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Acta Chir Orthop Traumatol Cech 2021 ;88(1):45-49

Klinika dětské chirurgie a traumatologie 3. lékařské fakulty Univerzity Karlovy a Fakultní Thomayerovy nemocnice, Praha.

PURPOSE OF THE STUDY The term toddler's fracture was first coined by J. S. Dunbar in 1964 as a nondisplaced fracture of the distal tibia in children aged 9 months to 3 years. Read More

Pediatr Radiol 2021 Jun 5;51(7):1231-1236. Epub 2021 Feb 5.

Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA.

Background: Salter-Harris 2 fractures of the distal radius are common in pediatrics. Children with these fractures have a theoretical risk of developing a physeal bridge with subsequent growth disturbance.

Objective: The purpose of this study was to investigate the clinical utility and economic impact of obtaining routine delayed radiographs in asymptomatic patients with uncomplicated Salter-Harris 2 fractures of the distal radius. Read More

JBJS Case Connect 2020 11 20;10(4):e20.00061. Epub 2020 Nov 20.

Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky.

Case: A 10-year-old boy presented with a Salter-Harris II distal radius fracture that was irreducible by closed methods. An open reduction was performed in the operating room where a sleeve of periosteum was found interposed between the fracture fragments. Successful reduction was performed without difficulty after the periosteum was removed from the fracture. Read More

JBJS Case Connect 2020 12 24;10(4):e20.00104. Epub 2020 Dec 24.

Department of Orthopaedic Surgery, KU-Wichita, Wichita, Kansas.

Case: We describe a case of posterior hip dislocation in a 13-year-old boy after a contact football injury with attempted closed reduction resulting in complete separation of the epiphysis from the femoral neck metaphysis with associated femoral head fracture and posterior dislocation of the femoral head. Treatment was emergently performed with a greater trochanteric osteotomy, open reduction internal fixation using cannulated screws, and additional small diameter drill holes in the femoral head to promote blood flow. The patient did well postoperatively and at over 4 years follow-up had no evidence of avascular necrosis and returned to full athletics participation. Read More

J Biol Regul Homeost Agents 2020 Jul-Aug;34(4 Suppl. 3):295-301. Congress of the Italian Orthopaedic Research Society

IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.

Physeal fractures are typical in childhood and for their involvement of the germinal layer of the physis they can be followed by growth complications. Axial deviation is one of these. Considering the young age of the patients it is critical to restore articular correct alignment with the least invasive surgery possible. Read More

Oper Orthop Traumatol 2020 Dec 25;32(6):509-529. Epub 2020 Nov 25.

Traumatologie des Bewegungsapparates, Kinderorthopädie, Universitätsklinik für Kinderchirurgie, Inselspital, Universitätsspital Bern, 3010, Bern, Schweiz.

Objective: Safe and stable fixation of metaphyseal and epiphyseal fractures by Kirschner (K-)wire osteosynthesis. Use of various K‑wire configurations depending on the fracture morphology.

Indications: In accordance with the AO Pediatric Comprehensive Classification of Long-Bone Fractures (PCCF), all Salter-Harris (SH) and metaphyseal fractures as well as fractures of the foot and hand independent of the reduction technique, closed or open, provided that adaptation osteosynthesis allows sufficient stability. Read More

Radiologe 2020 Dec;60(12):1183-1194

Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.

Transitional fractures are special forms of epiphyseal injuries in adolescents in whom the growth plate is already partially closed. Due to the partial ossification specific stereotypical fracture patterns can develop, which can be differentiated into twoplane, triplane I and triplane II fractures, depending on the involvement of the metaphysis and the number of fragments. At the beginning of the diagnostics conventional projection radiography in two planes is used; however, due to the complex fracture patterns computed tomography (CT) is often indicated, also for preoperative planning. Read More

J Forensic Leg Med 2020 Aug 30;74:102006. Epub 2020 Jun 30.

Sections of Public Health Pediatrics, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital Houston, TX, USA.

Long bone fractures at the infant growth plate, known as classic metaphyseal lesions (CMLs), raise a strong suspicion for abusive injury. CMLs persist as a hallmark for inflicted injury although a handful of documented cases of CMLs created by other, non-abusive mechanisms within various healthcare settings are scattered throughout the past few decades of medical literature. The forces required to sustain a CML are typically defined as a combination of tensile, compressive, or rotational energy applied to the metaphyseal regions of an infant's long bones. Read More

JBJS Case Connect 2020 Jul-Sep;10(3):e2000022

1Department of Orthopedic Surgery, University of Connecticut, Connecticut Children's Medical Center, Hartford, Connecticut.

Case: A 16-year-old boy underwent closed reduction and pinning of a Salter-Harris II distal radius fracture (DRF). Extensor pollicis longus (EPL) rupture occurred 6 weeks after the injury. Extensor indicis proprius transfer was performed using wide-awake local anesthesia no tourniquet (WALANT) technique. Read More

J Pediatr Orthop 2020 Nov/Dec;40(10):e958-e962

Hospital Roberto del Río, Santiago, Chile.

