• children
• fracture
• functional
• mobility arcs
• pediatric
• pelvis

• Humans
• Child
• Pelvic Bones/injuries
• Adolescent
• Male
• Female
• Fractures, Bone/surgery
• Fractures, Bone/therapy
• Fractures, Bone/classification
• Cross-Sectional Studies
• Child, Preschool
• Retrospective Studies
• Tertiary Care Centers
• Range of Motion, Articular
• Conservative Treatment/methods
• Treatment Outcome

• Fracture laterality
• Hand and foot dominance
• Injury mechanism
• Pediatric trauma

• Humans
• Child
• Retrospective Studies
• Fractures, Bone
• Lower Extremity/injuries
• Leg Injuries
• Arm Injuries

• cartilage, epiphyseal
• fracture fixation, internal
• fractures, bone
• fractures, growth plate
• orthopedics
• pediatrics

• Salter–Harris type
• fracture
• osteomyelitis
• sickle-cell disease

Acute compartment syndrome (ACS) is a surgical emergency that requires urgent fasciotomy to prevent irreversible sequelae. Symptoms usually include intense pain, tenderness in the affected area, tingling or burning sensation, and in severe cases, numbness or weakness and limb amputation due to ischemia from compression of the blood vessels, respectively. This case report describes a 19-year-old female who presented with complaints of severe pain and swelling in her right forearm. On examination, no bite marks, blisters, or skin necrosis were noted except for several surgical scars from her previous surgeries for the same condition, i.e., compartment syndrome. Upon thorough examination, including relevant investigation and clinical judgment, she was diagnosed with acute compartment syndrome, for which she underwent fasciotomy. There was no basic underlying pathology found in her case, making it an unidentified case of acute compartment syndrome.

Over the last 20 years, the incidence of pediatric femoral shaft fractures was increased, due to changes in the children’s daily activities. The healing times are different according to the chosen treatment and to other factors such as age, type of fracture, the involvement of the soft tissues, and concomitance with other injuries. The Bisaccia and Meccariello technique (Intramedullary titanium nail Osteosynthesis Linked External-fixator -IOLE) was born to prevent rotationally and lengthening malunion or nonunion in the treatment of pediatric femoral shaft fractures.

The aim or the objective of this paper is to compare the IOLE with the two most used methods for the treatment of femoral fractures in children.

From 2000 to 2016, 58 pediatric patients with femoral shaft fractures were surgically treated and enrolled in the study. The ranged age of the patients was between 3 and 15 years. Twenty-two patients were treated with endomedullary titanium nails (TEN), 22 with external axial or modular external fixators and 14 patients treated with IOLE technique. The IOLE technique, in brief, is the hybridization of titanium intramedullary nails with a modular external fixator. It is divided into three phases, the first revenue given the length of the femur with the external fixator; the second, the rotations are dominated by the elastic nails; and the third finally they are hybridized on the external fixator. Comparing the three groups, radiographic images were taken to assess fracture reduction and consolidation.

At the final follow-up, statistically significant differences in not weight-bearing times were found in favor of the IOLE group. There were no statistical differences between three groups in terms of significant rotation defects, angulation, growth, and/or nonunion.

The Bisaccia- Meccariello technique (IOLE) showed to lead to healing the pediatric femoral shaft fracture of the femur but allows an early weight-bearing to these patients and normal life like that.

The aim of the present paper was to investigate the clinical efficacy of minimally invasive elastic stable intramedullary nailing (ESIN) for long bone fractures in children.

A total of 350 children with limb fractures from June 2012 to June 2018 were recruited and randomized into two groups: an ESIN group (n = 175) treated with elastic stable intramedullary nailing, and an MPIF group (n = 175), treated with metal plate internal fixation. Both groups received the same physical examination and routine medication. Operation related indexes, clinical efficacy, complications, and postoperative quality of life scores were analyzed and compared.

