Introduction: Fractures in children and adolescents accounted for more than 15% of all traumatic fractures among all age groups. Eighty percent of all fractures in children occur at the upper extremity. The supracondylar fractures represent the most frequent pediatric elbow injury, with 64%. Methods: Our study includes 549 patients, aged 10-17 years (77% boys, 23% girls) with upper extremity fractures, who were admitted for surgical treatment between 2015-2019 with a mean hospitalization period of 7±3 days. 34.6% of patients presented with isolated radial bone fracture, 1.8% with isolated ulnar bone fracture, 37.5% with both bone forearm fracture and 26% with humerus bone fracture. Results: In this age group the most common humerus bone fracture was supracondylar 30.7%, and then medial epicondylar fractures 28.6%. Extension-type supracondylar fractures represent 98% of cases. Flexion-type 2%. In most cases (90%) the mechanism of trauma was a classical history of fall on an out stretched hand followed by pain and swelling over the elbow with loss of function of upper limb. Conclusion: supracondylar fractures are common in adolescents (extension-type more common) and many of them require surgical intervention. In most cases the mechanism of trauma is falling on an out stretched hand.

Introduction: Supracondylar fracture humerus is one of the common conditions in paediatric admissions. Closed reduction and percutaneous fixation is the primary aim; however, significant proportion of patients underwent open reduction and internal fixation. Aims of this study were to evaluate, factors that lead to pen reduction of fractures. Method: Retrospectively evaluated all paediatric supracondylar fractures that underwent surgical management between 2018 and 2020. We assessed followings: the time lag between admission and surgery, Pre and post-operative neurovascular status, degree of displacement, type of surgeries either open or closed reduction, type implants and quality of reduction. Results:Included 47 patients, mean age was 5.9 years. 16 fractures were Gartland type 2 and 31 were type 3. Close and open reduction were 60%(28) and 40%(19) respectively. 97% of the procedure were performed within 24 hours. 96% of fractures were fixed with wires, 34% lateral and 61% cross wire configurations were identified. Mean Boumann angle was 71.5(55-90), majority of fracture had residual extension and lateral translation within the acceptable parameters. Conclusion: There was no relationship between degree of fracture displacement, mode of fracture reduction and residual deformities. Even higher Gartland type fractures can be successfully treated with closed manipulation and percutaneous fixation without functional residual deformities.

Pediatric and adolescent clavicle fractures remain controversial regarding indications for surgical treatment.
 They represent 15% of upper extremity fractures and result from shoulder trauma or a fall on an outstretched arm. 
Surgery was classically reserved for open fractures, when present skin tenting, associated neurovascular injury (subclavian vascular bundle), shortening over 2 centimeters and polytrauma. Numerous surgical options have been described in literature. Conservative treatment generally provided favorable outcome. 
Nonetheless, a shift of attitude regarding pediatric clavicle fractures developed and surgical treatment has been more frequent. Pediatric Orthopaedic Society of North America concluded from an online survey that surgeons would prefer surgical treatment, perhaps related to the need of young athletes to return to sports activity sooner. A girl of 16 years old was involved in a motorcycle accident, resulting in right shoulder trauma. Skin tenting and clavicle deformity were evident. No neurovascular injury was apparent.
 Imaging radiographic study was conducted and a displaced middle third clavicle fracture was diagnosed. Open reduction and internal fixation with superior dynamic compression plating and screws were conducted. The patient received hospital leave with a sling immobilization for 7 days, followed by tolerated active motion. Patient was pain-free at 4 and 12 weeks. Active range of motion and radiographic evidence of union was observed. Studies agree surgery has favorable functional outcome and faster recovery. QuickDASH score was measured with a result of 2.3%. This case report focuses on the favorable outcome of the decision for surgical treatment, hoping to add more to this controversial topic.

Introduction: This study is to describe the demographics of pediatric sports-related compartment syndrome (CS), identify risk factors and evaluate associated factors. Methods: The Kid’s Inpatient Database was queried to identify pediatric CS patients that underwent fasciotomy from 2003-2012. Postoperative adverse events such as complications and extended length of stay were assessed. Logistic regression analyses were used to identify factors for sports-related CS, necessary fasciotomy, and adverse events following fasciotomy. Results: 10,096 patients were identified for sports-related traumatic injury, 143 (1.4%) had a documented diagnosis of CS. Team sports had the highest incidence of CS (105 patients, 73.4%), specifically American football (47, 32.9%). 117 patients had CS in the lower extremity (81.8%), and the most common concurrent injury was fracture of the tibia/fibula (38.9%). Of these patients, 72 (50.7%) underwent fasciotomy. Logistic regression revealed sports-related traumatic patients of age 15-17 (OR=2.4 [95%CI: 1.3-4.2]; p=0.003] and age 17-20 (OR=2.2 [95%CI: 1.2-3.9]; p=0.01], were twice as likely to have CS compared to patients age 11-14. Likewise, males were twice as likely to have sports-related CS compared to females (OR=2.0 [95%CI: 1.1-3.8]; p=0.027). However, no similar significant association was found using the same demographic factors when evaluating necessary fasciotomy as an outcome variable within sports-related CS patients (all, p>0.05). Conclusion: Males or those older than age 11-14 are more likely to present with CS. The rate of CS is the highest in team sports, specifically American football. A majority had lower extremity CS and the most common concurrent injury was fracture of the tibia/fibula.

