Open reduction of pediatric lateral condyle fractures: a systematic review

2021 ◽  
pp. 175857322110102
Author(s):  
Michael D Eckhoff ◽  
Josh C Tadlock ◽  
Tyler C Nicholson ◽  
Matthew E Wells ◽  
EStephan J Garcia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Internal Fixation ◽  
Range Of Motion ◽  
Lateral Condyle ◽  
Elbow Fracture ◽  
Infection Rates ◽  
Fixation Techniques ◽  
K Wires ◽  
Pediatric Elbow Fracture ◽  
The Cost

Introduction Lateral condyle fractures are the second most common pediatric elbow fracture. There exist multiple options for internal fixation including buried K-wires, unburied K-wires, and screw fixation. Our study aims to review the current literature and determine if fixation strategy affects outcomes to include fracture union, postoperative range of motion, and need subsequent surgery. Methods A systematic review of Pubmed, MEDLINE, and EMBASE databases was performed. Included articles involve pediatric patients with displaced lateral condyle fractures treated with internal fixation that reported outcomes to include union rates and complications. Results Thirteen studies met inclusion criteria for a total of 1299 patients (472 buried K-wires, 717 unburied K-wires, and 110 screws). The patients’ average age was 5.8 ± 0.6 years, male (64%), and had 16.3 months of follow-up. No differences in union and infection rates were found. Unburied K-wires had the shortest time to union and the greatest elbow range of motion postoperatively. Conclusions Our systematic review demonstrates similar outcomes with union and infection rates between all fixation techniques. Unburied K-wires demonstrated a shorter time to union and the greatest postoperative range of motion. Additionally, unburied K-wires may be removed in clinic, decreasing the cost on the healthcare system. Evidence Level 3.

scholarly journals Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates

2016 ◽  
Vol 17 (2) ◽  
pp. 187-202 ◽  
Author(s):  
Stephen L. Reintjes ◽  
Ernest K. Amankwah ◽  
Luis F. Rodriguez ◽  
Carolyn C. Carey ◽  
Gerald F. Tuite
Keyword(s):  
Systematic Review ◽  
Regression Analysis ◽  
Internal Fixation ◽  
Fusion Rate ◽  
Cervical Fusion ◽  
Bone Fusion ◽  
Fixation Techniques ◽  
Meta Regression ◽  
Meta Regression Analysis

OBJECT Fusion rates are high for children undergoing posterior cervical fusion (PCF) and occipito-cervical fusion (OCF). Autologous bone has been widely used as the graft material of choice, despite the risk of donor-site morbidity associated with harvesting the bone, possibly because very low fusion rates were reported with posterior allograft cervical fusions in children several decades ago. Higher overall fusion rates using allograft in adults, associated with improvements in internal fixation techniques and the availability of osteoinductive substances such as bone morphogenetic protein (BMP), have led to heightened enthusiasm for the use of bank bone during pediatric PCF. A systematic review was performed to study factors associated with successful bone fusion, including the type of bone graft used. METHODS The authors performed a comprehensive PubMed search of English-language articles pertaining to PCF and OCF in patients less than 18 years old. Of the 561 abstracts selected, 148 articles were reviewed, resulting in 60 articles that had sufficient detail to be included in the analysis. A meta-regression analysis was performed to determine if and how age, fusion technique, levels fused, fusion substrate, BMP use, postoperative bracing, and radiographic fusion criteria were related to the pooled prevalence estimates. A systematic review of the literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. RESULTS A total of 604 patients met the specific inclusion and exclusion criteria. The overall fusion rate was 93%, with a mean age of 9.3 years and mean follow-up of 38.7 months. A total of 539 patients had fusion with autograft (94% fusion rate) and 65 patients with allograft (80% fusion rate). Multivariate meta-regression analysis showed that higher fusion rates were associated with OCF compared with fusions that excluded the occiput (p < 0.001), with the use of autograft instead of allograft (p < 0.001), and with the use of CT to define fusion instead of plain radiography alone. The type of internal fixation, the use of BMP, patient age, and the duration of follow-up were not found to be associated with fusion rates in the multivariate analysis. CONCLUSIONS Fusion rates for PCF are high, with higher rates of fusion seen when autograft is used as the bone substrate and when the occiput is included in the fusion construct. Further study of the use of allograft as a viable alternative to autograft bone fusion is warranted because limited data are available regarding the use of allograft in combination with more rigid internal fixation techniques and osteoinductive substances, both of which may enhance fusion rates with allograft.

