Clinical predictors of pathological femoral fractures in children: a retrospective comparative study.

Paediatric tibial tubercle fractures – A retrospective case series

Background Tibial tubercle fractures (TTFs) are rare injuries in adolescents, representing 3% of all proximal tibia fractures and less than 1% of all physeal fractures. Despite their low incidence, they can be associated with significant complications such as periosteal stripping, vascular compromise, compartment syndrome and intra-articular damage. Given the increasing incidence due to youth sports participation and the limited existing literature, this study aimed to describe patient characteristics, treatment methods, outcomes, and complications in children aged 8–16 years with TTFs. Method and findings A retrospective cohort study was conducted at a level 2 trauma centre in the Netherlands, including 40 patients (41 fractures) between 2008 and 2023. The mean age at injury was 14.3 years, and 95% (38/40) of cases occurred in males, predominantly during sports activities. Thirty-two fractures (78% (31/41)) required surgical treatment, most commonly with screw fixation, while nine fractures (22% (9/41)) were treated non-operatively. The total complication rate was 9.8% (4/41), including two refractures and one implant loosening, all within the surgically treated group. No compartment syndromes were reported. At the end of follow-up 93.5% (29/31) of surgically treated patients and 77.8% (7/9) of non-surgically treated patients had returned to sport. Conclusion Tibial tubercle fractures in adolescents occur mostly in males during sports. The surgical treatment is not standardized and can be custom made per fracture. Patients receiving surgical or non-surgical treatment both have a good chance to return to sport after this specific injury.

Epidemiology and Clinical Outcomes of Vertebral Fractures in Older Adults: A Three-Year Study from Northwestern Iran

Elderly spinal fracture patients, particularly men and those with multiple vertebral fractures, are at an increased risk of spinal cord injury, associated fractures, prolonged hospitalization, and mortality.

Clinical and anatomical characteristics of mandibular angle fractures: a 10-year retrospective monocentric cohort study

Introduction Mandibular angle fractures represent a distinct subgroup of mandibular fractures with unique anatomical and biomechanical characteristics. However, factors influencing fracture patterns and treatment complexity remain incompletely understood. This study aimed to characterize the clinical, anatomical, and morphological features of mandibular angle fractures and to identify factors associated with fracture behavior. Methods This retrospective monocentric cohort study included 115 patients treated for mandibular angle fractures at a tertiary referral center between January 2015 and December 2025. Demographic, fracture related, radiological, morphological, dental, and treatment variables were retrospectively collected and analyzed to evaluate factors associated with fracture patterns, treatment complexity, and clinical outcomes. Results Of 115 patients, 104 (90.4%) were male and 11 (9.6%) were female. Female patients were significantly older than male patients (p < 0.001). Contralateral fracture patterns predominated among multiple fractures, most commonly involving the paramedian region. Pathological fractures were significantly associated with isolated fractures (p = 0.020) and occurred exclusively in patients aged ≥30 years (p < 0.001). Dentition status differed significantly between isolated and multiple fractures (p = 0.031). Morphological parameters, particularly anterior facial height and the posterior to anterior facial height (PFH/AFH) ratio, were significantly associated with fracture multiplicity and treatment complexity. Third molar status was significantly associated with treatment complexity (p = 0.010), whereas treatment modality differed significantly between age groups (p = 0.020). No significant association was observed between trauma mechanism and fracture pattern or treatment complexity. Conclusion Mandibular angle fractures appear to be primarily influenced by anatomical and biomechanical characteristics rather than trauma mechanism alone. Craniofacial morphology, age, and dental status may contribute to fracture patterns and treatment complexity, supporting a more individualized assessment of mandibular angle fractures.

Orbital floor fractures: clinical characteristics, mechanisms of injury, and surgical outcomes in a 25-year single-center study

Epidemiology and injury patterns of high-energy pediatric pelvic and acetabular fractures: A retrospective study with comparative outcomes

BACKGROUND This study aimed to evaluate the epidemiological characteristics, injury mechanisms, fracture patterns, associated injuries, and early hemoglobin (Hb) changes and physiological response in pediatric patients with pelvic fractures. In addition, clinical and injury-related variables were compared according to skeletal maturity status and treatment modality. METHODS This retrospective single-center study included 52 consecutive patients younger than 18 years who were treated for pelvic fractures between September 2022 and March 2025. Skeletal maturity was determined based on triradiate cartilage status. Fractures were classified using Torode-Zieg, Young-Burgess, and Letournel-Judet systems. Early physiological response was assessed using serial Hb measurements at admission, 24 h, and 48 h. Comparative analyses were performed according to skeletal maturity and treatment modality. RESULTS The median age was 14 years, and 55.8% of patients were female. Pelvic ring injuries were observed in 76.9% of patients, and associated injuries were present in 67.3%. Non-operative treatment was performed in 65.4% of patients. Hb levels decreased from 12.3±1.8 g/dL at admission to 11.1±2.0 g/dL at 24 h and 10.5 g/dL at 48 h. No significant differences in Hb decline were observed according to skeletal maturity (p>0.05). Patients who underwent operative treatment had significantly lower Hb levels at 24 and 48 h (p=0.006 and p=0.005, respectively); however, the magnitude of Hb decrease did not differ significantly between treatment groups (p>0.05). CONCLUSION Pediatric pelvic fractures are uncommon injuries typically associated with high-energy trauma and multiple concomitant injuries. Early Hb decline was modest and did not differ according to skeletal maturity. Lower Hb levels in surgically treated patients may reflect overall injury severity rather than pelvic fracture-related hemorrhage. Careful evaluation of associated injuries and close monitoring of Hb levels are essential in pediatric pelvic trauma.

Clinical and radiographic findings that impact treatment: a study of 418 proximal humerus fractures.

PURPOSE Regional skeletal maturation can influence injury pattern and treatment selection. This study aimed to systematically characterize pediatric proximal humerus fractures to identify radiographic findings that impact treatment selection. METHODS This IRB-approved retrospective comparative study included pediatric patients (< 18 years), who underwent pre-treatment radiographic examination for proximal humerus fractures (2014-2024). Demographics, injury mechanism, skeletal maturity, physeal involvement and pattern, maximum displacement, angulation, and treatment were collected. Findings between surgically and non-surgically treated fractures were compared using descriptive statistics and using optimal cutoff values, determined using the receiver operating characteristic (ROC) analysis and the Youden index, with additional regression modeling to identify independent predictors of surgery. RESULTS This study of 418 children (mean age, 9.8 ± 3.6 years; 53.1% girls, 46.9% boys) included fractures in 90.0% skeletally immature, 8.9% maturing, and 1.2% mature humeri. A minority had physeal involvement (14.0%) and underwent surgical treatment (10.0%). Overall, median fracture displacement (relative to shaft width) was 24% (IQR, 12%-53%) and angulation was 14° (IQR, 8-23°) with optimal thresholds identified at > 42% and > 22°, respectively. In the adjusted multivariable logistic regression, independent predictors for surgery included fracture displacement > 42% (OR: 13.3, 95% CI: 4.2-41.7, P < 0.01), age > 12 years (OR: 7.2, 95% CI: 2.2-24.1, P < 0.01), and a non-fall injury mechanism (OR: 6.3, 95% CI: 2.4-16.7, P < 0.01). CONCLUSION In our study group, fracture displacement, together with older age and a non-fall injury mechanism, independently impacts management of pediatric patients with acute proximal humerus fractures.