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Jacobo M, Grigorian A, Swentek L, Goodman LF, Guner Y, Delaplain PT, Nahmias J. Antibiotics Within One Hour for Pediatric Open Lower Extremity Fractures May Not be Warranted as a Quality Metric. Am Surg 2024:31348241269392. [PMID: 39097815 DOI: 10.1177/00031348241269392] [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: 08/05/2024]
Abstract
BACKGROUND Open fractures have been associated with a higher risk of infection if antibiotics are not administered within 1 h of presentation in adult trauma patients. Time to antibiotic administration for open fractures is frequently used as a quality metric for trauma centers, but there have been no large studies evaluating this topic for pediatric patients. METHODS The 2019 Trauma Quality Improvement Program dataset was queried for patients ≤ 16 years old with isolated open femur or tibia fractures undergoing operative intervention after blunt trauma. Patients transferred from another hospital were excluded. Pediatric patients receiving early antibiotics (EA) within 1 h were compared to patients receiving delayed antibiotics (DA) greater than or equal to 1 h from arrival. Multivariate logistic regression was used to evaluate risk of surgical site infection (SSI). RESULTS There were 150 patients with open lower extremity fractures: 98 (64.9%) EA vs 52 (34.4%) DA. There was no difference in the rate of SSI between the 2 groups (EA: 1.0% vs DA: 1.9%, P = 0.65). There remained similar associated risk of infection after adjusting for lower extremity abbreviated injury scale >3, blood transfusion requirement, and vital signs on arrival (OR 0.62, 95% CI 0.04-10.24, P = 0.74). CONCLUSIONS Most pediatric trauma patients with open lower extremity fracture received antibiotics within 1 h of presentation. However, SSI was rare and the risk of SSI was not associated with antibiotic administration within 1 h. Therefore, timing of antibiotic administration for pediatric open lower extremity fractures should be re-evaluated as a quality metric.Level of Evidence: Level III.
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Affiliation(s)
- Marlene Jacobo
- Division of Trauma, Burns & Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Areg Grigorian
- Division of Trauma, Burns & Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Lourdes Swentek
- Division of Trauma, Burns & Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Laura F Goodman
- Department of Surgery, University of California, Irvine, Orange, CA, USA
- Division of Pediatric Surgery, Children's Health of Orange County, Orange, CA, USA
| | - Yigit Guner
- Department of Surgery, University of California, Irvine, Orange, CA, USA
- Division of Pediatric Surgery, Children's Health of Orange County, Orange, CA, USA
| | - Patrick T Delaplain
- Division of Trauma, Burns & Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns & Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
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Aulisa AG, Marsiolo M, Basiglini L, Aletto C, Giordano M, Falciglia F. Management of Open Pediatric Fractures: Proposal of a New Multidisciplinary Algorithm. J Clin Med 2023; 12:6378. [PMID: 37835023 PMCID: PMC10573661 DOI: 10.3390/jcm12196378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND An algorithm for managing open fractures in children is still being debated; the present study suggests an evidence-based way to manage these patients in the emergency department. METHODS The literature on "Open fractures in children" was carefully analyzed using keywords. The primary sources were The Cochrane Library, PubMed, and Researchgate. CONCLUSION We proposed an evidence-based algorithm for managing open fractures in children to standardize clinical practice and improve the care of these patients.
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Affiliation(s)
- Angelo Gabriele Aulisa
- U.O.C. of Orthopaedics and Traumatology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.G.A.); (L.B.); (M.G.); (F.F.)
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy
| | - Martina Marsiolo
- U.O.C. of Orthopaedics and Traumatology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.G.A.); (L.B.); (M.G.); (F.F.)
| | - Luca Basiglini
- U.O.C. of Orthopaedics and Traumatology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.G.A.); (L.B.); (M.G.); (F.F.)
| | - Cristian Aletto
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy;
| | - Marco Giordano
- U.O.C. of Orthopaedics and Traumatology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.G.A.); (L.B.); (M.G.); (F.F.)
| | - Francesco Falciglia
- U.O.C. of Orthopaedics and Traumatology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.G.A.); (L.B.); (M.G.); (F.F.)
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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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Kuhn AW, Troyer SC, Martus JE. Pediatric Open Long-Bone Fracture and Subsequent Deep Infection Risk: The Importance of Early Hospital Care. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1243. [PMID: 36010133 PMCID: PMC9406608 DOI: 10.3390/children9081243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
The purpose of the current study was to identify risk factors for deep infection after an open long-bone fracture in pediatric patients. Systematic billing queries were utilized to identify pediatric patients who presented to a level I trauma center from 1998 to 2019 with open long-bone fractures. There were 303 open long-bone fractures, and 24 (7.9%) of these became infected. Fractures of the tibia/fibula (p = 0.022), higher revised Gustilo-Anderson type (p = 0.017), and a longer duration of time between the injury and hospital presentation (p = 0.008) were all associated with the presence of deep infection. Those who went on to have a deep infection also required more operative debridements (p = 0.022) and a total number of operative procedures (p = 0.026). The only factor that remained significant in multivariable regression was the duration between the injury and hospital presentation (OR 1.01 [95%CI 1.003-1.017]; p = 0.009), where the odds of deep infection increased by 1% for every minute of delayed presentation.
