Management strategies of pediatric ipsilateral olecranon with associated radial neck fractures based on multicenter experience

Abstract Background The ipsilateral olecranon with associated radial neck fractures does not include in the Bado classification of Monteggia fractures and equivalent lesions. The primary aims of this retrospective multicenter study were to characterize this type of injury and, noting its unique properties, evaluate the results of the treatment, determine the prognostic factors that influence the radiological and clinical outcome, and also give treatment strategies. Methods Between July 2011 and July 2016, forearm fracture patient charts were retrospectively reviewed from seven pediatric trauma centers. Patients diagnosed with ipsilateral olecranon with associated radial neck fractures and followed up for at least 24 months were included. Fracture characteristics, treatment, outcome, and complications were assessed. The clinical outcome of treatments was evaluated by the Mayo Elbow Performance Score (MEPS) and the Flynn criteria. Fisher’s exact test and ANOVA test were used; significance was defined as P < 0.05. Results One hundred thirty-seven consecutive patients (54 girls and 83 boys) from 8292 forearm fractures patients, the mean age of 7.5 years (1.5 to 14.8), with fractures of the ipsilateral olecranon with associated radial neck fractures were identified. One hundred twenty-five patients had radiologic and clinical follow-up. According to a simplified classification system with “operate” and “don’t operate” groups, including five subtypes proposed in this study, ipsilateral olecranon with associated radial neck fractures subtypes could be classified with significantly different characteristics and outcome in treatment and complications. Conclusions Fractures of the ipsilateral olecranon associated with the radial neck are not so rare as previously reported. Complications and poor outcomes were easy to encounter without knowing this type of fracture. Appropriate treatment strategies could be made according to a simple classification system based on the treatment result of follow-up. Level of evidence Retrospective comparative study; Level III

Download Full-text

Hip Dislocation and Subluxation in Athletes: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/03635465211036104 ◽

2021 ◽

pp. 036354652110361

Author(s):

Deepak V. Chona ◽

Paul D. Minetos ◽

Christopher M. LaPrade ◽

Mark E. Cinque ◽

Geoffrey D. Abrams ◽

...

Keyword(s):

Systematic Review ◽

Arthroscopic Surgery ◽

Treatment Strategies ◽

Hip Dislocation ◽

Return To Play ◽

Exclusion Criteria ◽

Level Of Evidence ◽

Radiographic Outcomes ◽

Center Edge

Background: Hip dislocation is a rare occurrence during sports but carries serious implications for athletes. Purpose: To systematically review treatment strategies and outcomes for hip dislocation in athletes, with the ultimate goal of providing sports medicine physicians with the information necessary to appropriately treat and counsel patients sustaining this injury. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, MEDLINE, and Embase were searched for studies relating to hip instability and athletics from January 1, 1989 to October 1, 2019. Abstracts and articles were evaluated on the basis of predefined inclusion and exclusion criteria. Inclusion criteria were the following: (1) data from ≥1 patients, (2) native hip dislocation or subluxation occurring during sports, (3) patients aged at least 10 years, and (4) written in English. Exclusion criteria were (1) patients younger than 10 years; (2) nonnative or postoperative hip dislocation or subluxation; (3) a native hip injury without dislocation or subluxation; (4) patients with dislocation or subluxation secondary to neuromuscular, developmental, or syndromic causes; (5) dislocation or subluxation not occurring during sports; (6) patients with physeal fractures; or (7) review articles or meta-analyses. Data were recorded on patient demographics, injury mechanism, treatment strategies, and clinical and radiographic outcomes. Where possible, pooled analysis was performed. Studies were grouped based on reported outcomes. Meta-analysis was then performed on these pooled subsets. Results: A total of 602 articles were initially identified, and after screening by 2 reviewers, 27 articles reporting on 145 patients were included in the final review. There were 2 studies that identified morphological differences between patients with posterior dislocation and controls, including decreased acetabular anteversion ( P = .015 and .068, respectively), increased prevalence of a cam deformity ( P < .0035), higher alpha angles ( P≤ .0213), and decreased posterior acetabular coverage ( P < .001). No differences were identified for the lateral center edge angle or Tonnis angle. Protected postreduction weightbearing was most commonly prescribed for 2 to 6 weeks, with 65% of reporting authors recommending touchdown, toe-touch, or crutch-assisted weightbearing. Recurrence was reported in 3% of cases. Overall, 4 studies reported on findings at hip arthroscopic surgery, including a 100% incidence of labral tears (n = 27; 4 studies), 92% incidence of chondral injuries, 20% incidence of capsular tears, and 84% incidence of ligamentum teres tears (n = 25; 2 studies). At final follow-up, 86% of patients reported no pain (n = 14; 12 studies), 87% reported a successful return to play (n = 39; 10 studies), and 11% had radiographic evidence of osteonecrosis (n = 38; 10 studies). Conclusion: Various treatment strategies have been described in the literature, and multiple methods have yielded promising clinical and radiographic outcomes in patients with native hip dislocation sustained during sporting activity. Data support nonoperative treatment with protected weightbearing for hips with concentric reduction and without significant fractures and an operative intervention to obtain concentric reduction if unachievable by closed means alone. Imaging for osteonecrosis is recommended, with evidence suggesting 4- to 6-week magnetic resonance imaging and follow-up at 3 months for those with suspicious findings in the femoral head.