scholarly journals Comparative analysis of surgical outcome of treatment of supracondylar humerus fractures Gartland’s extension type III by using closed reduction and K –wire fixation versus open reduction and K –wire fixation method

2017 ◽  
Vol 3 (2) ◽  
pp. 271
Author(s):  
Nilesh Janardan Keche ◽  
Abhijit Bhimrao Kale ◽  
Binoti Arun Sheth ◽  
Ashok Kumar Rathod
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Fixation Method ◽  
Elbow Fracture ◽  
Supracondylar Humerus Fractures ◽  
Wire Fixation ◽  
Group 2 ◽  
K Wires ◽  
Group 1

<p class="abstract"><strong>Background:</strong> Supracondylar fractures of the humerus are the most common elbow fracture in children of the age group 4-12 years. The modern approach for its treatment includes closed reduction or open reduction and internal fixation with K wires. The aim of the present study was to evaluate the clinical and radiological results of children who were treated with the two surgical approaches<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> In our institute children who underwent surgical treatment for supracondylar humeral fractures by closed reduction or open reduction and internal fixation with K wires and whose data were available with regular follow-up of at least 1 year were included in the study. Each group included 25 children in each. Clinical and radiological outcomes were evaluated and compared among the study groups.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean age of the patients in both the groups were 6.84 and 6.64 in group 1 and group 2 respectively. Fractures were more in boys compared to girls in both the groups. Most of the fractures were seen on left side with posteromedial displacement of distal fragment in almost 80% in both the groups. Mean change in Baumann’s angle (BA), carrying angle and range of motion (ROM) as compared to normal side in both the groups after 3<sup>rd</sup> and 9<sup>th</sup> month of follow ups was found to be not statistically significant. Overall result according to Flynn’s criteria was 60% excellent in group 1 as compared to 52% in group 2. Mean satisfaction score was also more in group 1 children when compared to group 2<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Closed reduction with internal fixation with K wires was found to be a better choice of treatment with good functional results<span lang="EN-IN">.</span></p>

scholarly journals OPEN REDUCTION AND K-WIRE FIXATION OF DISPLACED UNSTABLE LATERAL CONDYLE FRACTURES OF THE HUMERUS IN CHILDREN

2011 ◽  
Vol 18 (03) ◽  
pp. 501-509
Author(s):  
NOOR AKBAR SIAL ◽  
MUHAMMAD JAVAID IQBAL ◽  
MUHAMMAD KALEEM SHAUKAT
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Late Presentation ◽  
Lateral Condyle ◽  
Post Injury ◽  
Medical College ◽  
Fractures In Children ◽  
Pin Fixation ◽  
Wire Fixation ◽  
K Wires

Background: Lateral condyle fractures in children are the second most common fracture about the elbow. The problem arises in those cases which are difficult to treat by pop cast or by close reduction with percutaneous pin fixation. Late presentation is another challenge. We selected surgical treatment for such cases up to 12 weeks to evaluate our results. Objective: To study the usefulness of open reduction and K-wire fixation of displaced, unstable with or without rotation of fractures lateral condyle of the humerus in children presenting up to 12 weeks post injury Design: Prospective. Setting: Three teaching orthopaedic units Independent Medical College / Punjab Medical College, and University Medical College Faisalabad. Period: From January 2008 to December 2010. Method: In this prospective study a series of 22 patients were treated using technique of open reduction and internal fixation with k-wires. The results were assessed by criteria of Agarwal et al with little modification after follow-up for 1 year. Results: Excellent to good results were observed in all the12 patients presenting at 1–4 weeks post injury. In 5 patients presenting at 5–8 weeks, the results were excellent in one, good in 2, fair in1 and poor in one patient. In 5 patients presenting at 9-12 weeks good in 1 fair in 2 and poor in 2 patients. Conclusions: Open reduction and internal fixation is an effective treatment in all cases of displaced fractures of the lateral condyle of the humerus presenting up to 12 weeks post injury on the basis of low surgical complications and high union rate.

scholarly journals Comparison of Kirschner wires and Cannulated screw internal fixation for displaced lateral humeral condyle fracture in children

2019 ◽  
Vol 10 (6) ◽  
pp. 75-79
Author(s):  
Pabin Thapa ◽  
Krishna Sapkota ◽  
Krishna Wahegaonkar ◽  
Niraj Ranjeet ◽  
Pratyenta Raj Onta ◽  
...  
Keyword(s):  
Internal Fixation ◽  
P Value ◽  
Lateral Condyle ◽  
Kirschner Wires ◽  
Lateral Condyle Fracture ◽  
The Mean ◽  
K Wires ◽  
Condyle Fracture ◽  
Humeral Condyle ◽  
Screw Group

