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Strahl A, Willemsen JF, Schoof B, Reinshagen K, Frosch KH, Wintges K. The paediatric polytrauma CT-indication (PePCI)-score-Development of a prognostic model to reduce unnecessary CT scans in paediatric trauma patients. Injury 2024; 55:111494. [PMID: 38521635 DOI: 10.1016/j.injury.2024.111494] [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: 07/09/2023] [Revised: 02/03/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Whole-Body CT (WBCT) is frequently used in emergency situations for promptly diagnosing paediatric polytrauma patients, given the challenges associated with obtaining precise details about the mechanism and progression of trauma. However, WBCT does not lead to reduced mortality in paediatric patients, but is associated with high radiation exposure. We therefore wanted to develop a screening tool for CT demand-driven emergency room (ER)-trauma diagnostic to reduce radiation exposure in paediatric patients. METHODS A retrospective study in a Level I trauma centre in Germany was performed. Data from 344 paediatric emergency patients with critical mechanism of injury who were pre-announced by the ambulance for the trauma room were collected. Patients' symptoms, clinical examination, extended Focused Assessment with Sonography for Trauma (eFAST), routinely, laboratory tests and blood gas and - when obtained - WBCT images were analysed. To identify potential predictors of severe injuries (ISS > 23), 300 of the 344 cases with complete data were subjected to regression analyses model. RESULTS Multiple regression analysis identified cGCS, base excess (BE), medically abnormal results from eFAST screening, initial unconsciousness, and injuries involving three or more body regions as significant predictors for a screening tool for decision-making to perform WBCT or selective CT. The developed Paediatric polytrauma CT-Indication (PePCI)-Score was divided into three risk categories and achieved a sensitivity of 87 % and a specificity of 71 % when comparing the low and medium risk groups with the high risk group. Comparing only the low-risk group with the high-risk group for the decision to perform WBCT, 32/35 (91 %) of patients with an ISS >23 were correctly identified, as were 124/137 (91 %) with lower ISS scores. CONCLUSION With the newly developed PePCI-Score, the frequency of WBCT in a paediatric emergency patients collective can be significantly reduced according to our data. After prospective validation, the initial assessment of paediatric trauma patients in the future could be made not only by the mechanism of injury, but also by the new PePCI-Score, deriving on clinical findings after thorough clinical assessment and the discretion of the trauma team.
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Affiliation(s)
- André Strahl
- Department of Trauma and Orthopaedic Surgery, Division of Orthopeadics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Jan Fritjof Willemsen
- Department of Paediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Benjamin Schoof
- Department of Paediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Konrad Reinshagen
- Department of Paediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; Department of Trauma Surgery, Orthopedics and Sportstraumatology, BG Hospital Hamburg, 21033 Hamburg, Germany
| | - Kristofer Wintges
- Department of Paediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
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Popa Ș, Sârbu I, Ciongradi CI, Popa IP, Bulgaru-Iliescu D. Current Epidemiological Trends of Pediatric Traffic Accidents at a Romanian Clinical Hospital. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1525. [PMID: 37761486 PMCID: PMC10528258 DOI: 10.3390/children10091525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/27/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Pediatric road traffic accidents (RTAs) have a substantial impact on the worldwide youth population, resulting in a considerable burden of disability. According to the World Health Organization's (WHO) Global Status Report on Road Safety, around 1.35 million children die each year in RTAs around the world, having a big effect on health and financial costs. Today's high-income countries like the Netherlands have experienced a decrease in the incidence of fatal traffic accidents (TAs) in children compared to countries with higher-than-average scores, including Romania, where roughly one out of every two minor deaths was a pedestrian; however, there is a lack of comprehensive and up-to-date epidemiological data on non-fatal TAs regarding pediatric patients. The objective of this study is to perform a thorough examination of the epidemiological aspects of Tas in pediatric patients admitted to the Emergency Department (ED) of "St. Mary's" Emergency Clinical Hospital for Children in Iasi, Romania. MATERIALS AND METHODS A descriptive retrospective research study was conducted at the "St. Mary's" Emergency Clinical Hospital for Children in Iasi, Romania, from January 2015 to December 2022. The research population includes all pediatric trauma patients that were between the age range of 1 month and 18 years who were treated by the trauma department. A total of 358 cases met the inclusion criteria and fulfilled fulfilled fulfilled. Data concerning variables such as accident incidents, types of injuries, and length of hospitalization have been gathered. RESULTS The average age of the patients was 11.43 ± 4.07 years, with patients of both sexes, the representation of the male sex being 78.5%. The incidence occurred during the summer, representing 15.3% in June. Of the patients admitted to the ED, 55.5% (n = 196) did not require surgery. Most of the patients spent from a minimum of one day to a maximum of 28 days in the hospital, with an average of 8.50 hospital days. The most common injuries were fractures (n = 221), and the most frequent anatomical region affected was the upper limbs (n = 55.2%). CONCLUSION While the literature on fatal TA cases shows a declining trend, there is a lack of up-to-date information on non-fatal TAs involving children. The results of our study suggest that there is a high incidence of pediatric TAs due to the scale of "St. Mary's" Emergency Clinical Hospital for Children, from Iasi, which provides medical services to a considerable number of patients coming from both rural and urban areas of the seven counties of Moldova region, in Romania.
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Affiliation(s)
- Ștefan Popa
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy Iași, 700115 Iași, Romania; (Ș.P.); (C.I.C.)
| | - Ioan Sârbu
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy Iași, 700115 Iași, Romania; (Ș.P.); (C.I.C.)
| | - Carmen Iulia Ciongradi
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy Iași, 700115 Iași, Romania; (Ș.P.); (C.I.C.)
| | - Irene Paula Popa
- Surgery and Orthopaedic Clinic, “Sfânta Maria” Emergency Children Hospital Iași, 700309 Iași, Romania
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Diana Bulgaru-Iliescu
- 3rd Department of Medical Specialities–Legal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iași, 700115 Iași, Romania;
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Popa Ș, Ciongradi CI, Sârbu I, Bîcă O, Popa IP, Bulgaru-Iliescu D. Traffic Accidents in Children and Adolescents: A Complex Orthopedic and Medico-Legal Approach. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1446. [PMID: 37761407 PMCID: PMC10527870 DOI: 10.3390/children10091446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Traffic accidents involving children and adolescents present complex challenges from both the medico-legal and orthopedic standpoints. Despite the implementation of road traffic safety laws, pediatric road traffic injuries continue to be a significant contributor to mortality rates, physical harm, and hospitalization on a global scale. For children and young people, automobile accidents are considered to be the primary culprit of mortality in developed nations. Even in highly developed nations, trauma is a significant factor in infant mortality. Each age category, from childhood to young adulthood, has its fracture patterns, as their skeletons are considerably different from those of adults. The consequences of traffic accidents extend beyond the immediate physical trauma. The medico-legal aspects surrounding these incidents add another layer of complexity, as legal repercussions may affect the responsible adult or parent, particularly in cases involving child fatalities. To effectively address traffic accidents in children and adolescents, a comprehensive approach is necessary. This approach should involve not only medical professionals but also legal experts and policymakers. Collaboration between orthopedic specialists, medico-legal professionals, law enforcement agencies, and relevant government bodies can facilitate the development and implementation of strategies aimed at prevention, education, the enforcement of traffic laws, and improved infrastructure. By addressing both the medical and legal aspects, it is possible to enhance road safety for children and adolescents, reducing the incidence of injuries and their associated long-term consequences. In this review, we aimed to summarize traffic accidents in children and adolescents from a complex orthopedic and medico-legal approach.
