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Altmann-Schneider I, Kellenberger CJ, Pistorius SM, Saladin C, Schäfer D, Arslan N, Fischer HL, Seiler M. Artificial intelligence-based detection of paediatric appendicular skeletal fractures: performance and limitations for common fracture types and locations. Pediatr Radiol 2024; 54:136-145. [PMID: 38099929 PMCID: PMC10776701 DOI: 10.1007/s00247-023-05822-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Research into artificial intelligence (AI)-based fracture detection in children is scarce and has disregarded the detection of indirect fracture signs and dislocations. OBJECTIVE To assess the diagnostic accuracy of an existing AI-tool for the detection of fractures, indirect fracture signs, and dislocations. MATERIALS AND METHODS An AI software, BoneView (Gleamer, Paris, France), was assessed for diagnostic accuracy of fracture detection using paediatric radiology consensus diagnoses as reference. Radiographs from a single emergency department were enrolled retrospectively going back from December 2021, limited to 1,000 radiographs per body part. Enrolment criteria were as follows: suspected fractures of the forearm, lower leg, or elbow; age 0-18 years; and radiographs in at least two projections. RESULTS Lower leg radiographs showed 607 fractures. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were high (87.5%, 87.5%, 98.3%, 98.3%, respectively). Detection rate was low for toddler's fractures, trampoline fractures, and proximal tibial Salter-Harris-II fractures. Forearm radiographs showed 1,137 fractures. Sensitivity, specificity, PPV, and NPV were high (92.9%, 98.1%, 98.4%, 91.7%, respectively). Radial and ulnar bowing fractures were not reliably detected (one out of 11 radial bowing fractures and zero out of seven ulnar bowing fractures were correctly detected). Detection rate was low for styloid process avulsions, proximal radial buckle, and complete olecranon fractures. Elbow radiographs showed 517 fractures. Sensitivity and NPV were moderate (80.5%, 84.7%, respectively). Specificity and PPV were high (94.9%, 93.3%, respectively). For joint effusion, sensitivity, specificity, PPV, and NPV were moderate (85.1%, 85.7%, 89.5%, 80%, respectively). For elbow dislocations, sensitivity and PPV were low (65.8%, 50%, respectively). Specificity and NPV were high (97.7%, 98.8%, respectively). CONCLUSIONS The diagnostic performance of BoneView is promising for forearm and lower leg fractures. However, improvement is mandatory before clinicians can rely solely on AI-based paediatric fracture detection using this software.
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Affiliation(s)
- Irmhild Altmann-Schneider
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
- Paediatric Emergency Department, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
| | - Christian J Kellenberger
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
- Paediatric Emergency Department, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Sarah-Maria Pistorius
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
- Paediatric Emergency Department, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Camilla Saladin
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
- Paediatric Emergency Department, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Debora Schäfer
- Children's Research Centre, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Nidanur Arslan
- Children's Research Centre, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Hanna L Fischer
- Children's Research Centre, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Michelle Seiler
- Paediatric Emergency Department, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
- Children's Research Centre, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
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Tontanahal S, James D, Gahukamble A, Madhuri V, Palocaren T. Pediatric floating knee injuries: Clinical modifiers affecting sports and transfer outcomes. Injury 2023; 54:111001. [PMID: 37604744 DOI: 10.1016/j.injury.2023.111001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
AIM This study assessed the functional outcome, and the clinical modifiers that influence them with the aim to assist the clinician plan a better management strategy in Paediatric Floating Knee (PFK) injuries. METHODS A quasi-prospective, single-center observational study was designed to determine the functional and radiological outcomes in children (= 16 years), with minimum 1 year follow-up after treatment for PFK from 01-01-2014 to 01-08-2019. A retrospective audit was conducted, and a prospective patient/parent reported outcome score was determined with the Pediatric Outcome Data Collection Instrument (PODCI) questionnaire for 'transfer and mobility' and 'sports and physical function'. RESULTS Of 32 patients with PFK injury, twenty-five patients with a mean follow-up of 43 months (SD = 18) who completed the PODCI questionnaire were analysed. Fourteen (56%) children had open fractures (Lett's D or E types) with 6 open femur and 12 open tibia fractures. Majority underwent surgical fixation, 8 children required staged reconstruction and 11 children required soft tissue procedure in the ipsilateral limb. The mean time to union for femur and tibia fractures was 3.86 months (SD = 5.3) and 3.5 months (SD = 2.9), respectively with delayed union/non-unions in 3 femoral and 4 tibial fractures. The mean knee range of movement (RoM) was 102° (SD = 34.1) with limb shortening in 6 children, and overgrowth in 3 children. The mean normative PODCI (transfer) score was 35.6 (normal range: -74 to 52) and mean PODCI (sports) score was 37.6 (normal range: -33 to 56). Both the PODCI scores demonstrated strong inverse correlation with higher ISS(p < 0.01) and > 4 cm of bone loss (p < 0.01) but poor correlation with age at injury (p = 0.5), open fracture (p = 0.17), comminuted femoral and/or tibial fracture patterns (p > 0.05) and loss of soft tissue cover (p = 0.08). CONCLUSIONS Early recognition of clinical modifiers such as high ISS and bone loss > 4 cm warrants targeted limb reconstruction strategy and can help to prognosticate outcome.
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Affiliation(s)
- Sagar Tontanahal
- Department of Paediatric Orthopaedics, No. 1106, Paul Brand Building, Christian Medical College, Vellore, 632004, India
| | - Deeptiman James
- Department of Paediatric Orthopaedics, No. 1106, Paul Brand Building, Christian Medical College, Vellore, 632004, India
| | - Abhay Gahukamble
- Department of Paediatric Orthopaedics, No. 1106, Paul Brand Building, Christian Medical College, Vellore, 632004, India
| | - Vrisha Madhuri
- Department of Paediatric Orthopaedics, No. 1106, Paul Brand Building, Christian Medical College, Vellore, 632004, India
| | - Thomas Palocaren
- Department of Paediatric Orthopaedics, No. 1106, Paul Brand Building, Christian Medical College, Vellore, 632004, India.
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Garcia-Rueda MF, Mendoza-Pulido C, Taborda-Aitken JC, Becerra G, Velasquez-Urrego JL, Rincón-Lozano JD, Caicedo-Gutierrez ML, Silva-Amaro AC, Lorza-Toquica LD, Rodriguez-Lopez JA, Salazar-Sierra JA, Saravia-Hoyos GA, Schuster-Wasserman JA, Valencia-Chamorro MP. Distribution of fractured bones among children: Experience with the Comprehensive Pediatric AO classification in a children's orthopedic hospital in Bogotá-Colombia. Injury 2023; 54 Suppl 6:110780. [PMID: 38143128 DOI: 10.1016/j.injury.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Fractures in children and adolescents are a public health issue. However, reliable epidemiological descriptions of the South American population must be improved. This study aims to present epidemiological data on fractures from a children's orthopedic hospital in one of the five largest cities in Latin America. PATIENTS AND METHODS Descriptive epidemiological data from 2015 to 2019 were used to characterize children's fractures. Demographic variables, the number of fractured bones, high-energy trauma findings, fracture characteristics, fingertip injuries, and associated complications discriminated by the type of treatment are presented. Long bone fractures were classified according to the AO classification. All children less than 18 years of age were included. RESULTS In a population of 3,616 children, 4,596 fractures were identified. More boys than girls sustain a fractured bone, with ratios as high as 6:1 around 15 years old. Distal forearm fractures were the most common (31.9%), followed by distal humerus (20.2%). Most of the complications were related to these two sites of fractures. The OR of complications between surgical and conservative management was 2.86. CONCLUSION Epidemiological data of fractures from the authors' institution display the usual trending reported in most populations. Gender-related and age-related differences were relevant. Most fractures and complications are related to upper limb low-energy trauma. The most frequent are loss of ROM and loss of reduction. LEVEL OF EVIDENCE Level III - retrospective cohort study.