Background: Lateral condyle fracture of the distal humerus is the second most common injury around the elbow. Aims and Objective: The purpose of the study was to compare Kirschner wires (K-wire) and Cannulated cancellous (CC) screw for internal fixation of displaced lateral humeral condyle fracture in children. Materials and Methods: Forty-six patients with a displaced lateral condyle fracture of humerus were included in the study. Patients were treated with open reduction and internal fixation either with two 1.8mm K-wires or one 4mm CC screw. Fractures were classified according to Milch classification and clinical outcomes were evaluated according to criteria of Hardacre et al. Results: There were 23 patients in each group with the mean age of 6.57 years (range 2 to 12 years). Milch type II was common (n= 34) than Milch type I (n=12). Fracture union was observed at mean 4.13 weeks in the CC screw and 4.61 weeks in K-wire group.(p value = 0.026). On an average the CC screws were removed at 13.57 weeks and K-wires were at 4.57 weeks. The mean follow-up was 13.83 months in CC screw and 12.52 months K-wire group. Three patients (6.5%) had superficial pin site infection and 2 patient (4.3%) had lateral condyle prominence in the K-wire group and only one lateral condyle prominence (2.2%) was observed in the CC screw group. According to the Hardacre et.al criteria CC screw group were excellent in 20 (87%) and good in 3 (13%) patients whereas 13 (56.5%) excellent and 10 (43.5%) good results were found in the K-wire group. (p value = 0.022). Conclusion: Open reduction and internal fixation with either K-wires or cannulated cancellous screw for displaced lateral condyle fracture of humerus are both effective treatment methods but screw fixation provides absolute stability at the fracture site enhancing the fracture healing, reduces the probability of lateral prominence and allows early range of motion and activity in the affected elbow.

scholarly journals Outcome of Lateral Condyle Fracture of Humerus in Children Treated with Open Reduction and Internal Fixation

2019 ◽  
Vol 17 (2) ◽  
pp. 17-20
Author(s):  
Dipendra K.C. ◽  
S.M. Mishra ◽  
Sushil Yogi ◽  
Dinesh Shrestha ◽  
Prateek Karki ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
College Teaching ◽  
Implant Removal ◽  
Lateral Condyle ◽  
Type I ◽  
Age Group ◽  
Lateral Condyle Fracture ◽  
K Wires ◽  
Condyle Fracture

Introduction: Lateral condyle fracture is one of the commonest injuries encountered in pediatric age group. There is no unanimity regarding the method of treatment, however closed reduction is not applicable to all cases and have failure rates making open reduction and internal fixation (ORIF) as the treatment of choice at least in displaced fractures. There are a number of options during surgical management of these fractures; Kirschner-wire (K-wire) is the most commonly used implant for fixation. The purpose of our study was to evaluate the results of lateral condyle fractures of humerus in children treated by ORIF by K-wires based on Hardacre criteria. Materials: This prospective study was conducted in the department of orthopedics in Nepalgunj Medical College Teaching Hospital, Kohalpur from May 2016 to October 2018. All of the fractures in this study were treated by ORIF with unburied K-wires. It included 37 children of age group upto 14 years. Children were evaluated for age, sex, side of arm involved, mechanism of injury, type of fracture, presence of additional injuries, implant removal time, outcome and accompanying complications. K-wires were removed after clinico-radiological union of the fractures. Patients were evaluated using the Hardacre criteria in follow up till 6 months. Result: In this study of 37 children, 28 (75.7%) were males and 9 (24.3%) were females. All of them were 14 years of age or less with mean age of 6.7 ± 0.316. Majority of fractures (67.6%) were observed between six to ten years of age. Left side was predominantly involved (62.2%). Milch type I fracture was found in 5 (13.5%) children while Milch type II fracture were observed in 32 (86.5%) children. The final outcome and functions were evaluated using Hardacre criteria in which 27 (73%) cases had excellent result and all cases had good result as per Hardacre criteria. The complications were 10 (27%) cases of lateral spur; eight (21.6%) cases of hypertrophied scar and four (10.8%) cases of pin track infection and 2 (5.4%) of cubitus varus. Conclusion: The treatment of displaced lateral condyle fracture of humerus by open reduction and unburied K-wire fixation is safe, easy and cost effective procedure with good results. This modality of treatment provides good results among pediatric population without the need for second admission for implant removal.  