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Affiliation(s)
- Andrew W. Kuhn
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - Stockton C. Troyer
- Washington University School of Medicine in St. Louis, St. Louis, MO 63108, USA
| | - Jeffrey E. Martus
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Roper B, Parikh S, Haidar L, Warth R, Ambrose C, Younas S, Crawford L, Mansour A. Outcomes After Operative Treatment of Pediatric Monteggia Fracture-Dislocations: Comparison Between Open and Closed Injuries. J Pediatr Orthop 2022; 42:361-366. [PMID: 35543603 DOI: 10.1097/bpo.0000000000002171] [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: 02/07/2023]
Abstract
BACKGROUND Open pediatric Monteggia fracture-dislocations are a relatively uncommon injury pattern, with limited numbers reported in previous series. Open fracture-dislocations frequently represent more severe injury patterns with potential for contamination. We aim to determine differences in long-term clinical and functional outcomes in the operative management of closed versus open pediatric Monteggia fracture-dislocations. METHODS A retrospective review of operatively treated pediatric Monteggia fracture-dislocations was performed. Closed versus open injuries were compared in both clinical outcomes, as well as patient-reported outcomes through Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. RESULTS Of 30 operatively treated injuries, 12/30 (40%) were open fracture-dislocations. Patients were followed clinically for an average of 15.65 months in open injuries and an average of 4.61 months in closed injuries. A trend toward increased time to union was observed, however, significance was not achieved; open injuries averaged 8.0 versus 5.8 weeks for closed injuries ( P =0.07). Two patients (11%) in the closed fracture group experienced postoperative complications; both were minor. Five patients (42%) in the open fracture-dislocation group experienced a total of 6 postoperative complications; 5 of the 6 complications were major. QuickDASH scores were obtained at an average of 5 years postoperatively; mean QuickDASH scores were higher in the open fracture group, 13.1, compared with the closed fracture group, 5.9 ( P =0.038). Increased QuickDASH scores were independently associated with presence of postoperative complications. QuickDASH score could be expected to increase by 12.5 points in those with major complications ( P =0.044). CONCLUSION We present the largest single cohort of pediatric open Monteggia fracture-dislocation injuries to date. These injuries are predictive of poorer outcomes including trend toward increased time to union, increased risk of major complication, and can independently predict worse long-term patient-reported functional outcomes. LEVEL OF EVIDENCE Level III-these data represent a retrospective comparative study of clinical and functional outcomes.
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Affiliation(s)
- Brennan Roper
- Department of Orthopedic Surgery, University of Texas, Houston, TX
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A Simple Initiative to Decrease Time to Antibiotic Prophylaxis for Open Fractures Is Durable After 2 Years. J Am Acad Orthop Surg 2021; 29:e932-e939. [PMID: 33399289 DOI: 10.5435/jaaos-d-20-00075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 12/01/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION A simple antibiotic prophylaxis initiative can effectively decrease the time to antibiotic administration for patients with open fractures. We aim to determine whether adherence to the protocol decreased over time without active input from the orthopaedic trauma team. PATIENTS AND METHODS This retrospective cohort study included adult patients with open fractures (excluding hand) presenting directly to the emergency department at one Level I trauma center. Three separate 50-patient groups were included: a preimplementation cohort, immediately postimplementation cohort, and a retention cohort 2 years later. The primary outcome was time from emergency department presentation to antibiotic administration, and secondary outcomes were the percentage of patients receiving antibiotics within 60 minutes and incidence of infection requiring revision surgery within 90 days. The χ2 and Student t-tests evaluated between-group differences, and multivariable linear or logistic regression evaluated risk factors. RESULTS After implementation, the time from presentation to antibiotic administration decreased markedly from 123.1 to 35.7 minutes and remained durable (50.0 minutes) at retention. The proportion of patients receiving antibiotics within 60 minutes increased markedly from 46% preimplementation to 82% postintervention and remained similar at retention (80%). The postintervention and retention groups were markedly more likely to receive antibiotics within 60 minutes than the preintervention group (odds ratio [OR], 8.4 and 4.7, respectively), as were patients with a higher Gustilo-Anderson type (OR, 2.4/unit increase), lower extremity injury (OR, 2.8), and male sex (OR, 3.1); mechanism, age, and Injury Severity Score were not associated. No difference was observed in infection. CONCLUSIONS Our educational initiative showed durable results in reducing the time from presentation to antibiotic administration after 2 years. LEVEL OF EVIDENCE Therapeutic Level III.