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Affiliation(s)
| | - Camilo Mendoza-Pulido
- School of Medicine, Department of Physical Medicine and Rehabilitation, Universidad Nacional de Colombia, Carrera 45 #26-85, Bogotá, Colombia
| | - Juan Carlos Taborda-Aitken
- School of Medicine, Department Orthopedics and Traumatology, Universidad Javeriana, Carrera 7 #40-62, Bogotá, Colombia
| | - Gustavo Becerra
- School of Medicine, Universidad Militar Nueva Granada, Carrera 11 #101-80 Bogotá, Colombia
| | | | - Julián David Rincón-Lozano
- Department of Orthopedics and Traumatology, Instituto Roosevelt, Carrera 4 east #17-50, Bogotá, Colombia
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Scharf M, Walter N, Rupp M, Alt V. Treatment of Fracture-Related Infections with Bone Abscess Formation after K-Wire Fixation of Pediatric Distal Radius Fractures in Adolescents—A Report of Two Clinical Cases. CHILDREN 2023; 10:children10030581. [PMID: 36980139 PMCID: PMC10047903 DOI: 10.3390/children10030581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/11/2023] [Accepted: 03/17/2023] [Indexed: 03/22/2023]
Abstract
Closed reduction and K-wire fixation of displaced distal radius fractures in children and adolescents is an established and successful surgical procedure. Fracture-related infections after K-wire fixation are rare but can have significant consequences for the patient. There is a lack of literature on the treatment of K-wire-associated fracture-related infections in children and adolescents. Herein, we report two cases of fracture-related infection after initial closed reduction and Kirschner wire fixation in two adolescents. One 13-year-old boy and one 11-year-old girl were seen for fracture-related infections 4 and 8 weeks after closed reduction and percutaneous K-wire fixation of a distal radius, respectively. X-ray and magnetic resonance imaging (MRI) revealed a healed fracture with osteolytic changes in the metaphyseal radius with periosteal reaction and abscess formation of the surrounding soft tissue structures. A two-staged procedure was performed with adequate debridement of the bone and dead space management with an antibiotic-loaded polymethyl methacrylate (PMMA) spacer at stage 1. After infection control, the spacer was removed and the defect was filled with autologous bone in one case and with a calcium sulphate–hydroxyapatite biomaterial in the other case. In each of the two patients, the infection was controlled and a stable consolidation of the distal radius in good alignment was achieved. In one case, the epiphyseal plate was impaired by the infection and premature closure of the epiphyseal plate was noted resulting in a post-infection ulna plus variant. In conclusion, a fracture-related infection after Kirschner wire fixation of pediatric distal radius fractures is a rare complication but can occur. A two-stage procedure with infection control and subsequent bone defect reconstruction was successful in the presented two cases. Premature closure of the epiphyseal growth plate of the distal radius is a potential complication.
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Affiliation(s)
- Markus Scharf
- Department for Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Nike Walter
- Department for Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Department for Psychosomatic Medicine, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Markus Rupp
- Department for Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Volker Alt
- Department for Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Correspondence: ; Tel.: +49-941-944-6805; Fax: +49-941-944-6806
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Zhang Y, Yuan Q, Wei Q, Dong Y, Liu Y, He W, Jing Z, Zhang L, Wang H, Li W. Combined Deflection Angle Classification: A Novel Typing System of Adult Femoral Neck Fracture. Orthop Surg 2022; 15:839-850. [PMID: 36573274 PMCID: PMC9977581 DOI: 10.1111/os.13629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Femoral neck fracture (FNF) is a common clinical trauma with high mortality and disability rates. Furthermore, its incidence increases exponentially with increasing age. Existing classifications have some disadvantages. Thus, this study aimed to establish a novel typing system for FNF. METHODS We retrospectively analyzed all adult patients with FNF admitted to our hospital between December 2015 and November 2017 for cannulated screw internal fixation. The study population was divided into the femoral varus offset group (VAR) and the valgus offset group (VAL). The data collected included sex, age, affected side, injury mode, body mass index, complications, pelvic incidence (PI), hip deflection angle (HDA), combined deflection angle (CDA), and neck shaft angle. Statistical analysis was conducted to determine the correlation between complications and deviation angles. A novel typing system was developed and compared with the Garden classification to detect its superiority. RESULTS A total of 108 patients were recruited, with 59 patients in the VAR and 49 patients in the VAL groups. The incidence of complications in the VAR group was significantly higher than that in the VAL group (P < 0.05). Moreover, there were more male participants in the VAR group. Compared with the VAL group, the VAR group had significantly higher PI, HDA, and CDA (P < 0.05). The CDA classification (CDAC) was defined, with CDA as the main criterion and HDA as the supplementary criterion. Furthermore, there was a hierarchical correlation between the actual incidence of complications and the typing level, which was increased in CDAC but not in the Garden classification. This showed that CDAC was more accurate. CONCLUSION A novel typing system, CDAC, for FNF was established, which was more accurate than the Garden classification. We suggest combining CDAC and Garden classifications for the preoperative diagnosis, treatment selection, and prognostic evaluation for patients with FNF.
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Affiliation(s)
- Ying Zhang
- Medical Center of Hip, Luoyang Orthopedic—Traumatological Hospital (Orthopedics Hospital of Henan Province)LuoyangChina,Guangzhou University of Traditional Chinese MedicineGuangzhouChina
| | - Qiang Yuan
- Henan University of Traditional Chinese MedicineZhengzhouChina
| | - Qiushi Wei
- Institute of Orthopaedics of Guangzhou University of Traditional Chinese MedicineGuangzhouChina,The Third Affiliated Hospital of Guangzhou University of Traditional Chinese MedicineGuangzhouChina
| | - Yiping Dong
- Henan University of Traditional Chinese MedicineZhengzhouChina
| | - Youwen Liu
- Medical Center of Hip, Luoyang Orthopedic—Traumatological Hospital (Orthopedics Hospital of Henan Province)LuoyangChina
| | - Wei He
- Institute of Orthopaedics of Guangzhou University of Traditional Chinese MedicineGuangzhouChina,The Third Affiliated Hospital of Guangzhou University of Traditional Chinese MedicineGuangzhouChina
| | - Zhenhao Jing
- Henan University of Traditional Chinese MedicineZhengzhouChina
| | - Leilei Zhang
- Medical Center of Hip, Luoyang Orthopedic—Traumatological Hospital (Orthopedics Hospital of Henan Province)LuoyangChina
| | - Haibin Wang
- Guangzhou University of Traditional Chinese MedicineGuangzhouChina
| | - Wuyin Li
- Medical Center of Hip, Luoyang Orthopedic—Traumatological Hospital (Orthopedics Hospital of Henan Province)LuoyangChina
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Hayashi D, Kompel AJ, Ventre J, Ducarouge A, Nguyen T, Regnard NE, Guermazi A. Automated detection of acute appendicular skeletal fractures in pediatric patients using deep learning. Skeletal Radiol 2022; 51:2129-2139. [PMID: 35522332 DOI: 10.1007/s00256-022-04070-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to perform an external validation of an existing commercial AI software program (BoneView™) for the detection of acute appendicular fractures in pediatric patients. MATERIALS AND METHODS In our retrospective study, anonymized radiographic exams of extremities, with or without fractures, from pediatric patients (aged 2-21) were included. Three hundred exams (150 with fractures and 150 without fractures) were included, comprising 60 exams per body part (hand/wrist, elbow/upper arm, shoulder/clavicle, foot/ankle, leg/knee). The Ground Truth was defined by experienced radiologists. A deep learning algorithm interpreted the radiographs for fracture detection, and its diagnostic performance was compared against the Ground Truth, and receiver operating characteristic analysis was done. Statistical analyses included sensitivity per patient (the proportion of patients for whom all fractures were identified) and sensitivity per fracture (the proportion of fractures identified by the AI among all fractures), specificity per patient, and false-positive rate per patient. RESULTS There were 167 boys and 133 girls with a mean age of 10.8 years. For all fractures, sensitivity per patient (average [95% confidence interval]) was 91.3% [85.6, 95.3], specificity per patient was 90.0% [84.0,94.3], sensitivity per fracture was 92.5% [87.0, 96.2], and false-positive rate per patient in patients who had no fracture was 0.11. The patient-wise area under the curve was 0.93 for all fractures. AI diagnostic performance was consistently high across all anatomical locations and different types of fractures except for avulsion fractures (sensitivity per fracture 72.7% [39.0, 94.0]). CONCLUSION The BoneView™ deep learning algorithm provides high overall diagnostic performance for appendicular fracture detection in pediatric patients.
