A gyermekkori csonttörések kapcsolata az időskori osteoporosissal: véletlen vagy előrejelzés?

Összefoglaló. A gyermekek közel fele szenved el csonttörést. Ez lehet traumás esemény vagy a csontfejlődést megzavaró genetikus, hormonális vagy egyéb eltérés a csontváz bármely részén. A leggyakoribb azonban az enyhe trauma kapcsán jelentkező csuklótáji törés, amely többnyire a pubertas alatt fordul elő. A jelenség alapja, hogy a serdülés során átmenetileg elválik egymástól a csontok méretének gyors növekedése és a csonttömeg gyarapodása, ami a longitudinális növekedést kb. egy év késéssel követi. Az így kialakuló átmeneti csontgyengeség a gyermekkori csonttörés fő oka, aminek a hatásához az említett genetikai, hormonális és életmódi rendellenességek is csatlakozhatnak. A gyermekkorban előfordult kistraumás csonttörés a felnőtt férfiaknál az osteoporosisos csonttörések fokozott rizikójával jár, ezért szűrővizsgálati kérdésként is szolgál. Nők esetében ugyanez az összefüggés még bizonyításra vár. Orv Hetil. 2021; 162(42): 1687–1692. Summary. Bone fracture occurs nearly in half of the children. Some fractures are severe traumatic events while others are the results of genetic or hormonal or other alterations disturbing the normal development of bone. However, the majority of fractures are associated with a mild trauma, dominantly in the pubertal period. The basic pathology of the pubertal fractures is the transient deviation of peak velocity of height growth from the gain velocity of bone mass; the latter goes to peak 1 year later than height growth. This difference has been resulted in a physiologic but transient weakening of bones that can coincide with genetic, hormonal or life-style problems and all of these factors together may cause the increased fragility of the pubertal bone. Low-trauma fractures in childhood may be followed in high fracture risk of adult and aging men, so the childhood fracture seems to be a useful screening question for testing the osteoporosis in males. However, the same relation is still not proved in aging women. Orv Hetil. 2021; 162(42): 1687–1692.

Treatment of Paediatric Supra Condylar Fracture Humerus

Introduction: One of the most frequent elbow fractures in childhood, is supracondylar fracture whichrequires rapid diagnosis and treatment. It is usually associated with neurovascular, functional problems and deformity. Objectives: To assess demographic, clinical features and treatment outcomes of the patients who underwent closed reduction and splinting, stabilization by percutaneous pinning or Open Reduction and Internal Fixation(ORIF). Materials and Methods: This retrospective study was conducted in the department of orthopedic surgery, CMH, Bogura from June 2017 to December 2018. The inclusion criteria was Gartland type I,II,III fracture who attended in emergency and casualty, between 2 to 13 years of age. Total 40 patients with the mean age 7.5 years were included in the study group. Results: All were closed fractures, 2flexion and 38 extension type. Two (5%) Gartland type I, 24(60%) and 14(35%) had type II and III fracture respectively. 2(5%) were treated by cast immobilization,8(20%)of type llby closed reduction & splinting, 22(55%) and 8(20%) of type ll&lll by crossed k-wire or by ORIF respectively. According to Flynn’s criteria our study shows 33(82.5%) excellent, 4(10%) good, 2(5%) fair and 1(2.5%) poor outcome.4(10%) had ulnar nerve neuropraxia, 1(2.5%) elbow stiffness,1(2.5%) cubitusvarus, 2(5%) experienced superficial pin tract infection. Conclusion: Management of supracondylar fracture should be decided according to patient’s age, fracture pattern and deformity status. Closed reduction and stabilization by percutaneous wiring provides an effective and safe treatment, when failed, open fractures or associated neurovascular complications ORIF should be preferred. JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 171-174

Predictors of avascular necrosis of the trochlea after pediatric supracondylar humerus fractures

Background Supracondylar fractures of the humerus are the most common type of elbow fractures in childhood. Due to the potential risk of severe complications, trauma surgeons should address them with caution. Avascular necrosis of the trochlea presents a rare but oftentimes disabling complication and should not be underestimated. The aim of the present study was to identify possible predictors of avascular necrosis of the trochlea following pediatric supracondylar humerus fractures. Methods We reviewed the available body of literature reporting clinical outcomes, complications, and possible predictors of avascular necrosis of the trochlea after supracondylar humerus fractures in childhood. Data on patient age, sex, the affected side, fracture classification, treatment, the number of K‑wires, time to surgery, complications, and the time from injury to diagnosis of avascular necrosis were obtained. This study was performed according to the PRISMA guidelines. Results Eight clinical studies were included, comprising 30 patients with avascular necrosis after supracondylar fractures in childhood. The mean age at the time of injury was 5 years (min. 2; max. 10; SD: 2.8 years). In all, 18 patients (60.0%) were male, 11 (36.7%) were female, and one was unknown (3.3%). Five patients (16.7%) had a Gartland type I, three (10.0%) a type II, and 22 (73.3%) a type III fracture of the distal humerus. Six patients (20.0%) were treated conservatively, whereas 24 patients (80.0%) underwent operative treatment. The mean time from injury to diagnosis of avascular necrosis was 33 months (min. 4; max. 84; SD: 24.5 months). Conclusion The available literature on avascular necrosis of the trochlea following pediatric supracondylar humerus fractures is limited. While it can occur in any supracondylar fracture, fracture displacement may be considered a risk factor.

Complications after operative treatment of femoral shaft fractures in childhood and adolescence

Purpose of the study was to retrospectively analyze the complication rates after operatively treated femoral shaft fractures in childhood and adolescence. Retrospective evaluation of 42 children with operatively treated femoral shaft fractures between 2000 and 2014. Fractures were classified as 27 A type, 12 B type and 3 C type fractures according the OTA/AO classification. 8 (19.05%) fractures were open. Age averaged 10.2 years (3-16). Fracture treatment was recorded as temporary or definitive external fixation, ESIN, plate fixation or IMN. Complications such as wound infection, re-fractures, nonunion and malunion were analyzed. Six (14.29%) fractures were temporarily stabilized using an external fixator. In 22 (52.38%) children the femoral shaft fracture was stabilized using ESINs. 10 (23.81%) children had a plate fixation and 9 (21.43%) adolescents were treated using an IMN. ESIN treated children were significantly younger (P=0.000) and had less weight (P=0.000) than children treated with both other methods. Complications were two (4.76%) superficial and two deep (4.76%) wound infections, one (2.38%) re-fracture with the ESIN in situ, one (2.38%) nonunion and one (2.38%) malunion. Six (14.29%) children required a reoperation for a complication. Risk factors for complications were temporarily applied external fixators, open fractures, C Type fractures (P=0.031) and an increasing age (P=0.048) and weight (P=0.047) of the child. The majority of children in our study population were successfully treated using ESIN presenting a low complication rate. Complications were observed following open fractures and more complex fracture types. Furthermore we observed an increasing complication rate with increasing ages and weights of the children.