Objective: To evaluate the composite external fixation in the treatment of children with fracture of lower extremity metaphysis. Methods: A retrospective analysis was conducted of the 42 children with fracture of lower extremity metaphysis who had been admitted to Zhengda Shaoyang Orthopaedic Hospital between September 2016 and September 2018. They were 24 boys and 18 girls, aged from 3 to 14 years (mean, 8.3 years). Open injury occurred in 10 cases, with type Ⅰ in 2, type Ⅱ in 7 and type Ⅲ in one according to the Gustilo-Anderson classification, and closed injury in the other 32 ones. The fracture happened at distal femur in 12, at proximal tibia in 9 and at distal tibia in 21 cases. All the patients were fixated with composite external brackets. Fracture healing, functional recovery of the knee and ankle joints, and complications were recorded. Results: All the 42 patients were followed up for 12 to 18 months (mean, 15.8 months). All fractures healed well by the first intention with no malunion or no alignment change on the full length X-ray films of both lower limbs. Irritant growth within 1.5 cm was observed in 2 cases. No loosening occurred in the external fixation which was removed 3 to 5 months after surgery (mean, 3.8 months). Functional recovery of the knee and ankle joints was good at the last follow-up. For the patients with distal femoral metaphysis fracture, the knee function by the Merchan scoring was excellent in 3 cases, good in 7 cases, fair in one and poor in one; for the patients with proximal tibial metaphysis fracture, the knee function by the Merchan scoring was excellent in 3, good in 4 and fair in 2 cases; for the patients with distal tibial metaphysis fracture, the ankle function by the Kofoed scoring was excellent in 11, good in 7 and fair in 3 cases, giving an excellent and good rate of 83.3%. Of a total of 228 needle channels in the 42 patients, 58 were infected mildly or moderately, giving an infection rate of 25.4%. All the infections responded to active dressing change. Conclusion The composite external fixation brackets are a good choice for the treatment of children with fracture of lower extremity metaphysis, because they are easy in manipulation and stable in configuration, and can reduce the iatrogenic injury to the epiphyseal plate, spare cross-articular fixation and allow early functional exercise.

Objective To report the efficacy of closed pry reduction and cross Kirschner wiring in the treatment of refractory flexion-type fracture of supracondylar humerus in children.Methods A retrospective analysis was done of 19 children who had been treated for refractory flexion-type fracture of supracondylar humerus by closed pry reduction and cross Kirschner wiring at Department of Orthopaedics,Shaoyang Orthopaedic Hospital from March 2015 to March 2017.They were 9 boys and 10 girls,aged from 2 to 12 years (mean,6.37 years);10 left and 9 right sides were involved.According to the severity of fracture displacement,11 cases had rotational displacement with their broken ends obviously inserted into one another,and 8 cases complete displacement with no contact of the broken ends.All the fractures were closed,treated with closed reduction by leverage and cross fixation with Kirschner wire.Postoperative complications were recorded and the elbow function was evaluated by the Flynn assessment system at the last follow-up.Results The operation time for the 19 patients ranged from 15 to 60 minutes,with an average of 30 minutes.The patients were followed up for 12 to 24 months (average,18.0 months).All the fractures united after 2 to 4 months (average,2.8 Months).At the last follow-up,according to the Flynn system,the elbow function was evaluated as excellent in 10 cases,good in 7,and fair in 2.No ossifying myositis,cubitus varus or iatrogenic injury to the ulnar nerve was observed in any patient.Nails had to be removed in one case due to implant loosening after pin-hole infection.Conclusion Closed reduction and Kirschner wire cross fixation is an ideal surgical treatment for refractory flexion-type supracondylar fracture of humerus in children,because its intraoperative closed pry reduction can reduce the rate of incision.