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Affiliation(s)
- Daichi Hayashi
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA. .,Department of Radiology, Stony Brook University Renaissance School of Medicine, HSc Level 4, Room 120, Stony Brook, NY, 11794, USA.
| | - Andrew J Kompel
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA
| | - Jeanne Ventre
- Gleamer, 117-119 Quai de Valmy, 75010, Paris, France
| | | | - Toan Nguyen
- Gleamer, 117-119 Quai de Valmy, 75010, Paris, France.,Service de Radiopédiatrie, Hôpital Armand-Trousseau, AP-HP, Médecine Sorbonne Université, 26 avenue du Docteur Arnold-Netter, 75012, Paris, France
| | - Nor-Eddine Regnard
- Gleamer, 117-119 Quai de Valmy, 75010, Paris, France.,Réseau d'Imagerie Sud Francilien, 2 avenue de Mousseau, 91000, Evry, France
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA.,Department of Radiology, VA Boston Healthcare System, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA, 02132, USA
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Nguyen T, Maarek R, Hermann AL, Kammoun A, Marchi A, Khelifi-Touhami MR, Collin M, Jaillard A, Kompel AJ, Hayashi D, Guermazi A, Le Pointe HD. Assessment of an artificial intelligence aid for the detection of appendicular skeletal fractures in children and young adults by senior and junior radiologists. Pediatr Radiol 2022; 52:2215-2226. [PMID: 36169667 DOI: 10.1007/s00247-022-05496-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/07/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND As the number of conventional radiographic examinations in pediatric emergency departments increases, so, too, does the number of reading errors by radiologists. OBJECTIVE The aim of this study is to investigate the ability of artificial intelligence (AI) to improve the detection of fractures by radiologists in children and young adults. MATERIALS AND METHODS A cohort of 300 anonymized radiographs performed for the detection of appendicular fractures in patients ages 2 to 21 years was collected retrospectively. The ground truth for each examination was established after an independent review by two radiologists with expertise in musculoskeletal imaging. Discrepancies were resolved by consensus with a third radiologist. Half of the 300 examinations showed at least 1 fracture. Radiographs were read by three senior pediatric radiologists and five radiology residents in the usual manner and then read again immediately after with the help of AI. RESULTS The mean sensitivity for all groups was 73.3% (110/150) without AI; it increased significantly by almost 10% (P<0.001) to 82.8% (125/150) with AI. For junior radiologists, it increased by 10.3% (P<0.001) and for senior radiologists by 8.2% (P=0.08). On average, there was no significant change in specificity (from 89.6% to 90.3% [+0.7%, P=0.28]); for junior radiologists, specificity increased from 86.2% to 87.6% (+1.4%, P=0.42) and for senior radiologists, it decreased from 95.1% to 94.9% (-0.2%, P=0.23). The stand-alone sensitivity and specificity of the AI were, respectively, 91% and 90%. CONCLUSION With the help of AI, sensitivity increased by an average of 10% without significantly decreasing specificity in fracture detection in a predominantly pediatric population.
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Affiliation(s)
- Toan Nguyen
- Department of Pediatric Radiology, Armand Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012, Paris, France.
| | - Richard Maarek
- Department of Pediatric Radiology, Armand Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012, Paris, France
| | - Anne-Laure Hermann
- Department of Pediatric Radiology, Armand Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012, Paris, France
| | - Amina Kammoun
- Department of Pediatric Radiology, Armand Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012, Paris, France
| | - Antoine Marchi
- Department of Pediatric Radiology, Armand Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012, Paris, France
| | - Mohamed R Khelifi-Touhami
- Department of Pediatric Radiology, Armand Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012, Paris, France
| | - Mégane Collin
- Department of Pediatric Radiology, Armand Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012, Paris, France
| | - Aliénor Jaillard
- Department of Pediatric Radiology, Armand Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012, Paris, France
| | - Andrew J Kompel
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Daichi Hayashi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA.,Department of Radiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA.,Department of Radiology, VA Boston Healthcare System, West Roxbury, MA, USA
| | - Hubert Ducou Le Pointe
- Department of Pediatric Radiology, Armand Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012, Paris, France
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Risk factors for upper limb fractures due to unintentional injuries among adolescents: a case control study from Sri Lanka. BMC Public Health 2022; 22:1825. [PMID: 36162991 PMCID: PMC9513863 DOI: 10.1186/s12889-022-14154-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Injuries are the number one cause for morbidity and mortality among adolescents. Adolescent fractures are a hidden public health problem in Sri Lanka. Upper limb fractures are common in adolescents due to various risk factors. Many injuries are predictable and can be prevented by identifying the risk factors. The aim of the study was to determine the risk factors for upper limb fractures among adolescents in Sri Lanka. Methods A case control study was undertaken with 450 cases and 450 controls. Cases were recruited consecutively from all major hospitals among the adolescent victims who had admitted with newly diagnosed upper limb fractures in the district of Colombo. Controls were apparently healthy adolescents from the same district and excluded who had previous upper limb fractures. The age and gender were not matched in selecting controls since these two factors were potential risk factors for adolescent fractures according to previous literature. Risk factors for upper limb fractures were assessed by odds ratio (OR) with 95% confidence interval (CI) and adjusted for possible confounding by performing logistic regression analysis. Results The mean age of the cases was 13.62 years with a Standard Deviation (SD) of 2.8 and controls was 12.75 years (SD = 2.7) respectively. Having a high standard of living index (OR = 3.52; 95%CI: 2.3–5.2, p < 0.001), being in a high social class category (social class I & II) (OR = 2.58, 95%CI: 1.7–3.92, p < 0.001), engage in physical or sports activity (OR = 9.36; 95%CI: 3.31–26.47, p < 0.001), watching television (OR = 1.95; 95%CI: 1.18 -3.22, p = 0.009), playing video or computer games (OR = 2.35; 95%CI: 1.7–3.24, p < 0.001), and attending extra classes (OR = 1.82; 95%CI: 1.2–2.7, p = 0.007) were risk factors for having a upper limb fracture. Risk factors for upper limb fractures following adjusted for confounders were siblings in the family (aOR = 11.62, 95% CI: 6.95–41.29, p = 0.03) and attend extra classes after school hours (aOR = 2.51, 95%CI: 0.68–0.93, p = 0.04). Two significant effect modifications between being a Buddhist and low standard of living index (p < 0.001) and having one sibling in the family and attend extra classes after school hours (p = 0.01) were observed. Conclusions Modifiable risk factors in relation to lifestyle factors and socioeconomic position were important determinants of upper limb fracture risk in adolescents. Many fractures can be prevented by strengthening awareness programmes in the community.
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Vithran DTA, Song Z, Wang K, Tang Z, Xiang F, Wen J, Xiao S. Comparison of the midterm result between locking plate and elastic intramedullary nail treating oblique ulnar fracture Bado type I acute monteggia fracture in pediatric patients. BMC Musculoskelet Disord 2022; 23:858. [PMID: 36096778 PMCID: PMC9465865 DOI: 10.1186/s12891-022-05809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Acute Monteggia fracture (AMF) is defined as a fracture of the proximal ulna combined with a dislocation of the radial head, with less than 1 percent prevalence in pediatric patients with an elbow injury. This retrospective study aimed to compare the efficacy of two treatment methods for oblique ulnar fracture AMF Bado type I in children. Methods In this retrospective study, 28 children with oblique ulnar fracture acute Monteggia injury Bado I were included. Patients was divided into two groups: In the EIN group 16 patients were fixed with elastic intramedullary nail after reduction, and in the LCP group 12 patients were fixed with locking compression plate after reduction. Operation time and blood loss were recorded and the patients were assessed clinically by the Mayo Elbow Performance Score (MEPS), range of movement(ROM) and range of rotation(ROR). Results Twenty-eight patients were accessible for durable follow-up, with a mean age of 7.7 ± 1.3 years, follow up by 33.7 ± 5.1 months. The average operation time was 48.1 ± 9.2 min for the EIN group and 67.1 ± 7.2 min for the LCP group. The average blood loss was 8.2 ± 2.3 ml for the EIN group and 18.8 ± 3.8 ml for the LCP group. The average operation time and average blood loss in the EIN group are significant less than the LCP group. Mean MEPS, ROM, ROR in both group improved significantly before sugery to three months after surgery, and maintained very good results at last follow up. There is no significant difference between the EIN group and the LCP group in MEPS, ROM and ROR. Conclusions Oblique ulnar fracture Bado type I acute monteggia fracture in pediatric patients fixed by EIN and LCP can both get good mid-term results measured by MEPS, ROM and ROR, Fixed by EIN have shorter operation time and less blood loss than fixed by LCP.
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Affiliation(s)
- Djandan Tadum Arthur Vithran
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China
| | - Zhenqi Song
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China
| | - Kongjian Wang
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China
| | - Zhongwen Tang
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China
| | - Feng Xiang
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China.
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China. .,Department of Human Anatomy, Hunan Normal University School of Medicine, Changsha, Hunan, 410013, China.
