Objective:To systematically analyze the risk factors for knee injury complicated with adolescent tibial tubercle fractures (ATTF).Methods:A retrospective study was conducted to analyze the clinical data of the 90 adolescent patients (the observation group) who had been treated and fully followed up for knee injury complicated with ATTF at Department of Pediatric Orthopedics, The Second General Hospital of Fuzhou from September 2017 to April 2024. There were 86 males and 4 females, with a mean age of 14.0 (13.0, 14.0) years. The injury was on the left side in 51 cases, on the right side in 34 ones, and on the bilateral sides in 5 ones. All their injuries resulted from sports activities. In addition, another contemporary 90 patients with knee injury but no exercise-induced ATTF were enrolled as the control group, including 54 males and 36 females with a mean age of 14.0 (13.0, 14.3) years. Their injury was on the left side in 45 cases, on the right side in 41 ones, and on the bilateral sides in 4 ones. Univariate analysis was conducted to compare gender, age, injury side, height, weight, body mass index, history of Osgood-Schlatter disease (OSD), and injury mechanism between the 2 groups. Variables with P<0.1 were included in a multivariate logistic regression analysis to screen independent risk factors for ATTF. The receiver operating characteristic (ROC) curve was used to evaluate their predictive values. The optimal cutoff value was determined by Youden index. Results:The univariate analysis showed that gender, height, weight, body mass index, and OSD history were significantly correlated with the occurrence of ATTF ( P<0.05). The multivariate logistic regression analysis further confirmed that male ( P=0.017), height ( P=0.021), weight ( P=0.014), body mass index ( P=0.032) and history of OSD ( P=0.003) were independent risk factors for ATTF. The ROC curve analysis showed that weight had the largest area under the curve (AUC) in prediction of the ATTF risk, suggesting that its predictive value was the most significant. Conclusion:Male, height, weight, body mass index, and prior OSD are independent risk factors for ATTF, with the highest predictive value in weight.

Objective:To analyze the risk factors for growth disturbance (GD) in children with distal femoral epiphyseal fracture (DFEF) after surgical treatment.Methods:A retrospective study was conducted to analyze the clinical data of the 72 children who had undergone surgery for DFEF at Department of Pediatric Orthopaedics, The Second General Hospital of Fuzhou between February 2013 and February 2024. There were 52 boys and 20 girls with an age of 11.0 (5.0, 13.0) years. The data collected included age at injury, gender, side affected, cause for injury, time from injury to surgery, the maximum fracture displacement, Salter-Harris fracture classification, and presence of high-energy trauma. The risk factors for GD after DFEF surgical treatment were determined through univariate analysis and logistic regression analysis.Results:Distal femur GD occurred in 40.2% (29/72) of the children treated surgically for DFEF. The univariate analysis showed that, compared with the children without GD, those with GD had a significantly significantly longer time from injury to surgery ( P=0.005), a significantly greater fracture displacement ( P=0.002), and more severe Salter-Harris fracture classification ( P=0.045). The logistic analysis showed that all the 3 factors were independent risk factors for GD ( P<0.05). Conclusion:After DFEF surgery, the GD risk is significantly increased by the 3 factors:longer time from injury to surgery, greater fracture displacement, and more severe fracture classification.

