Background and purpose — We have previously shown that children with minimally displaced metaphyseal both-bone forearm fractures, who were treated with a below-elbow cast (BEC) instead of an above-elbow cast (AEC), experienced more comfort, less interference in daily activities, and similar functional outcomes at 7 months’ follow-up (FU). This study evaluates outcomes at 7 years’ follow-up. Patients and methods — A secondary analysis was performed of the 7 years’ follow-up data from our RCT. Primary outcome was loss of forearm rotation compared with the contralateral forearm. Secondary outcomes were patient-reported outcome measures (PROMs) consisting of the ABILHAND-kids and the DASH questionnaire, grip strength, radiological assessment, and cosmetic appearance. Results — The mean length of FU was 7.3 years (5.9–8.7). Of the initial 66 children who were included in the RCT, 51 children were evaluated at long-term FU. Loss of forearm rotation and secondary outcomes were similar in the 2 treatment groups. Interpretation — We suggest that children with minimally displaced metaphyseal both-bone forearm fractures should be treated with a below-elbow cast.

Primary hyperparathyroidism is characterised by high parathyroid hormone (PTH) levels and concomitant hypercalcaemia. Ninety per cent is caused by solitary parathyroid adenomas, 10% by multiple adenomas, hyperplasia and carcinomas. Less than 0.1% of the inferior parathyroid glands are ectopically located. This case is of a 54-year-old woman with hypercalcaemia 3.05 mmol/L and high PTH 22 pmol/L. Scintigraphy and CT scan of the neck in 2009 showed no signs of ectopic tissue. After treatment with Aredia (pamidronate disodium) infusion, calcium decreased to 2.73 mmol/L. In 2010 the serum calcium levels increased again to 3 mmol/L. Repeated CT showed no ectopic tissue. However, revision of the CT by the multidisciplinary team including an experienced endocrine surgeon revealed an ectopic parathyroid gland at the level of the hyoid bone, which was surgically removed in 2011. Preoperatively the PTH level was 16.8 mmol/L, postoperatively it decreased to 2.9 mmol/L, proving a successful excision. In case of suspicion of a parathyroid adenoma a CT of the neck should be thoroughly assessed by a dedicated multidisciplinary team, including the head and neck surgeon, as clinical data and radiological findings must be combined since ectopic parathyroid adenomas are a rare entity. Thereafter the adenoma can be surgically removed and the patient cured.

Introduction Traumatic bowing is a commonly missed diagnosis on which only little information is available, inadequate treatment can cause permanent function loss. Method A systematic review would determine what the effect is of treatment of traumatic bowing of the lower arm in children on the functional outcome. A search on Embase, Medline, Web of Science, Scopus, Cochrane, Pubmed publisher, CINAHL and Google scholar, last accessed at the 15th of May 2016. Intervention of interest was treatment; with reduction, reduction and cast or cast only. The primary outcome measure was (I) function; pro and supination, (II) posttraumatic function, (III) posttreatment function and (IV) residual bowing. Results Five articles were included. Treatment by reduction only showed a normal function, 4 weeks to 8 weeks of cast and reduction followed by cast, both resulted in 0 degrees to 20 degrees residual of pronation loss. Discussion The treatment was overall well tolerated, had a direct effect and lead to faster restore of function. It is unclear to what amount of bowing can be accepted without any loss of function. But in view of the few complications and good results for reduction, the overall opinion is to reduce all significant bowing fractures of the lower arm in children with limited function.

Background Short-term follow-up studies have shown that reduced metaphyseal both-bone forearm fractures in children should be treated with K-wires to prevent redisplacement and inferior functional results. Minimum 5-year follow-up studies are limited. Range of motion, patient-reported outcome measures, and radiographic parameters at minimum 5-year followup should be evaluated because they could change insights into how to treat pediatric metaphyseal forearm fractures.Questions/purposes (1) Does K-wire stabilization of reduced metaphyseal both-bone forearm fractures in children provide better forearm rotation at minimum 5year follow-up? (2) Do malunions (untreated redisplaced fractures) of reduced metaphyseal both-bone forearm fractures in children induce worse functional results? (3) Which factors lead to limited forearm rotation at minimum 5-year follow-up?Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Ethical approval for this study was obtained from METC Zuidwest Holland (number 41839.098.12).