Download Full-text

Clinical outcomes of muscle invasive bladder Cancer according to the BASQ classification

BMC Cancer ◽

10.1186/s12885-019-6042-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Hyeong Dong Yuk ◽

Chang Wook Jeong ◽

Cheol Kwak ◽

Hyeon Hoe Kim ◽

Kyung Chul Moon ◽

...

Keyword(s):

Bladder Cancer ◽

Classification System ◽

Expression Patterns ◽

Treatment Strategies ◽

Invasive Bladder Cancer ◽

Molecular Characteristics ◽

Muscle Invasive Bladder Cancer ◽

Cancer Specific Survival ◽

Muscle Invasive

Abstract Background We evaluated the clinical efficacy and prognosis of muscle-invasive bladder cancer according to the basal/squamous-like (BASQ) classification system based on immunohistochemical staining [CK5/6(+), CK14(+), GATA3(−), and FOXA1(−)]. Methods One hundred patients diagnosed with muscle-invasive bladder cancer (cT2-4 N0-3 M0) were included in the study. All patients underwent radical cystectomy after transurethral removal of bladder tumor. Immunostaining was performed for CK5/6, CK14, FOXA1, and GATA3 antibodies on tissue microarray slides, and expression patterns were quantitatively analyzed using a scanning program. Results The median follow-up time was 77.4 (interquartile range: 39–120.9) months. The mean age of the patients was 65.1 ± 11.2 years. FOXA1 or CK14 expression greater than 1% was respectively positively and negatively correlated with overall survival (OS; p = 0.011 and p = 0.042, respectively), cancer-specific survival (CSS; p = 0.050 for both), and recurrence-free survival (RFS; p = 0.018 and p = 0.040, respectively). For CK5/6+ and GATA3- or FOXA1- expression, 10% CK5/6+ cells were negatively correlated with OS (p = 0.032 and p = 0.039, respectively) and with RFS in combination with FOXA1- only (p = 0.050). Conclusions In this study, CK14 expression was associated with a poor prognosis. The new classification system of bladder cancer based on molecular characteristics is expected to helpful tool for the establishment of personalized treatment strategies and associated prediction of therapeutic responses.

Download Full-text

Radiological and functional outcomes of modified Metaizeau technique in displaced radial neck fractures

Acta Orthopaedica Belgica ◽

10.52628/87.2.05 ◽

2021 ◽

Vol 87 (2) ◽

pp. 235-241

Author(s):

Ökkeş Bilal ◽

Ali Murat Kalender ◽

Burçin Karslı ◽

Volkan Kılınçoğlu ◽

Mustafa Kınaş ◽

...

