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Pediatric Fractures—Volume II

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A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Orthopedics".

Deadline for manuscript submissions: closed (10 October 2023) | Viewed by 21988

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Special Issue Editors

Dr. Christiaan J. A. van Bergen

E-Mail Website1 Website2
Guest Editor

1. Department of Orthopaedic Surgery, Amphia, PO Box 90150, 4800 RK Breda, The Netherlands
2. Department of Orthopedic Surgery and Sports Medicine, Erasmus University Medical Center – Sophia Children’s Hospital, Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
Interests: pediatric orthopedics; fractures; trauma; cartilage; sports
Special Issues, Collections and Topics in MDPI journals

Dr. Joost W. Colaris

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Guest Editor

Department of Orthopedic Surgery and Sports Medicine, Erasmus University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
Interests: pediatric orthopedics; fractures; trauma; cartilage; sports

Special Issue Information

Dear Colleagues,

Fractures are extremely common in children. The fracture risk in boys is 40%, and is 28% in girls. Although many pediatric fractures are frequently regarded as “innocent” or “forgiving”, typical complications do occur in this precious population, including premature physeal closure and post-traumatic deformity, which may cause life-long disability.

Despite the high incidence of pediatric injuries, there is still much debate regarding the optimal treatment regimes. Although non-operative and surgical treatment techniques have developed enormously during the past several decades, current management is still more eminence-based rather than evidence-based because of the limited scientific evidence. For example, the recently developed comprehensive Dutch clinical practice guideline on the diagnosis and treatment of the most common pediatric fractures included almost solely “low” or “very low” level recommendations, based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. The only exceptions were some forearm fracture recommendations, which received “moderate” GRADEs. There is a clear lack of data and a need for higher-level science in pediatric trauma.

Considering the success and popularity of the previous Special Issue, “Pediatric Fractures”, published in the journal Children (https://0-www-mdpi-com.brum.beds.ac.uk/journal/children/special_issues/pediatric_fractures), we are now releasing a second Issue aiming to gather original research papers and review articles related to pediatric fractures, including the diagnosis, treatment, or follow-up of common fractures. Authors are also encouraged to submit papers on specific pediatric injuries, as well as vulnerable populations such as children with bone disease. We also welcome articles that discuss important advancements and novel interventions on closely related topics, including high-energy trauma, perioperative care, and complication management.

Dr. Christiaan J. A. van Bergen
Dr. Joost W. Colaris
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

pediatric orthopedics
fracture
trauma
injury
children
adolescents

Published Papers (12 papers)

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Research

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9 pages, 4778 KiB

Open AccessArticle

Pediatric Elbow Dislocations and Associated Fractures

by Laura Lewallen, Marilyn E. Elliott, Amy McIntosh and Christine A. Ho

Children 2023, 10(6), 993; https://0-doi-org.brum.beds.ac.uk/10.3390/children10060993 - 01 Jun 2023

Cited by 1 | Viewed by 1426

Abstract

The objective was to evaluate pediatric patients with acute elbow dislocation and/or associated fracture to determine which were indicated for surgical intervention, using a single institution, Institutional Review Board (IRB) approved retrospective review of patients who presented to the Emergency Department (ED) with an acute elbow dislocation. Inclusion criteria were age ≤ 18 years, acute elbow dislocation injury, and appropriate imaging. A total of 117 patients were included 37 had a simple elbow dislocation, 80 had an associated fracture (medial epicondyle 59, lateral condyle 9, radial head/neck 7, other 5). A total of 62% (73/117) were male. The average age was 10.3 years (range 4–17). Mechanisms of injury included: falls from height/playground equipment (46), trampoline (14), and sports (57). All 37 patients with a simple elbow dislocation were successfully treated with closed reduction. Of the 80 patients with an associated fracture, 30 (38%) went on to open reduction internal fixation (ORIF). A total of 59 patients had an associated medial epicondyle fracture; 24 (41%) of whom went on to ORIF. Nine patients had an associated lateral condyle fracture, five (56%) of whom went on to ORIF. Patients with a simple elbow dislocation can be successfully treated with a closed reduction in the ED. However, 30/80 patients with an associated fracture (medial epicondyle, lateral condyle, or radial neck) required operative management. Full article