Aims: Major trauma remains a leading causes of death for children. The aim of this study is to review the causes of injury and consequences of major trauma. Methods: A prospective database of consecutive paediatric trauma calls (age 0-18) at a single UK Level 1 trauma centre has been maintained from November 2015. Injury mechanism and patterns were reviewed until March 2021. Results: 296 patients (73.3% male) were included. Adolescents (age 16-19) were the most frequently injured group contributing to 42.2% of calls. Trauma calls resulted from road traffic collisions for 205 (69.3%) patients. 78 (38.0%) were pedestrians hit by a vehicle and 54 (26.3%) were occupants of a car. Falls from >2m contributed to 37 trauma calls. Chest injuries were sustained by 85 (28.7%) children, including 29 with rib fractures. Femoral fractures were found in 76 (25.7%). 263 other limb fractures were sustained including 51 open fractures. 177 (59.6%) children required management of their injuries in an operating theatre. Discussion: Major trauma remains a common presentation, with an average of 4.7 paediatric trauma calls per month. Our local paediatric population is approximately 960,000, equating to an annual incidence of 5.7 per 100,000 person years. The study has limitations in that we could not include children who died pre-hospital but it has highlighted that children attending as major trauma often have significant orthopaedic injuries requiring theatre and there is an urgent need for additional road safety campaigns to reduce injuries to children who are either car occupants or pedestrians.

Introduction- Congenital Radio-ulnar synostosis is a rare phenomenon leading to loss of forearm range of motion and fixed pronation deformity in children. Case- A 4 year old boy with inability to supinate the forearm and and inappropriate position of hand while doing hand to mouth activities like eating. On clinical examination there was 80 degree pronation deformity. Radioulnar synostosis was confirmed on x-ray at proximal forearm. Management- Patient was operates with Both bone De-rotational osteotomy. Tourniquete was not used. Radius osteotomy done at the junction of proximal and middle 1/3rd shaft. Ulnar osteotomy was done at proximal to radial osteotomy. Both bone were de-rotated till 20 degree of pronation. Radius was fixed with plate and ulnar was fixed with k-wire. Post op- Patient was kept in above elbow slab for 6 weeks after then ulnar k-wire was removed. Follow up- a 6 moths follow up patient is doing well and able to take his hand till mouth for eating. Patient and parents are satisfies with the results. Conclusion- Both bone De-rotational osteotomy gives a good functional outcome in congenital Radio-ulnar synostosis. Recommended age group is 4-8 years.

Introduction: Stable and severe proximal femoral epiphysiolysis (PFE) is responsible for functional limitation of the hip, cartilage damage and osteonecrosis, and early coxarthrosis. These complications are due to the morphological alteration of the head – neck junction by inferior sliding and posterior displacement, inducing an anterior cam effect. The place of the sub-capital osteotomy is to restore normal anatomy. The objective of this prospective study is to evaluate the clinical and radiographic results in the medium term.
Material and methods: between May 2013 and May 2019, 6 adolescents aged 14 ½ years on average (13 to 16 years), all benefited from a sub-capital shortening osteotomy for stable, severe PFE. They presented with joint limitation, lameness, frank Drehmann's sign, and posterior epiphyseal tilt> 50 °. With an epiphysiodesis bridge of less than 50%. The technique used an antero-external approach to the hip, without dislocation. with a follow-up of 6 years. The analysis at the last follow-up consisted of a clinical, functional and quality of life assessment (Postel-Merle d'Aubigné scores), and a comparison of morphological criteria compared to the healthy contralateral side. It included a standard radiographic protocol (face and profile of Lesquene).
Results: The results at the last follow-up showed a correction of the posterior epiphyseal tilt. No cartilage damage or osteonecrosis was found. Morphological restoration of the hip. Hip function was significantly improved in all of our patients.
Conclusion: The sub-capital osteotomy allows restoration of joint congruence and a clear functional improvement

This is a case describing Monostotic fibrous dysplasia of the right tibia shaft in a 6-year-old male patient. The patient's parents noticed a diffuse swelling in the right leg at around 3 years of age when the child complained of pain in his right leg and difficulty in walking and running. The patient developed gradual and progressive anterior bowing in the right leg in the next 3 years. The patient was provisionally diagnosed as monostotic FD of the right tibia based on clinical and radiological findings. Two level anterior wedge osteotomy was done with meticulous preoperative planning in the tibia and fibula which was secured with TENS nailing and was put in a cast for 1 month as a definitive procedure for the patient. The patient resumed his normal activities after removal of the cast and was followed up at 2 monthly intervals for the next 2 years. The deformity got corrected and the pain was relieved completely. This case is an example of an excellent clinical outcome using relatively inexpensive implants with meticulous preoperative planning and execution of wedge osteotomy in fibrous dysplasia in a child for deformity correction.