Purpose: Distal femoral growth arrest can result in progressive deformities and functional disability. The treatment is challenging given the significant growth potential of the distal femoral physis. This study addresses the short-term outcomes after distal femoral physeal bar resection combined with guided growth for the treatment of angular limb deformity. Read More

J Pediatr Orthop 2020 Nov/Dec;40(10):e910-e915

Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.

Introduction: The purpose of this study was to characterize the incidence of growth disturbance following intra-articular distal radius fractures in skeletally immature patients and to assess early radiographic and functional outcomes.

Methods: A retrospective investigation of pediatric patients with intra-articular distal radius fractures between 1997 and 2012 at a single institution was performed. Pathologic fractures and fractures in patients with closed physes were excluded. Read More

J Pediatr Orthop 2020 Nov/Dec;40(10):e936-e941

Case Western University, School of Medicine.

Background: Because of the complex nature and relatively rare prevalence of triplane fractures, ideal imaging and optimal treatment remain controversial. The purpose of this investigation was to systematically review and compare clinical outcomes in skeletally immature patients with triplane fractures on the basis of imaging modalities [radiography alone vs. radiography+computed tomography (CT)] and fracture management (operative vs. Read More

Radiographics 2020 May-Jun;40(3):754-774. Epub 2020 Apr 3.

From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642.

Distinct biologic and mechanical attributes of the pediatric skeleton translate into fracture patterns, complications, and treatment dilemmas that differ from those of adults. In children, increasing participation in competitive sports activities has led to an increased incidence of acute injuries that affect the foot and ankle. These injuries represent approximately 13% of all pediatric osseous injuries. Read More

Medicine (Baltimore) 2020 Feb;99(9):e19328

From the Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD.

We assessed factors associated with premature physeal closure (PPC) and outcomes after closed reduction of Salter-Harris type II (SH-II) fractures of the distal tibia. We reviewed patients with SH-II fractures of the distal tibia treated at our center from 2010 to 2015 with closed reduction and a non-weightbearing long-leg cast. Patients were categorized by immediate postreduction displacement: minimal, <2 mm; moderate, 2 to 4 mm; or severe, >4 mm. Read More

Injury 2020 Mar 29;51(3):636-641. Epub 2020 Jan 29.

Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, 500 University Drive, Mail Box 593, Hershey, PA 17033 United States.

Background: Distal Salter-Harris (SH) II fractures of the tibia are common injuries in the pediatric population. The purpose of this study is to evaluate our treatment and outcomes of SH II fractures of the distal tibia.

Methods: The study was approved by the medical school's institutional review board (IRB). Read More

Int Orthop 2020 03 6;44(3):545-550. Epub 2020 Jan 6.

Orthopedics and Trauma Surgery Department, University Hospital of Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso.

Introduction: Neglected epiphyseal fracture-separations of the distal femur are rare. Still reported in developing countries, they lead to therapeutic issues. The objective of the study is to describe their characteristics and to propose treatment options. Read More

Medicine (Baltimore) 2019 Dec;98(51):e18433

Department of Orthopedics and Traumatology, San Raffaele Scientific Institute.

Rationale: Posterior sternoclavicular joint dislocations (PSCJDs) are particularly rare injuries, accounting for 3% to 5% of sternoclavicular joint dislocations. With very few cases reported in the literature, these injuries are often misdiagnosed and imaging is not always clear, thus making physicians often unaware of them. The present case report aims to investigate a rare case involving a clavicular Salter-Harris II fracture with associated posterior displacement of the diaphysis, a term coined a "pseudodislocation. Read More

Skeletal Radiol 2020 Apr 2;49(4):521-530. Epub 2019 Dec 2.

Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA.

Pediatric ankle injuries require timely diagnosis due to their involvement of the distal tibial physis and subsequent impact on long bone growth. These injuries occur in a predictable pattern based on ankle position, direction of force, and degree of closure of the distal tibial physis. The Dias-Tachdjian classification describes possible ankle injury patterns for the completely open physis, and we present a simplified algorithm for applying this system in routine radiographic interpretation. Read More

Pediatr Radiol 2019 11 4;49(12):1595-1609. Epub 2019 Nov 4.

Department of Radiology, Nemours Children's Hospital and Health System, 13535 Nemours Parkway, Orlando, FL, 32827, USA.

The cartilaginous primary physis, or growth plate, at the end of long bones in children allows for longitudinal bone growth. A variety of insults to the physis can lead to physeal bridge formation, which in turn can lead to limb-shortening and angular deformities. This paper begins with a description of the causes, risk factors and mechanisms by which bridges form. Read More

Tissue Eng Part C Methods 2019 12 31;25(12):701-710. Epub 2019 Oct 31.

Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

Physeal injuries can lead to bony repair tissue formation, known as a bony bar. This can result in growth arrest or angular deformity, which is devastating for children who have not yet reached their full height. Current clinical treatment involves resecting the bony bar and replacing it with a fat graft to prevent further bone formation and growth disturbance, but these treatments frequently fail to do so and require additional interventions. Read More

BMJ Case Rep 2019 Aug 28;12(8). Epub 2019 Aug 28.