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10
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De Vitis R, D'Orio M, Passiatore M, Perna A, Cilli V, Taccardo G. Elastic stable intramedullary fixation using epibloc versus crossed kirschner wires fixation for distal forearm fractures in children: A retrospective analysis. Afr J Paediatr Surg 2022; 19:153-159. [PMID: 35775516 PMCID: PMC9290372 DOI: 10.4103/ajps.ajps_178_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Childrens' distal forearm fractures (DFFs) could be treated conservatively with closed reduction and immobilisation, but post-reduction displacements often occur. Displaced DFF should be surgically fixed, to avoid further displacement. Nevertheless, immobilisation after surgery is recommended. Epibloc system (ES), a system of stable elastic nail fixation, is widely used to stabilise adults extra-articular distal radius fractures, with advantages to not requiring post-surgical immobilisation. The present investigation represents a retrospective analysis of paediatric patients with DFF treated with ES applied with a minimal technical variation, to fix both ulna and radius fractures using a unique device. MATERIALS AND METHODS A retrospective analysis was performed on 44 children (age 6-11 years) who underwent closed reduction and internal fixation because of DFF (both ulna and radius). Group A (21 patients): ES fixation. Group B (23 patients): K-wires and short arm cast fixation. The primary outcome was the subsistence of reduction monitored through X-rays. The secondary outcome was the measurement of active range of motion (AROM) and the time of recovery. RESULTS No differences were observed comparing Group A and B in terms of the maintenance of reduction (P > 0.05). Seven days after the implant removal, patients in Group A reached significantly better results compared to patients in Group B in terms of AROM (P < 0.05). No differences were revealed in terms of complications between the two groups. CONCLUSION ES applied with a minimal technical variation is safe and effective in treating distal ulna and radius fractures, with minimal requirement of post-surgical rehabilitation.
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Affiliation(s)
- Rocco De Vitis
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco D'Orio
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Passiatore
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Perna
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vitale Cilli
- Hand Surgery Unit, CHIREC Site Delta, Bruxelles, Belgium
| | - Giuseppe Taccardo
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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11
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Korup LR, Larsen P, Nanthan KR, Arildsen M, Warming N, Sørensen S, Rahbek O, Elsoe R. Children’s distal forearm fractures: a population-based epidemiology study of 4,316 fractures. Bone Jt Open 2022; 3:448-454. [PMID: 35658607 PMCID: PMC9233428 DOI: 10.1302/2633-1462.36.bjo-2022-0040.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims The aim of this study was to report a complete overview of both incidence, fracture distribution, mode of injury, and patient baseline demographics of paediatric distal forearm fractures to identify age of risk and types of activities leading to injury. Methods Population-based cohort study with manual review of radiographs and charts. The primary outcome measure was incidence of paediatric distal forearm fractures. The study was based on an average at-risk population of 116,950. A total number of 4,316 patients sustained a distal forearm fracture in the study period. Females accounted for 1,910 of the fractures (44%) and males accounted for 2,406 (56%). Results The overall incidence of paediatric distal forearm fractures was 738.1/100,000 persons/year (95% confidence interval (CI) 706/100,000 to 770/100,000). Female incidences peaked with an incidence of 1,578.3/100,000 persons/year at age ten years. Male incidence peaked at age 13 years, with an incidence of 1,704.3/100,000 persons/year. The most common fracture type was a greenstick fracture to the radius (48%), and the most common modes of injury were sports and falls from ≤ 1 m. A small year-to-year variation was reported during the five-year study period, but without any trends. Conclusion Results show that paediatric distal forearm fractures are very common throughout childhood in both sexes, with almost 2% of males aged 13 years sustaining a forearm fracture each year. Cite this article: Bone Jt Open 2022;3(6):448–454.
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Affiliation(s)
- Lærke R. Korup
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Larsen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
| | - Kumanan R. Nanthan
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Marie Arildsen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Nikolaj Warming
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Sørensen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Rasmus Elsoe
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
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12
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Vescio A, Testa G, Sapienza M, Caldaci A, Montemagno M, Andreacchio A, Canavese F, Pavone V. Is Obesity a Risk Factor for Loss of Reduction in Children with Distal Radius Fractures Treated Conservatively? CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030425. [PMID: 35327797 PMCID: PMC8947058 DOI: 10.3390/children9030425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022]
Abstract
Background: Obesity in children is a clinical and social burden. The distal radius (DR) is the most common site of fractures in childhood and conservative treatment is widely used. Loss of reduction (LOR) is the major casting complication. The aim of this study is to evaluate obesity as a risk factor for LOR in children with displaced DR fractures (DRF) treated conservatively. Methods: 189 children under 16 years of age were treated conservatively for DRF. Patients were divided into three groups: normal weight (NW), overweight (OW) and obese (OB). The following radiographic criteria were evaluated in all patients: amount of initial translation (IT); quality of initial reduction; Cast (CI), Padding (PI), Canterbury (CaI), Gap (GI) and Three-Points (3PI) indices and the presence of LOR. Results: Statistically significant differences were found between the NW and the OB group for number of LOR (p = 0.002), severity (grade) of initial translation (p = 0.008), quality of initial reduction (p = 0.01) as well as CsI and CaI (p < 0.001). Conclusions: Obese children have a significantly higher rate of LOR compared to NW and OW children. A close follow-up is necessary in this population of patients. Preventive percutaneous pinning could be considered in older obese patients in order to reduce the need for further treatment.
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Affiliation(s)
- Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (A.V.); (G.T.); (M.S.); (A.C.); (M.M.)
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (A.V.); (G.T.); (M.S.); (A.C.); (M.M.)
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (A.V.); (G.T.); (M.S.); (A.C.); (M.M.)
| | - Alessia Caldaci
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (A.V.); (G.T.); (M.S.); (A.C.); (M.M.)
| | - Marco Montemagno
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (A.V.); (G.T.); (M.S.); (A.C.); (M.M.)
| | - Antonio Andreacchio
- Department of Pediatric Orthopedic Surgery, “V. Buzzi” Children Hospital, 20154 Milan, Italy;
| | - Federico Canavese
- Pediatric Orthopedic Surgery Service, Hôpital Jeanne de Flandre, University of Lille, 59037 Lille, France;
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (A.V.); (G.T.); (M.S.); (A.C.); (M.M.)
- Correspondence:
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13
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Laaksonen T, Kosola J, Nietosvaara N, Puhakka J, Nietosvaara Y, Stenroos A. Epidemiology, Treatment, and Treatment Quality of Overriding Distal Metaphyseal Radial Fractures in Children and Adolescents. J Bone Joint Surg Am 2022; 104:207-214. [PMID: 34780389 DOI: 10.2106/jbjs.21.00850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The incidence of completely displaced overriding distal metaphyseal radial fractures in children is unknown, and the optimal treatment is controversial. METHODS All completely displaced distal metaphyseal radial fractures in patients <16 years old treated in our tertiary-level institution from 2014 to 2019 were identified with use of the Kids' Fracture Tool Helsinki. Etiology, fracture characteristics, management, and quality of treatment were assessed. A telephone interview with the guardian of the patient was performed for 100 (89%) of 112 patients at 1.5 to 7.2 years (median, 4.6 years) after the injury. Pain during the last month and forearm function were recorded. Treatment satisfaction was assessed with use of a 7-point Likert scale. RESULTS A total of 113 completely displaced overriding distal metaphyseal radial fractures in 112 patients (81 of whom were residents of Helsinki) were treated during the 6-year-long study period. The mean annual incidence was 1.42 per 10,000 population. Most (73%) of these fractures occurred in children <11 years old, and most fractures were dorsally displaced and located nearly as far proximally from the distal radial physis as the maximum width of the distal metaphysis. Closed manipulation was attempted in two-thirds of cases in the emergency department, with a failure rate of 46%. Strong opioids were administered in 70 of 112 patients. None of the 26 patients whose fractures were immobilized in an overriding position had secondary interventions, pain, or functional disability. The mean satisfaction with treatment on the Likert scale was 6.2. CONCLUSIONS The annual incidence of overriding distal metaphyseal radial fractures patients <16 years old was shown to vary between 0.72 and 2.01 per 10,000 population. Opioids, local and general anesthesia, hospital admission, and secondary interventions can be avoided in prepubescent patients by casting these fractures in an overriding position while the patient is in the emergency department. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Topi Laaksonen
- Department of Pediatric Orthopedics and Traumatology, Helsinki New Children's Hospital, Helsinki, Finland
| | - Jussi Kosola
- Department of Pediatric Orthopedics and Traumatology, Helsinki New Children's Hospital, Helsinki, Finland
| | - Nicolas Nietosvaara
- Department of Pediatric Orthopedics and Traumatology, Helsinki New Children's Hospital, Helsinki, Finland
| | - Jani Puhakka
- Department of Spine Surgery, Schulthess Klinik, Zürich, Switzerland
| | - Yrjänä Nietosvaara
- Department of Pediatric Orthopedics and Traumatology, Helsinki New Children's Hospital, Helsinki, Finland.,Department of Pediatric Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Antti Stenroos
- Department of Pediatric Orthopedics and Traumatology, Helsinki New Children's Hospital, Helsinki, Finland
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14
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Cramer N, Zuckerbraun NS, Puller J, Furtado AD, Deb A, Dorfsman ML, Siripong N, Christie M, Tavarez MM. Putting Theory to Practice: Applying Cognitive Load Theory to Resident Medical Education. Pediatr Emerg Care 2022; 38:e771-e775. [PMID: 35100776 DOI: 10.1097/pec.0000000000002371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We built 2 versions of an asynchronous pediatric orthopedic educational intervention for emergency medicine residents and sought to compare the two. We hypothesized that the version incorporating more instructional scaffolding in the form of a cognitive aid (CA) would optimize germane cognitive load for our target novice learners and result in higher test scores. METHODS Learners were block randomized to either a "CA" or "non-CA" arm, each containing a random set of 18 modules. The CA arm incorporated an orthopedic fracture classification chart embedded within the diagnostic questions to guide the learner in forming a diagnosis. The non-CA arm was designed with more active learning as the classification chart was provided only after each diagnostic answer submission. For both arms, the final 6 modules completed per learner were scored. Learners also completed a perceived cognitive load assessment tool measured on a 10-point Likert scale. RESULTS Learners in the non-CA arm had a mean total score on the testing modules of 33% correct compared with a mean total score of 44% correct for learners in the CA arm (mean difference, 11; 95% confidence interval, 4%-19%, P = 0.005). There was a trend for the CA arm to have lower perceived overall cognitive load scores; however, this did not reach statistical significance. CONCLUSIONS Emergency medicine residents performed better after completing the CA version of our educational intervention. Applying cognitive load theory to an educational intervention may increase its success among target learners.