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Welch DM, Sauer C, Martin JM, Juergens AL. Simultaneous open fracture and rattlesnake bite on the same extremity. Proc AMIA Symp 2021; 34:634-635. [PMID: 34456498 DOI: 10.1080/08998280.2021.1930844] [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: 10/21/2022] Open
Abstract
Open fractures and rattlesnake envenomations are two emergencies that each require emergent intervention and treatment. While each is common, when they occur simultaneously on the same extremity, it creates a syndrome that is quintessential Central Texas. We present the case of a 13-year-old boy who sustained a lower-extremity rattlesnake envenomation with concomitant open tibia and fibula fractures after being thrown from an all-terrain vehicle. The envenomation from the snake bite compelled us to first treat his developing coagulopathy with a delayed operative management of his fractures.
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Affiliation(s)
- Dustin M Welch
- Department of Emergency Medicine, Baylor Scott & White Medical Center - Temple, Temple, Texas
| | | | - Justin M Martin
- Department of Emergency Medicine, Baylor Scott & White Medical Center - Temple, Temple, Texas
| | - Andrew L Juergens
- Department of Emergency Medicine, Baylor Scott & White Medical Center - Temple, Temple, Texas
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Stennett CA, O’Hara NN, Sprague S, Petrisor B, Jeray KJ, Leekha S, Yimgang DP, Joshi M, O’Toole RV, Bhandari M, P. Slobogean G. Effect of Extended Prophylactic Antibiotic Duration in the Treatment of Open Fracture Wounds Differs by Level of Contamination. J Orthop Trauma 2020; 34:113-120. [PMID: 32084088 PMCID: PMC8077225 DOI: 10.1097/bot.0000000000001715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the association between prophylactic antibiotic duration after the definitive wound closure of an open fracture and deep surgical site infection (SSI). DESIGN Retrospective cohort study. SETTING 41 clinical sites in the United States, Canada, Australia, Norway, and India. PARTICIPANTS Patients (N = 2400) with open fractures of the extremities who participated in the Fluid Lavage of Open Wounds (FLOW) trial. INTERVENTION Extended antibiotic prophylaxis, defined as more than 72 hours of continuous antibiotic use after definitive wound closure. MAIN OUTCOME MEASUREMENT Deep SSI diagnosed within 1 year of enrollment. RESULTS Forty-two percent of participants received extended antibiotic prophylaxis. Deep SSI prevalence was 5%, 8%, and 23% for wounds with mild, moderate, and severe contamination, respectively. In open fractures with mild contamination, extended antibiotic use showed a trend toward increased odds [adjusted odds ratio (aOR) = 1.39; 95% confidence interval (CI), 0.92-2.11] of deep SSI compared with shorter use. No association was found among patients with moderate contamination (aOR = 1.09; 95% CI, 0.53-2.27). By contrast, extended antibiotic prophylaxis was strongly protective (aOR = 0.20; 95% CI, 0.07-0.60) against deep SSI in patients with severe contamination. Propensity score sensitivity analysis results were consistent with these findings. CONCLUSIONS The evidence suggests differential effects of extended postclosure antibiotic duration on SSI odds contingent on the degree of contamination in open fracture wounds. Although extended antibiotic duration resulted in lower odds of SSI among patients with severely contaminated wounds, we observed a trend toward higher odds of SSI in mildly contaminated wounds. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christina A. Stennett
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Nathan N. O’Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Sheila Sprague
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Brad Petrisor
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Kyle J. Jeray
- Department of Orthopaedic Surgery, Greenville Health System, Greenville, SC
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Doris P. Yimgang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Manjari Joshi
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Robert V. O’Toole
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Gerard P. Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
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Harper CM, Dowlatshahi AS, Rozental TD. Evaluating Outcomes Following Open Fractures of the Distal Radius. J Hand Surg Am 2020; 45:41-47. [PMID: 31615707 DOI: 10.1016/j.jhsa.2019.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 06/27/2019] [Accepted: 08/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE A paucity of evidence exists regarding the optimal treatment of open fractures of the distal radius. The purpose of this study was to compare short-term complication rates between various treatment options following open fractures of the distal radius. METHODS We performed a retrospective review of all open fractures of the distal radius at a single level 1 trauma center over a 10-year period. The primary outcome measure was the number of minor and major complications. Demographic and clinical characteristics of patients across treatment and outcome groups were compared and models were used to describe the relationships between outcome and treatment. RESULTS Ninety patients met the inclusion criteria for evaluation. An even distribution between high-energy (n = 45) and low-energy (n = 45) injuries was seen with 61 fractures Gustilo I (67%), 19 Gustilo II (22%), and 10 Gustilo III (11%). The majority of fractures were intra-articular (n = 48 AO type C vs n = 42 AO type A/B). Fractures were treated with immediate open reduction internal fixation (ORIF) in 67 cases (74%), external fixation in 12 (13%), initial external fixation followed by ORIF at a later time in 8 (9%), or closed reduction and percutaneous pinning in 3 (4%). We observed 33 complications (37%) of which 24 were major and 9 minor. Mechanism of injury and type of treatment were the only variables shown to correlate with an increased rate of complications. CONCLUSIONS We conclude that open fractures of the distal radius treated by immediate ORIF at the time of index debridement can result in satisfactory outcomes compared with other forms of treatment. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Carl M Harper
- Beth Israel Deaconess Medical Center, Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Harvard Medical School, Boston, MA.
