3 research outputs found
Gartland type III supracondylar humerus fractures: outcome and complications as related to operative timing and pin configuration
Purpose
Supracondylar fractures of the humerus are the
most common fracture of theelbow in children. The pur-
pose of this study was to evaluate, in terms of outcomes
andcomplications, Gartland type III pediatric supracondy-
lar humerus fractures treated at apediatric level-one trauma
center over a 7-year period, specifically addressing the-
impact of time to surgery on the incidence of complications
and conversion to openreduction.
Methods
We retrospectively reviewed 297 pediatric
patients that sustained a closedGartland type III supra-
condylar humerus fracture treated between December 2004
andDecember 2011. The time to the operating room was
calculated from the medical recordsfor each patient. The
outcome measures evaluated were operative time, conver-
sion toopen procedure, and perioperative and postoperative
complications.
Results
In our study, there were 30 complications in 25
children (8.4%). Conversion to open reduction occurred in
28 children (9.4%). The time from the emergency depart-
ment to the operating room was not significantly correlated
with increased complications, increased operative time, or
conversion to open reduction (
p
>
0.05). Crossed pinning
resulted in an increased risk of overall complications [odds
ratio (OR) = 2.6] and iatrogenic nerve injuries (OR = 9.3).
Complications also occurred more commonly in boys
(OR = 3.3) and in older patients (
p
= 0.0069)
Conclusions
We found no significant correlation between
the time to surgery andcomplications, operative time, or
need for open reduction. These findings support thetrend of
treating Gartland type III supracondylar humerus fractures
in a less urgentmanner. In addition, our study supports the
concept that cross pinning leads to morecomplications than
lateral pinning, including an 8-fold increase in iatrogenic
nerveinjur
Ultrasound diagnosis of medial clavicular epiphysis avulsion fracture in a neonate.
Clavicle fractures are the most common bony injury that occurs during the delivery process. We present a case of medial clavicular physeal fracture mimicking sternoclavicular dislocation diagnosed by ultrasound (US) in a neonate. The infant presented to our clinic at 12 days old with improving left upper extremity pseudoparalysis and outside radiographs interpreted as left sternoclavicular dislocation. US demonstrated a displaced physeal fracture rather than a dislocation. The radiologist should be aware of this potential distinction. Our case shows the usefulness of US in obtaining the definitive diagnosis without the need for radiation or sedation, demonstrates a unique use of this modality, and illustrates that US should be considered for clarification in future cases of suspected sternoclavicular injury in the neonate
Association of Socioeconomic Status With Relapse After Ponseti Method Treatment of Idiopathic Clubfeet
Background: The Ponseti method is today's standard treatment of idiopathic talipes equinovarus (ITEV). Compliance with foot abduction bracing (FABO) and socioeconomic factors have been shown to impact treatment outcome. We wished to further study socioeconomic factors using the Area Deprivation Index (ADI), a more comprehensive way to evaluate socioeconomic status, which has not been done before.
Methods: All TEV patients from 2010 through 2019 treated with the Ponseti method were reviewed. Standard demographic variables, as well as the number of casts to complete initial correction, FABO compliance, and occurrence of relapse were tabulated. Socioeconomic level was quantified with the 2018 ADI.
Results: There were 168 children; 151 had typical and 17 complex TEV. Average follow-up was 4.3 ± 1.8 years; relapse occurred in 46%. There were no significant differences in the percentage of relapse by sex, race, or ADI. FABO noncompliance was present in 46%. Relapse increased with increasing time of follow-up and FABO noncompliance (76% vs 21%, P 4 years the OR was 4.97 (2.1, 11.70, P = .0003).
Conclusion: The outcome of the Ponseti method for TEV treatment is dependent on local circumstances. In our state, socioeconomic status, as determined by the ADI, was not associated with the occurrence of relapse. Thus, each center needs to assess its results, and analyze its own reasons for relapse. There were no other demographic variables associated with relapse except FABO compliance and length of follow-up. Parents should be strongly advised that FABO compliance and follow-up appears paramount to achieving the best results, and that complex TEV are at greater risk for relapse