Objective:To systematically analyze the risk factors for knee injury complicated with adolescent tibial tubercle fractures (ATTF).Methods:A retrospective study was conducted to analyze the clinical data of the 90 adolescent patients (the observation group) who had been treated and fully followed up for knee injury complicated with ATTF at Department of Pediatric Orthopedics, The Second General Hospital of Fuzhou from September 2017 to April 2024. There were 86 males and 4 females, with a mean age of 14.0 (13.0, 14.0) years. The injury was on the left side in 51 cases, on the right side in 34 ones, and on the bilateral sides in 5 ones. All their injuries resulted from sports activities. In addition, another contemporary 90 patients with knee injury but no exercise-induced ATTF were enrolled as the control group, including 54 males and 36 females with a mean age of 14.0 (13.0, 14.3) years. Their injury was on the left side in 45 cases, on the right side in 41 ones, and on the bilateral sides in 4 ones. Univariate analysis was conducted to compare gender, age, injury side, height, weight, body mass index, history of Osgood-Schlatter disease (OSD), and injury mechanism between the 2 groups. Variables with P<0.1 were included in a multivariate logistic regression analysis to screen independent risk factors for ATTF. The receiver operating characteristic (ROC) curve was used to evaluate their predictive values. The optimal cutoff value was determined by Youden index. Results:The univariate analysis showed that gender, height, weight, body mass index, and OSD history were significantly correlated with the occurrence of ATTF ( P<0.05). The multivariate logistic regression analysis further confirmed that male ( P=0.017), height ( P=0.021), weight ( P=0.014), body mass index ( P=0.032) and history of OSD ( P=0.003) were independent risk factors for ATTF. The ROC curve analysis showed that weight had the largest area under the curve (AUC) in prediction of the ATTF risk, suggesting that its predictive value was the most significant. Conclusion:Male, height, weight, body mass index, and prior OSD are independent risk factors for ATTF, with the highest predictive value in weight.

Objective:To analyze the risk factors for growth disturbance (GD) in children with distal femoral epiphyseal fracture (DFEF) after surgical treatment.Methods:A retrospective study was conducted to analyze the clinical data of the 72 children who had undergone surgery for DFEF at Department of Pediatric Orthopaedics, The Second General Hospital of Fuzhou between February 2013 and February 2024. There were 52 boys and 20 girls with an age of 11.0 (5.0, 13.0) years. The data collected included age at injury, gender, side affected, cause for injury, time from injury to surgery, the maximum fracture displacement, Salter-Harris fracture classification, and presence of high-energy trauma. The risk factors for GD after DFEF surgical treatment were determined through univariate analysis and logistic regression analysis.Results:Distal femur GD occurred in 40.2% (29/72) of the children treated surgically for DFEF. The univariate analysis showed that, compared with the children without GD, those with GD had a significantly significantly longer time from injury to surgery ( P=0.005), a significantly greater fracture displacement ( P=0.002), and more severe Salter-Harris fracture classification ( P=0.045). The logistic analysis showed that all the 3 factors were independent risk factors for GD ( P<0.05). Conclusion:After DFEF surgery, the GD risk is significantly increased by the 3 factors:longer time from injury to surgery, greater fracture displacement, and more severe fracture classification.

Objective:To compare the therapeutic effects of cannulated screws and Kirschner wires in the treatment of medial malleolar fractures of Salter-Harris types Ⅲ and Ⅳ in children.Methods:A retrospective study was conducted to analyze the data of 48 and 16 children who had been treated respectively at Department of Pediatric Orthopaedics, Fuzhou Second General Hospital, and Department of Pediatric Orthopaedics, Foshan Hospital of Traditional Chinese Medicine for medial malleolar fractures of Salter-Harris types Ⅲ and Ⅳ from June 2016 to June 2022. There were 32 males and 32 females with an age of 12 (10, 14) years; 31 left and 33 right sides were affected. By the Salter-Harris classification: type Ⅲ in 45 cases, and type Ⅳ in 19 cases. The patients were divided into 2 groups according to their internal fixation methods. Group A (44 cases) was subjected to internal fixation with cannulated screws and group B (20 cases) to internal fixation with Kirschner wires. At the last follow-up, anteroposterior and lateral X-ray films of their ankle joints were taken for imaging evaluation. Functional recovery of the affected limbs was evaluated based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scoring, and related complications were recorded.Results:The 2 groups were comparable because there were no significant differences in their preoperative general data except laterality ( P>0.05). All the patients were followed up for (37.3±21.5) months and achieved bony union. At the last follow-up, for groups A and B respectively, the distal lateral angle of the tibia was 89.0° (89.0°, 90.0°) and 89.0° (89.0°, 90.0°), the range of ankle motion was 73.5° (67.8°, 76.0°) and 70.0° (70.0°, 75.0°), and the good and excellent rate by the AOFAS ankle-hindfoot scoring was 97.7% (43/44) and 95.0% (19/20), showing no significant difference between the 2 groups ( P>0.05). There was a significant difference between the 2 groups in the incidence of premature physeal closure [36.4% (16/44) versus 65.0% (13/20)] ( P=0.033). Conclusions:In the treatment of medial malleolar fractures of Salter-Harris types Ⅲ and Ⅳ in children, internal fixation with both cannulated screws and Kirschner wires can lead to comparable efficacy in good functional recovery and imaging evaluation. However, fixation with cannulated screws may be more advantageous in reducing the risk of early closure of the epiphysis.

