Scar overlapping suture for treating chronic tendinous mallet finger in children.

PURPOSE: To evaluate the effect of scar overlapping suture for treating chronic tendinous mallet finger deformity in children. METHODS: Six patients younger than 18 years were investigated retrospectively. The active extensor lags of the distal interphalangeal joint (DIPJ) were all more than 40°, and the passive ranges of DIPJ motion were normal. They were all treated surgically by scar overlapping suture technique, featuring careful overlapping suture of the extensor scar and temporary transarticular Kirschner wire fixation of the DIPJ. RESULTS: Average follow-up was 3.1 years (ranging from 2 to 5 years). All patients made significant improvement in DIPJ activity. Three patients achieved full active DIPJ extension, whereas one patient had a 10° extensor lag and two patients had 5° extensor lags. All patients achieved normal active flexion ranges and full passive motion ranges of DIPJ compared with their uninjured side. There was no bone dysplasia, pain, or deformity recurrence. CONCLUSIONS: Scar overlapping suture for treating chronic tendinous mallet finger in children is safe and effective. According to the Crawford criteria, all patients were graded as excellent.

[Effectiveness of rigid interlocking nails through tip of greater trochanter for fixation of femur shaft fracture in adolescent].

Objective: To explore the effectiveness of rigid interlocking nails through the tip of the greater trochanter for fixation of femur shaft fracture in adolescent. Methods: A retrospective analysis was made on the clinical data of 23 adolescents with femoral shaft fractures treated between June 2011 and June 2015. Of 23 cases, 19 were male and 4 were female, aged from 13 years and 6 months to 17 years (mean, 15.2 years), weighed from 40 to 77 kg (mean, 53.5 kg). The causes were traffic accident injury in 13 cases, sports injury in 7 cases, and falling injury in 3 cases. Fracture located at the proximal 1/3 in 6 cases, middle 1/3 in 10 cases, and distal 1/3 in 7 cases; fracture was typed as transverse in 10 cases, oblique in 6 cases, spiral in 1 case, and comminuted in 6 cases. The course of disease was 3-17 days (mean, 6.2 days). At last follow-up, the leg length discrepancy, femoral neck shaft angle, femoral neck diameter, and articulotrochanteric distance (ATD) were measured on the X-ray films. Results: Wounds healed in all patients, and no infection occurred. All patients were followed up 15-36 months (mean, 26.5 months). The patients had no pain and had normal gait, without lameness. The X-ray films showed bone healing at 5-13 months (mean, 6.5 months). No nonunion, delayed union, malunion of more than 5 °, or rotational deformity occurred. The removal time of internal fixations was 12-24 months (mean, 19.5 months) after operation. No heterotopic ossification, re-fracture, proximal femoral deformity, or femoral head necrosis occurred during follow-up. Two patients had early epiphyseal closure of greater trochanter, which had no impact on gait; leg-length inequality of less than 1 cm was observed in 2 cases. At last follow-up, the neck shaft angle, femoral neck diameter, and ATD of normal and affected sides were (131.7±6.3) and (132.9±7.8)°, (34.1±3.2) and (33.9±3.8) mm, and (27.8±9.2) and (26.5±8.5) mm, showing no significant difference between two sides ( t=-0.24, P=0.86; t=0.18, P=0.92; t=1.03, P=0.49). Conclusion: It is a reliable and effective method to use rigid interlocking nails inserted through the tip of the greater trochanter for the fixation of femur shaft fracture in adolescent.

[SURGICAL TREATMENT OF Seymour FRACTURES IN CHILDREN AND ADOLESCENTS].

OBJECTIVE: To discuss the treatment method and effectiveness of Seymour fracture in children and adolescents. METHODS: Between January 2013 and November 2015, 26 children and adolescents with Seymour fractures were treated. There were 18 males and 8 females, aged from 1 year and 1 month to 17 years (median, 8.2 years). The injury causes included crush in 14 cases, bruise in 10 cases, and puncture in 2 cases. The thumb was involved in 2 cases, index finger in 1 case, middle finger in 12 cases, ring finger in 6 cases, and little finger in 5 cases. The time from injury to operation was 1-15 hours (mean, 3.2 hours). The patients underwent debridement, nail removal, nail matrix repair, closed reduction and osteosynthesis with Kirschner wires, and splinting in emergency. Kirschner wires and splints were removed at 4 weeks after surgery, and functional exercises were done. RESULTS: All wounds healed by first intention without infection. The follow-up duration was 2-24 months (mean, 12.3 months). The fracture healing was obtained at 1-2 months (mean, 1.4 months) on X-ray film, and no complications of nonunion, malunion, re-displacement, premature epiphyseal closure, or no growth of the nails occurred. Nail deformity developed in 1 case and no re-operation was given. At last follow-up, 1 patient had 10° extension limitation of the distal interphalangeal joint, but the flexion was normal. The motion range of distal interphalangeal joint was 0-75°, showing no significant difference when compared with that of contralateral side (0-78°). CONCLUSIONS: The effectiveness for treating Seymour fracture is satisfactory by debridement, nail removal, nail matrix repair, closed reduction and osteosynthesis with Kirschner wires, and splinting in emergency.

[Classification and treatment of Monteggia equivalent fractures in children].

OBJECTIVE: To investigate the classification and treatment of Monteggia equivalent fractures in children. METHODS: A retrospective analysis was made on the clinical data of 35 cases of Monteggia equivalent fractures between January 2008 and January 2012. There were 17 boys and 18 girls with an average age of 7 years and 5 months (range, 1 year and 2 months to 14 years and 11 months). The causes of injury were tumbling injury in 25 cases, falling injury in 3 cases, and sport injury in 7 cases. The disease duration from injuries to admission ranged from 1 hour to 16 days (median, 28 hours). According to the criteria of self-made classification, there were 22 cases of type I (ulnar fracture with radial neck fracture or proximal radial epiphysis injury), 2 cases of type II (posterior elbow dislocation with radial neck fracture or proximal radial epiphysis injury), 10 cases of type III (ulnar fracture and/or olecranon fracture with humeral lateral condylar fracture), and 1 case of type IV (fractures of radius and ulna with radial neck fracture or proximal radial epiphysis injury). All patients were treated by open reduction and internal fixation/external fixation. RESULTS: All incisions healed by first intention without infection. Thirty-four cases were followed up 14 months on average (range, 12-18 months). All fractures healed at 2.5 months on average (range, 6 weeks to 5 months). According to Hospital for Special Surgery (HSS) score system, the results were excellent in 29 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 94%. No cubit varus/valgus or delayed ulnar nerve injury was observed. CONCLUSION: New self-made classification is simple and easy to remember, and it is helpful to reduce omission diagnose rate and select therapeutic methods. Surgery is an effective method to treat Monteggia equivalent fractures.