Search Results (6)

The treatment of shoulder dysplasia resulting from brachial plexus birth injury (BPBI) remains a matter of debate within pediatric orthopedic and neurosurgical communities. Various approaches have been proposed to address the muscular imbalance and joint incongruity that develop in affected children, with special attention paid to the roles of humeral head reduction and tendon transfers. Background/Objectives: These procedures aim to correct the disproportionate strength between internal and external rotators of the shoulder. However, the specific contribution of skeletal procedures such as glenoid osteotomy to restoring shoulder mechanics remains controversial. Glenoid osteotomy, a technique that involves surgically reorienting the glenoid cavity, is hypothesized to promote better containment of the humeral head and allow more physiological joint development. On one hand, altering the glenoid axis could enhance joint congruency and facilitate remodeling during growth. On the other hand, there is limited evidence supporting its efficacy and safety. Methods: This review aims to assess the available literature to determine whether glenoid osteotomy represents a safe and effective procedure for patients with BPBI-associated shoulder dysplasia. A comprehensive literature search yielded 1380 titles. After excluding studies focused on adults and those failing to meet inclusion criteria, only three studies were selected for final analysis. Due to the limited data and variability in study design, no statistical meta-analysis could be performed. Results: Findings suggest that glenoid osteotomy, particularly when combined with tendon transfers, may lead to improvements in shoulder abduction and external rotation. However, outcomes are often difficult to interpret in isolation, and the specific benefits attributable to the osteotomy remain unclear. The lack of standardized imaging, follow-up, and scoring systems limits the strength of current conclusions. Conclusions: Further multicenter, prospective studies are needed to evaluate the long-term efficacy of glenoid osteotomy, its role in skeletal remodeling, and its contribution to overall shoulder stability and function. Such studies would help clarify the true potential of this surgical technique in the broader context of BPBI treatment. Full article

Background: Greater tuberosity fracture–dislocations (GTFDs) represent a distinct subset of proximal humerus fractures, occurring in up to 57% of anterior glenohumeral dislocations. Malreduction may result in impingement, instability, and functional limitation. Treatment is influenced by the displacement magnitude and direction, bone quality, and patient activity level. Methods: This narrative review was based on a comprehensive search of PubMed, Scopus, and Web of Science for English-language articles published between January 2000 and March 2025. Studies on pathomechanics, classification, diagnosis, treatment, and outcomes of GTFDs in adult and pediatric populations were included. Data were analyzed to summarize the current evidence and identify clinical trends. Results: A displacement ≥ 5 mm is the standard surgical threshold, though superior or posterosuperior displacement ≥ 3 mm—and ≥2 mm in overhead athletes—may justify surgery. Conservative treatment remains appropriate for minimally displaced fractures but is associated with up to 48% subacromial impingement and 11% delayed surgery. Surgical options include arthroscopic repair for small or comminuted fragments and open reduction and internal fixation (ORIF) with screws or plates for larger, split-type fractures. Locking plates and double-row suture constructs demonstrate superior biomechanical performance compared with transosseous sutures. Reverse shoulder arthroplasty (RSA) is reserved for elderly patients with poor bone stock, cuff insufficiency, or severe comminution. Pediatric cases require physeal-sparing strategies. Conclusions: GTFDs management demands an individualized approach based on fragment displacement and direction, patient age and activity level, and bone quality. While 5 mm remains the common threshold, lower cutoffs are increasingly adopted in active patients. A tiered treatment algorithm integrating displacement thresholds, fracture morphology, and patient factors is proposed to support surgical decision making. The incorporation of fracture morphologic classifications further refines fixation strategy. Further prospective and pediatric-specific studies are needed to refine treatment algorithms and validate outcomes. Full article

Background: Syndactyly, the congenital fusion of digits, compromises hand function and esthetics. Although surgical separation is the standard treatment, the optimal timing of the intervention remains controversial. Methods: We prospectively analyzed 20 pediatric patients (86 operated fingers) undergoing syndactyly repair, comparing early (≤24 months) versus delayed (>24 months) surgery. Outcome measures included range of motion (ROM) at the metacarpophalangeal (MP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints; complications (synostosis, nail deformities, finger length disparity, webbing); and patient-reported outcomes assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) and overall esthetic satisfaction scores. Results: The median age at surgery was 31 months (IQR25/75: 24.75–36.5), with a median follow-up of 72 months (IQR25/75: 42.0–86.25). Notably, digits III (28.24%) and IV (29.41%) were predominantly affected. Delayed surgery resulted in significantly improved MP ROM (90.98° ± 8.44° vs. 73.13° ± 22.37°, p = 0.004) and DIP ROM (76.28° ± 22.24° vs. 67.19° ± 22.78°, p = 0.028), with a non-significant trend toward better PIP ROM (93.00° ± 25.18° vs. 77.37° ± 30.29°, p = 0.075). Furthermore, the incidence of synostosis was markedly reduced in the delayed surgery group (6.0% vs. 38.9%, p = 0.001). Despite superior joint function associated with delayed intervention, early surgery patients reported higher satisfaction with cosmetic results (3.00 vs. 2.80, p = 0.028), while the DASH scores remained comparably low between groups (0.00 vs. 0.24, p = 0.141). Finger length disparities and webbing were minimal. Conclusions: Our study challenges the conventional advocacy for early syndactyly repair, by demonstrating that delaying surgery beyond 24 months significantly enhances joint mobility and reduces the synostosis rate. However, the higher satisfaction observed as a result of early intervention suggests that surgical timing should be individualized for affected fingers, joints, and severities to balance the functional and cosmetic outcomes. Further studies are needed to define the optimal surgical timing and techniques for pediatric syndactyly. Full article

