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J Bone Joint Surg Am 2021 Jun 24. Epub 2021 Jun 24.

Texas Scottish Rite Hospital for Children, Dallas, Texas.

Background: Radial head stress fractures (RHSFs) and capitellar osteochondritis dissecans (COCD) are rare but may be seen in gymnasts. The purpose of this study was to compare the clinical and radiographic characteristics and the outcomes of RHSF and COCD in pediatric and adolescent gymnastic athletes.

Methods: Classical gymnasts and competitive tumblers ≤18 years of age presenting with RHSF or COCD over a 5-year period were reviewed. Read More

J Clin Orthop Trauma 2021 Aug 24;19:200-208. Epub 2021 May 24.

Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India.

Elbow is an uncommon joint to be affected by infection. It is involved in approximately 1-5% of all cases with musculoskeletal tuberculosis (TB). Early diagnosis of TB of the elbow joint can be easily missed due to an indolent natural history, delay in presentation, and varied clinical features. Read More

Int J Endocrinol Metab 2021 Apr 19;19(2):e110792. Epub 2021 Apr 19.

Endocrine Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom.

Introduction: The art of medicine glorifies when a clinician listens carefully to the patient's story, gives a thorough examination, performs appropriate investigations, and finally links findings together to reach a definite diagnosis. An interesting case was reported here, highlighting the integration of different symptoms and manifestations with some relevant biochemical investigations to reach a final diagnosis. To the best of our knowledge, fixed flexion deformity, as a complication of subcutaneous calcification, has not been previously reported in a child with Albright hereditary osteodystrophy (AHO). Read More

Injury 2021 May 30. Epub 2021 May 30.

Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72070 Tuebingen, Germany.

Purpose The optimal management of medial humeral epicondyle fractures continues to be debated since decades. This single center study analyzes changes and optimizations of treatment over an observation period of 16 years and reports the results. Materials and Methods Retrospective analysis of all patients treated with a medial humeral epicondyle fracture between 2005 and 2020 at our institution. Read More

JSES Int 2021 May 8;5(3):564-570. Epub 2021 Mar 8.

Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon-City, Ehime, 791-0295 JAPAN.

Hypothesis: This study aimed to investigate the results, indications, and limitations of absorbable pin fixation for osteochondritis dissecans of the humeral capitellum in the separation stage.

Methods: This study included 35 patients (mean age, 14.0 years). Read More

Int Orthop 2021 Jun 12. Epub 2021 Jun 12.

1Orthopedic Department, Assiut University, Assiut, Egypt.

Purpose: This clinical trial compares the functional and radiological outcomes of single-bone fixation to both-bone fixation of unstable paediatric both-bone forearm fractures.

Methods: This individually randomized two-group parallel clinical trial was performed following the Consolidated Standards of Reporting Trials (CONSORT) statement at a single academic tertiary medical centre with an established paediatric orthopaedics unit. All children aged between nine and 15 years who presented to the emergency department at Assiut university with unstable diaphyseal, both-bone forearm fractures requiring surgical intervention between November 1, 2018, and February 28, 2020, were screened for eligibility against the inclusion and exclusion criteria. Read More

Am J Sports Med 2021 Jun 11:3635465211018208. Epub 2021 Jun 11.

UOC 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.

Background: An elongation of the radial lateral collateral complex (R-LCL) can provoke symptomatic minor instability of the lateral elbow leading to lateral elbow pain. Biomechanical models investigating the effects of elongation and partial or complete lesions of the R-LCL on lateral elbow stability are lacking.

Purpose: To evaluate how partial and complete R-LCL release affects radiocapitellar joint stability in a setting of controlled varus load and progressive soft tissue release. Read More

J Pediatr Orthop 2021 Jul;41(6):e470-e474

Children's Hospital of Philadelphia, Division of Orthopaedics, Philadelphia, PA.

Background: Complex fracture-dislocations of the elbow, including terrible triad of the elbow, are serious injuries with guarded outcomes in adults. Although described extensively in adults, little is known about similar complex fracture-dislocations of the elbow in the pediatric population. The purpose of this study was to describe patterns of elbow dislocations with associated fractures in children and report the outcomes of these injuries. Read More

J Shoulder Elbow Surg 2021 Jun 2. Epub 2021 Jun 2.

Texas Scottish Rite Hospital for Children, Dallas, TX, USA.

Background: Progressive displacement of diaphyseal clavicle fractures has been observed in adult patients, at times necessitating a change from non-operative to operative treatment. Whether this occurs in adolescent patients has not been well investigated. The purpose of this study was to assess the rate and extent of progressive clavicle fracture displacement in adolescent patients following injury and during the early stages of healing. Read More

J Pediatr Orthop 2021 Jun 2. Epub 2021 Jun 2.

UCLA Orthopaedic Hospital Department of Orthopaedics, David Geffen School of Medicine, University of California, Los Angeles UCLA David Geffen School of Medicine, University of California, Los Angeles Orthopaedic Institute for Children, Los Angeles, CA The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA.

