Is a Parry Fracture—An Isolated Fracture of the Ulnar Shaft—Associated with the Probability of Abuse in Children between 2 and 16 Years Old?

A parry fracture is an isolated fracture of the ulnar shaft. It occurs when the ulna receives the full force of an impact when the forearm is raised to protect the face. The aim of this study is to assess a possible association between a parry fracture and the probability of abuse in children. In this retrospective, observational, multicenter study, we identified patients between 2 and 16 years old who had been treated for an isolated ulnar shaft fracture. Patient characteristics were registered, anonymized radiographs were rated, and charts were screened for referral to a child protective team. A total of 36 patients were analyzed. As no referrals were registered during follow-up, the primary outcome was changed to a perpendicular force as trauma mechanism. Univariable regression analysis and independent t-test both showed no significant association between patient factors or radiographic classification, and the reported trauma mechanism. We were unable to determine an association between a parry fracture and the probability of abuse. Since trauma mechanism does have a biomechanical effect on the fracture type, we would advise that a very clear reconstruction (and documentation) of the trauma mechanism should be established when a parry fracture is identified on radiographs.

Challenges and Innovations in Osteochondral Regeneration: Insights from Biology and Inputs from Bioengineering toward the Optimization of Tissue Engineering Strategies

Due to the extremely high incidence of lesions and diseases in aging population, it is critical to put all efforts into developing a successful implant for osteochondral tissue regeneration. Many of the patients undergoing surgery present osteochondral fissure extending until the subchondral bone (corresponding to a IV grade according to the conventional radiographic classification by Berndt and Harty). Therefore, strategies for functional tissue regeneration should also aim at healing the subchondral bone and joint interface, besides hyaline cartilage. With the ambition of contributing to solving this problem, several research groups have been working intensively on the development of tailored implants that could promote that complex osteochondral regeneration. These implants may be manufactured through a wide variety of processes and use a wide variety of (bio)materials. This review aimed to examine the state of the art regarding the challenges, advantages, and drawbacks of the current strategies for osteochondral regeneration. One of the most promising approaches relies on the principles of additive manufacturing, where technologies are used that allow for the production of complex 3D structures with a high level of control, intended and predefined geometry, size, and interconnected pores, in a reproducible way. However, not all materials are suitable for these processes, and their features should be examined, targeting a successful regeneration.

The Modified West China Hospital Radiographic Classification for Fibrous Dysplasia in Femur: A Retrospective Analysis of 238 Patients

Background: To investigate the reliability and clinical outcome of a newly developed classification system for patients, who had fibrous dysplasia (FD) in the femur.Methods: A total of 238 patients with FD in the femur were included in this retrospective study. All affected femurs were measured and treated based on our classification. The intraobserver and interobserver reproducibility were assessed using the Cohen kappa statistic. The clinical outcome was evaluated using the criteria of Guille.Results: At a median follow-up of 60 months, 238 patients were categorized into the following five types: type I to V. The interobserver and intraobserver kappa scores were excellent. For clinical outcomes, there was no significant difference in the postoperative Guille score between type I (mean 9.01 ± 1.22), II (mean 8.40 ± 1.38), and V (mean 8.47 ± 1.69). Type III and IV had significantly lower postoperative Guille scores than type I, II, and V. Moreover, type III had a significantly higher Guille score (mean 7.81 ± 0.96) than type IV (mean 6.57 ± 2.09).Conclusion: Our classification is reproducible and provides a one-to-one correspondence between diagnosis and treatment. Therefore, we recommend this classification for the diagnosis and treatment of the FD in the femur.

Arthroscopic Findings in Symptomatic Fourth and Fifth Tarsometatarsal Joints with and without Arthritis

Category: Arthroscopy; Midfoot/Forefoot Introduction/Purpose: Refractory pain to the fourth and fifth tarsometatarsal (TMT) joint is a source of disability and functional impairment. The etiology of fourth and fifth TMT joint pain may be attributed to injury, post-traumatic arthritis, or arthrofibrosis, however, the principal pathologies associated with pain in the absence of arthritis are not well elucidated. The purpose of this study is to characterize arthroscopic pathology associated with chronic refractory pain to the fourth and fifth TMT joints with and without arthritis. Methods: We retrospectively examined 25 patients that underwent arthroscopic surgery of the fourth and fifth TMT joints for refractory pain at our academic institution between 2015 - 2020. Patients were placed in supine position, thigh tourniquet placed, prepped and draped in standard sterile fashion. The fourth and fifth TMT joints were accessed medially through a portal between the third and fourth TMT joint and laterally through a portal lateral to the fifth TMT joint. A 30° 2.5mm arthroscope was used as well as 2.5mm aggressive soft tissue shaver. Intraoperative fluoroscopy was use to confirm location of the arthroscope and shaver. The intraoperative findings were recorded into the medical record. We used the Outerbridge classification for chondral lesions, the Kellgren Lawrence (KL) radiographic classification for osteoarthritis, and described intraarticular pathologies as acute hypertrophic synovitis, chronic synovial fibrosis, hyaline bands, meniscoid bodies, loose joint bodies, arthrofibrosis. Results: Twenty-three fourth TMT joints and 26 fifth TMT joints, in 25 patients, underwent arthroscopic surgery for refractory pain. Average age was 62.6+-8.3 years. Average body mass index was 31.0+-5.0 kg/m2. All patients had pain with piano-key test. Twelve patients with arthritis to first through third TMT joints and eight patients to second through third TMT joints required arthrodesis. Approximately, 71.4% of TMT joints presented with radiographic evidence of arthritis and 28.6% of TMT joints were absent of radiographic signs of arthritis. The soft tissue pathology observed in patients without radiographic evidence of arthritis was arthrofibrosis (87.5%), chronic synovial fibrosis (75.0%), and acute hypertrophic synovitis (62.5%). Frequency plot of soft tissue pathologies, Outerbridge classification and KL radiographic classification for arthritis are shown in Figure 1. Conclusion: This is the first study to report arthroscopic findings associated with refractory pain of the fourth and fifth TMT joints with and without arthritis. These findings provide information regarding pathologies associated with fourth and fifth TMT joints pain and subsequent treatment.