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Commentary

Lascombes, Pierre, MD

Journal of Pediatric Orthopaedics: July 2018 - Volume 38 - Issue - p S38
doi: 10.1097/BPO.0000000000001146
Cutting-Edge Pediatric Orthopaedics 2017: A Global Perspective
Free

Children Hospital, HUG Genève, Switzerland

The author declares no conflicts of interest.

The classic treatment methods for childhood fractures were described by the Judet brothers in Europe, by W.P. Blount in the United States, and by many other prestigious 20th century surgeons. However, thanks to Jack Flynn’s vision of 5 unavoidable steps that these pediatric treatments moved into the modern era, with more and more minimally invasive surgery and prompter recoveries.

  • Accurate diagnosis: for all fractures, providing appropriate information to parents depends on the precision of the diagnosis. Mistakes in the treatment of elbow injuries are at the top of the list when it comes to pediatric medical malpractice suits; hence, looking out for an unhappy triad should be a top priority.
  • Pertinent diagnosis: 3D imaging remains helpful in some joint fractures. However, irradiation should be kept to a minimum, which means using MRI rather than a CT scan, and/or complementing this with fluoroscopy in the operating theater instead of taking multiple x-rays.
  • Surgical accuracy: new generations of 3D C-arms allow an ever wider range of minimally invasive surgical approaches. Yet, a good image of the fracture(s) is just one small part of the puzzle, and excellent knowledge of modern pediatric surgical techniques is a must to avoid common pitfalls and errors.
  • Quality control: a postoperative arthrography may prove that a joint fracture has been perfectly reduced, just as dynamic C-arm views can demonstrate the stability of any nails, pins, or plates. Being able to show the patient’s family a perfectly reduced and stabilized fracture is an excellent means of building trust.
  • In some circumstances, immobilization is required: nevertheless, unnecessary casts should be avoided in order to limit bone demineralization and a delayed return to activity. Finally, follow-up should be maintained until proof of normal posttraumatic growth.

When taking care of a trauma patient, pediatric orthopaedic surgeons should always keep these 5 steps in mind.

Pierre Lascombes, MD

Children Hospital, HUG Genève, Switzerland

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