1
|
Diametaphyseal Distal Forearm Fractures in Children: A STROBE Compliant Comparison of Outcomes of Different Stabilization Techniques Regarding Complications. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020374. [PMID: 36832503 PMCID: PMC9955196 DOI: 10.3390/children10020374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/12/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
Diametaphyseal forearm fractures are difficult to treat because standard methods for long-bone fracture stabilization in the metaphyseal or diaphyseal regions are less effective in this transition zone. We hypothesized that there is no difference in outcomes between conservative and surgical treatment of diametaphyseal forearm fractures. This retrospective analysis included 132 patients who had undergone treatment for diametaphyseal forearm fracture between 2013 and 2020 at our institution. The primary analysis compared complications occurring in patients treated conservatively with those occurring in patients managed surgically (ESIN, K-wire fixation, KESIN stabilization, or open reduction and plate osteosynthesis). In a subgroup analysis, we compared the two most frequently applied surgical stabilization techniques in distal forearm fractures (i.e., ESIN and K-wire) with conservative treatment. The mean age of the patients at the time of intervention was 9.43 ± 3.78 years (mean ± SD). Most patients were male (91; 68.9%), and 70 of 132 (53.1%) patients underwent surgical stabilization. The rate of re-intervention or complications was similar after conservative and surgical treatment, and ESIN or K-wire fixation achieved comparable complication rates. Recurrent displacement of fragments was the most frequent reason for re-interventions (13 of 15 patients; 86.6%). There was no permanent damage as a result of a complication. The median time of exposure to image intensifier radiation was comparable between ESIN (95.5 s) and K-wire fixation (85.0 s), but significantly lower during conservative treatment (15.0 s; p = 0.001).
Collapse
|
2
|
Perhomaa M, Stöckell M, Pokka T, Lieber J, Niinimäki J, Sinikumpu JJ. Clinical Follow-Up without Radiographs Is Sufficient after Most Nonoperatively Treated Distal Radius Fractures in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020339. [PMID: 36832469 PMCID: PMC9955157 DOI: 10.3390/children10020339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
Distal forearm fractures are common in children and are usually treated nonoperatively. No consensus has been reached on how to perform clinical and radiographic follow-up of these fractures. Our aim was to study whether radiographic and clinical follow-up is justified. We included 100 consecutive patients with non-operatively treated distal forearm fractures who were treated at Oulu University Hospital in 2010-2011. The natural history of the fractures during the nonoperative treatment was analyzed by measuring the potential worsening of the alignment during the follow-up period. The limits of acceptable fracture position were set according to the current literature using "strict" or "wide" criteria for alignment. We determined the rate of worsening fracture position (i.e., patients who reached the threshold of unacceptable alignment). In relation to splinting, we evaluated how many patients benefited from clinical follow-up. Most of the fractures (98%) preserved acceptable alignment during the entire follow-up period when wide criteria were used. The application of stricter criteria for alignment in radiographs showed loss of reduction in 19% of the fractures. Worsening of the alignment was recognized at a mean of 13 days (range 5-29) after the injury. One in three (32%) patients needed some intervention due to splint loosening or failure. Radiographic follow-up of nonoperatively treated distal forearm fractures remains questionable. Instead, clinical follow-up is important, as 32% of patients needed their splints fixed.
Collapse
Affiliation(s)
- Marja Perhomaa
- Research Unit of Clinical Medicine, Medical Research Center, Oulu Childhood Fracture and Sports Injury Study, Division of Pediatric Surgery and Orthopedics, Department of Children and Adolescents, (MRC) Oulu, Oulu University Hospital, Oulu University, 90220 Oulu, Finland
- Research Unit of Health Sciences and Technology, Department of Radiology, Oulu University Hospital, Oulu University, 90220 Oulu, Finland
- Correspondence:
| | - Markus Stöckell
- Research Unit of Clinical Medicine, Medical Research Center, Oulu Childhood Fracture and Sports Injury Study, Division of Pediatric Surgery and Orthopedics, Department of Children and Adolescents, (MRC) Oulu, Oulu University Hospital, Oulu University, 90220 Oulu, Finland
| | - Tytti Pokka
- Research Service Unit, Research Unit of Clinical Medicine, Oulu University Hospital, 90220 Oulu, Finland
