RESUMEN
Pediatric elbow fractures and dislocations have always been a challenge from a diagnostic and therapeutic point of view, primarily due to the complex nature of the pediatric elbow, especially its developmental anatomy. They must be diagnosed and treated on time to prevent numerous complications with long-term consequences. With the development of radiology and pediatric surgery and orthopedics, as well as the development of modern osteosynthesis materials, concerning current scientific and professional knowledge, the outcomes are getting better, with fewer acute and chronic complications. This comprehensive review aims to provide clinicians current knowledge about pediatric elbow fractures and dislocations so that in daily practice they have as few doubts as possible with the best possible treatment outcomes.
RESUMEN
The objective of this study was to assess whether the positioning of the wrist joint in the cast in such a manner that it counteracts the direction of angulation of fragments is more important than the cast index in the prevention of secondary displacements in distal forearm fractures. A retrospective review of all pediatric patients (0-16 years of age) who were hospitalized in our institution with displaced fractures of the distal forearm (either isolated fractures of the distal radius or both bone fractures) who underwent subsequent closed reduction and splinting in the period from August 2018 to October 2020. Patients with physeal fractures and open fractures, and skeletally mature patients were excluded from the study. Patients were divided into two categories - the first one in which the cast index was below 0.9 and the second in which it was above 0.9. In each category, we have identified two groups of patients - the first one in whom the wrist joint was positioned in such a manner that it counteracts the direction of angulation of fracture fragments and the second one in whom the wrist joint was in a neutral position. The two groups in each category have been compared according to age, sex, initial angulation, fracture type (isolated radius or both bone fractures), displacement type (angulation or complete dislocation) and the rate of secondary displacement. In both categories, the two groups were comparable according to age, sex, initial angulation, fracture and displacement type. In both categories (cast index below 0.9 and cast index above 0.9), a statistically significant higher portion of patients with secondary displacement was identified in the group of patients who had the wrist joint in a neutral position ( Z = -2.1997; P = 0.0278 - for cast index <0.9 and Z = -2.1672; P = 0.030216 for cast index >0.9). Our research supports the notion that positioning of the wrist joint in the position that counteracts the force that leads to angulation of fracture fragments is more important than the cast index in the prevention of secondary displacements in pediatric distal forearm fractures.
Asunto(s)
Fracturas del Radio , Fracturas del Cúbito , Fracturas de la Muñeca , Humanos , Niño , Muñeca , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/cirugía , Fracturas del Cúbito/diagnóstico por imagen , Fracturas del Cúbito/cirugía , Articulación de la Muñeca/diagnóstico por imagen , Moldes QuirúrgicosRESUMEN
AIM: To ensure a more reliable classification system for the femur neck fractures by estimating pressure and tensile force on the fracture crevice. METHODS: The study compared the kappa coefficient for the inter and intraobserver agreement of the same five observers on the same radiographic sample of the femur neck fracture with a time gap of one year for the AO group and original proposal of estimated dominant pressure and tensile force on the femur neck fracture's crevice. RESULTS: The kappa coefficient for the AO group was 0.49 and for the system for estimating the dominant force on the fracture's crevice it was 0.78. For the observer our proposal is easier to use than the AO system. CONCLUSION: The estimation system of the dominant force on the fracture's crevice is more reliable and thus more acceptable than the AO group system for femoral neck fractures.