1
|
Langlais T, Louis E, Badina A, Vialle R, Pannier S, Le Hanneur M, Fitoussi F. "Unhappy triad" of the trauma elbow in children: Diagnosis, classification, and mid-term outcomes. J Child Orthop 2023; 17:581-589. [PMID: 38050602 PMCID: PMC10693846 DOI: 10.1177/18632521231211643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
Background The aim of this study was to describe the epidemiology, physiopathology, and outcomes of elbow "unhappy triad" trauma in children, combining a posterior dislocation, a proximal radius fracture, and a third lesion (i.e. bony or capsuloligamentous injury). Methods A retrospective bicentric study was conducted between 1999 and 2020. All skeletally immature children who presented to the emergency department and underwent surgery for a proximal radius injury were selected. Among this selection, only patients with two associated ipsilateral elbow injuries (i.e. posterior elbow dislocation and a bony and/or capsuloligamentous injury) were included. Active elbow ranges of motion, Mayo Elbow Performance Score and Quick-Disabilities Of The Arm, Shoulder And Hand scores and standard radiographs were recorded at last follow-up. Results Twenty-one patients met the inclusion criteria (mean age at surgery = 11.4 years) among 737 selected. The "unhappy triad" diagnosis was made preoperatively in nine cases (bone lesion only), intraoperatively in nine cases, and postoperatively in one case. The third lesions were surgically treated when the lesion was a bony fracture or if the elbow remains unstable between 60° and 90° of flexion (i.e. capsuloligamentous injury). Twenty patients were reviewed (mean follow-up = 5.8 years). The complications and re-operations rates were of 10%. Conclusion The "unhappy" triad of the child's elbow is a rare injury, where the preoperative diagnosis is frequently missed and lead to 10% of complications and re-operations. Level of evidence level III.
Collapse
Affiliation(s)
- Tristan Langlais
- Department of Pediatric Orthopedics, Purpan Children Hospital, Toulouse University, Toulouse, France
- Department of Pediatric Orthopedics, Necker Hospital, Paris Cité University, Paris, France
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Emmanuelle Louis
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Alina Badina
- Department of Pediatric Orthopedics, Necker Hospital, Paris Cité University, Paris, France
| | - Raphael Vialle
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Stéphanie Pannier
- Department of Pediatric Orthopedics, Necker Hospital, Paris Cité University, Paris, France
| | - Malo Le Hanneur
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France
- Hand to Shoulder Mediterranean Center, ELSAN, Clinique Bouchard, Marseille, France
| | - Franck Fitoussi
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| |
Collapse
|
2
|
Pincin A, Tourtoulou C, Pfirrmann C, Lalioui A, Savidan P, Lefevre Y, Harper L, Angelliaume A. Elbow dislocation with and without an associated fracture in children: A prospective study of functional outcomes following 3 weeks of immobilization. Orthop Traumatol Surg Res 2022:103538. [PMID: 36587761 DOI: 10.1016/j.otsr.2022.103538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/06/2022] [Accepted: 07/29/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The initial management of elbow dislocations in children, emergency reduction and brachial-antebrachial-palmar (BABP) immobilization, remains the most widely used method. Osteosynthesis could be associated in case of fractures. On the other hand, there is no consensus on the duration of immobilization in the recent literature. The objective of this study was to describe the medium-term functional results of a prospective cohort of children presenting with an elbow dislocation immobilized for 3 weeks, with or without an associated fracture. The hypothesis of this study was that 3 weeks of immobilization was sufficient and made it possible to obtain a satisfactory, rapid functional recovery without residual instability. MATERIAL AND METHOD All children with an elbow dislocation with or without an associated fracture were included. The dislocation was urgently reduced and subsequent surgery could be indicated in the event of associated injuries. All the children had 3 weeks of immobilization with a BABP cast. Radiological and clinical follow-up was carried out for 2 years. The parameters evaluated were: 3 functional scores and the range of motion (ROM) of the elbow. Clinical or radiological complications were sought. RESULTS A total of 50 children were included, the mean age was 10.6 years (± 2.6). Functional score results were "good' or "excellent' at 3 months of follow-up, "excellent' at 6 months and thereafter. The mean limitation in ROM at the last follow-up was 4.7° (± 7.2°) with all ranges combined. Eighty-two percent of children had a mean limitation in ROM of less than 10°. None of the children presented with a recurrence of elbow dislocation and instability. CONCLUSION Immobilization of elbow dislocations for 3 weeks in children confers good medium-term functional results without exposing them to the risk of instability, whether or not the dislocation is associated with a fracture. LEVEL OF EVIDENCE II; Prospective cohort study.