Objective:To explore the clinical features and surgical outcomes of greater trochanteric fractures of the femoral neck in children.Methods:A retrospective study was conducted to analyze the 5 children with greater trochanteric fracture of the femoral neck who had been treated at Department of Pediatric Orthopaedics, Fuzhou Second General Hospital from January 2011 to December 2020. There were 1 boy and 4 girls, with an age of (11.0±1.9) years. By the Delbet classification, all were type Ⅲ fractures. The time from injury to operation was (4.4±2.1) days. The children were treated with cannulated screws (1 case) or fixation with a pediatric hip plate (4 cases). The clinical features of such fractures were analyzed; the fracture union time and hip function and complications at the last follow-up were recorded.Results:The clinical features of greater trochanteric fractures of the femoral neck in children were: (1) involvement of 2 anatomic sites in a narrow region, (2) comminuted fractures, and (3) all Delbet type Ⅲ fractures. The follow-up time was (22.8±6.0) months. All the 5 children obtained bony union. The union time was (5.2±1.8) weeks for greater trochanteric fractures, and 8.0 (8.0,10.0) weeks for femoral neck fractures. Follow-up observed no necrosis of the femoral head, premature closure of the femoral head epiphysis, hip varus deformity, or length disparity between the lower limbs. Premature closure of the greater trochanteric epiphysis occurred in 2 children after surgery. According to the Ratliff scoring, the hip function was excellent in 3 cases and good in 2.Conclusions:Greater trochanteric fractures of the femoral neck in children are a special kind of proximal femoral comminuted fractures that affect 2 anatomic sites in a narrow region and belong all to Delbet type Ⅲ fractures. Open reduction and internal fixation with cannulated screws or a pediatric hip plate is a safe and effective treatment for such fractures.

Objective:To compare the efficacy between Kirschner wire and clavicular hook plate in the fixation of distal clavicle fractures in older children.Methods:A retrospective analysis was conducted of the 28 pediatric patients with distal clavicle fracture who had undergone surgical treatment at Department of Pediatric Orthopedics, The Second General Hospital of Fuzhou from December 2014 to December 2023. There were 20 boys and 8 girls. Age: 10.0 (9.0, 12.8) years old; 22 left sides and 6 right sides; by the Craig modified Neer classification: 22 cases of type Ⅱ, 5 cases of type Ⅳ, and 1 case of type Ⅴ. The patients were divided into 2 groups based on their internal fixation methods. The Kirschner wire group of 12 cases were treated with open reduction and Kirschner wire fixation; the hook plate group of 16 cases were treated with open reduction and clavicular hook plate fixation. Operation time, hospital stay, fracture healing time, incidence of complications, and scores at the final follow-up (the Constant-Murley shoulder function score, quick disabilities of the arm, shoulder, and hand (quickDASH) score, and visual analog scale (VAS) for aesthetic satisfaction) were recorded and compared between the 2 groups.Results:There were no statistically significant differences in the baseline data between the 2 groups, indicating comparability ( P>0.05). The postoperative follow-up period for the 28 patients was (14.8±6.5) months. The operation time in the Kirschner wire group [(34.3±12.1) min] was significantly shorter than that in the hook plate group [(49.4±16.8) min] ( P<0.05), and the VAS score for aesthetic satisfaction at the final follow-up in the Kirschner wire group [(8.2±1.1) points] was significantly higher than that in the hook plate group [(6.2±2.6) points] ( P<0.05). There were no statistically significant differences between the 2 groups in terms of fracture healing time, hospital stay, incidence of complications, or Constant-Murley score and quickDASH score at the final follow-up ( P>0.05). Conclusions:For pediatric patients with distal clavicle fracture, both Kirschner wire fixation and clavicular hook plate fixation can achieve good functional outcomes. However, Kirschner wire fixation has advantages of shorter operation time, higher postoperative aesthetic satisfaction, and no need of a secondary surgery for implant removal.