The operation time, intraoperative blood loss, hospitalization time, and fracture healing time in the ESIN group were 43.74 ± 4.96 min, 8.14 ± 1.34 mL, 5.97 ± 1.88 days, and 55.89 ± 5.61 days, respectively, which were all significantly less than those in the MPIF group (all P < 0.001). In terms of common complications after limb fracture treatment, there were 6 cases of osteomyelitis, 5 cases of skin irritation response, and 7 cases of inflammatory granuloma in the MPIF group. There were 2 cases of skin irritation response and 5 cases of inflammatory granuloma in the ESIN group. The incidence of postoperative complications in the ESIN group was 4.00%, which was significantly lower than that in MPIF group (10.29%) (P < 0.05). The effective rate for recovery condition in the ESIN group (93.71%) was significantly higher than that in the MPIF group (P < 0.001). The quality of life scores after treatment in both groups were improved, while the score in the ESIN group was significantly higher than that in the MPIF group (79.43%) (P < 0.001). The postoperative satisfaction rate in the ESIN group (94.29%) was significantly higher than that in the MPIF group (86.29%) (P < 0.05). The quality of life scores after treatment in both groups were improved, while the score in the ESIN group was significantly higher than that in the MPIF group (P < 0.001). The postoperative satisfaction rate and the acceptance rate for adjacent joint function in the ESIN group (100%) were significantly higher than those in the MPIF group (92.00%) (P < 0.0001).

Elastic stable intramedullary nailing is a minimally invasive procedure for long bone fractures in children. It can effectively improve the operation‐related indicators and postoperative quality of life and reduce the incidence of complications.

• Bone fractures
• Children
• Clinical efficacy
• Intramedullary nailing

• Calcaneal skeletal traction
• Children
• Elastic intramedullary nailing
• Tibial shaft fracture

This study aims to investigate the effects of associated factors like age, fracture level, accompanying fibular fractures and wound condition on healing by determining and comparing union scores of pediatric tibial fractures (PTFs).

Forty-five patients with 46 PTFs (32 males, 13 females; mean age 9.5 years; range 2 to 16 years) who were treated by closed reduction and casting or operated between January 2016 and January 2019 were retrospectively evaluated. The union scores were evaluated at the end of fourth, sixth and eighth weeks and compared to each other. Effects of the age, associated fibular fractures, wound condition, fracture level and treatment type to union score were analyzed.

Twenty-eight (60.9%) out of 46 PTFs had associated fibular fractures and 18 (39.1%) did not. Motor vehicle accident was the most frequent etiologic factor (47.8%). Thirty-four out of 46 fractures were closed tibial fractures (73.9%) and 12 had open wound (26.1%). There was a negative correlation between age and the union scores (p<0.001 for each week). No significant difference was observed between the union score of diaphyseal and metaphyseal fractures at the fourth, sixth, and eighth weeks. The union scores of each week were higher in the conservative group compared to operative group (p<0.001 for each week). Associated fibular fracture group had lower union scores compared to isolated tibial fracture group at fourth, sixth and eighth weeks. Likewise, the union scores of the open fracture group were lower than the closed fracture group (p<0.05 for each week).

Associated fibular fractures, open fractures and aging negatively affect union scores of PTFs. Attention should be paid, particularly in these conditions, during the selection of the operation type and the follow-up period of PTFs.

To describe the novel hybrid fixation technique for paediatric femoral supracondylar fracture during circular external fixation of the lower limb.

The Ilizarov external fixator is commonly used for various orthopaedic conditions. Difficulties associated with external fixation have previously been described. A fall while using a circular external fixator can cause ipsilateral fracture. Such fractures are ideally treated conservatively, but it is difficult to fix the frame itself. No study has reported the treatment of paediatric femoral supracondylar fracture during circular external fixation. Herein, we describe a novel hybrid fixation technique that was successfully used to treat paediatric femoral supracondylar fracture in three paediatric patients with circular external fixators.

The fracture was manually manipulated and reduced by slight hyperextension of the lower extremity under general anaesthesia. After confirmation of good reduction, a stockinette, a cast padding, and a thin core cast were applied to the ipsilateral thigh. The hinge parts were attached to the medial and lateral sides of the proximal ring. The rods were connected to the medial and lateral hinges, and the half ring was connected to the ventral side of the proximal end. Under fluoroscopic confirmation, the thin core cast of the thigh and rods were connected by cast rolled in a figure-of-eight manner. The hinges were locked with the knee joint slightly flexed.

