The current literature suggests that up to 55% of complications after plate osteosynthesis treatment for patients with proximal humerus fractures are attributed to the surgical procedure. The hypothesis of this study was that a standardized surgical protocol would minimize surgery-related adverse events. This prospective cohort study included 50 patients with a mean age of 63.2 (range 28–92) years treated by one single surgeon using a previously published standardized surgical protocol. Clinical and radiological follow-up examinations were conducted for up to 24 months using Constant–Murley Score (CS), Subjective Shoulder Value (SSV) and radiographs in true anteroposterior, axial and y-view. Finally, CS was 73.9 (standard deviation [SD]: 14.0) points (89% compared to the uninjured shoulder), and SSV was 83.3% (SD: 16.7) at two years of follow-up. Postoperative radiologic evaluation revealed no primary surgical-related or soft-tissue-related complications (0%). The main complications were secondary, biological complications (20%), largely represented by avascular necrosis (8%). Eight patients underwent revision surgery, mainly for implant removal. In addition, a total of four patients were revised using a hemiarthroplasty (n = 2), reverse shoulder arthroplasty (n = 1) or re-osteosynthesis. The use of our standardized surgical technique on proximal humerus fractures improves fixation with regard to primary stability and prevents primary, surgical-technique-related complications. The subjective grading of a high level of difficulty surgery was associated with more complications.

/pdf/a-standardized-operative-protocol-for-fixation-of-proximal-1ik9zysk.pdf

A Standardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Surgery-Related Complications

Polydactyly is an axial malformation defined as supernumerary fingers in the foot or hand. It has a prevalence of 1.73 per every 1,000 live births worldwide, with a higher incidence in blacks (up to 13 cases per 1,000 births). The majority occurs sporadically as an isolated trait, however, it may be associated to genetic alternated syndromes, or environmental factors such as exposure to teratogenic agents during embryonic development. 1 The diagnosis is clinical and should be made at birth or at first contact. A radiological evaluation is essential during early stages of life to classify the pathology and determine the best surgical treatment. 2

/pdf/uncommon-variant-of-pre-axial-polydactyly-and-its-surgical-1d1xyxm9jc.pdf

Uncommon variant of pre-axial polydactyly and its surgical management: a case report

Bei der Kinderchirurgie handelt es sich um ein Fach mit einem breiten Behandlungsspektrum Neben der Neugeborenenchirurgie werden, je nach Zentrum, auch Krankheitsbilder aus den Bereichen Kinderurologie, Kindertraumatologie, Kinderneurochirurgie sowie plastischer Chirurgie ambulant und stationar behandelt Viele Befunde, die der operativen Versorgung bedurfen, sind pathognomonisch fur bestimmte Altersgruppen und fur den erfahrenen Behandler bereits klinisch diagnostizierbar

Schnappschüsse aus der kinderchirurgischen Sprechstunde – klinische Diagnosen von Kopf bis Fuß

Purpose: To evaluate the outcome of reconstruction of congenital bimanual polydactyly and bipedal polydactyly in children in a tertiary health facility in China. 
Methods: All 8 children diagnosed with polydactyly of hands and feet from March 31st of 2016 to April 1st of 2020 underwent surgical reconstruction and were followed up for 6 to 36 months. Evidence of family history and outcome of the surgical intervention in the hospital using Tada scoring were analyzed. 
Results: 7 of the patients had the same family history with the same diagnosis of the same symptom in their fathers, grandfather and great grandfather. All the incisions healed well, the appearance of both hands and feet was satisfactory, and the function was significantly improved. The children's hand shape was satisfactory and their motor function was better than that before operation. 
Conclusion: Congenital polydactyly of both hands and feet is rare and complex. As long as the timing and method of operation are properly chosen, both hands and feet can acquire good appearance and functions after operation.

/pdf/outcomes-of-reconstruction-of-polydactyly-among-children-in-1ytt2ym9.pdf

Outcomes of reconstruction of polydactyly among children in a tertiary health facility in China

Suggested timing of reconstruction of congenital hand differences varies widely. The goal of timely intervention is to achieve near-normal appearance and function. We evaluated national trends in surgical timing of congenital hand differences to determine whether interventions align with the literature. 