Objective:To analyze the risk factors for ankle varus deformity after McFarland fracture surgery in children.Methods:A total of 48 children with McFarland fracture who underwent surgical treatment in the Second General Hospital of Fuzhou from January 2015 to December 2022 were retrospectively analyzed, including 24 males and 24 females, aged 11.2±3.2 years (range, 2-14 years), 19 cases on the left side and 29 cases on the right side. Salter-Harris classification: 34 cases of type III and 14 cases of type IV. Causes of injuries: 28 cases of sports injuries, 15 cases of fall injuries, and 5 cases of car accident injuries. The time from injury to operation was 2.6±1.7 d (range, 1-7 d). The reduction methods included closed reduction in 38 cases and open reduction in 10 cases. Tibial internal fixation: 42 cases of hollow screws, 6 cases of Kirschner pins. There were 30 cases of combined fibula fracture, 20 cases were fixed with plate, 8 cases were fixed with Kirschner's pin, and 2 cases were not treated with internal fixation. The internal fixation survival time was 6.4±2.8 months (range, 1-12 months). The lateral distal tibial angle (LDTA) was used to determine whether the child had ankle varus deformity. The general data and perioperative indicators of the two groups were compared, and the indicators with statistically significant differences were included in binary logistic regression analysis to determine the independent risk factors for ankle varus deformity after McFarland fracture surgery in children. The receiver operating characteristic curve was drawn and the area under the curve of each independent risk factor was calculated.Results:All patients successfully completed the operation and were followed up for 39.2±21.8 months (range, 15-98 months). At the last follow-up, all the 48 children with McFarland fracture had bone union and the internal fixation was successfully removed, and 5 of them had ankle varus deformity. The LDTA of the affected side was 98.6°±4.8° (range, 94°-106°) in the ankle varus deformity group and 89.0°±0.8° (range, 87°-91°) in the non-ankle varus deformity group. The age of children in the ankle varus deformity group was 6.6±5.1 years, which was younger than that in the non-ankle varus deformity group (11.7±2.5 years), and the difference was statistically significant ( t=3.772, P<0.001). The survival time of internal fixation in the ankle varus deformity group was 4.4±2.2 months, which was shorter than that in the non-ankle varus deformity group (6.6±2.8 months), and the difference was statistically significant ( t=1.750, P=0.087). There was no significant difference in gender, side, cause of injury, fracture type, initial displacement distance, fibular fracture, time from injury to operation, reduction method, or fixation method between the two groups ( P>0.05). Age and duration of internal fixation were included in binary logistic regression analysis. The results showed that age ( OR=0.717, 95% CI: 0.543, 0.945, P=0.018) was an independent risk factor for postoperative ankle varus deformity in children with McFarland fracture. The receiver operating characteristic curve of independent risk factors predicting postoperative ankle varus deformity in children with McFarland fracture was drawn and the area under the curve was calculated. The results showed that the best cut-off value of age was 5.5 years, and the area under the curve was 0.807, and the prediction efficiency of the prediction model was good. Conclusion:Age<5.5 years is an independent risk factor for postoperative varus ankle deformity in children with McFarland fracture.