| | - A Samandar Dowlatshahi
- Beth Israel Deaconess Medical Center, Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Harvard Medical School, Boston, MA
| | - Tamara D Rozental
- Beth Israel Deaconess Medical Center, Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Harvard Medical School, Boston, MA
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Sekiya T, Aota Y, Yamada K, Kaneko K, Ide M, Saito T. Evaluation of functional and structural leg length discrepancy in patients with adolescent idiopathic scoliosis using the EOS imaging system: a prospective comparative study. SCOLIOSIS AND SPINAL DISORDERS 2018; 13:7. [PMID: 29721550 PMCID: PMC5910610 DOI: 10.1186/s13013-018-0152-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/13/2018] [Indexed: 11/10/2022]
Abstract
Background To our knowledge, no studies have reported the exact structural leg length discrepancies (LLDs) in patients with adolescent idiopathic scoliosis (AIS). Therefore, this study aimed to evaluate the differences between functional and structural LLDs and to examine the correlations between LLDs and spinopelvic parameters in patients with AIS using an EOS imaging system, which permits the three-dimensional reconstruction of spinal and lower-limb bony structures. Methods Eighty-two consecutive patients with AIS underwent whole-body EOS radiography in a standing position between August 2014 and March 2016. Functional LLD, lumbar Cobb angle, thoracic curve Cobb angle, coronal balance, and pelvic obliquity were measured using two-dimensional EOS radiography. Structural LLDs were measured using three-dimensional EOS-reconstructed images. The comparison between LLDs was assessed using paired t test. Pearson's correlation coefficient (r) was used to determine potential correlations between the LLDs and spinopelvic alignment parameters. Results Functional LLDs were significantly larger than structural LLDs (5.6 ± 5.0 vs. 0.2 ± 3.6 mm, respectively; p < 0.001). Both functional and structural LLDs were significantly correlated with pelvic obliquity (r = 0.69 and r = 0.51, respectively; p < 0.001 for both). Functional LLD, but not structural LLD, was correlated with lumbar Cobb angle (r = 0.44, p < 0.001; r = 0.17, p = 0.12, respectively). In addition, functional and structural LLDs were not correlated with thoracic Cobb angle (r = 0.09 and r = - 0.05, respectively; p ≥ 0.68 for both). Conclusions Although patients with AIS often have functional LLDs, structural LLDs tend to be smaller. The correlation between functional LLDs and the lumbar Cobb angle indicates that functional LLDs compensate for the lumbar curve. Thus, the difference between functional and structural LLDs indicates a compensatory mechanism involving extension and flexion of the lower limbs.
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Affiliation(s)
- Tatsuhiro Sekiya
- 1Department of Orthopedic Surgery, Yokohama City University, Fukuura 3-9, Kanazawa-ku, Yokohama City, Kanagawa Prefecture 236-0004 Japan
| | - Yoichi Aota
- Department of Orthopedic Surgery, Yokohama City Brain and Spine Center, Takigasira 1-2-1, Isogo-ku, Yokohama City, Kanagawa Prefecture 235-0012 Japan
| | - Katsutaka Yamada
- 1Department of Orthopedic Surgery, Yokohama City University, Fukuura 3-9, Kanazawa-ku, Yokohama City, Kanagawa Prefecture 236-0004 Japan
| | - Kanichiro Kaneko
- 1Department of Orthopedic Surgery, Yokohama City University, Fukuura 3-9, Kanazawa-ku, Yokohama City, Kanagawa Prefecture 236-0004 Japan
| | - Manabu Ide
- 1Department of Orthopedic Surgery, Yokohama City University, Fukuura 3-9, Kanazawa-ku, Yokohama City, Kanagawa Prefecture 236-0004 Japan
| | - Tomoyuki Saito
- 1Department of Orthopedic Surgery, Yokohama City University, Fukuura 3-9, Kanazawa-ku, Yokohama City, Kanagawa Prefecture 236-0004 Japan
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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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