubfeet, the relapse rate and sequela after the initial correction of manipulating and casting remain high. This study presents a scale to evaluate the relapse and identify the factors correlated with the relapse and latest follow-up mid-term results. A total of 101 children (newborn to 12 months), 142 idiopathic congenital clubfeet, were recruited for this study following treatment with the Ponseti method at the Hospital for Traumatology and Orthopaedics (Ho Chi Minh City, Vietnam) with a follow-up period of a minimum of 2 years. The clubfeet were then classified and evaluated during casting, for initial correction, and for relapse according to Diméglio's score. Next, the latest follow-up results were evaluated according to Richards' classification. The initial correction was successful in 95.8% (perfect: 74.0%, acceptable: 21.8%); 6.6% developed relapses and relapse-related factors were the initial correction and bracing program. The latest follow-up results are good in 74.7%, fair in 22.5%, and poor in 2.8%, and correlated with the age of presentation and the follow-up period in both univariate and multivariate analysis. On the basis of a precise evaluation of the relapse, this study indicates that the initial correction classified by the author on the basis of Diméglio's score and bracing compliance affect relapse. In addition, early treatment after birth and continuous long-term follow-up to appropriately manage the sequelae are essential to obtain the latest follow-up results as expected.