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Affiliation(s)
- Ștefan Popa
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Carmen Iulia Ciongradi
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Ioan Sârbu
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Ovidiu Bîcă
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Irene Paula Popa
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Diana Bulgaru-Iliescu
- 3rd Department of Medical Specialities–Legal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
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Padgett AM, Torrez TW, Kothari EA, Conklin MJ, Williams KA, Gilbert SR, Ashley P. Comparison of nonoperative versus operative management in pediatric gustilo-anderson type I open tibia fractures. Injury 2023; 54:552-556. [PMID: 36522213 DOI: 10.1016/j.injury.2022.12.005] [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: 11/04/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent studies suggest pediatric Gustilo-Anderson type I fractures, especially of the upper extremity, may be adequately treated without formal operative debridement, though few tibial fractures have been included in these studies. The purpose of this study is to provide initial data suggesting whether Gustilo-Anderson type I tibia fractures may be safely treated nonoperatively. METHODS Institutional retrospective review was performed for children with type I tibial fractures managed with and without operative debridement from 1999 through 2020. Incomplete follow-up, polytrauma, and delayed diagnosis of greater than 12 h since the time of injury were criteria for exclusion. Data including age, sex, mechanism of injury, management, time-to-antibiotic administration, and complications were recorded. RESULTS Thirty-three patients met inclusion criteria and were followed to union. Average age was 9.9 ± 3.7 years. All patients were evaluated in the emergency department and received intravenous antibiotics within 8 h of presentation. Median time-to-antibiotics was 2 h. All patients received cefazolin except one who received clindamycin at an outside hospital and subsequent cephalexin. Three patients (8.8%) received augmentation with gentamicin. Twenty-one patients (63.6%) underwent operative irrigation and debridement (I&D), and of those, sixteen underwent surgical fixation of their fracture. Twelve (36.4%) patients had bedside I&D with saline under conscious sedation, with one requiring subsequent operative I&D and intramedullary nailing. Three infections (14.3%) occurred in the operative group and none in the nonoperative group. Complications among the nonoperative patients include delayed union (8.3%), angulation (8.3%), and refracture (8.3%). Complications among the operative patients include delayed union (9.5%), angulation (14.3%), and one patient experienced both (4.8%). Other operative group complications include leg-length discrepancy (4.8%), heterotopic ossification (4.8%), and symptomatic hardware (4.8%). CONCLUSION No infections were observed in a small group of children with type I tibia fractures treated with bedside debridement and antibiotics, and similar non-infectious complication rates were observed relative to operative debridement. This study provides initial data that suggests nonoperative management of type I tibial fractures may be safe and supports the development of larger studies.
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Affiliation(s)
- Anthony M Padgett
- University of Alabama at Birmingham, Department of Orthopaedic Surgery, Birmingham, AL, United States.
| | - Timothy W Torrez
- University of Utah, Department of Orthopaedics, Salt Lake City, UT
| | - Ezan A Kothari
- University of Alabama at Birmingham, Department of Orthopaedic Surgery, Birmingham, AL, United States
| | - Michael J Conklin
- University of Alabama at Birmingham, Department of Orthopaedic Surgery, Birmingham, AL, United States; Children's of Alabama, Division of Orthopedic Surgery, Birmingham, AL, United States
| | - Kevin A Williams
- University of Alabama at Birmingham, Department of Orthopaedic Surgery, Birmingham, AL, United States; Children's of Alabama, Division of Orthopedic Surgery, Birmingham, AL, United States
| | - Shawn R Gilbert
- University of Alabama at Birmingham, Department of Orthopaedic Surgery, Birmingham, AL, United States; Children's of Alabama, Division of Orthopedic Surgery, Birmingham, AL, United States
| | - Philip Ashley
- University of Alabama at Birmingham, Department of Orthopaedic Surgery, Birmingham, AL, United States; Children's of Alabama, Division of Orthopedic Surgery, Birmingham, AL, United States
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Wang H, Yuan H, Liu L, Wu D, Ou L, Li C, Yu H. Incidence, characteristics, and treatments of traumatic open fractures in children and adolescents: A retrospective observational study. Medicine (Baltimore) 2022; 101:e29828. [PMID: 35777018 PMCID: PMC9239622 DOI: 10.1097/md.0000000000029828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We aimed to investigate the incidence, characteristics, and treatments of open fractures in children and adolescents (≤18 years old). We retrospectively reviewed the records of 2418 children and adolescents who presented with traumatic fractures and were admitted to our university-affiliated hospitals, among which 206 patients (8.5%) presented with open fractures. The patients' clinical and radiographic records were reviewed, and the age, gender, cause of injury, injury season, injury week, associated injuries and complications were collected. This study enrolled 1789 males (74.0%) and 629 females (26.0%) with an average age of 11.2 ± 5.0 years. The patients were divided into an open fracture group (OF group, n = 206) and a group with no open fracture (No-OF group, n = 2212). There were 206 patients (8.5%) who presented with open fractures and the most common fracture sites were the tibia (31.1%, 64/206) and fibula (20.9%, 43/206). The patients in the OF group presented with higher frequency of emergency admission (P < 0.001), self-supporting medical insurance (P < 0.001), MVCs (P < 0.001), wounded by machine (P < 0.001), struck by object (P < 0.001), hurt/cut by others (P < 0.001), lower limb fractures (P < 0.001), multiple fractures (P = 0.010), associated injuries (P < 0.001) and wound infection (P = 0.003) then the patients in the No-OF group. The most common complication were wound infection (5.8%) and pneumonia (1.0%) in the OF group, wound infection (2.1%) and pressure sores (2.0%) in the No- OF group. Multivariate logistic regression analysis indicated that mechanical trauma (OR = 64.229, P < 0.001), being hurt/cut by others (OR = 26.757, P < 0.001), and being struck by an object (OR = 15.345, P < 0.001) were stronger risk factors for open fracture than were low falls; additionally, lower limb fractures (OR = 5.970, P < 0.001), upper limb fractures (OR = 5.865, P < 0.001) and multiple fractures (OR = 5.414, P < 0.001) were stronger risk factors than craniofacial fractures for open fractures. The frequency of surgical treatment for the patients with traumatic open fractures (87.9%, 181/206) was significantly higher than those without open fractures (72.2%, 1596/2212) (P < 0.001). The hospital stays and fees for surgical treatment for the patients with traumatic open fractures were significantly higher than those without open fractures (P < 0.001). Etiology (especially being injured by a machine or being hurt/cut by others) and the fracture site (including lower limb fractures and upper limb fractures) were independent risk factors for open fractures. Traumatic open fractures presented with higher surgical treatment rate, hospital stays and fees.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, China
| | - Hong Yuan
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, China
| | - Lu Liu
- Department of Research and Training, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, China
| | - Deluo Wu
- Department of Orthopedics, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China
| | - Lan Ou
- Department of Radiology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, China
- *Correspondence: Hailong Yu (e-mail: )
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DeVictor S, DeGiovanni J, Carr MM. Pediatric penetrating cervical trauma in HCUP: Associations with hospital length of stay and cost. Int J Pediatr Otorhinolaryngol 2021; 143:110661. [PMID: 33667835 DOI: 10.1016/j.ijporl.2021.110661] [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: 11/09/2020] [Revised: 01/13/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe pediatric penetrating cervical trauma (PCT) and determine factors associated with increased length of stay (LOS) and total hospital charges. STUDY DESIGN Retrospective review of Healthcare Cost and Utilization Project (HCUP) from the Kids' Inpatient Database (KID) for 2016. SETTING Public database. METHODS A retrospective analysis of the HCUP from the KID for 2016 for inpatients ≤18 years of age. Comparisons between PCT and non-PCT patients were made, including hospital LOS and total charges. RESULTS There were 1279 patients with neck trauma of which 686 (53.6%) were identified as sustaining PCT. Patients with PCT were older (13.2 vs 11.8 yr, p = .001), and were more likely to be male (65.9% vs 54.8%, p < .001) and African-American (21.9% vs 15.9, p = .01). PCT patients were less likely to have a vascular injury (6.1% vs 20.1%, p < .001) and they were more likely to undergo airway evaluation (8.3% vs 2.2%, p < .001). Within the PCT group, 11.5% had open pharyngeal/esophageal lacerations, 6.1% had open tracheal injuries, 2.0% had open thyroid injuries, and 1.6% had open laryngeal injuries. LOS and total charges were not different between children with and without PCT (mean LOS 6.5 days, mean total charges US$106,000). Linear regression analysis showed significant associations with LOS for age, tracheal open injuries, cervical or vascular injury, and undergoing airway evaluation and/or esophagoscopy. Total charges associations were similar. CONCLUSION LOS and total charges were not different in children with PCT and non-PCT, but both were increased when there were more cervical injuries and more related procedures done.