(This article belongs to the Special Issue Pediatric Fractures—Volume II)

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12 pages, 1063 KiB

Open AccessArticle

Clinical Patterns and Treatment of Pediatric Facial Fractures: A 10-Year Retrospective Romanian Study

by Raluca Iulia Juncar, Abel Emanuel Moca, Mihai Juncar, Rahela Tabita Moca and Paul Andrei Țenț

Children 2023, 10(5), 800; https://0-doi-org.brum.beds.ac.uk/10.3390/children10050800 - 28 Apr 2023

Cited by 1 | Viewed by 1161

Abstract

Pediatric facial fractures have different clinical patterns and require different therapeutic approaches in comparison with those of facial fractures that occur among adults. The aim of this study was to describe the main clinical characteristics of pediatric facial fractures (such as fracture location, fracture pattern, treatment, complications and evolution) in a group of pediatric patients from NW Romania. This research was a retrospective study that was conducted for 10 years in a tertiary hospital for oral and maxillofacial surgery from NW Romania. A total of 142 pediatric patients were included in this study, with ages between 0 and 18 years. Mandibular (66.2%), midface (25.4%) and combined fractures (8.5%) were identified, and patients from the 13–18 years age group were more frequently affected by facial fractures (78.9%). Most of the diagnosed fractures among all three types of fractures were total fractures, and most mandibular (92.6%) and midface (80.6%) fractures were without displacement. Hematomas, lacerations and abrasions were identified as associated lesions. Patients with associated lesions were more frequently associated with combined fractures or midface fractures than mandibular fractures. The instituted treatment was, in general, orthopedic, for all three types of fractures (mandibular—86.2%; midface—91.7%; combined—66.7%). Most fractures, mandibular (96.8%), midface (100%) and combined (91.7%) fractures, had a favorable evolution. Most fractures did not present any complications at the follow-up. Pediatric facial fractures have unique patterns and must be treated with caution, considering the particularities of pediatric facial anatomy. Full article

(This article belongs to the Special Issue Pediatric Fractures—Volume II)

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9 pages, 1607 KiB

Open AccessArticle

Extra Lateral Pin or Less Radiation? A Comparison of Two Different Pin Configurations in the Treatment of Supracondylar Humerus Fracture

by Özgür Kaya, Batuhan Gencer, Ahmet Çulcu and Özgür Doğan

Children 2023, 10(3), 550; https://0-doi-org.brum.beds.ac.uk/10.3390/children10030550 - 14 Mar 2023

Cited by 1 | Viewed by 1069

Abstract

Background: Closed reduction and percutaneous fixation are the most commonly used methods in the surgical treatment of supracondylar humerus fractures. The pin configuration changes stability and is still controversial. The aim of this study was to investigate the relationship between surgical duration and radiation dose/duration for different pinning fixations. Methods: A total of 48 patients with Gartland type 2, 3, and 4 supracondylar fractures of the humerus were randomized into two groups—2 lateral and 1 medial (2L1M) pin fixation (n = 26) and 1 lateral 1 medial (1L1M) pin fixation (n = 22). A primary assessment was performed regarding surgical duration, radiation duration, and radiation dose. A secondary assessment included clinical outcome, passive range of motion, radiographic measurements, Flynn’s criteria, and complications. Results: There were 26 patients in the first group (2L1M) and 22 patients in the second group (1L1M). There was no statistical difference between the groups regarding age, sex, type of fracture, or Flynn’s criteria. The overall mean surgical duration with 1L1M fixation (30.59 ± 8.72) was statistically lower (p = 0.001) when compared to the 2L1M Kirschner wire K-wire fixation (40.61 ± 8.25). The mean radiation duration was 0.76 ± 0.33 s in the 1L1M K-wire fixation and 1.68 ± 0.55 s in the 2L1M K-wire fixation. The mean radiation dose of the 2L1M K-wire fixation (2.45 ± 1.15 mGy) was higher than that of the 1L1M K-wire fixation (0.55 ± 0.43 mGy) (p = 0.000). Conclusions: The current study shows that although there is no difference between the clinical and radiological outcomes, radiation dose exposure is significantly lower for the 1L1M fixation method. Full article