The cost of intraoperative adverse events in abdominal and pelvic surgery: A systematic review

2018 ◽  
Vol 215 (1) ◽  
pp. 163-170 ◽  
Author(s):  
A. Garbens ◽  
M. Goldenberg ◽  
C.J.D. Wallis ◽  
A. Tricco ◽  
T.P. Grantcharov
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Pelvic Surgery ◽  
The Cost

The cost of chemotherapy administration: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Gursharan K. Sohi ◽  
Jordan Levy ◽  
Victoria Delibasic ◽  
Laura E. Davis ◽  
Alyson L. Mahar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Chemotherapy Administration ◽  
The Cost

Accuracy of Wearable Sensor Technology in Hand Goniometry: A Systematic Review

Hand ◽  
2021 ◽  
pp. 155894472110146
Author(s):  
Francisco R. Avila ◽  
Rickey E. Carter ◽  
Christopher J. McLeod ◽  
Charles J. Bruce ◽  
Davide Giardi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Health Care Professionals ◽  
Inertial Sensors ◽  
Measurement Techniques ◽  
Infrared Camera ◽  
Wearable Devices ◽  
Sensor Technology ◽  
Accuracy Evaluation ◽  
Wearable Sensor

Background Wearable devices and sensor technology provide objective, unbiased range of motion measurements that help health care professionals overcome the hindrances of protractor-based goniometry. This review aims to analyze the accuracy of existing wearable sensor technologies for hand range of motion measurement and identify the most accurate one. Methods We performed a systematic review by searching PubMed, CINAHL, and Embase for studies evaluating wearable sensor technology in hand range of motion assessment. Keywords used for the inquiry were related to wearable devices and hand goniometry. Results Of the 71 studies, 11 met the inclusion criteria. Ten studies evaluated gloves and 1 evaluated a wristband. The most common types of sensors used were bend sensors, followed by inertial sensors, Hall effect sensors, and magnetometers. Most studies compared wearable devices with manual goniometry, achieving optimal accuracy. Although most of the devices reached adequate levels of measurement error, accuracy evaluation in the reviewed studies might be subject to bias owing to the use of poorly reliable measurement techniques for comparison of the devices. Conclusion Gloves using inertial sensors were the most accurate. Future studies should use different comparison techniques, such as infrared camera–based goniometry or virtual motion tracking, to evaluate the performance of wearable devices.

scholarly journals Systematic review of cost-effectiveness analysis of behavior change communication apps: Assessment of key methods

2021 ◽  
Vol 7 ◽  
pp. 205520762110005
Author(s):  
Cynthia Afedi Hazel ◽  
Sheana Bull ◽  
Elizabeth Greenwell ◽  
Maya Bunik ◽  
Jini Puma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Behavior Change ◽  
Quantitative Measure ◽  
Cost Effectiveness Analysis ◽  
Behavior Change Communication ◽  
Change Communication ◽  
Effectiveness Analysis ◽  
Life Years ◽  
The Cost

Objective Evidence backing the effectiveness of mobile health technology is growing, and behavior change communication applications (apps) are fast becoming a useful platform for behavioral health programs. However, data to support the cost-effectiveness of these interventions are limited. Suggestions for overcoming the low output of economic data include addressing the methodological challenges for conducting cost-effectiveness analysis of behavior change app programs. This study is a systematic review of cost-effectiveness analyses of behavior change communication apps and a documentation of the reported challenges for investigating their cost-effectiveness. Materials and methods Four academic databases: Medline (Ovid), CINAHL, EMBASE and Google Scholar, were searched. Eligibility criteria included original articles that use a cost-effectiveness evaluation method, published between 2008 and 2018, and in the English language. Results Out of the 60 potentially eligible studies, 6 used cost-effectiveness analysis method and met the inclusion criteria. Conclusion The evidence to support the cost-effectiveness of behavior change communication apps is insufficient, with all studies reporting significant study challenges for estimating program costs and outcomes. The main challenges included limited or lack of cost data, inappropriate cost measures, difficulty with identifying and quantifying app effectiveness, representing app effects as Quality-adjusted Life Years, and aggregating cost and effects into a single quantitative measure like Incremental Cost Effectiveness Ratio. These challenges highlight the need for comprehensive economic evaluation methods that balance app data quality issues with practical concerns. This would likely improve the usefulness of cost-effectiveness data for decisions on adoption, implementation, scalability, sustainability, and the benefits of broader healthcare investments.

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