This study aimed to compare the effectiveness of ultrasound-guided closed reduction and fixation versus traditional techniques in managing pediatric phalangeal and metatarsal fractures. This retrospective study included 112 pediatric patients with phalangeal or metatarsal fractures treated between January 2020 and December 2023. The participants were categorized into two groups: the ultrasound-guided group (US-guided; n = 50, including 37 with phalangeal and 13 with metatarsal fractures) and the conventional fluoroscopy-guided group (C-group; n = 62, including 32 with phalangeal and 30 with metatarsal fractures). The collected data included surgical time, frequency of X-ray examinations, radiation exposure, closed reduction rate, complication rate, and postoperative function. Postoperative functional outcomes were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system. Surgical time was significantly shorter in the US-guided group (average 44.36 ± 15.23 min) than in the C-group (average 59.15 ± 18.85 min; p < 0.001). Additionally, the US-guided group required approximately four fewer X-ray examinations (2.98 ± 0.94 vs. 7.31 ± 1.47, p < 0.001). Radiation exposure was significantly lower in the US-guided group (1.73 ± 0.54 mGy) than in the C-group (4.24 ± 0.85 mGy, p < 0.001). In the US-guided group, the surgical time for phalangeal fractures was shorter than that for metatarsal fractures (41.08 ± 14.17 min vs. 53.69 ± 14.74 min, p = 0.009). However, there were no significant differences in the closed reduction rate (US-guided group vs. C-group; 92

Previous ultrasound-guided cross-pin techniques, which employ 90° elbow flexion, have demonstrated effectiveness; however, they may be associated with an elevated risk of iatrogenic ulnar nerve subluxation or dislocation. The aim of this study was to evaluate the efficacy and safety of a modified ultrasound-guided cross-pin technique for reducing the risk of iatrogenic ulnar nerve injury in paediatric patients with supracondylar humerus fractures. This retrospective study was conducted from December 2017- October 2019 and included paediatric patients with displaced supracondylar humerus fractures. The modified ultrasound-guided cross-pin technique was utilized to identify the ulnar nerve and confirm the medial pin position during pin placement with elbow in extension. The primary outcome measure was the incidence of iatrogenic ulnar nerve injury. A total of 145 patients (mean age 5.8 years) were enrolled. There were 103 children with Gartland type III fractures, 35 with type II fractures, and 7 with type IV fractures. The incidence of iatrogenic ulnar nerve injury was significantly reduced to 0

Introduction: The objective of this case report is to provide clinical evidence that acute infectious wrist arthritis in children can lead to the rare condition of acute carpal tunnel syndrome (ACTS). This article discusses in detail the characteristics of infectious wrist arthritis complicating ACTS in children in terms of etiology, pathogenic bacteria, treatment modalities, and sequelae to improve the understanding of this disease. Patient concerns: A 10-year-old male child presented with a 15-day history of swelling and pain in the left forearm, wrist, and hand. Diagnoses: Left-sided infected wrist arthritis complicating ACTS. Interventions: The child received emergency surgery and anti-infective treatment combined with regular rehabilitation. Outcomes: During the treatment period, the child’s wrist pain and swelling gradually improved, and wrist movement was restored compared with the preoperative period. At 6-month follow-up, the activities of the metacarpophalangeal joints of the left hand were close to normal, and the flexion of the left wrist joint was slightly limited. Conclusion: In infectious wrist arthritis in children, ACTS is a serious complication that requires aggressive surgical carpal tunnel release to avoid median nerve injury in addition to anti-infective therapy.

