Search Results (3)

Despite advancements in surgical techniques, including the utilization of intra-operative fluoroscopy and custom surgical guides, intra-articular implant placement during the pinning of capital physeal fractures can occur and may result in catastrophic complications. Our objective in this study was to compare the epiphyseal purchase afforded by a linear and triangular pattern of Kirschner wires for stabilizing femoral capital physeal fractures. Archived pelvic limb computed tomography scans of 16 skeletally immature dogs were obtained, from which virtual femoral models were created. Separate linear and triangular arrangements of three virtual 1.6 mm Kirschner wires were centered on the thickest region of the proximal epiphysis. The length of each Kirschner wire implanted within the proximal femoral epiphysis was measured. Kirschner wire placement in triangular and linear patterns resulted in a mean epiphyseal purchase for each wire of 8.4 mm and 8.0 mm, respectively. The cumulative Kirschner wire purchase was greater with the triangular pattern (p = 0.004). The mean difference in the cumulative wire purchase was 1.3 mm. The use of a triangular Kirschner wire pattern resulted in greater implant purchase within the epiphysis compared to the linear pattern. The triangular Kirschner wire pattern may reduce the risk of intra-articular implant placement by more closely centering the wires within the thickest region of the epiphysis. Full article

Background: Distal humerus physeal separation (DHPS) presents a rare injury type in young children often associated with misdiagnosis and delayed treatment. The aim of this study was to summarize all the available current evidence regarding the management and outcome of DHPS and determine the incidence of complications and particularly the cubitus varus deformity and avascular necrosis of the trochlea. Methods: A systematic review was conducted under the PRISMA guidelines. Medline/Pubmed, Scopus, Web of Science, and Cochrane were searched for studies dealing with children suffering from traumatic DHPS. Results: Twelve studies with a total of 257 children with DHPS were included for analysis. The mean age was 16.8 months (range: 0.1–46 months) with a mean follow-up of 37 months (range: 0.5–516 months). Non-accidental trauma was reported in 17.2% and misdiagnosis at initial assessment in 7.8%. Closed reduction and percutaneous pinning (CRPP) was the treatment of choice in 54.4%, open reduction and percutaneous pinning (ORPP) in 26.5%, closed reduction and cast immobilization (CR+cast) in 10.9%, and cast immobilization without reduction in 8.2%. The average range of extension–flexion arc was 2.1° to 127.8° (range: −10–140°). The mean Bauman’s angle was 72.4° (range: 66–79°), the mean shaft–condylar angle was 43.8° (range: 25–59°), the mean humeral length was 21.9 cm (range: 15.5–25.8 cm), and the mean carrying angle was 5.1° (range: 16° varus–19° valgus). According to Flynn’s criteria, 85.2% of cases were classified as excellent or good. The ORPP technique was associated with excellent results, while the CR+cast treatment combination was correlated with the poorest outcome (p = 0.001). Cubitus varus occurred in 18.9% (34 cases) and was highly correlated with CR+cast or cast immobilization alone without fracture reduction (p = 0.014). Avascular necrosis of the trochlea was found in 3.9% (7 cases) and was mainly apparent after cast immobilization without reduction (p < 0.001). Conclusions: Post-traumatic cubitus varus deformity may be encountered in approximately one-fifth of young children with DHPS. Surgical intervention with either CRPP or ORPP is the most effective treatment approach, leading to superior functional outcome and a lower complication rate. Full article

Background: Little is known about age-related changes in injury characteristics and burden, and existing data are inconsistent, highlighting the need for new studies on this topic. This study aimed to describe age-related injury risk, severity and burden in a German elite youth football academy. Methods: A prospective cohort study was conducted in the 2012/2013 season, reporting 109 time-loss injuries among 138 young athletes playing at an elite football academy in Germany. For the most severe injuries, the injury burden in the different age groups was considered separately. Results: Athletes missed a total of 2536 days of exposure, resulting in an overall incidence of 2.6 per 1000 h (1.7–3.0; 95% CI) and a burden of 60.6 days lost per 1000 h (40.8–80.3; 95% CI). The incidence and burden of joint sprains and muscle injuries were higher in the older age groups. Physeal injuries peaked in the U14 age group during the pubertal growth spurt. Bone injuries and contusions showed no age trend. Conclusion: Injury characteristics vary with age. The overall incidence, severity and burden of injuries increased with the age of the athletes. To ensure the optimal development of young athletes, it is important to be aware of the differences in injury susceptibility between age groups in order to implement tailored prevention programmes. Full article