(This article belongs to the Special Issue Pediatric Fractures—Volume II)

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12 pages, 3930 KiB

Open AccessArticle

Treatment of Refractory Congenital Pseudoarthrosis of Tibia with Contralateral Vascularized Fibular Bone Graft and Anatomic Distal Tibial Locking Plate: A Case Series and Literature Review

by Te-Feng Arthur Chou, Ting-Yu Liu, Matthew N. Wang and Chen-Yuan Yang

Children 2023, 10(3), 503; https://0-doi-org.brum.beds.ac.uk/10.3390/children10030503 - 03 Mar 2023

Viewed by 3084

Abstract

Background: Congenital pseudoarthrosis of the tibia (CPT) remains a challenge for physicians. Several treatment options have been proposed, but the standard of care remains inconclusive. In this study, we present three patients for whom the failure of prior treatments was managed with a contralateral vascularized fibular bone graft (VFG) and an anatomic distal tibial locking plate. Methods: Between 2017 and 2021, three patients were referred for failed treatment of CPT. All patients had undergone multiple prior surgeries, including tumor excision and fixation with ring external fixators, plates, and screws. We performed radical tumor resection and reconstruction of bone defects with a VFG. The construct was fixed with an anatomic locking plate, and the patients were followed up for a mean of 45.7 months. Results: All three patients were able to obtain graft union at 19.3 weeks. At the final follow-up, all grafts achieved bony hypertrophy without evidence of bone resorption or local tumor recurrence. There was a mean leg length difference of 8.5 cm preoperatively, compared with 6.3 cm postoperatively. The average lower leg angulation was 7.4 degrees and the average ankle range of motion was 58.3 degrees. The mean VAS score was 0 and the mean AOFAS score was 88.3. No significant complications were noted. Conclusions: Implantation of a VFG and an anatomic distal tibia locking plate can be considered an option for treatment-refractory CPT. Patients can expect to achieve bone consolidation, ambulate as tolerated, and have a low complication rate. Full article

(This article belongs to the Special Issue Pediatric Fractures—Volume II)

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10 pages, 2768 KiB

Open AccessArticle

Accuracy of 3D Corrective Osteotomy for Pediatric Malunited Both-Bone Forearm Fractures

by Kasper Roth, Eline van Es, Gerald Kraan, Denise Eygendaal, Joost Colaris and Filip Stockmans

Children 2023, 10(1), 21; https://0-doi-org.brum.beds.ac.uk/10.3390/children10010021 - 23 Dec 2022

Cited by 1 | Viewed by 1604

Abstract

Re-displacement of a pediatric diaphyseal forearm fracture can lead to a malunion with symptomatic impairment in forearm rotation, which may require a corrective osteotomy. Corrective osteotomy with two-dimensional (2D) radiographic planning for malunited pediatric forearm fractures can be a complex procedure due to multiplanar deformities. Three-dimensional (3D) corrective osteotomy can aid the surgeon in planning and obtaining a more accurate correction and better forearm rotation. This prospective study aimed to assess the accuracy of correction after 3D corrective osteotomy for pediatric forearm malunion and if anatomic correction influences the functional outcome. Our primary outcome measures were the residual maximum deformity angle (MDA) and malrotation after 3D corrective osteotomy. Post-operative MDA > 5° or residual malrotation > 15° were defined as non-anatomic corrections. Our secondary outcome measure was the gain in pro-supination. Between 2016–2018, fifteen patients underwent 3D corrective osteotomies for pediatric malunited diaphyseal both-bone fractures. Three-dimensional corrective osteotomies provided anatomic correction in 10 out of 15 patients. Anatomic corrections resulted in a greater gain in pro-supination than non-anatomic corrections: 70° versus 46° (p = 0.04, ANOVA). Residual malrotation of the radius was associated with inferior gain in pro-supination (p = 0.03, multi-variate linear regression). Three-dimensional corrective osteotomy for pediatric forearm malunion reliably provided an accurate correction, which led to a close-to-normal forearm rotation. Non-anatomic correction, especially residual malrotation of the radius, leads to inferior functional outcomes. Full article