The management of length-unstable femoral shaft fractures(LUFSFs) in pediatric patients is still controversial. This study aims to explore the clinical efficacy of ultrasound-guided closed reduction combined with external fixation for treating LUFSFs in children. We conducted a retrospective analysis of clinical data from 19 pediatric patients with LUFSFs who underwent ultrasound-guided closed reduction and external fixation between January 2018 and January 2023. Ultrasound was employed not only to facilitate closed reduction of the fracture but also to guide real-time insertion of Schanz pins and monitor pin length as it traversed the opposite cortex. Surgical time, intraoperative fluoroscopy count, hospital stay length, fracture fixation duration, complication incidence, fracture reduction quality at the final follow-up were recorded. The patients’ average age was 7.5 years( range: 5 to 11 years). The mean surgical duration was 70.4 min (range: 48–105 min), and the average intraoperative fluoroscopy count was 6.5 (range: 2–16). Fracture fixation lasted an average of 10.9 weeks (range: 7–20 weeks). All patients were followed up for more than one year. 6 cases of superficial pin tract infection occurred, which resolved with oral antibiotics and enhanced needle tract care. No deep infections were observed. Temporary stiffness of the knee joint was observed in 2 patients. According to Flynn’s efficacy evaluation system, fracture reduction quality at the final follow-up was rated as excellent in 11 cases and satisfactory in 8 cases, yielding a combined success rate of 100

Background:Breathing exercise can help patients with dyspnea to change the wrong breathing pattern, improve the degree of freedom of respiratory muscles, increase alveolar ventilation, promote breathing, and relieve the symptoms of dyspnea patients. Therefore, this study is aimed at investigating the role of breathing training in alleviating postoperative pain in patients with spinal nerve root entrapment syndrome.Objective:To explore the effect of respiratory training in relieving postoperative pain in patients with spinal nerve root entrapment syndrome.Methods:Fifty-eight patients with spinal nerve root entrapment syndrome treated in our hospital from May 2020 to May 2021 were analyzed retrospectively. The patients were randomly divided into a control group (n = 29) and an observation group (n = 29). The control group was given routine postoperative pain nursing, and the observation group was given respiratory training on the basis of the control group. The scores of visual analogue scale (VAS), self-rating anxiety scale (SAS), Oswestry dysfunction index questionnaire (ODI), the dosage of postoperative analgesics, and the time of first out-of-bed activity were recorded before pain nursing intervention and 3 days and 7 days after intervention.Results:The VAS, SAS, and ODI scores of the observation group after 3 d and 7 d of intervention were lower than those of the control group. Compared with the same group, the scores of VAS, SAS, and ODI after 3 d and 7 d of intervention were lower than those before intervention, and those after 7 d of intervention were lower than those after 3 d of intervention (P < 0.05). The dosage of postoperative analgesics and the time of first out-of-bed activity in the observation group were lower than those in the control group (P < 0.05).Conclusion:Respiratory training can effectively relieve postoperative pain, reduce anxiety, and improve spinal function in patients with spinal nerve root entrapment syndrome, which is beneficial to the prognosis of patients and is worthy of promotion.

BACKGROUND:Pediatric lateral humeral condyle fractures (LHCFs) are sometimes misdiagnosed and inappropriately treated on the basis of x-ray radiographs because cartilage cannot be seen on radiographs. However, as a useful technique, transverse ultrasonography can accurately and readily determine the integrity of the cartilage hinge in pediatric LHCFs. The purpose of this study was to assess the reliability of the Jakob classification, the treatment plan, and the necessity for further examination of pediatric LHCFs with the use of x-ray with and without transverse ultrasound images.METHODS:Five pediatric orthopaedic surgeons with different levels of experience evaluated 62 cases on the basis of the use of x-ray alone and x-ray combined with transverse ultrasound images. These 2 types of evaluations were repeated after an interval of 4 to 6 weeks. At the time of each evaluation, all observers were asked to classify the fractures according to the Jakob classification, to formulate treatment plans, and to determine whether further examinations were required.RESULTS:After the training of transverse ultrasound image interpretation, the interobserver reliability of the Jakob classification significantly improved from fair (a kappa of 0.54) to moderate (a kappa of 0.71) with the addition of transverse ultrasound images. The treatment plan was changed from conservative treatment to surgical treatment in 7% of the ratings but from surgical treatment to conservative treatment in 15% of the ratings after reviewing the ultrasound images, and the difference was statistically significant (P=0.003).CONCLUSIONS:The use of the Jakob classification and a treatment plan for pediatric LHCFs can be optimized by the addition of transverse ultrasound images, especially after training for transverse ultrasound image interpretation.LEVEL OF EVIDENCE:Level III-diagnostic study.