Collapse
Affiliation(s)
- Antony Pincin
- University Hospital of Bordeaux, Pediatric Orthopaedics, Place Amelie Raba-Leon, 33076 Bordeaux, France
| | - César Tourtoulou
- University Hospital of Bordeaux, Pediatric Orthopaedics, Place Amelie Raba-Leon, 33076 Bordeaux, France
| | - Clémence Pfirrmann
- University Hospital of Bordeaux, Pediatric Orthopaedics, Place Amelie Raba-Leon, 33076 Bordeaux, France
| | - Abdelfetah Lalioui
- University Hospital of Bordeaux, Pediatric Orthopaedics, Place Amelie Raba-Leon, 33076 Bordeaux, France
| | - Pauline Savidan
- University Hospital of Bordeaux, Pediatric Orthopaedics, Place Amelie Raba-Leon, 33076 Bordeaux, France
| | - Yan Lefevre
- University Hospital of Bordeaux, Pediatric Orthopaedics, Place Amelie Raba-Leon, 33076 Bordeaux, France
| | - Luke Harper
- University Hospital of Bordeaux, Pediatric Orthopaedics, Place Amelie Raba-Leon, 33076 Bordeaux, France
| | - Audrey Angelliaume
- University Hospital of Bordeaux, Pediatric Orthopaedics, Place Amelie Raba-Leon, 33076 Bordeaux, France.
| |
Collapse
|
3
|
Topalis C, Kenanidis E, Konstantinidis CI, Potoupnis ME, Tsiridis E. A Rare Case of Traumatic Bilateral Elbow Dislocation Without a Fracture in a Seven-Year-Old Female Child. Cureus 2021; 13:e19459. [PMID: 34926031 PMCID: PMC8654059 DOI: 10.7759/cureus.19459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/05/2022] Open
Abstract
Pediatric bilateral elbow dislocation is an infrequent injury. This is a report of a seven-year-old girl, the youngest patient ever reported, with simultaneous isolated bilateral traumatic elbow dislocation without fracture, treated with closed reduction under sedation.
Collapse
Affiliation(s)
- Christos Topalis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC.,3rd Orthopaedic Department, Center of Orthopaedic and Regenerative Medicine, Center of Interdisciplinary Research and Innovation, Aristotle University Medical School, Thessaloniki, GRC
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC.,3rd Orthopaedic Department, Center of Orthopaedic and Regenerative Medicine, Center of Interdisciplinary Research and Innovation, Aristotle University Medical School, Thessaloniki, GRC
| | - Christos I Konstantinidis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC
| | - Michael E Potoupnis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC.,3rd Orthopaedic Department, Center of Orthopaedic and Regenerative Medicine, Center of Interdisciplinary Research and Innovation, Aristotle University Medical School, Thessaloniki, GRC
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC.,3rd Orthopaedic Department, Center of Orthopaedic and Regenerative Medicine, Center of Interdisciplinary Research and Innovation, Aristotle University Medical School, Thessaloniki, GRC
| |
Collapse
|
4
|
ICF linking of patient-reported therapy goals for children with acquired upper extremity impairment. J Hand Ther 2021; 36:74-84. [PMID: 34247881 DOI: 10.1016/j.jht.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/23/2021] [Accepted: 05/06/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patient reported outcome measures are used to evaluate hand therapy outcomes. Yet, limited evidence is available regarding the outcomes children desire from hand therapy. PURPOSE To determine the desired treatment outcomes of children with acquired upper extremity impairments. STUDY DESIGN Descriptive case series METHODS: Two raters independently applied International Classification of Function, Disability and Health (ICF) linking rules to the Canadian Occupational Performance goals of 151 children, age 6-18, receiving occupational therapy for acquired upper extremity impairments. Prevalence of the linked ICF codes was examined using frequency distributions. Kappa and the proportion of positive agreement assessed inter-rater agreement of the linked codes. RESULTS Following consensus, two independent raters linked 894 meaningful concepts to the study population's 501 goals derived from the Canadian Occupational Performance. Ninety-two unique ICF codes were linked to these 894 meaningful concepts. Twenty-three ICF codes account for 77.2% of the most frequently linked codes. For these top 23 codes, the greatest proportion (51.4%) of ICF codes are in the d4 mobility chapter representing specific constructs of hand and arm use. The second largest proportion (14.2%) of linked codes are in the d9 Community, society and civic life chapter aligning with participation in sports, music, performing arts and play. Within the d5 self-care chapter, the study population's top priorities included hair care, fitness and drinking. The primary concerns within the b body functions domain are reduced pain, improved joint mobility and strength. CONCLUSION The study population's top priorities align with specific dimensions of hand and arm use and participation in sports and fitness, performing arts, and play. Further research may elucidate alignment of these patient-desired outcomes and the item banks of commonly used patient reported outcome measurement scales in this population.