(This article belongs to the Special Issue Pediatric Fractures—Volume II)

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10 pages, 3568 KiB

Open AccessArticle

Stabilisation of Pathologic Proximal Femoral Fracture near the Growth Plate with Use of a Locking Plate and Transphyseal Screws

by Roman Michalik, Frank Hildebrand and Heide Delbrück

Children 2022, 9(12), 1932; https://0-doi-org.brum.beds.ac.uk/10.3390/children9121932 - 09 Dec 2022

Viewed by 1409

Abstract

Aneurysmal bone cyst (ABC) is a benign osseus lesion with a high pathologic fracture risk. The described treatment options are varied and inconsistent. For successful treatment results, it is essential to prevent recurrence and sufficiently stabilise the weakened bone. Lesions close to the growth plates, especially in the femoral neck region, are challenging to stabilise in children. In this study, 27 clinics, including 11 sarcoma centres, 15 paediatric orthopaedic clinics, and one sarcoma/paediatric orthopaedic centre, were surveyed and asked about their treatment approaches for an exemplary case of ABC in the femoral neck causing a pathological fracture in a 20-month-old infant, with a response rate of 81%. The heterogeneity of treatment options described in the literature is consistent with the survey results. The most favoured approach was curettage, defect filling of any kind, and surgical stabilisation. However, the lesion stabilisation option introduced in this paper, which involves the use of transphyseal screws, was not mentioned in the survey and has not been reported in the literature. Contrary to the existing concepts, our technique offers high stability without significant growth restriction. Transphyseal screws are also suitable for the treatment of femoral neck fractures of other aetiologies in children. Full article

(This article belongs to the Special Issue Pediatric Fractures—Volume II)

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Review

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28 pages, 2701 KiB

Open AccessReview

Tibial Spine Avulsion Fractures in Paediatric Patients: A Systematic Review and Meta-Analysis of Surgical Management

by Mehak Chandanani, Raian Jaibaji, Monketh Jaibaji and Andrea Volpin

Children 2024, 11(3), 345; https://0-doi-org.brum.beds.ac.uk/10.3390/children11030345 - 14 Mar 2024

Viewed by 811

Abstract

Background: Tibial spine avulsion fractures (TSAFs) account for approximately 14% of anterior cruciate ligament injuries. This study aims to systematically review the current evidence for the operative management of paediatric TSAFs. Methods: A search was carried out across four databases: MEDLINE, Embase, Scopus, and Google Scholar. Studies discussing the outcomes of the surgical management of paediatric TSAFs since 2000 were included. Results: Of 38 studies included for review, 13 studies reported outcomes of TSAF patients undergoing screw fixation only, and 12 studies used suture fixation only. In total, 976 patients underwent arthroscopic reduction and internal fixation (ARIF), and 203 patients underwent open reduction and internal fixation (ORIF). The risk of arthrofibrosis with the use of ARIF (p = 0.45) and screws (p = 0.74) for TSAF repair was not significant. There was a significantly increased risk of knee instability (p < 0.0001), reoperation (p = 0.01), and post-operative pain (p = 0.007) with screw fixation compared to sutures. Conclusions: While the overall benefits of sutures over screws and ARIF over ORIF are unclear, there is clear preference for ARIF and suture fixation for TSAF repair in practice. We recommend large-scale comparative studies to delineate long-term outcomes for various TSAF fixation techniques. Full article

(This article belongs to the Special Issue Pediatric Fractures—Volume II)

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12 pages, 6518 KiB

Open AccessReview

Lateral Humeral Condyle Fractures in Pediatric Patients

by Tim F. F. Saris, Denise Eygendaal, Bertram The, Joost W. Colaris and Christiaan J. A. van Bergen

