Background Elbow immobilization due to fractures of the upper limb is frequent in paediatric patients. Proper follow-up is critical to assess elbow functional recovery. Telemedicine can be an option for remote monitoring of these patients. The purpose of this study was to compare personal and virtual evaluation of elbow range of motion after long arm cast withdrawal in paediatric patients. Methods An observational cross-sectional study was carried out which included all paediatric patients with elbow immobilization in long arm casts treated at our centre. After cast withdrawal, elbow range of motion was evaluated by telemedicine and in office consultation in all four movements (flexion, extension, pronation and supination). Results Ninety-three patients met the selection criteria. Median age at time of immobilization was 8 years. Mean elbow immobilization time was 23 days (range 18–56 days). When comparing office and remote measurements, no statistical differences were found for any of the four elbow movements measured in our study. Conclusions Remote evaluation of elbow range of motion by telemedicine is technically feasible. We evaluated elbow range of motion in paediatric patients after immobilization and we did not find differences between digital and in office measurements. The results were similar to those obtained through assessment in the office. We believe that this is a useful tool to facilitate remote patient follow-up.

<div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><strong>Objetivo: </strong><span>Evaluar el resultado del tratamiento de niños con fractura desplazada de antebrazo mediante la estabilización con clavos endomedulares flexibles de titanio. </span></p><p><strong>Materiales­y­Métodos: </strong><span>Se evaluaron, en forma retrospectiva, 13 pacientes (edad promedio 11 años; rango 6-15). Se realizó una evaluación comparativa entre el antebrazo operado y el antebrazo sano contralateral. La evaluación radiológica comparó la longitud del radio, y la ubicación y magnitud del lugar de máxima curvatura del radio entre ambos antebrazos. La evaluación funcional comparó el rango de pronosupinación del antebrazo. El seguimiento promedio fue de 37 meses (rango 12-68).<br /> </span></p><p><strong>Resultados: </strong><span>La longitud del radio operado fue de 18,1 cm y la del radio contralateral sano, de 18,1 cm (p = 1). La localización del lugar de máxima curvatura del radio se ubicó a nivel del 66,8% de la longitud en el radio operado y a nivel del 61,5% de la longitud en el radio contralateral no operado (p &lt;0,01). La magnitud de la máxima curvatura del radio fue del 6,2% y del 6,7% de la longitud total del radio, en el antebrazo operado y en el no operado, respectivamente (p = 0,26). La pronación del antebrazo operado fue de 87,7 grados y la del contralateral sano, de 88,3 grados (p = 0,26). La supinación fue de 89,9 grados y de 90,9 grados en el antebrazo operado y en el no operado, respectivamente (p = 0,49).<br /> </span></p><p><strong>Conclusiones: </strong><span>El tratamiento de niños con fracturas desplazadas de antebrazo mediante la estabilización con clavos endomedulares flexibles produce resultados radiológicos y funcionales similares a los del antebrazo contralateral sano.</span></p><p> </p></div></div></div>

To present and describe an unusual case of spinal instability after craniocervical spinal decompression for a type-1 Chiari malformation. Type-1 Chiari malformation is a craniocervical disorder characterized by tonsillar displacement greater than 5 mm into the vertebral canal; posterior fossa decompression is the most common surgical treatment for this condition. Postoperative complications have been described: cerebrospinal fluid leak, pseudomeningocele, aseptic meningitis, wound infection, and neurological deficit. However, instability after decompression is unusual. A 9-year-old female presented with symptomatic torticollis after cervical decompression for a type-1 Chiari malformation. Spinal instability was diagnosed; craniocervical stabilization was performed. After a 12-month follow-up, spinal stability was achieved, with a satisfactory clinical neck alignment. We present a craniocervical instability secondary to surgical decompression; clinical and radiological symptoms, and definitive treatment were described.

Despite the high incidence of pediatric upper extremity fractures, there is still much debate on optimal management. In a webinar recently organized by the Sociedad Española de Ortopedia Pediátrica (SEOP) in conjunction with the Sociedad Argentina de Ortopedia y Traumatología Infantil (SAOTI), the evaluation and principles of treatment of five controversial upper extremity fractures were discussed. The aim of this special article is to provide readers with a summary of the evidence-based arguments used in that session.