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Affiliation(s)
- Sam DeVictor
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States.
| | - Jason DeGiovanni
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Michele M Carr
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States
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Choi WY, Park MS, Lee KM, Choi KJ, Jung HS, Sung KH. Leg length discrepancy, overgrowth, and associated risk factors after a pediatric tibial shaft fracture. J Orthop Traumatol 2021; 22:12. [PMID: 33721110 PMCID: PMC7960829 DOI: 10.1186/s10195-021-00575-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 03/06/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND This study was performed to investigate leg length discrepancy (LLD), overgrowth, and associated risk factors after pediatric tibial shaft fractures. MATERIALS AND METHODS This study included 103 patients younger than 14 years of age (mean age 7.1 years; 75 boys, 28 girls) with unilateral tibial shaft fracture and a minimum follow-up of 24 months. LLD was calculated as the difference between the lengths of the injured and uninjured limbs. Overgrowth was calculated by adding the fracture site shortening from the LLD. Risk factors were assessed in patients with LLD < 1 cm and ≥ 1 cm and overgrowth < 1 cm and ≥ 1 cm. RESULTS Casting and titanium elastic nailing (TEN) were performed on 64 and 39 patients, respectively. The mean LLD and overgrowth were 5.6 and 6.4 mm, respectively. There were significant differences in sex (p = 0.018), age (p = 0.041), fibular involvement (p = 0.005), injury mechanism (p = 0.006), and treatment methods (p < 0.001) between patients with LLDs < 1 cm and ≥ 1 cm. There were significant differences in sex (p = 0.029), fibular involvement (p = 0.002), injury mechanism (p = 0.008), and treatment methods (p < 0.001) between patients with overgrowth < 1 cm and ≥ 1 cm. Sex and treatment methods were risk factors associated with LLD ≥ 1 cm and overgrowth ≥ 1 cm following pediatric tibial shaft fracture. The boys had a 7.4-fold higher risk of LLD ≥ 1 cm and 5.4-fold higher risk of overgrowth ≥ 1 cm than the girls. Patients who underwent TEN had a 4.3-fold higher risk of LLD ≥ 1 cm and 4.8-fold higher risk of overgrowth ≥ 1 cm than those treated by casting. CONCLUSIONS Patients undergoing TEN showed greater LLD and overgrowth than those undergoing casting, with boys showing greater LLD and overgrowth than girls. Surgeons should consider the possibility of LLD and overgrowth after pediatric tibial shaft fractures, especially when performing TEN for boys. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Woo Young Choi
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, 13620 Gyeonggi Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, 13620 Gyeonggi Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, 13620 Gyeonggi Korea
| | - Kug Jin Choi
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, 13620 Gyeonggi Korea
| | - Hyon Soo Jung
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, 13620 Gyeonggi Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, 13620 Gyeonggi Korea
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Fischer JT, Cirino PT, DeMaster D, Alfano C, Bick J, Fan W, Ewing-Cobbs L. Frontostriatal White Matter Integrity Relations with "Cool" and "Hot" Self-Regulation after Pediatric Traumatic Brain Injury. J Neurotrauma 2020; 38:122-132. [PMID: 32993456 DOI: 10.1089/neu.2019.6937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic brain injury (TBI) produces microstructural damage to white matter pathways connecting neural structures in pre-frontal and striatal regions involved in self-regulation (SR). Dorsal and ventral frontostriatal pathways have been linked to cognitive ("cool") and emotional ("hot") SR, respectively. We evaluated the relation of frontostriatal pathway fractional anisotropy (FA) 2 months post-TBI on cool and hot SR assessed 7 months post-TBI. Participants were 8-15 years of age, including children with uncomplicated mild TBI (mTBI; n = 24), more severe TBI (complicated-mild, moderate, severe [cms]TBI; n = 60), and typically developing (TD) children (n = 55). Diffusion tensor tractography was used to map frontostriatal pathways. Cool SR included focused and sustained attention performance, and parent-reported attention, whereas hot SR included risk-taking performance and parent-reported emotional control. Multivariate general linear models showed that children with cmsTBI had greater parent-reported cool and hot SR difficulties and lower dorsal and ventral FA than TD children. Focused attention, risk taking, and emotional control correlated with FA of specific dorsal and ventral pathways; however, only the effect of TBI on focused attention was mediated by integrity of dorsal pathways. Results suggest that frontostriatal FA may serve as a biomarker of risk for SR difficulties or to assess response to interventions targeting SR in pediatric TBI and in broader neurodevelopmental populations.
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Affiliation(s)
- Jesse T Fischer
- Department of Psychology, Evaluation, and Statistics, University of Houston, Houston, Texas, USA
| | - Paul T Cirino
- Department of Psychology, Evaluation, and Statistics, University of Houston, Houston, Texas, USA
| | - Dana DeMaster
- Department of Pediatrics, University of Texas Health Sciences at Houston, Houston, Texas, USA
| | - Candice Alfano
- Department of Psychology, Evaluation, and Statistics, University of Houston, Houston, Texas, USA
| | - Johanna Bick
- Department of Psychology, Evaluation, and Statistics, University of Houston, Houston, Texas, USA
| | - Weihua Fan
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, Texas, USA
| | - Linda Ewing-Cobbs
- Department of Pediatrics, University of Texas Health Sciences at Houston, Houston, Texas, USA
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Fischer JT, Hannay HJ, Alfano CA, Swank PR, Ewing-Cobbs L. Sleep disturbances and internalizing behavior problems following pediatric traumatic injury. Neuropsychology 2019. [PMID: 29528681 DOI: 10.1037/neu0000420] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This prospective longitudinal study investigated sleep disturbance (SD) and internalizing problems after traumatic injury, including traumatic brain injury (TBI) or extracranial/bodily injury (EI) in children and adolescents, relative to typically developing (TD) children. We also examined longitudinal relations between SD and internalizing problems postinjury. METHOD Participants (N = 87) ages 8-15 included youth with TBI, EI, and TD children. Injury groups were recruited from a Level 1 trauma center after sustaining vehicle-related injuries. Parent-reported SD and internalizing problems were assessed at preinjury/baseline, and 6 and 12 months postinjury. Linear mixed models evaluated the relation of group and time of assessment on outcomes. RESULTS Controlling for age, the combined traumatic injury group experienced significantly higher postinjury levels of SD (p = .042) and internalizing problems (p = .024) than TD children; however, TBI and EI injury groups did not differ from each other. Injury severity was positively associated with SD in the EI group only, but in both groups SD was associated with additional postinjury sequelae, including fatigue and externalizing behavior problems. Internalizing problems predicted subsequent development of SD but not vice versa. The relation between injury and SD 1 year later was consistent with mediation by internalizing problems at 6 months postinjury. CONCLUSIONS Children with both types of traumatic injury demonstrated higher SD and internalizing problems than healthy children. Internalizing problems occurring either prior to or following pediatric injury may be a risk factor for posttraumatic SD. Consequently, internalizing problems may be a promising target of intervention to improve both SD and related adjustment concerns. (PsycINFO Database Record
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Affiliation(s)
| | - H Julia Hannay
- Texas Institute For Measurement, Evaluation, And Statistics, University of Houston
| | | | - Paul R Swank
- School of Public Health, University of Texas Health Science Center at Houston
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Significance of orthopedic trauma specialists in trauma centers in Korea. Arch Orthop Trauma Surg 2019; 139:1379-1384. [PMID: 31098687 DOI: 10.1007/s00402-019-03202-x] [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: 12/13/2018] [Indexed: 10/26/2022]
Abstract
INTRODUCTION In 2012, the Korean central government selected trauma centers to provide effective treatment and reduce preventable mortality in severe trauma patients. General surgeons, thoracic surgeons, orthopedists, and neurosurgeons play pivotal roles in trauma centers, as most trauma patients require orthopedic procedures. This study aimed to underscore the importance of trauma orthopedic specialists (TOSs) by comparing treatment outcomes between a TOS and general orthopedists. PATIENTS AND METHODS Orthopedic trauma patients with injury severity scores > 15 points, admitted to level 1 trauma centers between March 2015 and December 2016, were divided into the TOS group (treated by 1 orthopedic trauma specialist who treats trauma patients with no limitation in the joint of specialization) and the general orthopedist group (GOG; treated by several general orthopedists who manage both trauma and disease but are each specialized in a certain joint). Emergency room response time, triage time, surgical preparation time, number of surgeries per patient, intensive care unit (ICU) duration, complications, and mortality were retrospectively analyzed. RESULTS Among 272 patients, 52 were treated by a TOS and 220 were treated by several general orthopedists. For the TOS group and the GOG, the average emergency room response time was 8 and 32 min; average triage time, 27 and 162 min; average surgical preparation time, 141 and 350 min; average number of surgeries per patient, 1.9 and 2.7; and average ICU duration, 8.5 and 12.2 days, respectively. The TOS group saved $2700 per patient. No statistical differences were found in complications and mortality between the 2 groups. CONCLUSIONS TOSs can provide rapid treatment to trauma patients and systemically participate in collaborative treatment with other specialists in a trauma center. As treatment provided by a TOS can also reduce the ICU duration, TOSs can play an important role in rapid rehabilitation and cost reduction for trauma patients.