Children 2023, 10(6), 1033; https://0-doi-org.brum.beds.ac.uk/10.3390/children10061033 - 08 Jun 2023

Cited by 2 | Viewed by 2336

Abstract

Lateral humeral condyle fractures are frequently seen in pediatric patients and have a high risk of unfavorable outcomes. A fall on the outstretched arm with supination of the forearm is the most common trauma mechanism. A physical examination combined with additional imaging will confirm the diagnosis. Several classifications have been described to categorize these fractures based on location and comminution. Treatment options depend on the severity of the fracture and consist of immobilization in a cast, closed reduction with percutaneous fixation, and open reduction with fixation. These fractures can lead to notable complications such as lateral condyle overgrowth, surgical site infection, pin tract infections, stiffness resulting in decreased range of motion, cubitus valgus deformities, ‘fishtail’ deformities, malunion, non-union, avascular necrosis, and premature epiphyseal fusion. Adequate follow-up is therefore warranted. Full article

(This article belongs to the Special Issue Pediatric Fractures—Volume II)

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18 pages, 3036 KiB

Open AccessReview

Indications and Timing of Guided Growth Techniques for Pediatric Upper Extremity Deformities: A Literature Review

by Mark F. Siemensma, Christiaan J.A. van Bergen, Eline M. van Es, Joost W. Colaris and Denise Eygendaal

Children 2023, 10(2), 195; https://0-doi-org.brum.beds.ac.uk/10.3390/children10020195 - 20 Jan 2023

Cited by 1 | Viewed by 3477

Abstract

Osseous deformities in children arise due to progressive angular growth or complete physeal arrest. Clinical and radiological alignment measurements help to provide an impression of the deformity, which can be corrected using guided growth techniques. However, little is known about timing and techniques for the upper extremity. Treatment options for deformity correction include monitoring of the deformity, (hemi-)epiphysiodesis, physeal bar resection, and correction osteotomy. Treatment is dependent on the extent and location of the deformity, physeal involvement, presence of a physeal bar, patient age, and predicted length inequality at skeletal maturity. An accurate estimation of the projected limb or bone length inequality is crucial for optimal timing of the intervention. The Paley multiplier method remains the most accurate and simple method for calculating limb growth. While the multiplier method is accurate for calculating growth prior to the growth spurt, measuring peak height velocity (PHV) is superior to chronological age after the onset of the growth spurt. PHV is closely related to skeletal age in children. The Sauvegrain method of skeletal age assessment using elbow radiographs is possibly a simpler and more reliable method than the method by Greulich and Pyle using hand radiographs. PHV-derived multipliers need to be developed for the Sauvegrain method for a more accurate calculation of limb growth during the growth spurt. This paper provides a review of the current literature on the clinical and radiological evaluation of normal upper extremity alignment and aims to provide state-of-the-art directions on deformity evaluation, treatment options, and optimal timing of these options during growth. Full article

(This article belongs to the Special Issue Pediatric Fractures—Volume II)

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11 pages, 1730 KiB

Open AccessReview

Fracture through Pre-Existing Tarsal Coalition: A Narrative Review

by Albert T. Anastasio, Emily M. Peairs, Caitlin Grant, Billy I. Kim, Anthony Duruewuru and Samuel B. Adams

Children 2023, 10(1), 72; https://0-doi-org.brum.beds.ac.uk/10.3390/children10010072 - 29 Dec 2022

Cited by 2 | Viewed by 1635

Abstract

Tarsal coalitions are abnormal fibrous or bony connections between the tarsal bones of the foot. While not always symptomatic, coalitions can cause pain, alterations in forefoot and hindfoot morphology, and alterations in foot and ankle biomechanics. Previous research has described the association of tarsal coalitions with fractures of the lower extremity. Multiple reports of acute fracture in the presence of tarsal coalition have been presented, as have reports of stress fractures of the foot and ankle with concomitant coalition, insidious in onset and thought to be related to aberrancies in foot and ankle biomechanics. The purpose of this review is to discuss the biomechanics seen in tarsal coalitions and to describe reports of fracture occurring concomitantly with tarsal coalitions. We will discuss diagnostic options and treatment approaches in the setting of fracture with preexisting tarsal coalition. Full article

