Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: a systematic review

Purpose There is no clear evidence in the actual literature regarding which of the surgical approaches could bring about the best functional, cosmetic, and radiological outcomes, as well as fewer complications, when an open reduction and pinning of a severely displaced supracondylar humerus fracture is performed. We, therefore, performed a systematic review of the English literature to investigate the existing evidence regarding this issue. Methods A MEDLINE and EMBASE databases search was performed to identify articles that focused on the functional, cosmetic, and radiological outcomes, as well as post-surgical complications, regarding different surgical approaches used for open reduction and pinning in severely displaced supracondylar humerus fractures in children. One hundred and ninety-four articles were identified, of which seven were included for review. Data analysis included weighted means for all contingency tables and the Chi-square test. Standardized residues were studied when the Chi-square test was statistically significant. Statistical analyses were conducted using Stata 9.1/SE (StataCorp., College Station, TX) and P-values lower than 0.05 were considered to be statistically significant for all analyses. Results For functional outcome, a high frequency of excellent results was found within the lateral and medial approaches, and a high frequency of good results within the anterior approach. A high frequency of poor results was found within the posterior approach. For cosmetic outcome, there was a high frequency of fair results within the posterior and lateral approaches, and a high frequency of poor results within the posterior approach. No statistically significant difference regarding time to union, as well as complications, was found. Conclusion Our results suggest that a combined antero-medial approach could be the method which allows the achievement of better functional and cosmetic outcome according to Flynn’s criteria. Time to union, as well as post-surgical complications, should not be an issue regarding surgical approaches used for open reduction and pinning in these fractures

Outcome evaluation measures for wrist and hand – which one to choose?

The aim of this study was to critically analyse the various outcome measures available for assessing wrist and hand function. To this end, an extensive literature search was performed on Medline, PubMed and the Science Citation Index, focusing on terms associated with the method of development of the outcome measures item generation, item reduction, validity, reliability, internal consistency and their strengths and weaknesses. The most commonly used outcome measures described in literature were the DASH score (disability of shoulder, arm and hand questionnaire), the PRWE score (patient-rated wrist evaluation questionnaire), the Brigham and Women's carpal tunnel questionnaire and the Gartland and Werley score. Our study provides very useful evidence to suggest that the PRWE score is the most responsive instrument for evaluating the outcome in patients with distal radius fractures, while the DASH score is the best instrument for evaluating patients with disorders involving multiple joints of the upper limb. The Brigham and Women's score is a disease-specific outcome instrument for carpal tunnel syndrome; it has been validated and demonstrated to show good responsiveness and reliability in evaluating outcome in patients with carpal tunnel release. The Gartland and Werley score, although the most commonly described instrument in the literature for evaluating outcome after wrist surgery, has not been validated so to date

Operative treatment of distal radial fractures with locking plate system—a prospective study

The aim of this study was to determine the results of operative treatment of distal radial fractures with a 2.4-mm locking plate system in a single tertiary teaching hospital. Seventy-five patients were recruited into the study between May 2004 and November 2006. There were 41 males and 34 females, with a mean age of 51. Seventy-five percent of patients had AO type C fractures. All patients were allowed free active mobilisation of the wrist joint immediately after surgery. They were followed up at two weeks, three months, six months, one year and two years. Assessments of pain, motion, grip strength, and standard radiographs were performed. The Gartland and Werley functional scores, the modified Green and O’Brien score, and the disabilities of the arm, shoulder and hand (DASH) scores were recorded. The radiographic results at the final follow-up showed a mean of 18° of radial inclination, 5° of volar tilt, 1.3-mm radial shortening, and no articular incongruity. Twenty-nine percent of patients showed grade 1 osteoarthritic changes and 6% had grade 2 changes in their final follow-up radiographs. An excellent or good result was obtained in 98% and 96% of patients according to the Gartland and Werley, and modified Green and O’Brien scores, respectively. The mean DASH score was 11.6, indicating a high level of patient satisfaction. Internal fixation of distal radial fractures with a 2.4-mm locking plate system provided a stable fixation with good clinical outcomes and patient satisfaction