BackgroundMedial humeral epicondyle fractures of the elbow are one of the most common injuries in childhood and often require surgery. There are currently no standardised outcome measures to assess progress after an elbow injury in a child. Wide variation in currently reported outcomes makes comparison of treatment difficult. This study aims to identify outcome measures that have previously been reported in studies evaluating the management of medial epicondyle fractures in children and to facilitate the development of a consensus core outcome set (COS) suitable for use in all future studies of medial humeral epicondyle fractures in children.Methods/designThis study will include a systematic review of the academic literature to identify a list of outcome measures that have previously been reported. The list of outcome measures will be used in a consensus setting exercise with focus groups of key stakeholders to identify key outcomes. A Delphi process to include two rounds will then be used to define the most important outcomes to all stakeholders forming the COS.DiscussionCore outcomes represent the minimum expected data reported for a specific condition and will improve the quality of future studies reducing bias, allowing easier comparison and enhancing opportunities for larger meta-analysis. It is anticipated that this COS will form part of the feasibility to a National Institute for Health Research (NIHR) Health Technology Assessment (HTA)-funded trial concerning the management of elbow fractures in children.Trial registrationCore Outcome Measures in Effectiveness Trials Initiative (COMET), registration number:949. Registered on 17 January 2017.Prospero International prospective register of systematic reviews, registration number: CRD 42017057912. Registered on 16 April 2017.

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In children with developmental dysplasia of the hip (DDH), Salter's innominate osteotomy aims to surgically manipulate the acetabulum to increase anterior coverage and aid joint support. Consequently, this procedure may retrovert the acetabulum, predisposing patients to pain, osteoarthritis, impingement, or further surgical intervention. In this study, we aim to address whether the innominate osteotomy leads to acetabular retroversion postoperatively or at follow-up. Ninetytwo patients were identified from our institutions DDH database between 2009 and 2016, who underwent a unilateral innominate osteotomy for DDH, performed by expert surgeons in a leading paediatric hospital. A novel technique was utilized to measure acetabular version on postoperative computed tomography (CT) scans, where acetabular version was compared between the pathological and contralateral control hips. Measurement of acetabular version in postoperative and control hips demonstrated no incidence of acetabular retroversion. A significant difference was observed when comparing the acetabular version of control versus postoperative hips (P < 0.001), where hips postinnominate osteotomy had a larger degree of acetabular anteversion compared to the control hip. Furthermore, on follow-up radiographic imaging, there was no evidence of acetabular retroversion when using previously defined markers. This study confirms that the Salter innominate osteotomy does not lead to acetabular retroversion both immediately post-operatively and throughout follow-up. In fact, it demonstrates that the acetabula are more anteverted than the contralateral control hip, which has not been previously documented. Additionally, this study demonstrates a novel method of measuring acetabular retroversion using CT technology that adjusts for pelvic tilt, which is repeatable among individuals.

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A four-year-old child attended Accident and Emergency following a fall from a slide with a displaced and angulated proximal tibial metaphyseal fracture. Treatment included closed manipulation under anaesthesia and an above knee cast for seven weeks. Serial radiographs over the following few months were satisfactory demonstrating good alignment and evidence of healing. However, at four-months review new-onset genu valgum with mechanical axis deviation was noted. No evidence of spontaneous resolution was noted over the following 12 months and hence a corrective hemi-epiphysiodesis was performed. At 12-months post-operatively, there was marked clinical and radiographical improvement in alignment. Classically Cozen's phenomenon is described as the late-onset post-traumatic valgus deformity associated with proximal tibial metaphyseal fractures in children. We want to reemphasise the early recognition of children at risk of this unique complication. In addition, we wish to highlight the progression of the late-onset valgus and its subsequent management.