Background: The treatment of acute pediatric Monteggia injuries involving a complete fracture of the ulna remains controversial. The purpose of this study is to compare the outcomes of immediate operative fixation to a trial of closed reduction and casting of acute pediatric Monteggia fractures involving complete ulna fractures.

Methods: We performed a retrospective analysis of 73 patients with Monteggia injuries with complete ulna fractures presenting to 2 pediatric trauma centers from 2008 to 2018. Read More

JBJS Essent Surg Tech 2020 Oct-Dec;10(4). Epub 2020 Dec 24.

C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, Michigan.

Background: Elastic intramedullary nailing of both-bone pediatric forearm fractures is used to treat unstable fractures that fail conservative management with closed reduction and casting, open injuries, or injuries with neurovascular compromise.

Description: Small incisions are used to enter the medullary canal of the distal end of the radius and proximal part of the ulna, avoiding injury to the adjacent physis. The elastic nail is advanced to the fracture site under fluoroscopic guidance. Read More

JBJS Essent Surg Tech 2020 Oct-Dec;10(4). Epub 2020 Nov 19.

Children's Hospital Los Angeles, Los Angeles, California.

Background: Lateral condylar fractures of the humerus are the second most common elbow fracture seen in pediatrics, behind supracondylar humeral fractures. All practicing orthopaedic surgeons should be able to identify and treat these injuries appropriately, as the intra-articular and transphyseal nature of this fracture pattern contributes to the relatively high complication rate. Treatment has evolved with time as classification systems better characterize the different types of lateral condylar fractures, aiding in decision-making for management. Read More

Semin Musculoskelet Radiol 2021 Feb 21;25(1):105-122. Epub 2021 May 21.

Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.

Pediatric upper extremity injuries, acute and chronic due to overuse, are commonly encountered in the clinical setting. However, interpretation of imaging studies is often challenging in pediatric patients because of changing postnatal skeletal development and the broad spectrum of pathology that can potentially occur. This article discusses normal skeletal development and the pathomechanics of skeletal injuries in pediatric patients. Read More

J Shoulder Elbow Surg 2021 May 18. Epub 2021 May 18.

The Children's Hospital of Philadelphia, Division of Orthopaedics, Philadelphia, PA, USA. Electronic address:

Background: Radial neck fractures are the third most common elbow fracture in children. Open reduction may be required if closed or mini-open techniques are not successful in reducing the fracture. Previous reports on open reduction have noted poor outcomes and complications with this treatment approach. Read More

Eur J Orthop Surg Traumatol 2021 May 21. Epub 2021 May 21.

Hand Upper Limb Surgery Unit, Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, AOU Città della Salute e della Scienza di Torino, via Zuretti 29, 10126, Turin, Italy.

Introduction: Recent studies have allowed a great improvement in understanding elbow and forearm traumatic injuries. Simple elbow dislocations combined with forearm injuries have been occasionally reported in the literature. The aim of this study was to detect the possible patterns of simple elbow dislocations and forearm fracture-dislocations, providing a classification scheme to guide surgical treatment. Read More

Indian J Orthop 2021 Jun 13;55(3):688-694. Epub 2021 Jan 13.

Department of Orthopaedics and Traumatology, Faculty of Medicine, Gaziantep University, Gaziantep, 27310 Turkey.

Background: The coexistence of supracondylar humerus fracture and forearm fracture is a rare trauma (3-13%) and it is called floating elbow. The aim of this study is to clinically compare the treatment outcomes of the patients diagnosed with floating elbow who underwent surgical treatment and who were followed up forearm with immobilization with splint.

Materials And Methods: When scanned retrospectively, 60 patients who were treated with the diagnosis of floating elbow due to traumatic causes and followed up for at least 1 year were included in our study. Read More

Arch Orthop Trauma Surg 2021 May 13. Epub 2021 May 13.

Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany.

Introduction: The supracondylar humerus fracture (SCHF) is one of the most common pediatric injuries. Highly displaced fractures can be very challenging. If closed reduction fails, the therapy algorithm remains controversial. Read More

Arch Orthop Trauma Surg 2021 May 11. Epub 2021 May 11.

Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.

Introduction: Pediatric radial neck and head fractures are rare, accounting for only 1% of all fractures in children. The aim of this study is to describe the management and results of the respective fracture types and different injury characteristics.

Materials And Methods: This study performs a retrospective data analysis of 100 consecutive patients with a fracture of the proximal radius treated in a single high-volume pediatric trauma center. Read More

BMJ Open 2021 05 3;11(5):e044627. Epub 2021 May 3.

Department of Pediatric Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland.

Introduction: Medial epicondyle fracture of the humerus is a common injury in childhood. There is uniform agreement that minimally displaced fractures (dislocation ≤2 mm) can be treated nonoperatively with immobilisation. Open fractures, fractures with joint incarceration or ulnar nerve dysfunction require surgery. Read More

J Hand Surg Am 2021 Apr 23. Epub 2021 Apr 23.

Department of Orthopedic Surgery, Shriners Hospitals for Children, Philadelphia, PA.

Purpose: To assess the outcomes of osteochondral autograft transplantations in the treatment of osteochondritis dissecans of the capitellum in the pediatric population.