(This article belongs to the Special Issue Pediatric Fractures—Volume II)

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Other

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13 pages, 2790 KiB

Open AccessSystematic Review

A Systematic Review and Meta-Analysis on the Management and Outcome of Isolated Skull Fractures in Pediatric Patients

by Lucca B. Palavani, Raphael Bertani, Leonardo de Barros Oliveira, Sávio Batista, Gabriel Verly, Filipi Fim Andreão, Marcio Yuri Ferreira and Wellingson Silva Paiva

Children 2023, 10(12), 1913; https://0-doi-org.brum.beds.ac.uk/10.3390/children10121913 - 12 Dec 2023

Cited by 1 | Viewed by 1068

Abstract

Background: The impact of traumatic brain injury (TBI) on the pediatric population is profound. The aim of this study is to unveil the state of the evidence concerning acute neurosurgical intervention, hospitalizations after injury, and neuroimaging in isolated skull fractures (ISF). Materials and Methods: This systematic review was conducted in accordance with PRISMA guidelines. PubMed, Cochrane, Web of Science, and Embase were searched for papers until April 2023. Only ISF cases diagnosed via computed tomography were considered. Results: A total of 10,350 skull fractures from 25 studies were included, of which 7228 were ISF. For the need of acute neurosurgical intervention, the meta-analysis showed a risk of 0% (95% CI: 0–0%). For hospitalization after injury the calculated risk was 78% (95% CI: 66–89%). Finally, for the requirement of repeated neuroimaging the analysis revealed a rate of 7% (95% CI: 0–15%). No deaths were reported in any of the 25 studies. Conclusions: Out of 7228 children with ISF, an almost negligible number required immediate neurosurgical interventions, yet a significant 74% were hospitalized for up to 72 h. Notably, the mortality was zero, and repeat neuroimaging was uncommon. This research is crucial in shedding light on the outcomes and implications of pediatric TBIs concerning ISFs. Full article

(This article belongs to the Special Issue Pediatric Fractures—Volume II)

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11 pages, 976 KiB

Open AccessSystematic Review

Management of Traumatic Nerve Palsies in Paediatric Supracondylar Humerus Fractures: A Systematic Review

by Christy Graff, George Dennis Dounas, Maya Rani Louise Chandra Todd, Jonghoo Sung and Medhir Kumawat

Children 2023, 10(12), 1862; https://0-doi-org.brum.beds.ac.uk/10.3390/children10121862 - 27 Nov 2023

Viewed by 1156

Abstract

Purpose: Up to 12% of paediatric supracondylar humerus fractures (SCHFs) have an associated traumatic nerve injury. This review aims to summarize the evidence and guide clinicians regarding the timing of investigations and/or surgical interventions for traumatic nerve palsies after this injury. Methods: A formal systematic review was undertaken in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews and PRISMA guidelines. Manuscripts were reviewed by independent reviewers against the inclusion and exclusion criteria, and data extraction, synthesis, and assessment for methodological quality were undertaken. Results: A total of 51 manuscripts were included in the final evaluation, reporting on a total of 510 traumatic nerve palsies in paediatric SCHFs. In this study, 376 nerve palsies recovered without any investigation or intervention over an average time of 19.5 weeks. Comparatively, 37 went back to theatre for exploration beyond the initial treatment due to persistent deficits, at an average time of 4 months. The most common finding at the time of exploration was entrapment of the nerve requiring neurolysis. A total of 27 cases did not achieve full recovery regardless of management. Of the 15 reports of nerve laceration secondary to paediatric SCHFs, 13 were the radial nerve. Conclusions: Most paediatric patients who sustain a SCHF with associated traumatic nerve injury will have full recovery. Delayed or no recovery of the nerve palsy should be considered for exploration within four months of the injury; earlier exploration should be considered for radial nerve palsies. Full article

(This article belongs to the Special Issue Pediatric Fractures—Volume II)

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