| | - Justus Lieber
- Department of Pediatric Surgery and Pediatric Urology, University Children’s Hospital of Tübingen, 72076 Tübingen, Germany
| | - Jaakko Niinimäki
- Research Unit of Health Sciences and Technology, Department of Radiology, Oulu University Hospital, Oulu University, 90220 Oulu, Finland
| | - Juha-Jaakko Sinikumpu
- Research Unit of Clinical Medicine, Medical Research Center, Oulu Childhood Fracture and Sports Injury Study, Division of Pediatric Surgery and Orthopedics, Department of Children and Adolescents, (MRC) Oulu, Oulu University Hospital, Oulu University, 90220 Oulu, Finland
| |
Collapse
|
3
|
Effect of the COVID-19 Outbreak on Pediatric Patients' Admissions to the Emergency Department in an Italian Orthopedic Trauma Hub. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8080645. [PMID: 34438536 PMCID: PMC8394969 DOI: 10.3390/children8080645] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022]
Abstract
Background: The rapid diffusion of Coronavirus disease (COVID-19) in Northern Italy led the Italian government to dictate a national lockdown from 12 March 2020 to 5 May 2020. The aim of this observational cohort study is to analyze the differences in the number of pediatric patients’ admission to the Emergency Room (ER) and in the type and causes of injury. Methods: The pediatric population during the pandemic was compared to a similar group of patients admitted to the ER in 2019. Sex, age, triage color-code at admission, cause of trauma and presence of symptoms related to COVID-19 infection, discharge diagnosis and discharge modes were investigated. Results: The lockdown period led to a reduction of 87.0% in ER admissions with a particular decrease in patients older than 12 years old. Moreover, a trend towards more severe codes and an increase in home-related injuries were observed during the pandemic, whereas the diagnosis of fracture was less frequent in the pre-pandemic group (p < 0.0001). Conclusions: A significant decrease in the ER attendances was reported during the lockdown. A shift in the cause and type of injury was observed; only the most serious traumas sought medical care with a higher percentage of severe triage codes and fractures.
Collapse
|
4
|
Laaksonen T, Stenroos A, Puhakka J, Kosola J, Kautiainen H, Rämö L, Nietosvaara Y. Casting in finger trap traction without reduction versus closed reduction and percutaneous pin fixation of dorsally displaced, over-riding distal metaphyseal radius fractures in children under 11 years old: a study protocol of a randomised controlled trial. BMJ Open 2021; 11:e045689. [PMID: 34039573 PMCID: PMC8160196 DOI: 10.1136/bmjopen-2020-045689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/18/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Distal radius is the most common site of fracture in children, comprising 23%-31% of all paediatric fractures. Approximately one-fifth of these fractures are displaced. Completely displaced distal metaphyseal radius fractures in children have traditionally been treated with closed reduction. Recent evidence suggests that correcting the shortening in over-riding distal metaphyseal radius fractures is not necessary in prepubertal children. To date, no published randomised controlled trial (RCT) has compared treatment of these fractures in children by casting the fracture in bayonet position to reduction and pin fixation. METHODS AND ANALYSIS We will conduct an RCT to compare the outcomes of casting the fracture in bayonet position in children under 11 years of age to reduction and percutaneous pin fixation. 60 patients will be randomly assigned to casting or surgery groups. We have two primary outcomes. The first is ratio (injured side/non-injured side) in the total active forearm rotation and the second is ratio (injured side/non-injured side) in total active range of motion of the wrist in the flexion-extension plane at 6 months. The secondary outcomes will include axial radiographic alignment, passive extension of the wrists, grip strength and length of forearms and hands, patient-reported outcome QuickDASH and pain questionnaire PedsQL. Patients not willing to participate in the RCT will be asked to participate in a prospective cohort. Patients not eligible for randomisation will be asked to participate in a non-eligible cohort. These cohorts are included to enhance the external validity of the results of the RCT. Our null hypothesis is that the results of the primary outcome measures in the casting group are non-inferior to surgery group. ETHICS AND DISSEMINATION The institutional review board of the Helsinki and Uusimaa Hospital District has approved the protocol. We will disseminate the findings through peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT04323410. PROTOCOL V.1.1, 29 September 2020.