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Investigation of the Lower Extremity Fractures in Children Who Applied to the Emergency Department of University Hospital. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/gopctd.503015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cruz AI, Raducha JE, Swarup I, Schachne JM, Fabricant PD. Evidence-based update on the surgical treatment of pediatric tibial shaft fractures. Curr Opin Pediatr 2019; 31:92-102. [PMID: 30461511 DOI: 10.1097/mop.0000000000000704] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To describe surgical treatment options for pediatric tibial shaft fractures which are the third most common pediatric long bone fracture. Management of these injuries is dictated by fracture location, fracture pattern, associated injuries, skeletal maturity, and other patient-specific factors. Although most pediatric tibial shaft fractures can be treated nonoperatively, this review provides an update on surgical treatment options when operative intervention is indicated. RECENT FINDINGS Advances in surgical implants and techniques affords a wide range of options for the surgical treatment of pediatric tibial shaft fractures. Flexible intramedullary nailing is gaining wide adoption for acute surgical treatment. Recent studies support cross-sectional imaging for further evaluation and scrutiny of fracture patterns suspicious for intraphyseal or intra-articular extension. Grade I open tibial shaft fractures may be safely treated with irrigation and debridement in the emergency department; however, no high-level comparative studies have been performed to make any definitive conclusions regarding the effectiveness of this treatment strategy. SUMMARY Tibial shaft fractures are common injuries in pediatric patients. Management is dictated by fracture location, fracture pattern, associated injuries, patient age, and other patient-specific factors. Surgical intervention is indicated for fractures that are open, irreducible, have failed nonoperative management, are associated with compartment syndrome, or in the multiply injured patient. Surgical treatment options include flexible intramedullary nailing, plate osteosynthesis, external fixation, and rigid intramedullary nailing. Recent literature has shown increased rates of flexible intramedullary nailing. All operative and nonoperative management options can result in complications including compartment syndrome, infection, delayed union, nonunion, malunion, limb length discrepancy, and symptomatic hardware. Most pediatric patients go on to uneventful union with excellent final outcomes and return to full activities.
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Affiliation(s)
- Aristides I Cruz
- Department of Orthopaedic Surgery, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University
| | - Jeremy E Raducha
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Ishaan Swarup
- Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Jonathan M Schachne
- Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Peter D Fabricant
- Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA
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Raducha JE, Swarup I, Schachne JM, Cruz AI, Fabricant PD. Tibial Shaft Fractures in Children and Adolescents. JBJS Rev 2019; 7:e4. [DOI: 10.2106/jbjs.rvw.18.00047] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Gremminger R, Acklin YP. [Not Available]. PRAXIS 2018; 107:255-261. [PMID: 29486645 DOI: 10.1024/1661-8157/a002894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Zusammenfassung. Unterschenkelfrakturen gehören zu den häufigsten Schaftfrakturen bei Kindern und werden mehrheitlich konservativ behandelt. Die Analyse der Frakturmorphologie und Kenntnis des Remodeling-Potenzials des kindlichen Skeletts sind wichtige Voraussetzungen zur Einleitung der korrekten Therapie. Die konservative Therapie besteht aus einer Gipstherapie über drei bis sechs Wochen je nach Alter des Kindes. Zudem besteht die Möglichkeit, über eine Gipskeilung das Repositionsresultat günstig zu beeinflussen. Die Indikation für eine operative Therapie beschränkt sich auf stark dislozierte oder instabile sowie offene Frakturen. Im Rahmen der Nachkontrollen werden sekundäre Dislokationen sowie Wachstumsstörungen erkannt und behandelt.
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Abstract
Multiply injured child is a unique challenge to the medical communities worldwide. It is a leading cause of preventable mortality and morbidity in children. Common skeletal injuries include closed or open fractures of tibia and femur and pelvic injuries. Initial management focuses on saving life and then saving limb as per pediatric advanced life support and advanced trauma life support. Orthopedic management of open fracture includes splinting the limb, administration of prophylactic antibiotic, and surgical debridement of the wound when safe. However, gross contamination, compartment syndrome, and vascular injuries demand urgent attention.
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Affiliation(s)
- Om Lahoti
- Department of Trauma and Orthopaedics, King's College Hospital, Denmark Hill, London, UK,Address for correspondence: Dr. Om Lahoti, King's College Hospital, Denmark Hill, London SE5 9RS, UK. E-mail:
| | - Anand Arya
- Department of Trauma and Orthopaedics, King's College Hospital, Denmark Hill, London, UK
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Abstract
Open fractures in children differ from adults owing to their better healing potential. Management strategies for open fracture in children are changing with improvement in our understanding of soft-tissue reconstruction and fracture fixation. A literature review was performed for articles covering management of open fractures in children. The cornerstones of management include prevention of infection, debridement, and skeletal stabilization with soft-tissue coverage. The injury should be categorized according to the established trauma classification systems. Timely administration of appropriate antibiotics is important for preventing infections. Soft-tissue management includes copious irrigation and debridement of the wound. Fractures can be stabilized by a variety of nonoperative and operative means, taking into consideration the special needs of the growing skeleton and the role of a thick and active periosteum in the healing of fractures. The soft-tissue coverage required depends on the grade of injury.
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Affiliation(s)
- Akshat Sharma
- Department of Paediatric Orthopaedics, KUMC GURO Hospital, Seoul, Korea,Address for correspondence: Dr. Akshat Sharma, 15, Nav Vikas Apartments, Sector – 15, Rohini, New Delhi - 110 089, India. E-mail:
| | - Vikas Gupta
- Central Institute of Orthopaedics, Safdarjung Hospital, New Delhi, India
| | - Kumar Shashikant
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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A descriptive study of accidental skeletal injuries and non-accidental skeletal injuries of child maltreatment. J Forensic Leg Med 2017; 54:14-22. [PMID: 29291497 DOI: 10.1016/j.jflm.2017.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 11/09/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lack of awareness and recognition of child maltreatment is the major reason behind underreporting. All victims often interact with the health care system for routine or emergency care. In several research works, non-accidental fractures are the second most common injury in maltreated children and it is represented up to one-third of cases. AIM OF THE STUDY To determine the incidence of different types of accidental and non-accidental skeletal injuries among children, estimate the severity of injuries according to the modified injury severity score and to determine the degree of fractures either closed or opened (Gustiloe-Anderson open fracture classification). Moreover, identifying fractures resulting from child abuse and neglect. This aimed for early recognition of non-accidental nature of fractures in child maltreatment that can prevent further morbidity and mortality. PATIENTS AND METHOD A descriptive study was carried out on all children (109) with skeletal injuries who were admitted to both Main Alexandria and El-Hadara Orthopedic and Traumatology University Hospitals during six months. History, physical examination and investigations were done for the patients. A detailed questionnaire was taken to diagnose child abuse and neglect. Gustiloe-Anderson open fracture classification was used to estimate the degree of open fractures. RESULTS Out of 109 children, twelve cases (11%) were categorized as child maltreatment. One case was physical abuse, eight cases (7.3%) were child neglect and three cases (2.8%) were labour exploitation. Road traffic accidents (RTA) was the commonest cause of skeletal injuries followed by falling from height. Regarding falls, they included 4 cases of stair falls in neglected children and another four cases of falling from height (balcony/window). The remaining 36 cases of falls were accidental. The skeletal injuries were in the form of fractures in 99 cases, dislocation in two cases, both fracture and/or dislocation in three cases, and bone deformity from brachial plexus injury in five cases. Fractures of the lower limb (42.2%) and both bones of the forearm (35%) represented the highest incidence of skeletal injuries in children. 54.5% of fractures due to neglect were lower limb fractures due to falling from height. Ninety-nine cases were diagnosed as long bone fractures and classified as the following; eighty patients as closed fractures, six patients as open grade I fractures, three patients as open grade II fractures, three patients as open grade IIIA fractures, four patients as open grade IIIB fractures and three patients as open grade IIIC fractures. CONCLUSION AND RECOMMENDATION Cases of neglect and child abuse represented 11% of all the studied cases, where neglect was the main cause. RTA and falling from height represented the most common cause of skeletal injury in children. Most fractures due to neglect were lower limb fractures resulting from falling from height. This demonstrates the need for early detection of neglect and child maltreatment aiming for early initiation of parental educational programs about child care and safety. Misinterpretation of skeletal injuries due to neglect or abuse can be avoided by proper training of orthopedic and traumatology staff on signs of child neglect and abuse.