Characterizing the Timing of Surgical Repair of Congenital Hand Differences in the United States

Objective To compare the efficacy of two different surgical approaches during and after pyeloplasty according to the degree/severity of hydronephrosis factor. Materials and methods Sixty child patients with UPJ obstruction admitted to our hospital from August 2019 to October 2021 were collected. Patients who underwent retroperitoneal laparoscopic pyeloplasty (RPLP) were enrolled into Group A (n = 20), while those who received transperitoneal laparoscopic pyeloplasty (TLP) were selected as Group B (n = 40). Clinical parameters, including gender, age, laterality of UPJ obstruction, degree/severity of hydronephrosis, body weight, operation time, drainage tube indwelling time, complete oral feeding time, and length of hospital stay, were compared between the two groups. Results All 60 child patients were operated upon successfully without conversion to open surgery. There were no statistically significant differences in gender, age, laterality of UPJ obstruction, and body weight between the two groups, while the operation time of TLP was shorter than that of RPLP, indicating a statistically significant difference (P < 0.001). The differences in complete oral feeding time, drainage tube indwelling time, and length of hospital stay were statistically significant between the two groups, and RPLP was superior to TLP in terms of postoperative recovery time (P < 0.001). A stratified comparison showed that there were no statistically significant differences in anteroposterior diameter ≤ 20 mm, while there were statistically significant differences in anteroposterior diameter >20 mm. Hydronephrosis is reviewed after 3 months of the operation, degree/severity of hydronephrosis have been reduced. Conclusion Both RPLP and TLP are safe and feasible in the treatment of UPJ obstruction, and their overall surgical effects are equivalent. For child patients with anteroposterior diameter ≤ 20 mm, RPLP is available, while patients with anteroposterior diameter >20 mm, TLP is recommended.

Comparative study of different surgical approaches for treatment of UPJ obstruction according to the degree/severity of hydronephrosis factor

Displaced proximal humerus fractures treated with ORIF via the deltoid interfascicular approach vs the deltopectoral approach

Objective To investigate the optimal surgical timing and treatment of congenital duplication of the thumb in children.Methods A clinical study was performed on 154 fingers of the 132 patients (including 85 males,47 females; mean age (1.53 ± 2.47) years; ranged from 2 months to 13 years).Duplicated thumbs were surgically treated from December 2007 to February 2012.All patients underwent detailed physical examination and radiological assessment.Surgical methods should be selected according to the age,Wassel classification and deformity.The operation steps included resection of the most hypoplastic thumb,followed by skin flap plasty,tendon shift (transplantation),reconstruction of collateral ligament and articular capsule.11 cases over the age of 6 underwent osteotomy discretion as appropriate.Results A total of 117 fingers of the 104 patients were followed up for an average 36.7 months (range,6-55 months).We adopted upgrade Tada standard to evaluate the follow-up results as excellent in 77 thumbs,good in 21 thumbs,fair in 15 thumbs and poor in 4 thumbs.Three thumbs appeared secondary angular deformity 2 years after operation and one thumb appeared residual osteoepiphysis in the radial side of metacarpophalangeal joint 3 years after operation.The appearance and the function were almost normal after second operation.Conclusions The optimal surgical timing of congenital duplication of thumb should be based on the appearance of thumb ossification center.The surgical timing of Wassel type-Ⅰ and Ⅱ should be chosen at 1.5 years old when the ossification center of distal phalanx appears,Wassel type-Ⅲ and Ⅳ should be chosen at 1 year old when the ossification center of proximal phalanx appears,Wassel type-Ⅴ and Ⅵ should be chosen at 2.5 years old when the ossification center of metacarpal appears,and Wassel type-Ⅶ should be chosen at 2.5 years old.The surgical method should be selected on individualized principle.The key points are reconstruction of collateral ligament,tendon and articular capsule and correction of ulnar deviation(or radial deviation).

Key words: 
Child;  Thumb;  Polydactyly;  Surgical procedures,operative

Optimal surgical timing and treatment of thumb duplication in children

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Comparative study of different surgical approaches for treatment of UPJ obstruction according to the degree/severity of hydronephrosis factor

Displaced proximal humerus fractures treated with ORIF via the deltoid interfascicular approach vs the deltopectoral approach

Optimal surgical timing and treatment of thumb duplication in children