The minimally invasive hybrid fixation technique enables conservative treatment of paediatric femoral supracondylar fracture during circular external fixation of the lower limb with no complications, and early exercise and recovery.

This novel hybrid fixation technique will be an effective method for paediatric femoral supracondylar fracture in patients with a circular external fixator.

Oka Y, Kim W-C, Yoshida T, et al. Hybrid Fixation for Paediatric Femoral Supracondylar Fracture during Circular External Fixation of the Lower Limb. Strategies Trauma Limb Reconstr 2020;15(3):179–183.

• Children
• Circular external fixation
• Femur fracture

There are no recent studies on the frequency of paediatric lower extremity fractures in Germany. The aims of this study were to report fracture rates of paediatric lower extremity fractures treated in German hospitals in 2002 and 2017 and to detect changes over time as well as to evaluate the gender and age distribution for each fracture location.

Data from the German National Hospital Discharge Registry, which covers over 99% of all German hospitals, were used for this study. The absolute frequencies and incidence of lower extremity fractures as well as age at the time of fracture and gender were included in the data. The population was subdivided into four age groups: 0–4, 5–9, 10–14, and 15–19 years. The boy: girl ratio (BGR) for all fracture locations was calculated by dividing the absolute frequency of boys by that of girls. The fracture incidence in 2017 was compared with 2002 by calculating the incidence rate ratio (IRR).

The total number of fractures decreased by 39.9% from 2002 to 2017. The most common fracture locations in 2002 were femoral shaft, tibial shaft, distal tibia, and lateral and medial malleolus; the absolute number of all these fractures was lower in 2017 than in 2002 in all age groups. The incidence of hip and thigh fractures, knee and lower leg fractures, and foot fractures decreased by 39.0, 41.1, and 33.3%. Proximal tibial fractures increased both in absolute numbers and in incidence in the age groups 0–4, 10–14, and 15–19 years (IRR ≥ 1.1). The overall BGR was 2.3 in 2002 and 2.0 in 2017, indicating that the number of girls relative to that of boys who suffered a lower extremity fracture was higher in 2017 than in 2002. Furthermore, the BGR of all fracture locations increased with age in both years.

The number of paediatric lower extremity fractures treated in German hospitals in 2017 was significantly lower than that in 2002. However, the fracture frequency in girls decreased to a lesser extent than that in boys. The incidence of proximal tibial fractures increased.

Tibial shaft fractures are common injuries among the pediatric and adolescent population. Conservative treatment remains the preferred treatment. However, over the last two decades, there has been an increasing trend of operative fixation in pediatric tibia fractures, commonly with intramedullary nail fixation (IMN). Elastic stable intramedullary nails (ESIN) are heavily used especially in skeletally immature patients as they are physeal respecting and the technique for insertion is familiar. Alternatively, reamed locked intramedullary nails (RIMN) have gained traction in adolescents and skeletally immature pre-adolescents. When identifying publications germane to intramedullary fixation of pediatric tibia fractures, the majority investigated clinical and radiographic outcomes associated with ESIN. We were able to identify only one study specifically examining RIMN in this population, albeit other studies included patients treated with RIMN. In parallel, there has been considerable progress in the field of skeletal maturity estimation with criteria based on different anatomic regions. However, little data exists for trauma purposes as no gold standard system had been accepted and proven to be precise for determination of potential growth remaining around the knee or for quantifying the risk of damage to the proximal tibial physis. Systems devised have been either unvalidated or unnecessarily complex or both. In order to achieve more informed treatment choices and optimal patient outcomes when using IMN fixation in pediatrics, simple to use, validated plain film-based methodology is needed to define skeletal maturity for the proximal tibia. Additionally, further examination of outcomes and the role of RIMN in this population are warranted.

• Pediatric
• Trauma
• Skeletal maturity
• Reamed nail
• Intramedullary
• Fixation