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Ramasubbu RA, Ramasubbu BM. Surgical stabilization for open tibial fractures in children: External fixation or elastic stable intramedullary nail - which method is optimal? Indian J Orthop 2016; 50:455-463. [PMID: 27746486 PMCID: PMC5017165 DOI: 10.4103/0019-5413.189613] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Management of open tibial fractures is well documented in adults, with existing protocols outlining detailed treatment strategies. No clear guidelines exist for children. Surgical stabilization of tibial fractures in the pediatric population requires implants that do not disrupt the open epiphyses (growth plate). Both elastic stable intramedullary nails and external fixation can be used. The objective of this study was to identify the optimal method of surgical stabilization in the treatment of open tibial fractures in children. MATERIALS AND METHODS MEDLINE and Embase were searched from their inception to March 2014 using the following advanced search terms (Key words): "open tibia fracture," "fracture fixation," "external fixation," "intramedullary," and "bone nail." Only studies in English and pertaining to children with open fractures treated with elastic stable intramedullary nails or external fixation between 1994 and 2014 were included. Twelve clinical studies were critically appraised. RESULTS Due to a paucity in the literature coupled with a nonsystematic presentation of results, it proved to be very difficult in extracting relevant results from the studies. This was further added by a variation in outcome measures. Consequently, the results we obtained were difficult to draw conclusions from. CONCLUSION There is no conclusive evidence or best practice guidelines for their management. Thus, as is highlighted in this study, more research is needed to determine the optimum treatment strategy for this common pediatric injury. The existing literature is of poor quality; consisting mainly of retrospective reviews of patients' medical records, charts, and radiographs. Carefully designed, high-quality prospective cohort studies utilizing a nationalized multi-hospital approach are needed to improve understanding before protocols and guidelines can be developed and implemented.
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Affiliation(s)
- Rohan A Ramasubbu
- Department of Clinical Anatomy, School of Medicine, University of St. Andrews, Fife, Scotland,Address for correspondence: Mr. Rohan A Ramasubbu, 13/2 Gilmore Place, Edinburgh, EH3 9NE, Scotland. E-mail:
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Type I Open Fractures Benefit From Immediate Antibiotic Administration But Not Necessarily Immediate Surgery. J Pediatr Orthop 2016; 36 Suppl 1:S6-S10. [PMID: 27100039 DOI: 10.1097/bpo.0000000000000766] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pediatric open fractures are rare, occurring in approximately 2% to 9% of all pediatric fractures. Type I open fractures represent the most common type of open fractures seen in pediatrics and are commonly caused by low-energy mechanisms. The management of these injuries has been primarily dictated by the adult literature. Immediate antibiotic administration, specifically a first generation cephalosporin, has been shown to reduce infection rates. The duration of antibiotic treatment is less clear, but longer courses of antibiotics have not been significantly better than a shorter course. Retrospective case series have shown no difference in infection rates with nonoperative management of type I open fractures. However, concern regarding serious and even life-threatening infection continues to limit the universal adoption of nonoperative treatment protocols. A prospective randomized control trial is underway and will hopefully elucidate which open fractures can be safely managed with prompt antibiotic administration and nonoperative care.
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Marmor M, Elson J, Mikhail C, Morshed S, Matityahu A. Short-term pelvic fracture outcomes in adolescents differ from children and adults in the National Trauma Data Bank. J Child Orthop 2015; 9:65-75. [PMID: 25648432 PMCID: PMC4340850 DOI: 10.1007/s11832-015-0634-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 01/08/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Pediatric pelvic fractures are associated with high-energy trauma and injury to other systems, leading to an increased incidence of complication and mortality. Previous studies analyzed the pediatric population as a whole, including both children and adolescents. The purpose of this study was to examine whether adolescents with pelvic fracture have different complication and mortality rates compared to younger children and adults. METHODS Using the National Trauma Data Bank, 37,784 patients below the age of 55 years with pelvic fractures were identified and divided into children (age <13 years), adolescents (age 13-17 years), and adults (age >17 years). Descriptive statistics and bivariate and multivariate analyses were performed. RESULTS Children had an increased odds of death [odds ratio (OR) 2.29, 95 % confidence interval (CI) 1.96-2.67] and complications (OR 1.36, 95 % CI 1.20-1.55), whereas adolescents had a decrease in odds of death (OR 0.89, 95 % CI 0.74-1.06) and complications (OR 0.70, 95 % CI 0.61-0.81) compared to the adult population. CONCLUSIONS Adolescents with pelvic fractures exhibit a different physiologic response to the children and adult populations. This emphasizes the need to distinguish these subpopulations in future epidemiological research and treatment planning.
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Affiliation(s)
- Meir Marmor
- Orthopaedic Trauma Institute (OTI), San Francisco General Hospital, University of California, San Francisco (UCSF), 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110 USA
| | - Joshua Elson
- Medical School for International Health, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | | | - Saam Morshed
- Orthopaedic Trauma Institute (OTI), San Francisco General Hospital, University of California, San Francisco (UCSF), 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110 USA
| | - Amir Matityahu
- Orthopaedic Trauma Institute (OTI), San Francisco General Hospital, University of California, San Francisco (UCSF), 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110 USA
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Kraus R, Stahl JP, Heiss C, Horas U, Dongowski N, Schnettler R. [Fractures of the thoracic and lumbar spine in children and adolescents]. Unfallchirurg 2013; 116:435-41. [PMID: 22101777 DOI: 10.1007/s00113-011-2113-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Only 1.5-2% of all fractures in children and adolescents are fractures of the thoracic and lumbar spine. Treatment is most often conservative. This study compares the own experience with the recent literature. MATERIAL AND METHODS Over a 48 month period all patients with fractures of the thoracic and lumbar spine, younger than 16 years were included prospectively. Of the patients 67 underwent follow-up investigations after 3-36 months. RESULTS The average age of the patients was 11.9 years. Sports (53%) and traffic (28%) accidents were most frequent. Fractures most often appeared in the mid-thoracic (47%) and thoracolumbar spine (41%). Operative treatment was performed in 9 cases (10.4%). Secondary loss of alignment was not observed neither after conservative nor operative treatment. Neurological deficits (n=2) did not completely improve. CONCLUSIONS Most fractures of the thoracic and lumbar spine heal fast and without any sequelae. Unstable fractures of type B and C (exclusively occurring as a result of traffic accidents) need operative stabilization as in adults.
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Affiliation(s)
- R Kraus
- Klinik für Unfallchirurgie, Unversitätsklinikum Gießen und Marburg GmbH, Klinikstrasse 33, 35392, Giessen, Deutschland.
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Developmental biomechanics of the human cervical spine. J Biomech 2013; 46:1147-54. [DOI: 10.1016/j.jbiomech.2013.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 11/22/2022]
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Abstract
BACKGROUND Pediatric obesity is associated with lower-extremity injuries and poor outcomes after blunt trauma. Our aim was to determine if obese pediatric patients with femur and tibia fractures have more severe injury patterns and worse outcomes compared with those of nonobese patients. METHODS We performed a retrospective cohort study of obese and nonobese pediatric patients with femur or tibia fractures treated at two Level I trauma centers from 2004 to 2010. Patients weighing 95th percentile or greater for age and sex were classified as obese. Patients were compared regarding demographics, Injury Severity Score (ISS), as well as intra-abdominal and orthopedic injuries. Outcomes included fracture treatment, orthopedic complications, intensive care unit and hospital length of stay, ventilator days, and mortality. RESULTS Of the 356 patients included in the study, 78 (21.9%) were obese and 278 (78.1%) were nonobese. Obese patients were older (mean [SD], 9.9 [3.7] years vs. 8.8 [3.9] years; p = 0.0162), had a higher ISS (20.8 [13.4] vs. 14.5 [10.8]; p = 0.0002), and sustained more intra-abdominal solid organ (24.4% vs.13.5%; p = 0.0200) and hollow viscus (3.9% vs. 0.0%; p = 0.0105) injuries. They had more pelvic fractures (15.4% vs. 6.9%; p = 0.0196), bilateral tibia fractures (8.0% vs. 0.0%; p = 0.0332), and operatively treated femur fractures (89.9% vs. 79.1%; p = 0.0484). Adjusting for age, obese patients were more likely to be admitted to the intensive care unit (relative risk, 1.68; 95% confidence interval, 1.10-2.55) and die in the hospital (relative risk, 3.45; 95% confidence interval, 1.14-10.41). Adjusting for ISS, these associations were nonsignificant. CONCLUSION Obese patients with femur and tibia fractures have more severe injuries, which may predispose them to greater inpatient morbidity and mortality than do nonobese patients. LEVEL OF EVIDENCE Epidemiologic study, level III.
