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NEGLECTED SEYMOUR FRACTURES OF THE HALLUX IN CHILDREN: FIXATION VERSUS NO FIXATION, AND TRANSARTICULAR VERSUS EXTRA-ARTICULAR TECHNIQUE.

Demir Ibrahim Halil IH, Gonder Nevzat N, Unat Beytullah B, Erol Ramazan R et al.

Open Seymour fractures of the hallux, distinct from closed physeal injuries, lack a clear optimal stabilization strategy when presentation is delayed. To compare reduction maintenance and recovery of interphalangeal (IP) motion after three operative strategies for neglected, open hallux Seymour fractures. Retrospective comparative cohort study. Forty-four children presenting more than 48 hours after injury underwent irrigation, debridement, and nail bed repair, with transarticular fixation (TFx, n=16), extra-articular crossed-wire fixation (EFx, n=17), or no skeletal fixation (NoFx, n=11). Minimum follow-up was 12 months. Categorical outcomes were compared with exact tests; continuous outcomes with Kruskal-Wallis tests and adjusted pairwise comparisons. Loss of reduction occurred in 5/11 NoFx patients versus 0/33 fixed patients (p < 0.001). Median time to full IP motion was 77 days in TFx versus 56 days in both EFx and NoFx (TFx vs EFx, p = 0.002 after adjustment). Physeal alteration occurred in 3/16 TFx, 3/17 EFx, and 7/11 NoFx patients (overall p = 0.027), though pairwise comparisons were not significant. All 5 patients with loss of reduction had physeal alteration, versus 8/39 without (exploratory p = 0.001). Osteomyelitis occurred in 12/44 patients and correlated with longer treatment delay. Fixation was associated with maintained reduction in this neglected, open-injury cohort. Extra-articular fixation showed earlier recovery of full IP motion than transarticular fixation, with no loss of reduction in either fixed group. These findings support joint-sparing fixation when feasible but do not establish causal superiority or identify which fractures may safely remain unfixed. Level III, retrospective comparative study.

Transport Intramedullary Nail for Nonunion.

Crist Brett D BD, Lee Mark A MA

Nonunions with bone defects create technical challenges for fracture healing. All-internal bone transport with an intramedullary nail offers benefits over the other bone segment transport options including being simpler for the patients, avoiding the associated soft tissue issues that externally based implants or techniques and minimizing residual deformity by maintaining the anatomical axis along the intramedullary nail. This article reviews preoperative planning, technical tricks and specific techniques for internal bone transport, including the corticotomy, distraction, docking site and regenerate management, and the available literature.

Intramedullary Bone Transport Nail for the Treatment of Segmental Tibial Bone Defect After Acute Traumatic Bone Loss.

Scolaro John A JA

Medullary bone transport is a valuable technique to perform distraction osteogenesis with all-internal components. This technique has notable advantages over other techniques which rely on external pins, wires, and frames. Preoperative templating and surgical planning are critical to the success of this procedure to ensure that movement of the segment across the defect can be performed based on the specifications of the nail. The case of a young patient with a 67 mm diaphyseal tibial defect after an open tibial shaft fracture who had successful reconstruction with a medullary bone transport nail is presented.

Another Nail In The Coffin for Ex Vivo Heart Perfusion?

Teimouri Dereshgi Amir A, Chin Clifford W CW, Shah Ashish S AS, Bommareddi Swaroop S et al.