Collapse
Affiliation(s)
- Topi Laaksonen
- Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, Helsinki, Uusimaa, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Antti Stenroos
- Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
- Orthopaedics and Traumatology, Töölö Hospital, Helsinki, Uusimaa, Finland
| | - Jani Puhakka
- Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
- Orthopaedics and Traumatology, Töölö Hospital, Helsinki, Uusimaa, Finland
| | - Jussi Kosola
- Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
- Department of Orthopedics and Traumatology, Kanta-Häme Central Hospital, Hämeenlinna, Kanta-Häme, Finland
| | | | - Lasse Rämö
- Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
- Orthopaedics and Traumatology, Töölö Hospital, Helsinki, Uusimaa, Finland
| | - Yrjänä Nietosvaara
- Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, Helsinki, Uusimaa, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
| |
Collapse
|
5
|
Bergman E, Lempesis V, Jehpsson L, Rosengren BE, Karlsson MK. Childhood Distal Forearm Fracture Incidence in Malmö, Sweden 1950 to 2016. J Wrist Surg 2021; 10:129-135. [PMID: 33815948 PMCID: PMC8012093 DOI: 10.1055/s-0040-1720965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022]
Abstract
Background Distal forearm fracture is the most common pediatric fracture. As studies have indicated time trends in fracture incidence, we wanted to update the epidemiology and estimate time trends between 1950 and 2016 in Malmö, Sweden. Methods The city of Malmö, Sweden, had 318,107 inhabitants (58,585 of the population was aged <16 years) in 2014 and one hospital. We, therefore, used the hospital diagnosis registry and hospital medical records to identify and classify distal forearm fractures 2014 to 2016 in children aged 0 to 15 years. For long-term trend calculations, we also included published data from 1950 to 2006 (resulting in 17 evaluated years) and used joinpoint regression to estimate annual percent changes (APC). To describe differences in incidence between two periods, we calculated incident rate ratios (IRR) with 95% confidence intervals (95% CI) to describe uncertainty. Results Childhood distal forearm fracture incidence in 2014 to 2016 was 546/100,000 person-years (660 in boys and 427 in girls). The age-adjusted incidence in 2014 to 2016 and in 2005 to 2006 was similar (boys IRR 1.0, 95% CI: 0.9-1.2 and girls IRR 1.1, 95% CI: 0.9-1.3). Time-trend analyses from 1950 to 2016 revealed increasing age-adjusted incidence in both boys (APC +0.9%, 95% CI: 0.7-1.2) and girls (APC +0.6%, 95% CI: 0.3-0.9). Conclusion Distal forearm fracture incidence was similar in 2014 to 2016 and in 2005 to 2006. Age-adjusted incidence had increased in both sexes from 1950 to 2016. Level of Evidence This is a Level III b study.
Collapse
Affiliation(s)
- Erika Bergman
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Vasileios Lempesis
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Lars Jehpsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Björn E. Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus K. Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
6
|
Adam O, Horhat FG, Amaricai E, David VL, Derzsi Z, Boia ES. Upper Extremity Fractures in Children-Comparison between Worldwide, Romanian and Western Romanian Region Incidence. CHILDREN-BASEL 2020; 7:children7080084. [PMID: 32751193 PMCID: PMC7464623 DOI: 10.3390/children7080084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022]
Abstract
(1) Background: Fractures represent a significant part of all pediatric injuries, with distal forearm fracture being the most common fracture type in children. (2) Methods: In this comparative, epidemiological study we collected fracture incidence data from the scientific literature and compared it to real-world data extracted from the Romanian national and regional hospital database. In order to collect information on the epidemiology of upper extremity fractures in children, we conducted a systematic literature review on Medline, via PubMed. Extracted incidence data were stratified by fracture location, age or age interval and gender. Nationwide and Western Region incidence values were calculated for different fracture locations of the upper extremity using data extracted from a centralized hospital database. Incidence values were calculated using the mid-2018 census data. The search was restricted to the pediatric population. (3) Results: Incidence values for upper arm fractures nationwide and for Western Region were 54.83/100,000 person-years and 64.79/100,000 person-years, respectively. Forearm fractures had an incidence of 139.77/100,000 person-years and 139.56/100,000 person-years, respectively. The overall incidence of upper extremity fractures nationwide and for the Romanian Western Region were 206.02/100,000 person-years and 220.14/100,000 person-years, respectively. (4) Conclusions: Incidence of upper extremity fractures in the pediatric population varies according to the analyzed data. The calculated incidence depends on the site of fractures, assessed population (worldwide, Romanian population or regional-Western part of Romania) or patients' age.
Collapse
Affiliation(s)
- Ovidiu Adam
- Department of Pediatric Surgery and Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Street No. 2, 300041 Timisoara, Romania; (O.A.); (E.S.B.)
| | - Florin George Horhat
- Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Street No. 2, 300041 Timisoara, Romania
- Correspondence: (F.G.H.); (V.-L.D.)
| | - Elena Amaricai
- Department of Rehabilitation, Physical Medicine and Rheumatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Street No. 2, 300041 Timisoara, Romania;
| | - Vlad-Laurentiu David
- Department of Pediatric Surgery and Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Street No. 2, 300041 Timisoara, Romania; (O.A.); (E.S.B.)
- Correspondence: (F.G.H.); (V.-L.D.)
| | - Zoltán Derzsi
- Department of Pediatric Surgery and Orthopedics, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Gh. Marinescu Street No. 38, 540139 Targu Mures, Romania;
| | - Eugen Sorin Boia
- Department of Pediatric Surgery and Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Street No. 2, 300041 Timisoara, Romania; (O.A.); (E.S.B.)
| |
Collapse
|