Background: Supracondylar humeral fracture is probably the most common elbow fracture in children requiring surgical intervention. We observed a subtype of pediatric supracondylar humeral fracture with a sideward translation, without substantial displacement in the sagittal plane on initial radiographs. The purpose of this study was to calculate the incidence of this fracture subtype and suggest a modification to the standard operative technique, to achieve the desired fracture alignment and fixation. Methods: We reviewed the clinical records and radiographs of all pediatric patients with supracondylar humeral fractures surgically treated in our institution between the years 2006 and 2014. The fracture types, fixation configuration and any complications were recorded. Results: Overall, 263 consecutive patients were included. The incidence of supracondylar fracture of the humerus with solely sideward displacement was 6%. The fracture was characterized clinically and radiographically. We proposed a modification to the standard operative technique for this fracture subtype for successful closed reduction and percutaneous pinning. Conclusions: Special attention to this fracture subtype, including appropriate operating room setup and the application of a suitable reduction and pinning technique, has the potential to achieve successful results and avoid the need for open reduction.

Background: Femoral torsional malalignment is a common cause of in-toeing and out-toeing in children, often leading to gait disturbances, functional limitations, and increased risk of falls. Traditionally, osteotomy was the only surgical option for correction. A minimally invasive technique known as rotational guided growth (RGG) has recently been introduced to address these malalignments. This study aims to assess the effectiveness of rotational femoral malalignment correction by rotational epiphysiodesis with tension band 8-plates (Orthofix, Verona, Italy). Methods: Eleven patients with in-toeing and out-toeing (19 femurs) were treated using RGG with 8-plates. The 8-plates were applied laterally and medially, with screws placed above and below the growth plate of the distal femur, angled obliquely to the long axis of the bone in opposite directions. Changes in foot progression angle (FPA), femoral version, the alteration in the angle between the 8-plates, and the rate of correction were recorded. Results: All patients reported functional gait improvement. The FPA was corrected from a mean of 32 degrees to 7 degrees, the femoral version improved from a mean of 60 degrees to 22 degrees. The angle between the 8-plates changed from a mean of 75 degrees to 28 degrees, with a correction rate of 4.1 degrees per month. The average time for correction was 11 months. No complications were observed during the treatment. Conclusions: RGG using 8-plates is a novel, minimally invasive surgical technique that effectively corrects rotational femoral deformities and may serve as a preferred alternative to derotational osteotomy in growing patients.

Introduction: The optimal surgical strategy for symptomatic tarsal coalition in pediatric patients remains debated. This study assessed the clinical and radiographic outcomes of addressing symptomatic talocalcaneal coalition through a combination of coalition resection and calcaneal lengthening osteotomy. Materials and methods: We retrospectively reviewed cases of 10 children (11 feet) with symptomatic talocalcaneal tarsal coalition and painful flat feet who were treated between 2017 and 2019. All underwent calcaneal lengthening osteotomy (CLO) and coalition resection (RC). In half of the cases, the Achilles tendon was lengthened, and two children underwent medial plication. We analyzed demographic, clinical, and radiographic data, including CT scans for coalition confirmation and joint evaluations. Pre- and postoperative radiographic measurements and American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score assessed outcomes. Results: The cohort, averaging 13.9 years at surgery, showed significant deformity correction. At follow-up (mean 54 months), six children were pain-free, and four experienced mild pain after intense activities. AOFAS scores were excellent or good. Complications included one superficial infection and mild forefoot supination in two children. No additional surgeries were needed. Conclusion: Resection of talocalcaneal coalition combined with CLO effectively corrects rigid flat foot and alleviates pain, providing reliable outcomes in symptomatic cases.

This study aimed to assess the clinical efficacy of C-arm computed tomography (CT) for radiographic visualization in operating room settings for the treatment of pediatric patients with developmental acetabular dysplasia and hip dislocation. We included in our retrospective study all cases of dislocated hips in which an intraoperative C-arm CT was performed to evaluate hip reduction and maintenance following spica cast application between the years 2018 and 2022. We compared the radiation dose to children who were evaluated using standard diagnostic multislice postreduction CT scans. C-arm CT was used in 12 patients with developmental hip dysplasia and hip dislocation. Two patients (15.38%) required immediate repeated closed reduction and spica cast reapplication because of failure of concentric femoral head reduction maintenance. Final C-arm CT demonstrated successful attainment of concentric femoral head reduction and maintenance. The intraoperative C-arm CT registered an average radiation dose of 49.1 vs. 124.4 mGy when postoperative standard diagnostic multislice postreduction CT scans were done (P < 0.004). The use of C-arm CT in the treatment of developmental dysplasia of the hip has proven to be effective and efficient. It offers new possibilities that can potentially improve patient outcomes in the management of hip dysplasia. Level of evidence: Level IV – case series.

Our study aimed to assess the clinical and radiographic outcomes of symptomatic tarsal coalition resection in combination with arthroereisis.

Background Femoral fractures are the most common type of injury requiring hospitalization in children. Treatment for femoral shaft fractures (FSFs) in children under six years old using closed reduction and spica cast (SC) application is a widely accepted method. In our institution, we offer the option of titanium elastic nail (TEN) fixation to parents of children under five years old. This study aimed to compare the results of SC treatment and TEN fixation in children under five years of age diagnosed with FSFs. Methodology We retrospectively reviewed medical records of all children under the age of five who had FSF treated at our institution and were managed with either an SC (28 children) or TEN fixation (26 children) between 2016 and 2022. The parents made the choice of treatment following discussions with the surgical team. In our analysis, the primary outcomes focused on radiological fracture healing and alignment, time until ambulation and limb mobilization, and complications. Additionally, we compared epidemiological data, hospitalization course, caregiver satisfaction, and follow-up duration between the two groups. Results No statistically significant differences were observed in time until fracture management or duration of anesthesia between the two groups. However, in the TEN group, short-term clinical and radiological outcomes were superior (coronal angulation: 0.92° vs. 5.9°, p = 0.0018; sagittal angulation: 0.42° vs. 7.82°, p = 0.0005; femoral shortening: 0.12 vs. 1.87 cm, p < 0.0001), although the time until ambulation was longer (5.9 vs. 4.75 weeks, p < 0.0001). Caregiver satisfaction was also higher in this group (p < 0.005). Conversely, children treated with TEN fixation more frequently required strong analgesic prescriptions (90% vs. 42%, p = 0.01), underwent more radiographs (during surgery: 6.73 vs. 3.61, p < 0.0001; during follow-up- 6.42 vs. 4.3, p = 0.003), had longer-lasting follow-up (7.9 vs. 3.2 weeks, p = 0.003), had an extended hospitalization (1.8 vs. 1.2 days, p = 0.004), and needed additional procedures for TEN removal. Both methods exhibited a low complication rate. Conclusions Titanium elastic nailing can be considered a viable treatment option for FSF in children aged two to five years, offering favorable clinical and radiological outcomes, enhanced caregiver satisfaction, and a low incidence of complications.