Operative versus non-operative management of pediatric medial epicondyle fractures: a systematic review

There is ongoing debate about the management of medial epicondyle fractures in the pediatric population. This systematic review evaluated non-operative versus operative treatment of medial epicondyle fractures in pediatric and adolescent patients over the last six decades. A systematic review of the available literature was performed. Frequency-weighted mean union times were used to compare union rates for closed versus open treatments. Moreover, functional outcomes and range-of-motion variables were correlated with varying treatment modalities. Any complications, including ulnar nerve symptoms, pain, instability, infection, and residual deformity, were cataloged. Fourteen studies, encompassing 498 patients, met the inclusion/exclusion criteria. There were 261 males and 132 female patients; the frequency-weighted average age was 11.93 years. The follow-up range was 6–216 months. Under the cumulative random effects model, the odds of union with operative fixation was 9.33 times the odds of union with non-operative treatment (P < 0.0001). There was no significant difference between operative and non-operative treatments in terms of pain at final follow-up (P = 0.73) or ulnar nerve symptoms (P = 0.412). Operative treatment affords a significantly higher union rate over the non-operative management of medial epicondyle fractures. There was no difference in pain at final follow-up between operative and non-operative treatments. As surgical indications evolve, and the functional demands of pediatric patients increase, surgical fixation should be strongly considered to achieve stable fixation and bony union

Identification of potentially dangerous glacial lakes in the northern Tien Shan

Like in many other parts of the world, the glaciers in northern Tien Shan are receding, and the permafrost is thawing. Concomitantly, glacial lakes are developing. Historically, outbursts of these glacial lakes have resulted in severe hazards for infrastructures and livelihood. Multi-temporal space imageries are an ideal means to study and monitor glaciers and glacial lakes over large areas. Geomorphometric analysis and modelling allows to estimate the potential danger for glacial lake outburst floods (GLOFs). This paper presents a comprehensive approach by coupling of remote sensing, geomorphometric analyses aided with GIS modelling for the identification of potentially dangerous glacial lakes. We suggest a classification scheme based on an additive ratio scale in order to prioritise sites for detailed investigations. The identification and monitoring of glacial lakes was carried out semi-automatically using band ratioing and the normalised difference water index (NDWI) based on multi-temporal space imagery from the years 1971 to 2008 using Corona, ASTER and Landsat data. The results were manually edited when required. The probability of the growth of a glacial lake was estimated by analysing glacier changes, glacier motion and slope analysis. A permafrost model was developed based on geomorphometric parameters, solar radiation and regionalised temperature conditions which permitted to assess the influence of potential permafrost thawing. Finally, a GIS-based model was applied to simulate the possibly affected area of lake outbursts. The findings of this study indicate an increasing number and area of glacial lakes in the northern Tien Shan region. We identified several lakes with a medium to high potential for an outburst after a classification according to their outburst probability and their downstream impact. These lakes should be investigated more in detail