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Background Supracondylar humerus fractures (SCHF) are the most common elbow fractures requiring surgical treatment in the pediatric age group. Most fractures are reduced and stabilised adequately. Yet, post-surgical malunion may occur. The purpose of this study is to evaluate our results of early revision surgery in 21 surgically treated pediatric SCHF with immediate postoperative loss of alignment and compare them with previous reports of late corrective osteotomies. Methods Twenty-one pediatric SCHF patients that underwent revision surgery for malalignment within 3 weeks of the initial reduction and fixation consisted the study group. Indications for revision were unacceptable radiographic alignment diagnosed within the first 3 weeks after the index surgery. Clinical outcome included pain, range of motion (ROM) and appearance of the elbow. Radiographic outcome was defined as fracture healing and final alignment, assessed in both coronal and sagittal planes. Results The average time interval between index and revision surgery was 7.6 days (range 3–18). In revision surgery, closed reduction was performed in 17 out of 21 patients, and open reduction was required in four. In one patient, an external fixator was added. In the most recent follow up, all patients but three regained full ROM. The remaining three had a deficit of 10° or less. Two patients had cubitus varus of 10° or less. All patients had a marked radiographic improvement after revision, especially in the sagittal plane increasing the humero-capitaller flexion angle by an average of 20°. Discussion Malunion after reduction and Kirschner wires (KW) fixation of SCHF is an uncommonly reported phenomenon. When malunion is recognised after fracture healing, corrective osteotomies may carry a significant complications rate. We describe our favourable experience with early diagnosis and revision surgery of malaligned SCHF. [ABSTRACT FROM AUTHOR]

Background: Cycling is gaining more popularity both as a sport, on and off-road and also as a means of commute. Cycling accidents harbour significant injury risks including fractures. Proximal femoral fractures are uncommonly associated with cycling in the young adult population. The purpose of this study is to describe this unique pattern of injury as well as the outcome of proximal femoral fractures caused by cycling in the young to mid age population. Methods: Study design: retrospective cohort study. 23 fractures in 22 patients were available for analysis. 11 were femoral neck fractures, with six displaced ones, and the rest trochanteric fractures. 21 patients were male patients, and the average age was 42 (range 27–60). All patients but two were operated within 24h from admission. Radiographic analysis included reduction quality, fracture classification and arthritic changes. Clinical outcome was measured using SF-12 and Oxford hip scores. Results: All fractures healed. Two patients with displaced femoral neck fractures developed avascular necrosis requiring arthroplasty. One patient developed an AVN 2 years after a stable trochanteric fracture but did not require an arthroplasty as of yet. Eight patients required hardware removal due to symptoms. 77% of patients had resumed cycling at the pre-injury level. Mean SF-12 score was 47.1±11.7 for the physical component and 53.7±6.3 for the mental component. Mean oxford hip score as was 40.1±12.2. Radiographic analysis revealed good to acceptable reduction quality. Fracture type, age, cycling type and reduction were not significantly associated with outcome. Conclusion: Proximal femoral fractures caused by cycling in young to mid-aged adults are an emerging pattern of injury. Overall favourable result can be expected in the majority of cases, with displaced femoral neck fractures having a risk for AVN. Further delineation of the exact cause for this phenomenon is required with possible intervention for injury prevention. [ABSTRACT FROM AUTHOR]

Background: Rotator cuff tears are the most frequent tendon injury in the adult population. However, the natural history of nonoperatively treated full-thickness tears is poorly defined. Knowledge of the expected evolution in tear size is important when considering nonoperative versus surgical care, especially in relatively young, active patients.Purpose: To evaluate the size change of nonoperatively treated full-thickness rotator cuff tears over 2 to 3 years’ follow-up. Study Design: Case series; Level of evidence, 4.Methods: The authors prospectively followed patients 60 years old or younger who had a full-thickness rotator cuff tear equal to or larger than 5 mm, as diagnosed by bilateral shoulder ultrasound, and who were treated nonoperatively. At 2 to 3 years after the index ultrasound examination, a repeat ultrasound examination was performed by the same ultrasonographer. Results of the follow-up ultrasound examinations of both shoulders were compared with those of the index ultrasound examinations for change in rotator cuff tear size. The correlations were examined between these changes and age, sex, history of initial trauma, size of tear on the index ultrasound, and current shoulder symptoms.Results: Fifty-one patients with 61 rotator cuff tears were evaluated. At a follow-up of 25 to 39 months (mean, 29), 49% of the tears (30 tears) increased in size, 43% (26 tears) had not changed, and 8% (5 tears) decreased in size. For 25% (10 shoulders ) of initially intact shoulders (41 shoulders), a new full-thickness rotator cuff tear was diagnosed. No correlation was found between the change in tear size and age of the patient (P = .85), sex (P = .93), existence of a prior trauma (P = .63), size of tear at index ultrasound ( P = .62), and bilateral tears (P = 1.00). There was a correlation between the existence of considerable pain at the time of the follow-up ultrasound and a clinically significant increase in tear size (P = .002).Conclusion: Full-thickness rotator cuff tears tend to increase in size in about half of patients aged 60 years or younger. Surgery should be initially considered in these patients to prevent a probable increase in size tear. Patients treated nonoperatively should be routinely monitored for tear size increase, especially if they remain symptomatic. [ABSTRACT FROM AUTHOR]