Keyword(s):

Closed Reduction ◽

Good Choice ◽

Radial Neck Fracture ◽

Radial Neck ◽

Fractures In Children ◽

Radial Neck Fractures ◽

Neck Fracture ◽

Elbow Function ◽

Poor Outcomes

The management of displaced radial neck fractures in children is still a controversial topic. The objective of this study is to examine the outcomes of modified Metaizeau technique in the children with displaced radius neck fractures. The retrospective study included 15 children with displaced radial neck fracture with an angulation of more than 30° who were managed with the use of leverage technique by mosquito clamps and internal fixation with elastic stable intramedullary nailing (ESIN). Radiological and functional assessments were performed during follow-up. Additionally, the patients were evaluated using Mayo Elbow Per- formance Score (MEPS). All the children could be managed with clamp-assisted closed reduction. The average duration of follow up was 25.5 ± 6.1 months (15-36 months). An excellent elbow function was achieved in all but one patient. Based on Metaizeau classification, excellent, good, fair, and poor outcomes were achieved in 11, 1, 2, and 1 patients, respectively. The average postoperative MEPS score was 98.7 ± 5.1 (80-100). Clamp-assisted closed reduction and fixation with ESIN is a good choice in the children with displaced radial neck fractures. This technique is associated with good functional and radiologic outcomes in the medium-term. Further studies are warranted with larger sample sizes.

Download Full-text

Sports and Recreation Activity of Patients with Femoroacetabular Impingement before and after Arthroscopic Osteoplasty

The American Journal of Sports Medicine ◽

10.1177/0363546508330144 ◽

2009 ◽

Vol 37 (5) ◽

pp. 917-922 ◽

Cited By ~ 106

Author(s):

Alexander Brunner ◽

Monika Horisberger ◽

Richard F. Herzog

Keyword(s):

Clinical Outcome ◽

Pain Score ◽

Femoroacetabular Impingement ◽

Case Series ◽

Level Of Evidence ◽

Level Of Activity ◽

First Occurrence ◽

And Function ◽

Sports Activities

Background Hip arthroscopy represents a new and minimally invasive method of treating patients with femoroacetabular impingement (FAI). However, participation in popular sports after this procedure has not yet been analyzed. Hypotheses Arthroscopic treatment of FAI increases the level of popular sports activities, and this level of activity correlates with the clinical outcome in terms of pain and function. Study Design Case series; Level of evidence, 4. Methods Fifty-three patients (41 male, 12 female) were evaluated preoperatively and after a mean follow-up of 2.4 years (range, 2-3.2 years) after arthroscopic osteoplasty for cam and mixed FAI. Evaluation included the type and level of sports activities (sports frequency score [SFS]) as well as clinical outcome in terms of pain (VAS) and function (nonarthritic hip score [NAHS]). Results Forty-five of the 53 patients had regularly participated in popular sports until the first occurrence of FAI symptoms. Preoperatively, only 4 of these 45 patients had maintained their accustomed level of activity. At the final follow-up, 31 patients had returned to their full accustomed level of activity. None of the patients who had not been active in sports before the first occurrence of symptoms of FAI (n = 8) had begun participation in sports after arthroscopic osteoplasty. The SFS significantly increased from 0.78 to 1.84 (P < .001), and the mean VAS pain score significantly improved from 5.7 (range, 1-9) to 1.5 (range, 0-6) points (P < .001). The NAHS improved from 54.4 (range, 28.75-92.5) to 85.7 (range, 47.5-100) (P < .001). There was no significant correlation between SFS and NAHS (r = .051, P = .35), as well as between SFS and VAS pain score (r = .159, P = .140) preoperatively, but a significant correlation was seen at the time of the last postoperative follow-up (SFS/NAHS: r = .392, P = .003; SFS/VAS: r = .242, P = .049). The 3 most frequent sports activities postoperatively were biking, hiking, and fitness. Conclusion Arthroscopic osteoplasty can significantly improve the rate and level of popular sports activities in patients with FAI. The level of postoperative sports activity directly correlates with the clinical outcome in terms of pain and function.