The malignant phyllodes tumor (PT) of the breasts is a rare type of fibroepithelial neoplasm. Osteoclast-like giant cells (OLGCs) exist in many types of tumors. But malignant PTs with OLGCs were rarely reported. Here, we presented a case of a 49-year-old woman who had a 23 cm ×21 cm ×6 cm mass which was growing for 2 years in her left breast. The patient had moderate anemia due to the hemorrhage and exudation on the surface of the tumor. The imaging examinations such as PET-CT found no lymphatic involvement and distant metastasis. We performed mastectomy with a 2 cm surgical margin and free skin flap transplantation to restore the big wound. The vacuum assisted closure (VAC) system was used to promote wound healing. Histological examination of the surgical specimen showed atypical spindle-like stroma cells, marked nuclear pleomorphism, focal necrosis, and mitotic activity. Typical leaf-like architectures of PTs were observed in some regions. OLGCs were found in many sections of the tumor with a number of vascular proliferations. The final diagnosis was malignant PT with OLGCs. After a three-month follow-up, no local recurrence or metastasis was found. Autogenous skin grafts with VAC are available for large area skin defect after excising a huge breast tumor. The presence of OLGCs in malignant tumors may be related to necrosis and hemorrhage of the tumor. These findings also provide opportunities for understanding the mechanisms of tumor formation and development.

Rationale: The physeal separations and septic osteomyelitis in newborns are unusual, which represents a challenging problem in diagnosis and treatment. Patient concerns: A 2-day-old mature male suddenly complained by parents about minimal swelling around the left knee, decreased left extremity motion and no fever. Diagnosis: Preliminary x-rays of the lower extremities demonstrated a displaced distal femoral physeal, Laboratory investigation indicated infection. Magnetic resonance imaging and ultrasound showed displaced distal femoral physeal. A needle aspiration confirmed the diagnosis. Intervention: Debridement and ultrasound guide reduction with pinning of physeal separations was performed. Outcome: At 5 years later, his last follow-up showed that there was only 1.6cm limb-length discrepancy without angular deformity, the child did not report any pain and was perfectly able to perform his daily activities. Lessons: Distal femoral physeal fractures after neonatal osteomyelitis requires immediate and reliable decision for management. We point out the important role of the application of sonography, which is helpful to make an early diagnosis and guide reduction and percutaneous pinning of distal femoral physeal fractures.

BackgroundIngestion of button batteries occurs in about ten persons per one million persons each year, with most of them children, and one in every 1000 battery ingestions leads to serious injuries. This study aimed to describe the clinical features and outcome of ingestion or inhalation of button batteries in children spanning a decade from January, 2006 to December, 2016 at a tertiary care hospital.MethodsWe reviewed the clinical records of children who sought treatment for inhaled or ingested button batteries at our hospital during the study period. Data on gender, age, time from ingestion to treatment, site of impaction, imaging findings, and outcomes were retrieved and analyzed.ResultsWe identified 116 pediatric cases of ingestion or inhalation of button batteries. Their mean age was 26months. The time from ingestion or inhalation of button batteries to treatment was 0.5hours to 2weeks. Ninety-seven (83.6%) button batteries were located in the nasal cavity, 13 (11.2%) in the gastrointestinal (GI) tract including 6 in the esophagus, and 7 in the stomach and lower GI tract, and 6 (5.2%) in the auditory tract. Twenty-one (21.6%) children with nasal button batteries had preoperative septal perforations and one (1.0%) had postoperative septal perforation. One child with esophageal button battery developed esophageal stricture and one died of sudden cardiac arrest perioperatively. One child had auditory damages in the right tympanic membrane and ossicles.ConclusionsInhalation or ingestion may occur in the nasal cavities, the esophagus and GI tract and the auditory tract. Prompt diagnosis and treatment are required for a satisfactory outcome and ingested or inhaled button batteries require different treatment protocols.