Collapse
|
5
|
García-Mata S, Arbeloa-Gutierrez L, Brun M, Sánchez-Guardamino D. Prospective study of pediatric medial humeral epicondyle fractures nonoperatively treated. Clinical, radiologic, and functional evaluation at long term. J Pediatr Orthop B 2021; 30:180-189. [PMID: 32694434 DOI: 10.1097/bpb.0000000000000775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of the study is to evaluate the natural history of the medial epicondyle avulsion in children with nonoperative treatment (NOPT) on different magnitude of displacement and long-term follow-up. A prospective study of 34 patients with medial epicondyle avulsion with (NOPT) was performed. Clinical test (stability, strength, atrophy, tenderness, Tinel test, and range of motion), subjective scores [Visual Analog Scale (VAS), Likert scale, side-to-side valgus test], and objective four scores were performed. Age at the time of injury was 8.9 ± 2.81 years. Follow-up was 7 ± 2.81 years. Four of the patients had anterior displacement. Displacement varied between 3 and 26 mm (10.49 ± 6.16 mm). Subjective: VAS and ordinal three-point Likert scale were excellent. Objective results were also excellent Mayo Elbow Score: 98.67 ± 4.31 (85-100), Oxford Elbow Score: 59.35 ± 1.68 (51-100), Elbow Assessment Score System: 96.27 ± 9.77 (57-100), Disabilities of the Arm, Shoulder, and Hand (DASH) score 0.64 ± 1.001 (0-4.16). We did not find any differences in strength or forearm diameter. There was an extension deficit in seven cases with a significant association with the magnitude of displacement (P = 0.02) and with the presence of concomitant lesions or anterior displacement of the medial epicondyle >5 mm. All except one were stable clinically on valgus stress. There is a significant association between the objective outcomes (scores) and concomitant lesions but not with regards to the DASH score P = 0.102). There is no association between the magnitude of medial epicondyle displacement or the follow-up and the objective outcomes. Instability was associated with valgus stress activities. There is no association between the magnitude of displacement of the medial epicondyle or the follow-up and the objective outcomes. NOPT produces excellent subjective and objective outcomes that worsened when there were associated lesions, anterior medial epicondyle displacement, or in patients who performed activities with repeated valgus stress. Based on our study, NOPT is suitable except for Open Reduction Internal Fixation indications: absolute indications, high energy injury with associated lesions, medial humeral epicondyle fracture in the dominant elbow in patients subject to activities with chronic valgus stress, and anterior displacement.
Collapse
Affiliation(s)
- Serafín García-Mata
- Pediatric Trauma and Orthopaedic Section, Orthopaedic Surgery and Traumatology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | | |
Collapse
|
6
|
Arthroscopic anterior capsular release for posttraumatic elbow flexion contracture in pediatric patients: a case report of two patients with treatment protocol. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
Abstract
PURPOSE OF REVIEW The management of displaced medial humeral epicondyle fractures in children remains controversial. The indications for surgery, the ideal surgical strategy and the implications of a painful nonunion remain unclear. RECENT FINDINGS This article describes the state of the evidence and the art in the management of medial humeral epicondyle fractures concentrating on recent research and current opinion. Treatment of paediatric medial epicondylar fractures of the elbow remains the domain of expert opinion and subject to great variance. Anatomical, biomechanical and computer simulation models suggest great importance should be given to the medial epicondyle and the structures, which insert onto it. However, this does not correlate with outcomes as reported by patients, parents and surgeons. SUMMARY The question of which paediatric medial humeral epicondylar fractures benefit from operative fixation remains unanswered. A large randomized prospective trial is required.
Collapse
|