Introduction The treatment of the displaced fracture of the lateral condyle of the distal humerus in children aims not only to avoid nonunion, malalignment, and impairment of the range of motion of the elbow but also to prevent delayed healing and the development of any prearthrotic deformity. To date there is no agreement on what kind of osteosynthesis should be used. So far, the screw fixation and Kirschner wire fixation have both been applied. Therefore, the goal of this study was to compare the outcome of these two methods. Materials and Methods A retrospective cohort study was undertaken including 43 patients aged 2 to 13 years who underwent osteosynthesis for a condylar fracture of the humerus over a period of 10 years. The electronic archive, including the radiological diagnostics, was analyzed. Statistical analysis was performed using IBM SPSS Statistics 20.0. Statistical significance was set at an α level of p = 0.05. Results Kirschner wire fixation was performed in 48.9% of condylar fractures of the humerus while screw fixation (alone or in combination with a pin) was assessed with a percentage of 51.1% of the cases in this study. Screw fixation only was applied in 20.9% of fractures of the lateral condyle. The selection of the method was independent of the age of the patient (p = 0.2). The comparison of the rate of complications and an impaired range of motion after Kirschner wire osteosynthesis to the rate after screw osteosynthesis showed a significantly lower percentage for the Kirschner wire group (p = 0.046). No case of nonunion, nerve palsy, or pin migration was detected in any patient in this study. Conclusion Kirschner wire fixation of condylar humeral fractures in children resulted in a lower rate of complications than screw fixation. No case of nonunion of the fracture was found in the patients that we investigated so that we conclude that Kirschner wires sufficiently adapt the fracture in these cases. Level of Evidence Level III.

Objective To detect the influence of the type of osteosynthesis, the timing of surgery, and the experience of the surgeon on the outcome of supracondylar humeral fractures in children. Methods In this study we included 97 patients aged 0 to 18 years with displaced supracondylar humeral fractures that required osteosynthesis within a time period of 5 years. In detail, unstable type II as well as type III and type IV fractures were registered. Fractures were treated with Kirschner wire fixation or with elastic stable intramedullary nailing (ESIN). A C‐arm was used to control the position of the fragments. Immobilization, if indicated after the operation, was achieved through the fitting of long‐arm plaster, or fiberglass splints. The study was carried out retrospectively. The time period to surgery, the duration of the surgery, the type of osteosynthesis, and the experience of the surgeon were determined and correlated to the incidence of complication intraoperatively, postoperatively, and during the long‐term follow‐up. The hospital's electronic archive, including all charts and radiological studies, was analyzed. Statistical significance was set at an alpha level of 0.05. Results Of the 97 supracondylar fractures in this study, 55 (56.7%) occurred in boys and 42 (43.3%) in girls; the average age was 5.8 years. The outcome of the operation was independent of the time interval between the trauma and the operation as well as the mode of transportation ( P > 0.05) because the complication rate did not differ significantly between patients who had surgery on the same day and between patients who waited for up to 2 days for surgery. Furthermore, the duration of surgery and the experience of the performing surgeon did not influence the occurrence of any complications. However, the complication rate increased after operations performed during the night shift. During the shift between 10 pm and 2 am, the incidence of paresthesia was significantly increased ( P = 0.01) compared to the shift from 7:30 am to 4:30 pm. However, no difference was detected between business and non‐business days regarding any complications. In addition, ESIN and closed reductions resulted in lower complication rates than Kirschner wire fixation and open reductions in this study population. Conclusion In our study population, patients undergoing surgery during the night shift, Kirschner wire fixation and open reduction were associated with an increased rate of complications in comparison to operations during the day, closed reduction, and ESIN. Notably, the timing of surgery and the experience of the surgeon did not have any impact on the outcome after supracondylar humeral fracture.

PurposeThe therapy of distal radial fractures in children is expected to be as non-invasive as possible but also needs to deliver the definite care for gaining optimal reduction and stabilizing the fracture. Therefore, closed reduction and immobilization is competing with routine Kirschner wire fixation. The aim of our study was to investigate if closed reduction and immobilization without osteosynthesis can ensure stabilization of the fracture.MethodsWe chose a retrospective study design and analyzed 393 displaced distal radial fractures in children from 1 to 18 years with open epiphyseal plates studying medical files and X-rays. The Pearson’s χ2 test was applied. Statistical analysis was performed using IBM SPSS Statistics 20.0. Statistical significance was set at an alpha level of P = 0.05.ResultsOf these studied fractures 263 cases were treated with closed reduction and immobilization. Only 38 of these needed secondary interventions, 28 of these underwent reduction after redisplacement and ten patients received secondary Kirschner wire fixation. The last follow-up examination after 4–6 weeks revealed that 96.4 % of fractures initially treated with closed reduction and immobilization were measured within the limits of remodeling. 104 of the studied fractures were treated with cast immobilization alone when displacement was expected to correct due to remodeling. Here 22.1 % of patients needed secondary reduction. Furthermore, primary Kirschner wire fixation was performed in only 25 children with unstable fractures and only one received further treatment. Interestingly, operative reports of primary closed reduction revealed that repeated maneuvers of reduction as well as residual displacement are risk factors for redisplacement.ConclusionFor the treatment of displaced distal radial fractures in children closed reduction and immobilization can be considered the method of choice. However, for cases with repeated reduction maneuvers or residual displacement we recommend primary Kirschner wire fixation to avoid redisplacement.Level of evidenceRetrospective comparative study, Level III

This study confirms that PECARN rules as administered in this study can ensure safe decision-making regarding ambulatory or inpatient treatment.

Infantile hemangioma is a vascular neoplasm and is one of the most common tumors diagnosed in young children. Although most hemangiomas are harmless and involute spontaneously, some show severe progression, leading to serious complications, such as high-output cardiac failure, ulcerations, compression of the trachea or deprivation amblyopia, depending on their size and localization. However, the pathogenesis and cause of hemangioma are largely unknown to date. The goal of this study was to identify markers that could predict hemangiomas with aggressive growth and severe progression that would benefit from early intervention. By using a PCR-based screening approach, we first confirmed that previously known markers of hemangioma, namely FGF2 and GLUT1, are highly expressed in hemangioma. Nevertheless, these genes did not show any differential expression between severely progressing tumors and mild tumors. However, transcriptional upregulation of several Hedgehog signalling components, comprising the ligand Sonic Hedgehog (SHH), the transcription factor GLI2 and its target gene FOXA2 were detected in extremely aggressive hemangioma specimens during the proliferation phase. Notably, GLI2 was even overexpressed in involuting hemangiomas if they showed an aggressive growth pattern. In conclusion, our data suggest that overexpression of the Hedgehog components SHH, GLI2 and FOXA2 might be used as markers of an aggressive hemangioma that would benefit from too early intervention, while FGF2 and GLUT1 are more general markers of hemangiomas.