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Affiliation(s)
- Natan Cramer
- From the Department of Emergency Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh
| | - Noel Spears Zuckerbraun
- From the Department of Emergency Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh
| | | | - Andre D Furtado
- Department of Radiology, Children's Hospital of Pittsburgh of UPMC
| | - Arjamon Deb
- Department of Emergency Medicine, UPMC Presbyterian
| | | | - Nalyn Siripong
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA
| | | | - Melissa M Tavarez
- From the Department of Emergency Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh
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15
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Wang R, Wu L, Wang Y, Fan M, Wang Y, Ning B, Zheng P. Limited Open Reduction and Transepiphyseal Intramedullary Kirschner Wire Fixation for Treatment of Irreducible Distal Radius Diaphyseal Metaphyseal Junction Fracture in Older Children. Front Pediatr 2022; 10:871044. [PMID: 35498785 PMCID: PMC9043865 DOI: 10.3389/fped.2022.871044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/23/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This study aimed to compare limited open reduction and transepiphyseal intramedullary fixation with Kirschner wire (LOR-TIKW) versus open reduction and internal fixation with plate and screw (ORIF-PS) for treatment of irreducible distal radius diaphyseal-metaphyseal junction (DMJ) fracture in older children. METHODS Data of children (aged 10-14 years) treated in our hospital for distal radius DMJ fractures with LOR-TIKW or ORIF-PS from January 2018 to December 2019 were retrospectively analyzed. Follow-up was until radiographic union. Demographic, clinical, and radiographic data; treatment cost; healing time; functional outcome (by Price criteria); complications; and postoperative angulation and displacement were compared between children treated by the two methods. Statistical analysis was performed with alpha set at P < 0.05. RESULTS A total of 26 children were included: 14 treated with LOR-TIKW and 12 with ORIF-PS. Operation time was less (22.1 min vs. 46.7 min, P < 0.0001), surgical incision smaller (2.43 cm vs. 5.00 cm, P < 0.0001), cost of internal fixation lower (US$, 40.6 vs. 2020, P < 0.0001), and healing time shorter (4.79 weeks vs. 5.64 weeks, P = 0.03) with LOR-TIKW; however, postoperative fracture angulation was slightly larger (1.07° vs. 0.83°, P = 0.85) and displacement slightly more (0.86 mm vs. 0.58 mm, P = 0.44) in the LOR-TIKW group. Rate of union, functional outcome, and complications were not significantly different between the groups. CONCLUSION For irreducible DMJ fracture of distal radius in older children, LOR-TIKW appears to be a promising method with several advantages over ORIF-PS.
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Affiliation(s)
- Rufa Wang
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Liwei Wu
- Department of Pediatric, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yinming Wang
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Minjie Fan
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yiwei Wang
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Bo Ning
- National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Pengfei Zheng
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
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16
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Saugy CA, Bregou AB. When to Suspect DRUJ's Instability in Children? Case Report of a Rare Presentation of Distal Forearm Fractures. European J Pediatr Surg Rep 2022; 10:e73-e75. [PMID: 35694179 PMCID: PMC9183950 DOI: 10.1055/s-0042-1748317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/02/2022] [Indexed: 11/24/2022] Open
Abstract
Pediatric displaced distal metaphyseal ulnar fractures and distal radial buckle fractures are common. However, to the best of our knowledge, their association has never been specifically reported. Thus, classification and management of this pattern remain challenging especially in young children. Distal radioulnar joint (DRUJ)'s assessment is difficult. A Galeazzi-equivalent injury should be suspected. We report the case of a 2-year-old boy who presented the above-mentioned association of forearm fractures and compare our management with actual recommendations. We would recommend a low-suspicion threshold for DRUJ's instability in young children presenting with displaced distal metaphyseal ulnar fracture associated with distal radial buckle fracture. That suspicion should raise the necessity of appropriate treatment and follow-up.
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Affiliation(s)
- Claire-Anne Saugy
- Service d'Orthopédie, Hôpital de zone de Morges, Morges, Switzerland
| | - Aline Bourgeois Bregou
- Unité Pédiatrique de Chirurgie Orthopédique et Traumatologique, CHUV, Lausanne, Vaud, Switzerland
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17
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Merckaert S, Chaibi E, Meriem S, Kwiatkowski B, Divjak N, Zambelli PY. Epidemiology of Pediatric Upper Extremity Fractures in a Tertiary Care Center in Switzerland. Pediatr Emerg Care 2021; 37:e825-e835. [PMID: 32106152 DOI: 10.1097/pec.0000000000002047] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Fractures in children are common and account for 10% to 25% of injuries in children with considerable effects on activity restriction and subsequent high socioeconomically impact. Eighty percent of all fractures in children occur at the upper extremity. The article investigates the epidemiology and fracture pattern of the upper extremity within a pediatric population consulting a tertiary referral hospital in Switzerland. METHODS Study population included all patients younger than 18 years presenting with an upper extremity fracture. Recorded data were age, sex, side, season of the year, mechanism, type of fracture, and applied treatment. RESULTS Fractures of the upper extremities represented 76% with a mean age of 9 years and 7 months. Compared with girls, boys had a risk ratio of 1.35 (1.14-1.6) of having a traumatic injury. The radius, with 298 fractures (37%), was the most injured bone. Overall simple fall from his or her height and soccer represented the main injury mechanisms accounting for 26% and 9%, respectively. Eighty-six percent of fractures were treated by cast with or without closed reduction, 11% (92) by closed reduction and pinning or elastic stable intramedullary, and only 3% of fractures were treated by open reduction and internal fixation. CONCLUSIONS Eighty-six percent of all fractures could be treated by conservative methods. Only 17% need surgical treatments by orthopedic surgeons. This shows how important it is to train residents in pediatrics for the treatment of upper limb fractures in children.