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Willenberg L, Curtis K, Taylor C, Jan S, Glass P, Myburgh J. The variation of acute treatment costs of trauma in high-income countries. BMC Health Serv Res 2012; 12:267. [PMID: 22909225 PMCID: PMC3523961 DOI: 10.1186/1472-6963-12-267] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 08/14/2012] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In order to assist health service planning, understanding factors that influence higher trauma treatment costs is essential. The majority of trauma costing research reports the cost of trauma from the perspective of the receiving hospital. There has been no comprehensive synthesis and little assessment of the drivers of cost variation, such as country, trauma, subgroups and methods. The aim of this review is to provide a synthesis of research reporting the trauma treatment costs and factors associated with higher treatment costs in high income countries. METHODS A systematic search for articles relating to the cost of acute trauma care was performed and included studies reporting injury severity scores (ISS), per patient cost/charge estimates; and costing methods. Cost and charge values were indexed to 2011 cost equivalents and converted to US dollars using purchasing power parities. RESULTS A total of twenty-seven studies were reviewed. Eighty-one percent of these studies were conducted in high income countries including USA, Australia, Europe and UK. Studies either reported a cost (74.1%) or charge estimate (25.9%) for the acute treatment of trauma. Across studies, the median per patient cost of acute trauma treatment was $22,448 (IQR: $11,819-$33,701). However, there was variability in costing methods used with 18% of studies providing comprehensive cost methods. Sixty-three percent of studies reported cost or charge items incorporated in their cost analysis and 52% reported items excluded in their analysis. In all publications reviewed, predictors of cost included Injury Severity Score (ISS), surgical intervention, hospital and intensive care, length of stay, polytrauma and age. CONCLUSION The acute treatment cost of trauma is higher than other disease groups. Research has been largely conducted in high income countries and variability exists in reporting costing methods as well as the actual costs. Patient populations studied and the cost methods employed are the primary drivers for the treatment costs. Targeted research into the costs of trauma care is required to facilitate informed health service planning.
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Affiliation(s)
| | - Kate Curtis
- Sydney nursing school, University of Sydney, 88 Mallet St, Camperdown, Australia
- St George Hospital, Gray St, Kogarah, Australia
| | - Colman Taylor
- The George Institute for Global Health, Kent St, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, Kent St, Sydney, Australia
| | - Parisa Glass
- The George Institute for Global Health, Kent St, Sydney, Australia
| | - John Myburgh
- The George Institute for Global Health, Kent St, Sydney, Australia
- St George Hospital, Gray St, Kogarah, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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Malheiros DS, Bárbara GHS, Mafalda LG, Madureira JL, Braga GF, Terra DL. FLOATING ELBOW IN CHILDREN: A DESCRIPTIVE STUDY OF 31 CASES ATTENDED IN A REFERENCE CENTER FOR PEDIATRIC TRAUMA. Rev Bras Ortop 2011; 46:500-4. [PMID: 27027045 PMCID: PMC4799306 DOI: 10.1016/s2255-4971(15)30403-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 11/04/2011] [Indexed: 11/19/2022] Open
Abstract
Objective: To conduct a descriptive analysis on 31 cases of children with floating elbow who were attended at our clinic between 1994 and 2009, and to review the literature relating to this topic. Methods: Data were obtained through examining the medical records. The following variables were used: age, gender, side, mechanism, type of fracture, classification, treatment and complications. Results: Twenty-four patients (77.4%) were male and seven (22.6%) were female. The mean age was 8.5 (± 3.2) years, ranging from one to 14 years. The left side was predominantly affected (67.7%). The commonest injury mechanism was a fall from a height (74.2%). All the supracondylar fractures were Gartland type III. Distal radius fractures alone, of Salter-Harris type II, were diagnosed in 22 patients (71%). Open fractures occurred in 22 cases (71%). Closed reduction and application of a plaster cast for a closed fracture of the distal radius was performed in two patients (6.45%). Simultaneous conservative treatment for two fractures was not used. Sixteen supracondylar fractures (54.8%) were fixed using crossed wires, at 90° to each other, and in 14 cases (45.16%), an intramedullary wire was used together with another wire introduced through the lateral epicondyle at 45°. The following complications were observed: deformed consolidation (10%), nerve injuries (6%), compartment syndrome (3%) and pin path infection (16%). Conclusions: This is an uncommon injury that in most cases results from high-energy trauma. Surgical treatment for both fractures is recommended by most authors. Ulnar nerve injuries were correlated with the fixation method, but no neurological injuries were triggered by the initial trauma.
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Affiliation(s)
- Dorotea Starling Malheiros
- Orthopedist and Traumatologist; Specialist in Pediatric Orthopedics at Hospital Maria Amélia Lins, FHEMIG, Belo Horizonte, MG; MSc in Health Sciences (UFMG), focusing on Children's and Adolescents' Health
| | | | - Leandro Gonçalves Mafalda
- Resident Physician in Orthopedics and Traumatology, Hospital Maria Amélia Lins, FHEMIG, Belo Horizonte, MG
| | | | | | - Dalton Lopes Terra
- Orthopedist and Traumatologist; Specialist in Pediatric Orthopedics at Hospital Maria Amélia Lins, FHEMIG, Belo Horizonte, MG
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Schildhauer TA, Bellabarba C, Selznick HS, McRoberts D, Vedder NB, Chapman JR. Unstable pediatric sacral fracture with bone loss caused by a high-energy gunshot injury. ACTA ACUST UNITED AC 2008; 63:E95-9. [PMID: 17308489 DOI: 10.1097/01.ta.0000246879.13468.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas A Schildhauer
- Chirurgische Klinik und Poliklinik, BG-Kliniken Bergmannsheil, Ruhr-Universität Bochum, Germany.
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Franciozi CEDS, Tamaoki MJS, Araújo EFAD, Dobashi ET, Utumi CE, Pinto JA, Ishida A. Trauma na infância e adolescência: epidemiologia, tratamento e aspectos econômicos em um hospital público. ACTA ORTOPEDICA BRASILEIRA 2008. [DOI: 10.1590/s1413-78522008000500001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUÇÃO: A realização deste trabalho foi motivada pela escassez de artigos encontrados na literatura que estudam o politrauma na infância e na adolescência.. O objetivo é descrever o perfil epidemiológico das lesões traumáticas na infância tratadas num centro de trauma, avaliar os aspectos econômicos relacionados com o gasto hospitalar e o tempo de internação de acordo com o tratamento realizado. MATERIAIS E MÉTODOS: analisamos todos os prontuários do hospital Geral de Pirajussara no período de dezembro de 2005 a dezembro de 2006. Obtivemos 182 pacientes, sendo 71% do sexo masculino e 29% do feminino; 48% brancos e 52% não brancos. RESULTADOS: houve predominância dos indivíduos do sexo masculino com 71% dos pacientes. O mecanismo de trauma mais freqüente foi a queda (36%). A média de dias de internação foi 4,1 dias, com gasto estimado de R$ 649,50 para cada paciente. A taxa de mortalidade foi de 2,74%, sendo o traumatismo crânio-encefálico responsável por 80% da mortalidade e os maus tratos presentes em 40% dos óbitos. CONCLUSÃO: a população pediátrica tem particularidades que a tornam distinta da população adulta em relação à epidemiologia e manejo das lesões.
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Abstract
A number of triage tools have been developed and used to make triage decisions. Studies have demonstrated better outcomes in patients who receive care in trauma centers. The field triage decision scheme from the American College of Surgeons Committee on Trauma involves patient triage based on the presence of physiologic derangement, specific anatomic injuries, mechanism of injury, and comorbid factors. Issues such as distance to a trauma center (rural areas) and methods of transport (e.g., air, ground) complicate the prehospital triage of trauma patients. The best system for a given community or region is one that begins with a triage scheme that is evidence based to the greatest extent possible but is then modified based on community or regional resources and geography. Delivering the severely injured trauma patient to a facility that can provide optimal care, in the shortest amount of the time, remains the overarching principle.