Background/Objectives: There is no consensus in the literature regarding the optimal treatment for complex proximal humerus fractures (PHFs). The aim of this study is to evaluate the clinical, functional, and radiological outcomes, and complications, associated with the Bilboquet implant in the treatment of PHFs. Methods: The search was conducted from the first description of the Bilboquet device in 1994 to June 2024, across PubMed, Web of Science, and Google Scholar, using specific keywords such as (“Bilboquet” OR “Bilboquet prosthesis” OR “Bilboquet device”) AND (“proximal humerus fracture” OR “shoulder fracture”), along with Boolean operators. The inclusion criteria comprised studies published in English or French that focused on the use of the Bilboquet implant for PHFs. Eligible study designs included case series, cohort studies, randomized controlled trials (RCTs), and non-RCTs evaluating clinical, functional, and radiological outcomes, and complications. Studies that do not contain relevant results to this systematic review, pediatric populations, or the use of alternative implants were excluded. Results: A total of eight studies (235 patients) published between 1996 and 2021 were included. The mean age was 68.6 years (56 to 76.8) in all the studies. The majority of patients, 76.2%, were females, with male patients accounting for only 23.8%. A total of 10 (4.3%) patients had 2-part fractures, 40% of patients had 3-part fractures, and 55.7% of patients had 4-part fractures. The mean follow-up was 36.4 months (25.8–88.7), with a mean constant score of 69.7 (62–78.6). Complications included non-union in 2.65% of cases, avascular necrosis in 19.7%, revision surgery in 5.1%, and protrusion of the staple in 4.3%. Conclusions: Despite limited knowledge of the Bilboquet implant, it shows promise in managing complex PHFs in both young and older adults, with favorable clinical and radiological outcomes. It offers advantages over traditional fixation methods and allows easy conversion to arthroplasty if osteonecrosis occurs. However, the long-term outcomes require further study. While early results are promising, larger randomized studies are needed to confirm its broader clinical utility. Full article

Background/Objectives: Secondary problems in BPBI occur due to decreased muscle strength in the upper extremities. Comprehensive assessment methods are necessary to understand structural problems and to plan appropriate interventions in children with BPBI. We investigated the relationship between distal muscle strength, range of motion (ROM), and functionality by comparing distal muscle strength on the affected and unaffected sides in patients with BPBI who underwent shoulder tendon transfer. Methods: A total of 25 children with BPBI, 13 (52%) girls and 12 (48%) boys, aged 4–7 years (mean age: 5.98 ± 1.27 years), who had undergone shoulder tendon transfer surgery at least one year prior to the study were included. The muscle strength of the elbow, forearm, and wrist were assessed using the MicroFET^®2 Digital Hand Dynamometer. The ROM of the elbow, forearm, and wrist were measured using the universal goniometer. The Pediatric Evaluation of Disability Inventory (PEDI) was used for functionality assessment. Results: The strength of the elbow flexor–extensor, forearm pronator–supinator, and wrist extensor muscles on the affected side was greater than on the unaffected side in all children (p < 0.001). No correlation was found between muscle strength, ROM, and functionality in the affected extremity (p > 0.005). Conclusions: Although children with BPBI have good shoulder function after shoulder tendon transfer, structural problems in the distal joints may affect their functionality during daily life. Distal joint strengthening and ROM exercises, as well as bimanual functional activities, should be included in the rehabilitation programs of children with BPBI after shoulder tendon transfer. Full article

Introduction: There are scarce papers about the use of fluorescence-guided surgery (FGS) in the open surgical field. This study aimed to assess the usefulness of FGS in an open setting in the pediatric population and to report our preliminary experience using the Rubina^® Lens system. Methods: All patients undergoing ICG fluorescence-assisted open surgery over the period September 2022–September 2023 were enrolled. Each surgical procedure was performed using the Rubina^® Lens for ICG fluorescence visualization. Results: A total of 25 patients, 14 boys and 11 girls with a median age at surgery of 5.8 years-old (range 0–15), were enrolled. Surgical indications were dermoid/epidermoid cysts of the head (n = 7), lymphangiomas of the head/neck (n = 2), thyroglossal duct cysts (n = 7), gynecomastia (n = 3), preauricular fistula (n = 2), second branchial cleft fistula (n = 1), fibrolipoma of the shoulder (n = 1) and myofibroma of the gluteal/perineal region (n = 2). In all procedures, an intralesional injection of 2.5 mg/mL ICG solution using a 30-gauge needle was administered. No adverse reactions to ICG occurred. Median operative time was 68.6 min (range 35–189). The visualization of ICG-NIRF with the Rubina^® Lens was achieved in all cases. No intraoperative complications were reported. Postoperative complications occurred in 3/25 patients (12%), with gynecomastia (n = 1), thyroglossal duct cyst (n = 1) and neck lymphangioma (n = 1), who developed a fluid collection in the surgical site, requiring needle aspiration in outpatient care (Clavien–Dindo 2). Complete mass excision was confirmed with pathology reports. Conclusions: Based on this initial experience, FGS using the Rubina^® Lens was very helpful in open surgery, providing enhanced visualization of anatomy and identification of margins, real-time reliability and low complication rate. It was easy to use, time saving, feasible and clinically safe. Previous experience in MIS is necessary to adopt this technology. The accuracy of the injection phase is important to avoid diffusion of the ICG into the perilesional tissue. Full article