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Affiliation(s)
- Sophie Merckaert
- From the Department of Women, Mother, and Child's Health Care, Paediatric Surgery, Unit of Paediatric Orthopedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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18
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Lahoti O, Akilapa O. Not Kidding! Sequalae of elbow trauma in children. J Clin Orthop Trauma 2021; 20:101471. [PMID: 34194970 PMCID: PMC8217682 DOI: 10.1016/j.jcot.2021.06.001] [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: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022] Open
Abstract
Elbow injuries are common in children and while majority heal very well, some result in deformities of the elbow. Although deformities such as cubitus varus and non-progressive cubitus valgus are considered cosmetic by the paediatric orthopaedic surgeons and intentionally ignored, they are not always benign and can result in functional deficit due to instability, pain, tardy nerve palsies and osteoarthritis later in life. Similarly congenital and developmental conditions that do not cause major functional loss in childhood, become very disabling in adults due to increasing functional demands. Congenital radial head dislocation and radioulnar synostosis fall into this category. In this paper we discuss clinical presentation, treatment options and outcomes of common elbow conditions presenting later in the life.
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Affiliation(s)
- Om Lahoti
- Diploma in Gait Analysis (Stratchclyde), Consultant Adult and Paediatric Orthopaedic Surgeon, King's College Hospital, London, SE5 9RS, United Kingdom,Corresponding author. King's College Hospital, London, SE5 9RS, United Kingdom.
| | - Oluwasegun Akilapa
- Sports/Exercise Medicine, Specialist Registrar in Orthopaedics, King's College Hospital, London, SE5 9RS, United Kingdom
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19
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ALBERGHINA F, CANAVESE F, ANDREACCHIO A. Humeral shaft fractures in children and adolescents. MINERVA ORTHOPEDICS 2021; 72. [DOI: 10.23736/s2784-8469.20.04040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
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20
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Liu Y, Liu C, Guo D, Wang N, Zhao Y, Li D. Effect of childhood overweight on distal metaphyseal radius fractures treated by closed reduction. J Orthop Surg Res 2021; 16:182. [PMID: 33691732 PMCID: PMC7944895 DOI: 10.1186/s13018-021-02336-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The medical community has recognized overweight as an epidemic negatively affecting a large proportion of the pediatric population, but few studies have been performed to investigate the relationship between overweight and failure of conservative treatment for distal radius fractures (DRFs). This study was performed to investigate the effect of overweight on the outcome of conservative treatment for DRFs in children. METHODS We performed a retrospective study of children with closed displaced distal metaphyseal radius fractures in our hospital from January 2015 to May 2020. Closed reduction was initially performed; if closed reduction failed, surgical treatment was performed. Patients were followed up regularly after treatment, and redisplacement was diagnosed on the basis of imaging findings. Potential risk factors for redisplacement were collected and analyzed. RESULTS In total, 142 children were included in this study. The final reduction procedure failed in 21 patients, all of whom finally underwent surgical treatment. The incidences of failed final reduction and fair reduction were significantly higher in the overweight/obesity group than in the normal-weight group (P = 0.046 and P = 0.041, respectively). During follow-up, 32 (26.4%) patients developed redisplacement after closed reduction and cast immobilization. The three risk factors associated with the incidence of redisplacement were overweight/obesity [odds ratio (OR), 2.149; 95% confidence interval (CI), 1.320-3.498], an associated ulnar fracture (OR, 2.127; 95% CI, 1.169-3.870), and a three-point index of ≥ 0.40 (OR, 3.272; 95% CI, 1.975-5.421). CONCLUSIONS Overweight increases the risk of reduction failure and decreases the reduction effect. Overweight children were two times more likely to develop redisplacement than normal-weight children in the present study. Thus, overweight children may benefit from stricter clinical follow-up and perhaps a lower threshold for surgical intervention.
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Affiliation(s)
- Yu Liu
- Department of Pediatrics, Tangshan Workers Hospital, 27 Wenhua Road, Lubei District, Tangshan City, Hebei Province, People's Republic of China.
| | - Chunjie Liu
- Department of Orthopedics, Tangshan Workers Hospital, Tangshan City, Hebei Province, People's Republic of China
| | - Dongmei Guo
- Department of Pediatrics, Tangshan Workers Hospital, 27 Wenhua Road, Lubei District, Tangshan City, Hebei Province, People's Republic of China
| | - Ning Wang
- Department of Clinical Laboratory, Tangshan Workers Hospital, Tangshan City, Hebei Province, People's Republic of China
| | - Ying Zhao
- Department of Pediatrics, Tangshan Workers Hospital, 27 Wenhua Road, Lubei District, Tangshan City, Hebei Province, People's Republic of China
| | - Dan Li
- Department of Pediatrics, Tangshan Workers Hospital, 27 Wenhua Road, Lubei District, Tangshan City, Hebei Province, People's Republic of China
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Functional and radiological outcome in patients with acute Monteggia fracture treated surgically: a comparison between closed reduction and external fixation versus closed reduction and elastic stable intramedullary nailing. J Pediatr Orthop B 2020; 29:438-444. [PMID: 31305359 DOI: 10.1097/bpb.0000000000000645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The aim of this study was to compare the clinical and radiological outcomes in children with acute Monteggia fracture treated by two different surgical techniques. Twenty-six children treated by either closed reduction and external fixation (group A) or elastic stable intramedullary nails (group B) were retrospectively reviewed. Clinical outcome was evaluated with the Quick DASH questionnaire. Overall, both surgical techniques provided similar excellent healing rates and good clinical outcomes (P > 0.05), as well as radiological outcomes (P > 0.05). Radiographically, no secondary displacement, wire migration, consolidation delays, non-union, malunion or re-fractures were noted. However, two patients (7.6%), one in group A (1/15; 6.7%) and one in group B (1/11; 9.1%), developed heterotopic ossification at the level of the ulna. Clinical functional outcomes were similar between the two groups of patients. The mean overall Quick DASH score was 0.79 (range, 0-18.2). However, six in group A (40%) and one in group B (9.1%) complained of the clinical appearance and had intermittent residual pain on the injured side. In conclusion, both elastic stable intramedullary nailing and external fixation can achieve satisfactory clinical and radiographic outcomes in children with acute Monteggia fractures. However, the rate of residual pain and less satisfactory clinical appearance was higher in patients managed by external fixation compared to those treated by elastic stable intramedullary nailing. According to our results, elastic stable intramedullary nailing should be used as primary treatment option in children with acute Monteggia fracture requiring surgical management.
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Passiatore M, De Vitis R, Perna A, D'Orio M, Cilli V, Taccardo G. Extraphyseal distal radius fracture in children: is the cast always needed? A retrospective analysis comparing Epibloc system and K-wire pinning. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1243-1250. [PMID: 32405758 DOI: 10.1007/s00590-020-02698-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Closed reduction and internal fixation are a widespread surgical treatment for pediatrics displaced extraphyseal distal radius fractures. Post-surgical cast immobilization is usually needed. Epibloc system (ES) is a device used to fix Colles fractures in adults, not requiring post-surgical immobilization. The aim of the study is to investigate the effectiveness of ES in a pediatric population suffering from displaced extraphyseal distal radius fractures. METHODS We retrospectively analyzed 52 patients (age 8-12 years) who underwent CRIF. Patients were divided into two groups. Group A (25 patients): ES osteosynthesis. Group B (27 patients): K-wires and short arm cast osteosynthesis. The primary outcome is the maintenance of reduction in radiographs (displacement on frontal and lateral view). The secondary outcome is the reaching of the complete active range of motion recovery (compared with the contralateral side) and the time needed to obtain it. The need of further additional treatment (physiotherapy) and the presence of complication were also assessed. RESULTS Reduction was equally maintained in both groups (p > 0.05). Physiotherapy was mandatory for 11 patients in group B; only for 3 patients in group A, the difference was statistically significant (p = 0.03) according to Fisher test. Otherwise, the difference was not statistically significant regarding complications. (p > 0.05). At the last follow-up, complete functional recovery was reached in all patients. CONCLUSIONS Functional recovery is faster, and postoperative physiotherapy is rarely required with ES. This device allows us to go beyond the traditional concept of mandatory postoperative immobilization after pediatric wrist fractures surgery.