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Affiliation(s)
- Jeffrey P Salomone
- Department of Surgery Trauma & General Surgery/Surgery Critical Care, Emory University School of Medicine, Atlanta, GA 30303, USA.
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Abstract
Appropriate care of pediatric polytrauma patients requires the knowledge and expertise of a variety of subspecialists. Though most of pediatric polytrauma patients survive, long-term sequelae are common. The most common causes of long-term functional deficits after pediatric polytrauma involve injuries to the central nervous and musculoskeletal systems. Orthopaedic care of polytrauma patients is important to facilitate early mobilization and care of these children, as well as to minimize late impairment.
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Affiliation(s)
- Robert M Kay
- University of Southern California Keck School of Medicine, Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA
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Nuckley DJ, Ching RP. Developmental biomechanics of the cervical spine: Tension and compression. J Biomech 2006; 39:3045-54. [PMID: 16321394 DOI: 10.1016/j.jbiomech.2005.10.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2004] [Accepted: 10/12/2005] [Indexed: 11/24/2022]
Abstract
Epidemiological data and clinical indicia reveal devastating consequences associated with pediatric neck injuries. Unfortunately, neither injury prevention nor clinical management strategies will be able to effectively reduce these injuries or their effects on children, without an understanding of the cervical spine developmental biomechanics. Thus, we investigated the relationship between spinal development and the functional (stiffness) and failure biomechanical characteristics of the cervical spine in a baboon model. A correlation study design was used to define the relationships between spinal tissue maturation and spinal biomechanics in both tension and compression. Eighteen baboon cervical spine specimens distributed across the developmental spectrum (1-26 human equivalent years) were dissected into osteoligamentous functional spinal units. Using a servo-hydraulic MTS, these specimens (Oc-C2, C3-C4, C5-C6, C7-T1) were non-destructively tested in tension and compression and then displaced to failure in tension while measuring the six-axes of loads and displacements. The functions describing the developmental biomechanical response of the cervical spine for stiffness and normalized stiffness exhibited a significant direct relationship in both tension and compression loading. Similarly, the tensile failure load and normalized failure load demonstrated significant maturational increases. Further, differences in biomechanical response were observed between the spinal levels examined and all levels exhibited clinically relevant failure patterns. These data support our understanding of the child cervical spine from a developmental biomechanics perspective and facilitate the development of injury prevention or management schema for the mitigation of child spine injuries and their deleterious effects.
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Affiliation(s)
- David J Nuckley
- Applied Biomechanics Laboratory, Department of Mechanical Engineering, University of Washington, 501 Eastlake Avenue East, Suite 102, Seattle, Washington 98109, USA.
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Stewart DG, Kay RM, Skaggs DL. Open fractures in children. Principles of evaluation and management. J Bone Joint Surg Am 2005; 87:2784-2798. [PMID: 16322632 DOI: 10.2106/jbjs.e.00528] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- David G Stewart
- Children's Bone and Spine Surgery, 10001 South Eastern Avenue, Suite 407, Henderson, NV 89052
| | - Robert M Kay
- Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS 69, Los Angeles, CA 90027.
| | - David L Skaggs
- Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS 69, Los Angeles, CA 90027.
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Abstract
Tibial shaft fractures are among the most common pediatric injuries managed by orthopaedic surgeons. Treatment is individualized based on patient age, concomitant injuries, fracture pattern, associated soft-tissue and neurovascular injury, and surgeon experience. Closed reduction and casting is the mainstay of treatment for diaphyseal tibial fractures. Careful clinical and radiographic follow-up with remanipulation as necessary is effective for most patients. Surgical management options include external fixation, locked intramedullary nail fixation in the older adolescent with closed physis, Kirschner wire fixation, and flexible intramedullary nailing. Union of pediatric diaphyseal tibial fractures occurs in approximately 10 weeks; nonunion occurs in <2% of cases. Some clinicians consider sagittal deformity angulation >10 degrees to be malunion and indicate that 10 degrees of valgus and 5 degrees of varus may not reliably remodel. Compartment syndromes associated with tibial shaft fractures occur less frequently in children and adolescents than in adults. Diagnosis may be difficult in a young child or one with altered mental status. Although the toddler fracture of the tibia is one of the most common in children younger than age 2 years, child abuse must be considered in the young child with an inconsistent history or with suspicious concomitant injuries.
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Affiliation(s)
- Rakesh P Mashru
- Campbell Clinic, University of Tennessee College of Medicine, Memphis, TN, USA
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Abstract
Not all pediatric fractures require emergent orthopedic attention. The information needed to assess and provide the appropriate interventions to children and their families following an extremity fracture is discussed in this article. A case study is used to describe a fracture that requires emergent intervention. The role of the pediatric orthopaedic nurse practitioner in the emergency department, inpatient, and outpatient setting is also illustrated.
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Affiliation(s)
- Rachel DiFazio
- Department of Orthopaedic Surgery, Childrens Hospital Boston, MA, USA.
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Wechsler B, Kim H, Gallagher PR, DiScala C, Stineman MG. Functional status after childhood traumatic brain injury. ACTA ACUST UNITED AC 2005; 58:940-9; discussion 950. [PMID: 15920407 DOI: 10.1097/01.ta.0000162630.78386.98] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Identification of children after traumatic brain injury (TBI) likely to have functional deficits at trauma center discharge will facilitate care. METHODS Two logistic regression models were derived from data on 4,439 children after TBI 7 to 14 years old enrolled in the National Pediatric Trauma Registry between 1994 and 2001 to predict physical and cognitive disabilities. RESULTS Children with open or multiple fractures or closed fractures or injured by motor vehicles were 8.2, 3.5, or 2.5 times more likely, respectively, than those without those circumstances to have discharge physical disabilities. Likelihood of cognitive impairment was increased by factors of 3.2 and 5.8 in children obtunded or comatose on arrival. Preexisting cognitive deficits, injury severity, and intubation predicted physical and cognitive disabilities. The C statistic was 0.862 for the motor model and 0.860 for the cognitive model. CONCLUSION Predicting the likelihood of morbidity after acute management of childhood TBI can provide information pertinent to providing effective care.
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Affiliation(s)
- Barbara Wechsler
- Rehabilitation Program, Cleveland Clinic Children's Hospital for Rehabilitation, Cleveland, Ohio 44104, USA.
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Galano GJ, Vitale MA, Kessler MW, Hyman JE, Vitale MG. The most frequent traumatic orthopaedic injuries from a national pediatric inpatient population. J Pediatr Orthop 2005; 25:39-44. [PMID: 15614057 DOI: 10.1097/00004694-200501000-00010] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pediatric trauma remains a leading cause of morbidity and mortality of children in the United States and entails exorbitant costs. A 1997 national pediatric inpatient database, the Kids' Inpatient Database, was reviewed for current trauma and practice patterns and was found to contain over 84,000 patients admitted for orthopaedic trauma. These patients accrued an estimated 932.8 million dollars in hospital charges. Femur fracture was the most frequent injury among this patient group (21.7% of orthopaedic trauma), followed by tibia and/or fibula fracture (21.5%), humerus fracture (17.0%), radius and/or ulna fracture (14.8%), and vertebral fracture (5.2%). While the majority of pediatric orthopaedic trauma was treated at non-children's hospitals (70.4%), patients with certain diagnoses such as femur, humerus, vertebral, pelvic, or hand/finger fracture or a back sprain/strain were directed to children's hospitals more frequently compared with the total number of pediatric orthopaedic trauma patients. Practice patterns varied for certain subgroups (eg, femoral shaft fractures) of patients, depending on the type of hospital where the child was treated. Children who sustained a femoral shaft fracture in the 6-to-10-year age group were significantly more likely to receive internal fixation versus casting or traction if they were treated at a children's hospital. Understanding the patterns in which traumatic injuries occur in children is paramount to establishing effective injury prevention, as well as adapting treatment to optimize outcomes.
