Aim Distal radius/forearm fractures in adolescent patients remain challenging injuries to treat. Distal radius/forearm bony anatomy is not completely restored with intramedullary K wire fixation. The aim of this study was to compare radiographic and functional outcomes obtained using intramedullary K wire fixation and open reduction and internal fixation in the treatment of distal radius/forearm fracture.Methods A total of 43 patients who presented with distal radius/forearm fractures were enrolled and divided into two groups: 23patients treated with K-wire (IMNK) and 20 patients treated with plate and screws (ORIF). The evaluation criteria were: fracture healing time, objective quality of life measured by the Mayo wrist score (MWS) and quick disabilities of the arm, shoulder and hand score (QuickDash), length time of surgery, complications, sport or play return, forearm visual analogic pain (FVAS), bone healing by radius union scoring system (RUSS).Results In both groups the results obtained were comparable in terms of functional, pain and return to play/sport after the thirdmonth after surgery. Bone healing was faster in IMNK than ORIF but without significance (p>0.05). There was less complication in ORIF than IMNK (p<0.05).Conclusion The treatment of adolescent distal radius or forearm fractures remains challenging. One challenge facing the physicianis the choice of surgical technique and fixation method, which will be influenced by individual experience and preference.The question of distal radius or forearm fractures in adolescents would be best answered with a prospective randomized study.

Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2–13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14–44). Three patients died after a mean of 19.3 months postoperatively—two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%. 3D prostheses may yield biological advantages due to possible integration with the host bone and also through the use of vascularized flaps. Further research is warranted.

This study presents the mid-term outcomes of a novel “biological prosthesis” for pediatric humerus reconstruction after major bone tumor removal. This approach involves a hollow 3D-printed titanium custom-made prosthesis combined with bone grafting. The primary aim was to preserve and revitalize the unaffected autologous proximal or distal humeral stump. Between 2017 and 2021, we treated five pediatric patients (mean age 11.2 years; range 7–17) with humeral bone sarcomas. A one-stage surgical procedure involved tumor resection and implanting a hollow 3D-printed custom-made prosthesis. In two cases, we preserved the proximal humerus; in two, the distal part; and in one, both. Graft materials included homologous bone chips in three cases and free vascularized fibular grafts in two cases. All patients were clinically and radiographically assessed after a mean follow-up of 32.2 months (range of 14–68). No significant complications were observed, and no implant revisions were needed. Osseointegration was evident in all cases within eight months post-surgery; vascular support for the remaining autologous stump was demonstrated in all cases. Our hollow 3D-printed custom-made prosthesis and bone grafting offer the potential for partial or complete articular surface preservation. This approach encourages revascularization of the epiphysis, leading to satisfactory outcomes in humerus reconstruction within the pediatric population.

Background: Flexion-type supracondylar humerus fractures are rare, highly unstable, and often associated with technical challenges. Current literature is limited to small series, and no standardized diagnostic-therapeutic guidelines have been established. Methods: This retrospective study includes 47 patients with Gartland type II or III flexion-type supracondylar fractures surgically treated between September 2012 and October 2023. Demographic, clinical, radiographic, and functional data were collected to evaluate outcomes after closed or open reduction with percutaneous pinning. Univariate and multivariate model testing were used to analyze associations between fracture severity, surgical timing, rotational or translational deformities, and the need for open reduction and functional outcomes. Results: No major complications occurred. In the multivariate analysis, translational deformity emerged as the sole independent predictor of open reduction ( P =0.017). While the Gartland classification and rotational deformities correlated with the need for open surgery in univariate analysis, they were not significant in the final model. Surgical delay beyond 48 hours was not associated with open reduction ( P =0.751) or inferior functional outcomes ( P =0.327). Regarding functional results, although translational or rotational components were associated with higher QuickDASH scores in the univariate analysis ( P =0.036), this significance was not confirmed in the multivariate model. The requirement for open reduction itself was not associated with worse functional outcomes ( P =0.173). Conclusion: Translational deformity is the most significant predictor of the need for open reduction. However, complex fracture patterns do not independently result in inferior functional outcomes when appropriately managed. Our results suggest that open reduction is a safe option that does not negatively impact long-term function. It should be considered a valid alternative for unstable flexion-type fractures whenever closed reduction fails to restore anatomy. Levels of Evidence: Level IV.