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Affiliation(s)
- Marco Passiatore
- Istituto Di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via Giuseppe Moscati 31, 00168, Roma, Italia.
| | - Rocco De Vitis
- Istituto Di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Andrea Perna
- Istituto Di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via Giuseppe Moscati 31, 00168, Roma, Italia
| | - Marco D'Orio
- Istituto Di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via Giuseppe Moscati 31, 00168, Roma, Italia
| | - Vitale Cilli
- Chirurgie de La Main, CHIREC Site Delta, Bruxelles, Belgium
| | - Giuseppe Taccardo
- Istituto Di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italia
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Johnson L, Messner J, Igoe EJ, Foster P, Harwood P. Quality of life and post-traumatic stress symptoms in paediatric patients with tibial fractures during treatment with cast or Ilizarov frame. Injury 2020; 51:199-206. [PMID: 31703960 DOI: 10.1016/j.injury.2019.10.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare quality of life in children and adolescents with tibial fracture during treatment with either a definitive long-leg cast or Ilizarov frame. METHODS A prospective, longitudinal cohort study was undertaken. Patients aged between 5 and 17 years with tibial fractures treated definitively using a long-leg cast or Ilizarov frame were recruited at first follow-up. Health related quality of life was measured at each clinic appointment during treatment using the Pediatric Quality of Life Inventory (PedsQL) [1]; a validated measure of age-adjusted physical and psychosocial functioning. Psychological trauma symptoms were assessed using the Children's Revised Impact of Events Scale (CRIES) [2]. Results were analysed based on time from injury (less than 30 days, 30 to 120 days). Data regarding injury and treatment was recorded from the clinical records. Statistical analysis was undertaken using a Kruksal-Wallis test with a Tukey-Kramer subgroup analysis. RESULTS Twenty-five patients from each group were included in the final analysis. Injuries were more severe in the frame patients based on the AO/OTA classification and number of open fractures. No statistically significant differences were detected in any of the outcome scores between treatment groups at either time point. A significant improvement was found in the child reported physical and total domains in both treatment groups based on time from application (<30 days vs. >30 days, frame: p < 0.0001, cast: p = 0.003). There were no differences in the child reported psychosocial domain scores at any time point or between treatment groups. Parent reported scores only showed a significant physical improvement in the frame group (p < 0.0001). CRIES scores for psychological trauma in the intrusion and avoidance domain improved significantly in the cast group between time points (p < 0.05), Multivariate analysis identified polytrauma, mechanism of injury and time from injury but not treatment modality (cast or frame) as significant predictors of quality of life scores (PedsQL) and severity of post-traumatic symptoms (CRIES). CONCLUSION We found no difference in health-related quality of life during treatment between our patients treated for tibial fractures using a cast or an Ilizarov frame.
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Affiliation(s)
- L Johnson
- Limb Reconstruction Unit and Leeds Major Trauma Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom.
| | - J Messner
- Limb Reconstruction Unit and Leeds Major Trauma Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom
| | - E J Igoe
- Limb Reconstruction Unit and Leeds Major Trauma Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom
| | - P Foster
- Limb Reconstruction Unit and Leeds Major Trauma Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom
| | - P Harwood
- Limb Reconstruction Unit and Leeds Major Trauma Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom
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Harly E, Angelliaume A, Lalioui A, Pfirrmann C, Harper L, Lefèvre Y. Divergent Intramedullary Nailing (DIN): A Modified Intramedullary Nailing Technique to Treat Paediatric Distal Tibial Fractures. J Pediatr Orthop 2020; 39:e773-e776. [PMID: 30925580 DOI: 10.1097/bpo.0000000000001366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Elastic stable intramedullary nailing (ESIN) allows for efficient reduction and stabilization of fractures of the tibial shaft in children and adolescents. However, for fractures of the distal third of the tibia, traditional ESIN could be inappropriate, thus compromising the stability and the healing of the fracture. The aim of this study was to present and to assess a new technique of modified ESIN to treat fracture of the distal third of the tibia, called divergent intramedullary nailing (DIN). METHODS We performed a retrospective monocentric study. All patients less than 16 years old, managed in our pediatric orthopaedics department, and operated upon according to the DIN technique for a displaced and/or unstable fracture of the distal third of the tibia were included. Demographic and surgical data were collected. X-rays were performed preoperatively, postoperatively, at 6 weeks, and every 6 months. The surgical technique starts as does the classic ESIN. However, nails are not curved, so that they cross only once at the proximal part of the tibia; they are divergent and supported by the medial and lateral distal part of the tibial shaft. This allows for reduction and stabilization of the fracture. RESULTS A total of 13 patients were included, with a mean age of 10 years and a mean follow-up of 32 months. The size of the nail varied between 2.5 and 4 mm. The mean surgical time was 54 minutes. The DIN technique provided a satisfying reduction (coronal and sagittal angulation <3 degrees) for the 13 fractures. In addition, there was no secondary displacement at 6 weeks. All patients were healed at 6 months, with no clinical torsion or axis malalignment. CONCLUSIONS The current study confirms the feasibility and the efficiency of the DIN method to treat fracture of the distal third of the tibia.
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Affiliation(s)
- Edouard Harly
- Department of Pediatric Orthopaedics, University Hospital of Bordeaux, France
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Yuan Z, Xu HW, Liu YZ, Li YQ, Li JC, Canavese F. The use of external fixation for the management of acute and chronic Monteggia fractures in children. J Child Orthop 2019; 13:551-559. [PMID: 31908671 PMCID: PMC6924126 DOI: 10.1302/1863-2548.13.190115] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The main objective of this study was to retrospectively evaluate the clinical and radiological outcomes of acute (AMF) and chronic Monteggia fractures (CMF) in children treated by closed or open reduction and external fixation (EF). METHODS This is a retrospective review of 26 patients with Monteggia fracture. Patients with AMF (time between trauma and surgery less than two weeks) were treated by closed reduction and EF of the ulna (Group A; 15 patients) while those with CMF (time between trauma and surgery more than three weeks) were managed by closed or open reduction and EF of the ulna (Group B; 11 patients). Clinical outcome was evaluated with radiography and the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). Complications were recorded in both groups. RESULTS No secondary displacement, wire migration, consolidation delays, nonunion, malunion or re-fracture was noted. However, one patient in Group A (6.7%) developed heterotopic ossification of the ulna; the final functional outcome was good (Quick DASH score: 18.2). One case of postoperative redislocation of the radial head was detected in Group B (9.1%). Two patients (7.6%) developed transient pin tract infection. Despite the fact that 16 out of 26 patients (six in Group A and ten in Group B) complained of the clinical appearance and/or had intermittent residual pain on the injured side, the results were essentially the same between the two groups of patients (p > 0.05). CONCLUSION EF is an alternative for the management of acute and chronic paediatric Monteggia fractures. It provides satisfactory radiological and clinical outcomes with relatively low rates of complications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Z. Yuan
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China
| | - H. W. Xu
- University Hospital Estaing, Department of Pediatric Surgery, Clermont Ferrand, France
| | - Y. Z. Liu
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China
| | - Y. Q. Li
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China
| | - J. C. Li
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China
| | - F. Canavese
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China,University Hospital Estaing, Department of Pediatric Surgery, Clermont Ferrand, France,Correspondence should be sent to F. Canavese, Department of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, 9th JinSui Road, GuangZhou, 510623, China. E-mail:
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Kubiak R, Aksakal D, Weiss C, Wessel LM, Lange B. Is there a standard treatment for displaced pediatric diametaphyseal forearm fractures?: A STROBE-compliant retrospective study. Medicine (Baltimore) 2019; 98:e16353. [PMID: 31305426 PMCID: PMC6641800 DOI: 10.1097/md.0000000000016353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To review our institutional results and assess different surgical and non-surgical techniques for the treatment of displaced diametaphyseal forearm fractures in children and adolescents.Thirty-four children (25M, 9F) with a total of 36 diametaphyseal forearm fractures who underwent treatment under general anesthesia between July 2010 and February 2016 were recruited to this retrospective study. From October 2016 until March 2018 patients and/or parents were contacted by telephone and interviewed using a modified Pediatric Outcomes Data Collection Instrument (PODCI).Median age at the time of injury was 9.1 years (range, 1.9-14.6 years). Initial treatment included manipulation under anesthesia (MUA) and application of plaster of Paris (POP) (n = 9), elastic stable intramedullary nailing (ESIN) (n = 10), percutaneous insertion of at least one Kirschner wire (K-wire) (n = 16), and application of external fixation (n = 1). Eleven children (32%) experienced a total of 22 complications. Seven complications were considered as major, including delayed union (n = 1) and extensor pollicis longus (EPL) tendon injury (n = 1) following ESIN, as well as loss of reduction (n = 2) and refractures (n = 3) after MUA/POP. The median follow-up time was 28.8 months (range, 5.3-85.8 months). In 32 out of 34 cases (94%) patients and/or parents were contacted by telephone and a PODCI score was obtained. Patients who experienced complications in the course of treatment had a significantly lower score compared with those whose fracture healed without any sequelae (P = .001). There was a trend towards an unfavorable outcome following ESIN compared with K-wire fixation (P = .063), but not compared with POP (P = .553). No statistical significance was observed between children who were treated initially with a POP and those who had K-wire fixation (P = .216).There is no standard treatment for displaced pediatric diametaphyseal forearm fractures. Management with MUA/POP only is associated with an increased refracture rate. Based on our experience K-wire fixation including intramedullar positioning of at least one pin seems to be favorable compared with ESIN.