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Affiliation(s)
- Gregory J Galano
- International Center for Health Outcomes and Innovation Research, New York, New York, USA
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Abstract
Pediatric trauma remains a leading cause of morbidity and mortality of children in the United States and entails exorbitant costs. A 1997 national pediatric inpatient database, the Kids' Inpatient Database, was reviewed for current trauma and practice patterns and was found to contain over 84,000 patients admitted for orthopaedic trauma. These patients accrued an estimated 932.8 million dollars in hospital charges. Femur fracture was the most frequent injury among this patient group (21.7% of orthopaedic trauma), followed by tibia and/or fibula fracture (21.5%), humerus fracture (17.0%), radius and/or ulna fracture (14.8%), and vertebral fracture (5.2%). While the majority of pediatric orthopaedic trauma was treated at non-children's hospitals (70.4%), patients with certain diagnoses such as femur, humerus, vertebral, pelvic, or hand/finger fracture or a back sprain/strain were directed to children's hospitals more frequently compared with the total number of pediatric orthopaedic trauma patients. Practice patterns varied for certain subgroups (eg, femoral shaft fractures) of patients, depending on the type of hospital where the child was treated. Children who sustained a femoral shaft fracture in the 6-to-10-year age group were significantly more likely to receive internal fixation versus casting or traction if they were treated at a children's hospital. Understanding the patterns in which traumatic injuries occur in children is paramount to establishing effective injury prevention, as well as adapting treatment to optimize outcomes.
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Nuckley DJ, Hertsted SM, Ku GS, Eck MP, Ching RP. Compressive tolerance of the maturing cervical spine. STAPP CAR CRASH JOURNAL 2002; 46:431-40. [PMID: 17096236 DOI: 10.4271/2002-22-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
While a number of experiments have reported injury thresholds for the adult cervical spine in compression, the compressive failure tolerance of the child spine has not been characterized. In order to develop useful safety measures for children, the biomechanical effects of maturation must be evaluated. Hence, this study examined the effects of spinal development on the compressive mechanics of the cervical spine. An animal model was used due to the lack of human tissues in the pediatric age range. Twenty-two fresh cadaveric baboon cervical spines (all male) were dissected into two functional spinal unit segments: Occiput-C2, C3-C5, C6-T1. The specimens ranged in age from 1 to 30-human equivalent years based upon radiographic assessment of their skeletal maturity. Dynamic (1.0-m/sec) haversine displacement inputs up to 70% strain were imparted on each specimen and the resulting loads were recorded. Significant increases in the compressive failure load were observed with increased maturation of the spinal tissues (ANOVA, p = 0.003). Differences were also observed between the spinal levels examined. The lower cervical spine, C6-T1, had the smallest failure load for specimens greater than 8-human-equivalent years, while the upper cervical spine was the most susceptible to injury at less than 8-human-equivalent years. The compressive failures generated are consistent with those observed clinically, consisting of primarily burst fractures and physis (growth plate) failures. These data clearly suggest that spinal compressive tolerance is directly related to maturation. Therefore, through scaling, these data may provide tolerance values applicable to anthropomorphic test dummies and computational models aimed at injury prevention for the pediatric occupant.
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Affiliation(s)
- David J Nuckley
- University of Washington, Department of Mechanical Engineering, Applied Biomechanics Laboratory
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Grisoni N, Connor S, Marsh E, Thompson GH, Cooperman DR, Blakemore LC. Pelvic fractures in a pediatric level I trauma center. J Orthop Trauma 2002; 16:458-63. [PMID: 12172275 DOI: 10.1097/00005131-200208000-00003] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Assess the characteristics associated with the risk of complications and mortality in children sustaining pelvic fractures. SETTING Urban university pediatric Level I trauma center in a large metropolitan community. PATIENTS/PARTICIPANTS Retrospective analysis of 57 consecutive children with 66 pelvic fractures seen between 1993 and 1999. INTERVENTION Fifty-two patients were treated nonoperatively, and five patients required operative stabilization (four acetabular fractures and one partial sacroiliac joint disruption). MAIN OUTCOME MEASURE Type and cause of pelvic fracture, type of management used, incidence of associated injuries, hemorrhage requiring transfusion, and mortality. RESULTS Hemorrhage directly related to the pelvic fracture occurred in only one patient (2%), whereas 11 other patients required transfusions associated with other body-area injuries. Three patients with pelvic fractures died (5%), but deaths were due to other body-area injuries. CONCLUSIONS Children with pediatric pelvic fractures require careful evaluation for other body-area injuries, as these are most likely to be related to hemorrhage or mortality.
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Affiliation(s)
- Nicolas Grisoni
- Northwestern University Medical Center, Chicago, Illinois, USA
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Abstract
Foot fractures account for 5% to 8% of all pediatric fractures and for approximately 7% of all physeal fractures. A thorough understanding of the anatomy of the child's foot is of central importance when treating these injuries. Due to the difficulties that may be encountered in obtaining an accurate physical examination of a child with a foot injury and the complexities of radiographic evaluation of the immature foot, a high index of suspicion for the presence of a fracture facilitates early and accurate diagnosis. Although the treatment results in pediatric foot trauma are generally good, potential pitfalls in the treatment of Lisfranc fractures, talar neck and body fractures, and lawn mower injuries to the foot must be anticipated and avoided if possible.
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Affiliation(s)
- R M Kay
- Orthopaedic Surgery, University of Southern California School of Medicine, Los Angeles, CA, USA
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Abstract
Pediatric ankle fractures account for approximately 5% of pediatric fractures and 15% of physeal injuries. The biomechanical differences between mature and immature bones, as well as the differing forces applied to those bones, help explain the differences between adult and pediatric fractures. The potential complications associated with pediatric ankle fractures include those seen with adult fractures (such as posttraumatic arthritis, stiffness, and reflex sympathetic dystrophy) as well as those that result from physeal damage (including leg-length discrepancy, angular deformity, or a combination thereof). The goals of treatment are to achieve and maintain a satisfactory reduction and to avoid physeal arrest. A knowledge of common pediatric ankle fracture patterns and the pitfalls associated with their evaluation and treatment will aid the clinician in the effective management of these injuries.
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Affiliation(s)
- R M Kay
- Orthopaedic Surgery, University of Southern California School of Medicine, Los Angeles, USA
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van der Sluis CK, Kingma J, Eisma WH, ten Duis HJ. Pediatric polytrauma: short-term and long-term outcomes. THE JOURNAL OF TRAUMA 1997; 43:501-6. [PMID: 9314315 DOI: 10.1097/00005373-199709000-00019] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the short-term and long-term outcomes of pediatric polytrauma patients and to analyze the extent to which short-term outcomes can predict long-term outcomes. MATERIALS AND METHODS All pediatric polytrauma patients (Injury Severity Score of > or = 16, < or = 15 years of age) who were treated at a Level I trauma center between 1985 and 1989 and who were 18 years or older at follow-up (1996) were included. Short-term outcomes were quantified using the Glasgow Outcome Scale. The Functional Independence Measure, the RAND-36, and questions on social outcome were used to assess long-term outcomes. MEASUREMENTS AND MAIN RESULTS Fifty-nine of 74 patients survived (80%). At 1 year after injury, 22% were disabled, mainly due to severe brain injuries, and 32% had changed school. After 9 years of follow-up, the degree of physical disablement was low (12%). Cognitive impairments were found in 42% of the patients. Only 10% were in receipt of disablement allowances; 76% were employed or attended school. The quality of life enjoyed by the patients (RAND-36) did not differ from that enjoyed by a healthy reference population. The Glasgow Outcome Scale (from 6 weeks onward) was a good predictor of long-term disablement. CONCLUSIONS Although the short-term impact of injuries is extensive, the long-term outcomes are satisfactory. Severe injuries sustained during childhood do not lead to a diminished quality of life during adulthood.
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Affiliation(s)
- C K van der Sluis
- Department of Rehabilitation, University Hospital Groningen, The Netherlands
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Abstract
Healthcare cost containment and a desire for early discharge of the pediatric patient to the home environment have become important factors in the treatment of femoral shaft fractures in children. As a result, newer techniques of treatment have become popular. The immediate hip spica cast remains the primary method of treatment for most children 6 years of age and younger. The treatment for children between the ages of 6 and 10 years is the most controversial. Many such patients may be treated successfully with immediate hip spica casts. However, external fixation and flexible intramedullary rod fixation are being used more frequently, particularly in patients with multiple trauma. The initial enthusiasm for rigid intramedullary rod fixation of adolescent femoral fractures has been tempered by recent reports of femoral head avascular necrosis. Avoiding the piriformis fossa during rod insertion may prevent this complication. Most children and adolescents with femoral fractures can be treated successfully with a brief hospital course without compromising care or outcome.
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Affiliation(s)
- S L Buckley
- Department of Orthopaedics and Pediatrics, Emory University School of Medicine, Atlanta, GA 35801, USA
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