Background: As there is a current increasing tendency to treat displaced tibial shaft fractures in adolescents surgically, it has become more important to predict failure of cast treatment for these patients. In the past, redisplacement of pediatric tibial shaft fractures has been reported at rates of 20% to 40%. Although the efficacy of the three-point index (TPI), gap index, and cast index has been demonstrated for upper extremity fractures in children, to date no index has been shown to accurately predict redisplacement for pediatric tibial shaft fractures. The aim of this study was to determine the predictive factors for redisplacement in pediatric tibial shaft fractures. Methods: In all, 157 displaced pediatric tibial shaft fractures were evaluated retrospectively. Patient age, initial and postreduction fracture angulation, shortening and translation, quality of reduction, obliquity of fracture, associated fibular fractures, and 3 indices (TPI, cast index, and gap index) were analyzed. Receiver operating characteristic analysis was performed to determine the cutoff points and logistic regression was used to show the risk factors of redisplacement. Results: There were 53 female and 104 male patients with a mean age of 9.1 (5 to 15 y) and 45 patients developed redisplacement during the follow-up. Mean TPI and gap index and initial and postreduction fracture translation were higher in patients with redisplacement, while TPI>0.855 and postreduction translation >18% were the only independent risk factors for fracture redisplacement. No differences were observed regarding associated fibular fracture, quality of reduction, initial/postreduction angulation, and shortening. Conclusions: The TPI>0.855 and postreduction translation >18% are independent risk factors for redisplacement of tibial shaft fractures in children. Although the gap index can be useful, the cast index is not an appropriate tool for these fractures.

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Background: Acetabular dysplasia (AD) may appear after six-months-old despite normal previous physical and ultrasonographic examination, and management remains unclear. The purpose of the current study was to evaluate the success of abduction orthosis in the treatment of primary AD patients. Methods:Patients presented with AD between 2010-2017 were retrospectively reviewed. The study included AD patients who had stable hip joints on previous physical examination and Graf type1 on ultrasonography when younger than six months. AD was diagnosed according to the age-related acetabular index (AI) values. Abduction orthoses were applied full-time for five months plus part-time for three months. AI was re-measured at the sixth month, at the end of the first and third year. AI change was compared between dysplastic and nondysplastic hips.Results: It was evaluated 60 hips of 39 patients with AD treated with abduction orthosis at the median age of 6 months. The mean AI was 31.4 (range: 29-35)°±2.1° in dysplastic hips. AI decreased to 26.5°±2.2°, 24.5°±2°, 21°±2.1° at sixth months, first and third years after treatment; respectively. The mean AI of non-dysplastic hips was 25.3°(range: 22-28)±2.1°; and decreased to 22.6°±2.4°, 21.1°±2°, 17.9°±1.8° at sixth months, first and third years follow-ups, respectively. At the end of the first six months, dysplastic hips had significantly better improvement in AI (4.9±2.1°) compared to non-dysplastic hips (2.7°±0.8°) (p<0.001). There was no significant difference in AI improvement after six months. Conclusion:Primary acetabular dysplasia should not be ignored despite normal previous physical and ultrasonographic examination. Abduction orthosis may be used in the treatment of children with primary AD older than six months.