Download Full-text

The unstable hip in children with cerebral palsy: does an acetabuloplasty add midterm stability?

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.210154 ◽

2021 ◽

pp. 1-7

Author(s):

Matthias W. Axt ◽

Danielle L. Wadley

Keyword(s):

Cerebral Palsy ◽

Classification System ◽

Group Versus ◽

Level Of Evidence ◽

Hip Stability ◽

Children With Cerebral Palsy ◽

Migration Percentage ◽

Outcome Difference ◽

Retrospective Comparative Study

Purpose This study addresses whether an additional pelvic procedure is superior to a varus derotation osteotomy femur (VDRO) alone in unstable hips in children with cerebral palsy (CP). Methods All patients had unstable hips utilising the Melbourne Cerebral Palsy Hip Classification System (MCPHCS). We compared one group that underwent VDRO alone with one that had a combination of VDRO and Dega osteotomy (VDRO+). Measurements were taken before surgery, postoperatively, two years after surgery and at latest follow-up. Generalised estimating equations were used to account for known and unknown correlations between hips from bilateral cases. Results In total, 74 hips in 57 children fulfilled the inclusion criteria. There was no outcome difference between Gross Motor Function Classification System levels III, IV and V. Age at time of operation ranged from three to 16 years (mean 9.8 years). Mean follow-up was 49.1 months. In the VDRO group (28 hips) migration percentage (MP) changed from 61% preoperative to a final value of 35.7%. In the VDRO+ group (46 hips) the MP changed from 64.4% to 19.3%. At final follow-up 15 hips (54%) were stable in the VDRO group, 37 hips (83%) in the VDRO+ group. The odds ratio (OR) of hip stability at final follow-up was 3.5-times higher in the VDRO+ group versus the VDRO group (OR = 3.9; 95% confidence interval = 1.5 to 9.7; p = 0.004). Conclusion Reconstruction of unstable hips via VDRO + Dega in children with CP provides a higher likelihood of long-term stability than an isolated VDRO. Level of Evidence Level III, retrospective comparative study

Download Full-text

Closed reduction and percutaneous intramedullary pinning of displaced radial neck fracture in a 12 years old child: reduction technique and outcome

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20202548 ◽

2020 ◽

Vol 6 (4) ◽

pp. 854

Author(s):

Sunil Chandrashekar ◽

Jagadish Laxmansa Katwa ◽

Amlan Singh

Keyword(s):

Closed Reduction ◽

Forearm Fracture ◽

Kirschner Wire ◽

Fracture Dislocation ◽

Radial Neck Fracture ◽

Radial Neck ◽

Radial Neck Fractures ◽

Intramedullary Pinning ◽

Fracture Dislocations ◽

Neck Fracture

Fracture of the radial neck are uncommon injuries in the pediatric age group. In children, they may present as radial neck fractures, a component of forearm fracture-dislocations, or as isolated fracture-dislocations. Most of the displaced radial neck fractures with more than 300 angulations (Judet type III and IV fractures) should be surgically treated. An unusual variant of radial neck fracture with dislocation of the radial head to the radial side without associated nerve injury. The fracture-dislocation was fixed with closed reduction and Kirschner wire under image intensifier. The patient is being followed up for 6 months. Operative treatment with closed reduction and intramedullary pinning has better correction of angulation and rotation compared to closed reduction techniques with angulation of 300 or more with 100 of rotation. we achieved a supination of 800 and a pronation of 500.

Download Full-text

Percutaneous leverage technique for reduction of radial neck fractures in children: technical tips

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.190130 ◽

2020 ◽

Vol 14 (2) ◽

pp. 118-124

Author(s):

Colyn J. Watkins ◽

Caleb M. Yeung ◽

Emily Rademacher ◽

Dennis E. Kramer

Keyword(s):

