We aimed to evaluate the health-related quality of life (HRQoL) in children with supracondylar humeral fractures (SCHFs), who were treated following the recommendations of the Paediatric Comprehensive AO Classification, and to assess if HRQoL was associated with AO fracture classification, or fixation with a lateral external fixator compared with closed reduction and percutaneous pinning (CRPP). We were able to follow-up on 775 patients (395 girls, 380 boys) who sustained a SCHF from 2004 to 2017. Patients completed questionnaires including the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH; primary outcome), and the Pediatric Quality of Life Inventory (PedsQL).Aims
Methods
Several studies have reported the safety and efficacy of subcapital
re-alignment for patients with slipped capital femoral epiphysis
(SCFE) using surgical dislocation of the hip and an extended retinacular
flap. Instability of the hip and dislocation as a consequence of
this surgery has only recently gained attention. We discuss this
problem with some illustrative cases. We explored the literature on the possible pathophysiological
causes and surgical steps associated with the risk of post-operative
instability and articular damage. In addition, we describe supplementary
steps that could be used to avoid these problems.Aims
Materials and Methods
The fractures of the humerus shaft and of the proximal humerus in childhood turn off less than 1% of all fractures. Healing is unproblematic, according the literature the non operative treatment is the treatment of choice. Under the influence of the ESIN (Elastic Stable Intramedullary Nailing) the readiness to operate children’s fractures has changed completely. The reasons for it are multiple. According to this trend, also is to recognize a change in the treatment of the humeral fractures in childhood obviously. The presentation on hand shall show the reasons of this paradigm change more nearly. The classic indications for the operative therapy of humeral fractures were: 3∞ open fractures, comminuted fractures, secondary complications. We have asked whether, today, this concept is still valid in Europe. The tendency towards more operative treatment becomes apparent in the documentation of children’s fractures that has started by the international working group for children’s trauma in collaboration with the AO – Doc in 1991. We think every unstable humerus fracture should be stabilized today. We posit in the rest, that if a general anaesthesia for reduction of humeral fracture is indicated, we aim at a definitive, stable and save fixation, i.e. potentially unstable fractures should be reduced in the OR. In our hands and relying on our experience we prefer to stabilize humeral fractures with ESIN.
