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Intracondylar T-type fractures of distal humerus represent a rare condition in paediatric population with unknown incidence since the literature is limited to case reports or case series. The main purpose of this article is to provide a comprehensive review of the current literature about the incidence and diagnostic modalities, as well as to evaluate all treatment options with results and complications. Review of the literature identified nine institutional reports in the period between 1984 and 2015, involving a total of 135 children and adolescents. Treatment options were open reduction with internal fixation and closed reduction in 118 and 17 cases, respectively. Open reduction was performed by different surgical approaches: triceps-sliding, triceps-splitting and olecranon osteotomy. Reported follow-up ranged from ten to 49 months. Outcomes were estimated by various tests, which are mainly based on range of motion. Patients younger than ten years generally had a better range of motion then older patients. Transient neuropathy and elbow stiffness were the most common complications, reported in 16.3% and 9.6% of cases, respectively. Despite the small number of reported clinical series, it is widely accepted that this fracture should be treated by open reduction with internal fixation to reduce and stabilise the displaced intra-articular fragments and to achieve anatomical congruity of the joint and integrity of medial and lateral columns.

Background: The purpose of this scoping review was to examine the nature and quality of research regarding paediatric supracondylar humerus (SCH) fractures in low and lower middle-income countries (LICs)., Methods: We searched PubMed, Embase, Web of Science, and African Journals Online on January 9, 2018, for studies of SCH fractures in LICs. Studies were categorized by geographic region, Gartland classification of included patients, and study design. We evaluated each study's methodology and conclusions., Results: Out of 1805 results, we analyzed 105 studies, most of which included type 3 fractures only (66%). Many were conducted in South Asia (58%) and assessed treatment outcomes (78%). Most of the studies had level IV evidence (67%). Common limitations of research were small sample size (12%) and inadequate follow-up (6%). Epidemiological studies concluded that SCH fractures are more common among male children, are usually secondary to falls, and rarely present with nerve injuries. Most therapeutic studies reported outcomes of surgery (91%). Thirteen studies concluded that all-lateral versus cross-pinning techniques have similar outcomes. Seven studies reported preference for closed reduction over open reduction, when intra-operative fluoroscopy was available. Most common outcome measures were Flynn criteria (77%) and range of motion (53%). None of the papers looked at treatment costs., Conclusions: Our data show a predominance of small level IV studies from LICs, with few studies of higher level of evidence. Many studies examined controversies with surgical technique, similar to studies performed in high-income countries. Few studies examined non-operative treatment, which is commonly the predominant treatment available for patients in LICs. Further investigation of common treatment modalities and outcomes for SCH fractures in LICs is needed.

Purpose: The purpose of this study was to record the incidence and management of periprosthetic humeral fractures (PHF) using reverse total shoulder arthroplasty (RTSA) in our institution., Methods: We performed a retrospective study of 203 RTSA implanted in 200 patients between 2003 and 2014. The mean follow-up was 78.82 months (range, 12-141). Mean age of the study cohort was 75.87 years (range, 44-88). There were only 25 male patients (12.5 %). We assessed the presence of periprosthetic humeral fractures studying the medical files and X-rays of all patients., Results: We identified seven periprosthetic humeral fractures in 203 RTSA (3.4 %): three intra-operative (1.47 %) and four post-operative (1.97 %). The average age at the time of the fracture was 75.14 years (59-83). All patients were women (100 %). Three patients with post-operative fractures type B were treated by osteosynthesis, and one patient with post-operative fracture type A was treated conservatively. All intra-operative fractures needed cerclage wire and in one case long cemented stem. All our periprosthetic fractures healed., Conclusions: Surgical treatment with osteosynthesis in type B post-operative fractures with a stable stem is recommended. Conservative treatment is sufficient in non-displaced type A post-operative fracture. Special attention should be paid to bone quality patients using non-cemented stems in primary surgery but especially in revision shoulder surgery.

Purpose: While performing CT examinations of the elbow, we frequently observed a previously undescribed fracture fragment of the supinator crest of the ulna. According to the anatomy of the lateral collateral ligament complex, this fracture might be an avulsion fracture of the annular ligament and/or the lateral ulnar collateral ligament. The aim of this study was to further characterize these fragments and document their associated injuries., Methods: Retrospective evaluation of CT scans of the elbow was performed. Conventional X-ray and CT diagnoses were used to systematically document any associated injuries., Results: A total of 152 CT scans were evaluated. The fragment in question was discovered in 17 patients (11.2%). The average age of the patients was 40 years (±14.9; 9-71 years). The fragment size varied between a few millimetres and 2.4 cm. Multifragmented fractures were observed. In 82.3% of the cases, associated radial head fractures were diagnosed. In 29.4%, a coronoid process fracture was present. Distal humerus fractures were found in 23.5%. Instability in the medial collateral ligament and an Osborne-Cotterill lesion were found in 11.8% of the patients, respectively., Conclusions: In a significant percentage of the population, a previously undescribed fracture fragment of the supinator crest of the ulna could be detected. The most frequently occurring associated injuries were fractures of the radial head, the coronoid process, and the distal humerus. The aetiology of these lesions is unknown; however, bony avulsion of the annular or the lateral ulnar collateral ligament seems to be the most likely cause. If this fragment is to be diagnosed by CT, the possibility of lateral or posterolateral instability should be considered.

We retrospectively analysed 106 consecutive traumatic humeral shaft fractures over a five-year period. The mechanism of injury, age, gender, fracture types, associated injury and the presence of injury to the radial nerve were reviewed. The incidence was about 10 per 100,000 per year; most were closed fractures in young males which had been sustained as a result of traffic accidents. The age-gender distribution was characterised by gradually increased incidence from the fifth decade in women, while it reached a peak at the third decade and decreased after the fifth decade in men. The results revealed different epidemiological features from previous studies. The epidemiology differs between ethnicity and country, and updating the epidemiological features of humeral shaft fractures may provide information for appropriate treatment programmes. This study documents the epidemiology of humeral shaft fracture in Taiwan, probably for the first time in this Asian community.

We analysed and determined retrospectively the location, age, gender and side of the body of humeral fractures from 258 antero-posterior radiographs of all patients aged 3-81 years over a 5-year period. It was observed that 160 fractures occurred on the left side while 98 were on the right side with 156 occurring in males and 102 in females. Forty-eight percent of the fractures occurred at the lower end of the humerus while 41% occurred at the mid-shaft with only 10% occurring at the upper end. Furthermore, the age group of 3-12 years had the highest incidence of fractures (40.7%) with the age group of 30-39 years the lowest incidence (6.2%). Most supracondylar fractures (75.4%) occurred in children, with teenagers accounting for the majority of mid-shaft fractures (51.9%). However, middle-aged and elderly individuals had the highest incidence of upper humeral fractures (73.1%). There was significant relationship between the site of these fractures, age, gender and body side of the patients studied (p<0.001). These results are, however, not in agreement with some previously documented studies. The importance of epidemiological study of humeral fractures in planning, training and resource management in a given population is therefore stressed.

We carried out a retrospective review of 75 children with unicameral bone cysts, who had sustained 52 pathological fractures, to determine which cysts were likely to be at risk and whether healing was accelerated after a fracture. Most lesions were in the metaphysis of a tubular bone, the commonest sites being the the upper part of the humerus and femur. The percentage of bone occupied by the cyst in the transverse plane was more than 85% in both anteroposterior and lateral radiographs in every case of pathological fracture. In most cases, the cyst recurred and sometimes became large without any acceleration of healing.