Trauma and Orthopaedic Surgery, Midland Regional Hospital Tullamore, Co Offaly, Ireland.

A 10-year-old girl presented to the emergency department having sustained a fall onto an outstretched left hand while playing soccer. Clinical and radiographical assessment identified a Salter-Harris I distal ulna fracture, as well as a buckle fracture of the distal radius. The injury was closed, and she had no neurovascular deficits on examination. Read More

Clin Case Rep 2019 Jul 16;7(7):1450-1451. Epub 2019 May 16.

Radiology Department European Interbalkan Medical Center Thessaloniki Greece.

A rare clinical presence of Salter-Harris type II fracture of the distal femur in a newborn. The crucial role of imaging in depicting urgent anatomical alterations. Read More

J Pediatr Orthop 2020 Mar;40(3):e210-e215

Department of Pediatric Orthopaedics and Traumatology, Hospital Universitario La Fe, Avinguda de Fernando Abril Martorell, València, Spain.

Background: Isolated intra-articular radial head (IARH) fractures in skeletally immature patients represent a rare injury. Despite their initial benign radiologic appearance, these fractures are at risk for progressive radial head subluxation and may end with degenerative irreversible changes of the radiocapitellar joint. The aim of this study is to highlight the seriousness of these injuries and the importance of early diagnosis and a proper follow-up to achieve optimal outcomes. Read More

Hand Surg Rehabil 2019 09 16;38(4):251-256. Epub 2019 May 16.

Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland. Electronic address:

The purpose of this study was to document and evaluate patient characteristics, injury mechanisms and clinical outcomes of epiphyseal stress fractures of the finger phalanges in adolescent rock climbers to identify contributing factors to this injury. Twenty-eight climbers with epiphyseal pain treated at our clinic between 2006 and 2018 were included in the study. Sixteen patients completed a questionnaire addressing injury details as well as training regimen before and after the injury. Read More

Medicine (Baltimore) 2019 May;98(18):e15396

Department of Pediatric Orthopedic Surgery.

Rationale: The physeal separations and septic osteomyelitis in newborns are unusual, which represents a challenging problem in diagnosis and treatment.

Patient Concerns: A 2-day-old mature male suddenly complained by parents about minimal swelling around the left knee, decreased left extremity motion and no fever.

Diagnosis: Preliminary x-rays of the lower extremities demonstrated a displaced distal femoral physeal, Laboratory investigation indicated infection. Read More

J Magn Reson Imaging 2020 01 1;51(1):133-143. Epub 2019 May 1.

Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Background: Growth plate injuries and disorders cause premature closure, resulting in shortened or deformed limbs. Quantitative assessment by MRI might monitor the status of the growth plate and may assist in the prediction of these deformations.

Purpose: To investigate whether the status of the growth plate can be monitored by quantitative evaluation using MRI of the noninjured region of the growth plate in a physeal injury model. Read More

J Pediatr Orthop 2020 Jan;40(1):e1-e5

Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic.

Background: The purpose of this study was to determine the frequency of concurrent ipsilateral distal tibial fractures with tibial shaft fractures in the pediatric population; to identify patient and fracture characteristics that increase the likelihood of a concurrent fracture; and determine if any of these concurrent distal tibial fractures were missed on initial radiographic examination.

Methods: Retrospective chart review was done to identify patients 5 to 17 years old who were treated for a tibial shaft fracture at a large, Level 1 free-standing children's hospital and an outpatient orthopaedic practice between 2008 and 2016. Patient and fracture characteristics were recorded. Read More

Br J Hosp Med (Lond) 2019 Apr;80(4):201-203

Associate Professor, Academic Orthopaedics, Department of Trauma and Sports Medicine, University of Nottingham, Queen's Medical Centre, Nottingham.

Ankle fractures are a common injury in children and adolescents - 1 in 1000 children will sustain an ankle fracture each year. Understanding the diagnosis and management of these injuries is vital for any doctor or clinician working in the emergency department, orthopaedics or providing community care. This review identifies the important features of high- and low-risk ankle fractures, how to prevent the use of unnecessary radiation and the management of these injuries. Read More

Acta Biomed 2019 01 18;90(1):116-121. Epub 2019 Jan 18.

Azienda Ospedaliera Universitaria Integrata di Verona.

Fractures of the acetabulum are rare in the pediatric age and may be complicated by the premature closure of the triradiate cartilage. We report a case of triradiate cartilage displaced fracture treated surgically. A 14 years old boy, following a high-energy road trauma, presented an hematoma in the right gluteal region with severe pain. Read More

J Orthop Sports Phys Ther 2019 Mar;49(3):209

A 15-year-old high school football player sustained direct impact to his anteromedial left knee by a teammate's helmet during practice. The physician referred the athlete immediately to an after-hours clinic for imaging to rule out a fracture. Radiographs of the knee showed a nondisplaced Salter-Harris type II fracture. Read More