Case Series ◽

Intramedullary Fixation ◽

Complication Rates ◽

Level Of Evidence ◽

Small Incision ◽

Radial Neck Fracture ◽

Radial Neck ◽

Fractures In Children ◽

Radial Neck Fractures ◽

Neck Fracture

Purpose Paediatric radial neck fractures are challenging to treat. Multiple strategies exist for reduction and fixation; there is no clear consensus on the best surgical technique to achieve reduction. The percutaneous leverage technique is a method for reduction of radial neck fractures that has previously been described by Wallace, though there is a lack of published literature on this technique. We present a technical note and a modest case series on our modification to the percutaneous leverage technique accompanied by intramedullary fixation. Methods We describe a retrospective series of patients who underwent the modified percutaneous leverage technique for paediatric radial neck fracture reduction followed by flexible intramedullary nail fixation at a single Level I trauma centre from 2008 to 2016. This technique involves making a small incision over the dorsal border of the ulna and using a blunt curved surgical forceps to dissect towards the ulnar border of the radius just distal to the radial neck fracture site. The curved forceps is then used to push the radial shaft away from the ulnar shaft which reduces the radial neck fracture. Intramedullary fixation is then utilized to stabilize the reduction. Pre- and postoperative radiographs and clinical data from the medical record were reviewed, and patient, injury and treatment characteristics as well as complication rates are summarized. Results We successfully treated a series of eight radial neck fractures with the modified percutaneous leverage technique. This technique allows for a small incision and a minimally invasive method for the reduction of paediatric radial neck fractures. This allowed for subsequent intramedullary fixation and early postoperative elbow mobilization. In our series, no patients developed synostoses or sustained peripheral nerve injuries using this technique. Conclusion The modified percutaneous leverage technique followed by intramedullary fixation is a safe and effective technique for fixation of displaced paediatric radial neck fractures. Level of Evidence Level IV

Download Full-text

Thrower’s Exostosis of the Shoulder: A Systematic Review With a Novel Classification

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120932101 ◽

2020 ◽

Vol 8 (7) ◽

pp. 232596712093210

Author(s):

Michael T. Freehill ◽

Sandeep Mannava ◽

Laurence D. Higgins ◽

Alexandre Lädermann ◽

Austin V. Stone

Keyword(s):

Systematic Review ◽

Classification System ◽

Treatment Options ◽

Treatment Strategies ◽

Return To Sport ◽

Current Treatment ◽

Operative Intervention ◽

Diagnosis And Treatment ◽

Level Of Evidence ◽

Anatomic Locations

Background: A variety of thrower’s exostoses are grouped under the term Bennett lesion, which makes understanding diagnosis and treatment difficult. Purpose: To identify all types of reported thrower’s and overhead athlete’s exostoses and categorize them into a classification system to allow a morphology-based classification. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of all articles pertaining to Bennett lesions and thrower’s exostosis was performed. The classification and treatments were evaluated to describe the types, proposed causes, diagnosis, and treatment options. Results: A total of 27 studies were included in the systematic review. The anatomic locations referenced in the study demonstrated posteroinferior, posterior, and posterosuperior glenoid lesions. Aggregate radiographic data demonstrated 158 of 306 patients (52%) with a thrower’s exostosis of any type and location. Of these 158 patients with a radiographic lesion, 119 (75%) patients were symptomatic. The locations were posteroinferior in 110 patients (70%), directly posterior in 2 patients (1.3%), posterosuperior in 44 patients (28%), and unknown in 2 patients (1.3%). Avulsed lesions were present in 9 (5.7%) posteroinferior lesions, 0 direct posterior lesions, and 2 (1.3%) posterosuperior lesions. Treatment plans included both nonoperative and operative strategies, but operative intervention was more commonly reported for detached lesions. After operative intervention, only 61% of reported athletes returned to preinjury performance. Conclusion: Based on a comprehensive review of the literature, we identified several anatomic locations for a thrower’s exostosis beyond the classic Bennett lesion. We categorized the reported exostoses into a new classification system for description of location and type (subperiosteal or free fragment) of the thrower’s exostosis, which may be used to study future treatments. Current treatment strategies recommend that surgical treatment of thrower’s exostosis is considered only after exhausting nonoperative management because reported return to sport is variable after surgery. The effectiveness of excision or repair for both subperiosteal and detached lesions has not been established.