Objective:To explore the effects of residual rotational deformity after supracondylar fractures of the humerus on the surgical efficacy in children.Methods:From January 2020 to December 2021, 453 patients with Gardland type Ⅲ supracondylar humeral fracture were treated with closed reduction and percutaneous pinning at Department of Pediatric Orthopedics, The Second Hospital of Fuzhou. They were assigned into 2 groups according to the quality of reduction. In the group of residual rotational deformity of 69 cases (group A), there were 44 boys and 25 girls, with an age of (6.3±2.9) years. The Baumann angle was maintained at 65° to 80° on the anteroposterior view of intraoperative fluoroscopy and the anterior humeral line passed through the anterior 1/3 of the capitellum on the lateral view with a normal carrying angle (from 4° to 23°). In the anatomical reduction group of 384 patients (group B), there were 242 boys and 142 girls, with an age of (5.9±2.7) years. The anteroposterior view and the lateral view of intraoperative fluoroscopy showed anatomical reduction of the fracture ends. The fluoroscopy frequency, operation time, intraoperative carrying angle, the carrying angle at 6 months after operation and the Flynn score at 6 months after operation were recorded and compared between the 2 groups.Results:There was no significant difference in gender, age, side or fixation time between the 2 groups before operation, showing they were comparable ( P>0.05). All patients were followed up for (6.3±2.9) months after operation. The median intraoperative fluoroscopy frequency was 6 (4, 6) times in group A, significantly lower than that in group B [8(6, 8)], and the median operation time was 20 (20, 25) min in group A, significantly shorter than that in group B [30(25, 30) min] ( P<0.05). There was no significant difference between group A and group B in the intraoperative rying angle (19.7°±2.7° versus 20.2°±2.8°) or in the carrying angle at 6 months after operation (17.4°±2.7° versus 17.6°±2.7°) ( P>0.05). By the Flynn scoring for the elbow joint at 6 months after operation, group A had 28 excellent cases, 30 good cases, 9 moderate cases, and 2 poor cases, yielding an excellent and good rate of 84.1%(58/69); group B had 241 excellent cases, 104 good cases, 34 moderate cases, and 5 poor cases, yielding an excellent and good rate of 89.8%(345/384). There was no statistically significant difference between the 2 groups ( P>0.05). No cubitus varus, delayed union, non-union, compartment syndrome, or iatrogenic ulnar nerve injury was observed in either group at postoperative 6-month follow-up. Conclusions:A certain degree of residual rotational deformity is acceptable after supracondylar fracture of the humerus in children, because it may have a little significant effect on the postoperative outcomes but may reduce fluoroscopy frequency and shorten operation time.

Objective:To explore the diagnosis and treatment of humeral medial epicondyle fracture combined with radial neck fracture in children and adolescents.Methods:The clinical data were retro-spectively analyzed of the 12 pediatric patients with fractures of the humeral medial epicondyle plus the radial neck who had been admitted from February 2015 to August 2021 to Department of Pediatric Orthopedics, The Second Hospital of Fuzhou. There were 6 males and 6 females, with an age of (11.1 ± 2.5) years. According to the Papavasiliou classification, the humeral medial epicondyle fractures were type Ⅱ in 7 cases, type Ⅲ in 2 cases and type Ⅳ in 3 cases; according to the Judet classification, the radial neck fractures were type Ⅰ in 3 cases, type Ⅱ in 4 cases and type Ⅲ in 5 cases. Two Judet-Ⅰ radial neck fractures were missed by X-ray exam-ination but diagnosed by CT examination. Of the humeral medial epicondylar fractures, 9 were treated by open reduction and hollow screwing and 3 by closed reduction and Kirschner wiring. Of the radial neck fractures, 8 were treated by closed reduction and elastic intramedullary nailing and 4 conservatively. Fracture healing was followed up by postoperative radiographs. At the last follow-up, the carrying angles were measured, Kim Elbow Function Score (KEPS) was used to evaluate the functional recovery of the injured limb, and related complications were recorded.Results:All the 12 patients were followed up for (40.0±25.6) months. Fractures headed after (6.3±1.2) weeks. At the last follow-up, the carrying angle was 15.5°±2.6° on the injured side and 14.7°±2.0° on the healthy side, showing no significant difference ( P>0.05); KEPS was (96.3±5.3) points on the injured side and (98.8±2.3) points on the healthy side, showing no significant difference either ( P>0.05). No incision infection, bone nonunion, elbow valgus, joint stiffness or other complications were found; the postoperative elbow stability recovered well. Conclusions:As the fracture of the humeral medial epicondyle combined with the radial neck fracture is a special type of injury of straightened elbow during valgus stress in children and adolescents, it is likely to be missed in diagnosis. The goal of treatment is good functional recovery by restoring the articular match and elbow stability.