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Affiliation(s)
- Rainer Kubiak
- Department of Pediatric Surgery, Medical Faculty Mannheim (UMM), Heidelberg University
| | - Devrim Aksakal
- Department of Pediatric Surgery, Medical Faculty Mannheim (UMM), Heidelberg University
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, Mannheim, Germany
| | - Lucas M. Wessel
- Department of Pediatric Surgery, Medical Faculty Mannheim (UMM), Heidelberg University
| | - Bettina Lange
- Department of Pediatric Surgery, Medical Faculty Mannheim (UMM), Heidelberg University
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Use of external fixation for juxta-articular fractures in children. Injury 2019; 50 Suppl 1:S87-S94. [PMID: 30955875 DOI: 10.1016/j.injury.2019.03.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/28/2019] [Indexed: 02/02/2023]
Abstract
In this article, the use of external fixation in the management of juxta-articular fractures in paediatric patients is discussed. Basic principles of Ilizarov technique are described for distal radial, distal femoral, distal humeral and distal tibial fractures. Common indications for external fixation in pediatric fractures are comminuted, complicated, and/or open fractures, particularly at the distal humerus, distal radius, distal femur and distal tibia. There are several benefits of external frame fixation in these type of injuries in children. This method avoids additional injury to the growth plate as K-wires are not placed through it. It enables careful reduction without interfragmentary compression and correct anatomic alignment. There is no soft tissue dissection and periosteal blood supply is preserved. External fixation ensures primary fracture stability even in presence of comminution and high adjustment capability. Immediate joint motion and early weight-bearing are further advantages. Joint bridging is an option in severe bone loss or soft tissue injuries.
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Iles BW, Samora JB, Singh S, Ruess L. Differentiating stable buckle fractures from other distal radius fractures: the 1-cm rule. Pediatr Radiol 2019; 49:358-364. [PMID: 30547221 DOI: 10.1007/s00247-018-4316-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/30/2018] [Accepted: 11/30/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Treatment pathways for isolated distal radius fractures in children are becoming more tailored to specific fracture types and include different management plans for stable buckle fractures versus potentially unstable distal radius fractures. OBJECTIVE To propose a measurement rule to aid in differentiating stable buckle fractures from other distal radius fractures in children. MATERIALS AND METHODS A medical record search identified 203 children with closed distal radius fractures during a 14-month period. A consensus of two senior readers served as a reference standard to distinguish buckle fractures from other distal radius fractures. We measured fracture-to-physis distance on posteroanterior (PA) and lateral radiographs for each of the isolated distal radius fractures. We analyzed diagnostic accuracy, using fracture-to-physis distance as a predictor for buckle fractures, in children ages 3-16 years. We used a receiver operating characteristic (ROC) curve to determine the cut-off values tested. RESULTS There were 148 buckle fractures (73%) and 55 isolated potentially unstable distal radius fractures (27%). For children 7-16 years, buckle fracture-to-physis distance was <1 cm in only 1/106 (0.9%) on the PA projection and none on the lateral projection. Diagnostic accuracy for buckle fracture diagnosis was 82% using a cut-off of 14 mm (PA) and 13 mm (lateral). In children 3-6 years old, the buckle fracture-to-physis distance was <1 cm in 1/42 (2.4%) on the PA radiographs and another 1/42 (2.4%) on the lateral radiographs. Diagnostic accuracy was low for younger children for all tested distances. CONCLUSION We propose utilizing a measurement rule to increase diagnostic accuracy for buckle fractures in children ≥7 years old. An isolated distal radius fracture in a child 7 years or older is not likely to be a buckle fracture if the fracture-to-physis distance is <1 cm.
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Affiliation(s)
- Benjamin W Iles
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Julie B Samora
- Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Orthopedic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Satbir Singh
- Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Lynne Ruess
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- Department of Radiology, The Ohio State University College of Medicine, Columbus, OH, USA.
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Audigé L, Slongo T, Lutz N, Blumenthal A, Joeris A. The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). Acta Orthop 2017; 88:133-139. [PMID: 27882814 PMCID: PMC5385106 DOI: 10.1080/17453674.2016.1258534] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF) describes the localization and morphology of fractures, and considers severity in 2 categories: (1) simple, and (2) multifragmentary. We evaluated simple and multifragmentary fractures in a large consecutive cohort of children diagnosed with long bone fractures in Switzerland. Patients and methods - Children and adolescents treated for fractures between 2009 and 2011 at 2 tertiary pediatric surgery hospitals were retrospectively included. Fractures were classified according to the AO PCCF. Severity classes were described according to fracture location, patient age and sex, BMI, and cause of trauma. Results - Of all trauma events, 3% (84 of 2,730) were diagnosed with a multifragmentary fracture. This proportion was age-related: 2% of multifragmentary fractures occurred in school-children and 7% occurred in adolescents. In patients diagnosed with a single fracture only, the highest percentage of multifragmentation occurred in the femur (12%, 15 of 123). In fractured paired radius/ulna bones, multifragmentation occurred in 2% (11 of 687); in fractured paired tibia/fibula bones, it occurred in 21% (24 of 115), particularly in schoolchildren (5 of 18) and adolescents (16 of 40). In a multivariable regression model, age, cause of injury, and bone were found to be relevant prognostic factors of multifragmentation (odds ratio (OR) > 2). Interpretation - Overall, multifragmentation in long bone fractures in children was rare and was mostly observed in adolescents. The femur was mostly affected in single fractures and the lower leg was mostly affected in paired-bone fractures. The clinical relevance of multifragmentation regarding growth and long-term functional recovery remains to be determined.
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Affiliation(s)
- Laurent Audigé
- AO Clinical Investigation and Documentation, Dübendorf;,Schulthess Clinic, Research and Development Upper Extremities, Zürich
| | - Theddy Slongo
- Department of Pediatric Surgery, Traumatology and Orthopedics, University Hospital (Inselspital), Bern
| | - Nicolas Lutz
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Alexander Joeris
- AO Clinical Investigation and Documentation, Dübendorf;,Correspondence:
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30
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Hvid I, Parsch K. Classification of long bone fractures in children. Acta Orthop 2017; 88:121-122. [PMID: 28361619 PMCID: PMC5385103 DOI: 10.1080/17453674.2017.1289326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Ivan Hvid
- Division of Orthopaedic Surgery, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
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Tzavellas AN, Kenanidis E, Potoupnis M, Pellios S, Tsiridis E, Sayegh F. Interobserver and intraobserver reliability of Salter-Harris classification of physeal injuries. Hippokratia 2016; 20:222-226. [PMID: 29097889 PMCID: PMC5654440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Prognostic value of Salter-Harris (SH) classification is well established. Its reliability, however, can be questioned. We aim to evaluate the interobserver and intraobserver reliability of SH classification and to correlate the level of rater's experience with the correct scoring for each SH subclass. METHODS Twenty-eight independent raters stratified in three levels of seniority evaluated 50 randomly selected radiographs of physeal injuries. The interval for intraobserver reliability was 12 weeks. The overall agreement between raters was assessed using kappa statistics. Student's t-test and Spearman correlation coefficient used to compare results between groups. RESULTS Overall kappa for interobserver reliability was 0.45. The mean kappa difference between specialists and residents was significant (p <0.001). The mean kappa difference was also significant between senior and junior residents (p <0.001), favoring senior residents. Intraobserver kappa differs between specialists (0.55) and residents (0.49), but this did not reach statistical significance (p =0.34). SH type II and III demonstrated the highest category-specific kappa coefficient. Seniority was correlated significantly with the number of correct answers (Spearman rho =0.6 p =0.001). CONCLUSIONS Moderate interobserver reliability that was improved with greater rater's experience was found. Type II and III are the best scored regardless rater's experience. Type I, IV, and V when in doubt, require additional imaging. Hippokratia 2016, 20(3): 222-226.
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Affiliation(s)
- A N Tzavellas
- 3 Academic Orthopaedic Unit, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - E Kenanidis
- 3 Academic Orthopaedic Unit, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - M Potoupnis
- 3 Academic Orthopaedic Unit, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - S Pellios
- 3 Academic Orthopaedic Unit, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - E Tsiridis
- 3 Academic Orthopaedic Unit, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - F Sayegh
- 3 Academic Orthopaedic Unit, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
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