Download Full-text

Results of stemless shoulder arthroplasty: a systematic review and meta-analysis

EFORT Open Reviews ◽

10.1302/2058-5241.6.200067 ◽

2021 ◽

Vol 6 (1) ◽

pp. 915-929

Author(s):

Joost I.P. Willems ◽

Jim Hoffmann ◽

Inger N. Sierevelt ◽

Michel P.J. van den Bekerom ◽

Tjarco D.W. Alta ◽

...

Keyword(s):

Clinical Outcome ◽

Shoulder Arthroplasty ◽

Meta Analysis ◽

Stress Shielding ◽

Fracture Rate ◽

Level Of Evidence ◽

Sufficient Power ◽

Study Heterogeneity ◽

Stemless Shoulder Arthroplasty

Stemless shoulder arthroplasty relies solely on cementless metaphyseal fixation and is designed to avoid stem-related problem such as intraoperative fractures, loosening, stress shielding or stress-risers for periprosthetic fractures. Many designs are currently on the market, although only six anatomic and two reverse arthroplasty designs have results published with a minimum of two-year follow-up. Compared to stemmed designs, clinical outcome is equally good using stemless designs in the short and medium-term follow-up, which is also the case for overall complication and revision rates. Intraoperative fracture rate is lower in stemless compared to stemmed designs, most likely due to the absence of intramedullary preparation and of the implantation of a stem. Radiologic abnormalities around the humeral implant are less frequent compared to stemmed implants, possibly related to the closer resemblance to native anatomy. Between stemless implants, several significant differences were found in terms of clinical outcome, complication and revision rates, although the level of evidence is low with high study heterogeneity; therefore, firm conclusions could not be drawn. There is a need for well-designed long-term randomized trials with sufficient power in order to assess the superiority of stemless over conventional arthroplasty, and of one design over another. Cite this article: EFORT Open Rev 2021;6:915-929. DOI: 10.1302/2058-5241.6.200067

Download Full-text

Suture Button vs Conventional Screw Fixation for Isolated Lisfranc Ligament Injuries

Foot & Ankle International ◽

10.1177/1071100720976074 ◽

2020 ◽

pp. 107110072097607

Author(s):

Jaeho Cho ◽

Jahyung Kim ◽

Tae-Hong Min ◽

Dong-Il Chun ◽

Sung Hun Won ◽

...

Keyword(s):

Clinical Outcome ◽

Screw Fixation ◽

Single Case ◽

Foot Pressure ◽

Level Of Evidence ◽

Suture Button ◽

Significant Difference ◽

Lisfranc Ligament ◽

Screw Group

Background: Suture buttons have been used for isolated Lisfranc ligament (ILL) fixation. However, no study has reported on its clinical and radiologic outcomes. Method: In this retrospective comparative study, patients with ILL injuries were divided into 2 groups according to the treatment method: 32 conventional screw group and 31 suture button group. The clinical and radiologic outcomes at preoperation, 6 months and 1 year postoperation, and last follow-up period were measured. Plantar foot pressure was measured at postoperative month 6 months. Postoperative complications at the last follow-up were evaluated. Result: The suture button group showed better American Orthopaedic Foot & Ankle Society midfoot scale ( P < .001) and visual analog scale ( P < .001) scores compared with the conventional screw fixation group at the postoperative month 6 period before screw removal. However, no significant difference in clinical outcome between the 2 groups was found at postoperative year 1 or last follow-up. No differences in radiologic outcomes were found between the 2 groups. Plantar foot pressure was significantly elevated in the conventional screw group at the great toe and first metatarsal head area compared with the contralateral foot just before screw removal. Recurrent Lisfranc joint diastasis was found in a single case in the conventional screw group and 2 cases in the suture button group. Conclusion: Suture button fixation in the treatment of ILL injuries may provide comparable fixation stability and clinical outcome with conventional screw fixation in the early postoperative period. Level of Evidence: Level III, retrospective case-control study, therapeutic.

Download Full-text