BACKGROUND:Thread delamination associated with cannulated screws have been reported but likely represent an under-recognized complication in the orthopaedic literature. The purpose of this study is to report the occurrence of repeated hardware failures through thread delamination in the setting of a commonly used orthopaedic cannulated screw implant in a small cohort involving pediatric fracture care at a single academic level I trauma center.METHODS:Between August 2015 and December 2020, 9 cases of hardware failure associated with 4.5 mm arbeitsgemeinschaft für osteosynthesefragen cannulated stainless-steel screws were identified within a pediatric orthopaedic division at a single academic level I trauma center. Three cases were excluded, and 6 cases of thread delamination were retrospectively reviewed.RESULTS:Six cases of thread delamination comprised a cohort of patients with a mean age of 13.7 years (range: 12 to 15 y). All cases involved 4.5 mm arbeitsgemeinschaft für osteosynthesefragen cannulated screws, including 5 partially threaded and 1 fully threaded screw. Five cases involved open reduction and internal fixation of incarcerated medial humeral epicondylar fragments and the other case was an open reduction and internal fixation of a displaced medial malleolar fracture. Five of these occurred within a recent 18-month period of time. There were 4 cases of partial, distal thread delamination, 1 case of partial proximal thread delamination and another case of complete thread delamination which had unwound into the tibiotalar joint and required an anterior ankle arthrotomy to retrieve the thread. None of the 5 patients in this series who currently harbor a retained thread have experienced symptoms because of this issue.CONCLUSIONS:Thread delamination associated with cannulated screw implantation likely represents an under-reported phenomenon in orthopaedic surgery. In cases where retained, delaminated threads exist, these do not appear to cause short-term concern.LEVEL OF EVIDENCE:Level IV-case series.

Pediatric humeral proximal metaphyseal and diaphyseal fractures are mostly caused by trauma. Pathological fractures and stress fractures should always be ruled out. Nonoperative treatment is the preferred modality of treatment for most of these fractures. Operative treatment is indicated for open fractures, vascular injuries or if adequate functional reduction cannot be maintained. For pediatric proximal humeral metaphyseal fractures, percutaneous pinning and flexible intramedullary nailing may be necessary, both of which are reported to have good outcomes. For humeral diaphyseal fractures which cannot be managed nonoperatively, elastic intramedullary nailing or plate and screw fixation can be used with good outcomes. These methods of fixation are usually associated with low complication rates. Complications are mainly related to skin and soft tissue irritation by pins or nails or radial nerve injury. External fixation can also used for open fractures with extensive soft tissue injury. While postoperative stiffness is feared complication after surgical fixation of humeral fractures in adults, it is not a common complication after fixation of pediatric fractures. Similarly, nonunions and malunion requiring corrective osteotomy are not common. (C) 2019 Elsevier Inc. All rights reserved.

The treatment of scoliosis in neuromuscular patients is a challenging problem. The natural history of neuromuscular scoliosis is that of curve progression. However, not all patients need surgical fixation. We discuss the pre-, peri-, and postoperative management of these patients. Our preferred technique is hybrid fixation and iliac screw modification of the Luque–Galveston technique. Rigid fixation with pedicle screws is used proximally and distally. Sublaminar wires are used in the central part of the fixation. If pelvic fixation is to be undertaken, the use of iliac screws with offset connectors is preferred. This technique has provided us with a safe and effective means of fixation in this group of patients.

This clinical practice guideline (CPG) is based on the consensus of current clinical practice and review of the clinical literature. The guideline was developed by the Clinical Practice Guideline Pediatric Flatfoot Panel of the American College of Foot and Ankle Surgeons. The guideline and references annotate each node of the corresponding pathways.

Grudziak, Jan S. MD, PhD; Rohde, Rachel S. MD; Mendelson, Stephen A. MD Author Information