Methods: Between 2011 and 2016, 15 patients who had undergone osteochondral autograft transplantation at a mean age of 13.7 years at surgery were identified. Read More

Cureus 2021 Mar 15;13(3):e13903. Epub 2021 Mar 15.

Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.

Purpose: Supracondylar humerus (SCH) fractures are the most common elbow fracture in children; however, they rarely occur as open injuries. Open fractures are associated with higher rates of infection, neurovascular injury, compartment syndrome, and nonunion. The purpose of this study was to evaluate the treatment and outcomes of open SCH fractures in children. Read More

J Orthop Sci 2021 Apr 14. Epub 2021 Apr 14.

Department of Hand Surgery and Microsurgery, Azienda Ospedaliero Universitaria Modena, Largo Del Pozzo, 71, 41125 Modena, Italy.

Background: The incidence of median nerve injuries in pediatric elbow dislocations is approximately 3% and avulsion of the open medial epicondylar epiphysis in the pediatric population is one predisposing factor that may explain this age predilection. These lesions can be difficult to diagnose in the acute phase because symptoms tend to be mild or delayed, consequently their management can be challenging and functional outcome poorer.

Methods: We present the case of an unrecognized median nerve entrapment in a 16-year-old boy with posterior dislocation of the elbow and a medial epicondyle fracture, treated initially with close reduction and open stabilization with a cannulated screw. Read More

Int Orthop 2021 Apr 12. Epub 2021 Apr 12.

Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, 100035, China.

Objectives: Trans-olecranon fracture-dislocations are rare in children. To our knowledge, only 12 cases have been described in children till now and the treatment strategy for this injury in children remains unclear. To provide a clear clinical description and more accurate treatment options, we retrospectively reviewed cases with this kind of injury in our institution. Read More

J Orthop Surg Res 2021 Mar 30;16(1):232. Epub 2021 Mar 30.

Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.

Background: The ipsilateral olecranon with associated radial neck fractures does not include in the Bado classification of Monteggia fractures and equivalent lesions. The primary aims of this retrospective multicenter study were to characterize this type of injury and, noting its unique properties, evaluate the results of the treatment, determine the prognostic factors that influence the radiological and clinical outcome, and also give treatment strategies.

Methods: Between July 2011 and July 2016, forearm fracture patient charts were retrospectively reviewed from seven pediatric trauma centers. Read More

Eur J Trauma Emerg Surg 2021 Mar 24. Epub 2021 Mar 24.

Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Elbow injuries and fractures are a common pathology in the pediatric emergency unit. X-ray and CT scan of the elbow are the standard diagnostic procedures, which increase exposure to radiation in children. Previous studies have shown that fractures can also be visualized by ultrasound (US); thus, this study aimed to evaluate the diagnostic accuracy of elbow US compared with radiography for the diagnosis of elbow fracture in children. Read More

Arch Argent Pediatr 2021 04;119(2):e133-e137

Hospital Italiano de Buenos Aires, Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi". Buenos Aires, Argentina.

Even though the elbow is the most often dislocated joint in children, this injury accounts for 3-6 % of elbow pathology. Dislocations without associated fractures are extremely rare. They result from a fall onto an outstretched hand. Read More

Am J Case Rep 2021 Mar 18;22:e930277. Epub 2021 Mar 18.

Department of Special Surgery, Orthopaedic Division, Jordan University of Science and Technology, Irbid, Jordan.

BACKGROUND Supracondylar fracture is one of the most common pediatric traumatic fractures. It is subclassified into 2 entities: the extension type, which is predominantly seen, and the flexion type. It can be further classified into 4 types according to the Gartland classification, which assesses the anatomical severity of the fracture depending on the lateral radiographs of the elbow and operative findings. Read More

JSES Int 2021 Mar 6;5(2):328-333. Epub 2021 Feb 6.

Department of Orthopedics and Traumatology, Ospedale degli Infermi di Faenza, Faenza (RA), Italy.

Background: The Oxford Elbow Score (OES) is an English-language questionnaire specifically designed to evaluate surgical elbow outcomes. This scoring system has been translated into other languages. Given the lack of an Italian version of the OES, the present study was designed to establish, culturally adapt, and validate the Italian version. Read More

J Pediatr Orthop 2021 Apr;41(4):242-248

Division of Pediatric Orthopaedics.

Background: The incidence of supracondylar humerus (SCH) fracture declines and fracture types change as children grow. Optimal treatment method is unclear in older children. The aim of the study was to determine if fracture type and configuration of distal humerus fractures changes as patients approach skeletal maturity, and to assess the success of closed reduction and percutaneous pin (CRPP) in extra-articular SCH fractures in this transitional age group. Read More

BMC Public Health 2021 03 2;21(1):428. Epub 2021 Mar 2.

The Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.

Background: Extremity injury is one of the most common injury types for bicyclists. Extremity injury can lead to long-term disability and contribute to adverse health-related quality of life and prolonged absence from work.

Objectives: The objectives of our study were to identify crash factors associated with bicyclist upper and lower extremity injury and characterize type of extremity injury by bicyclist age category. Read More