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Regmi A, Singh V, Bandhu Niraula B, Gowda AKS, Bansal S, Gowda R, Sharma C, Barman S. Outcome of early versus delayed presentation of proximal femur fractures in children: A prospective cohort study. Orthop Traumatol Surg Res 2024; 110:103840. [PMID: 38360173 DOI: 10.1016/j.otsr.2024.103840] [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: 10/03/2023] [Revised: 01/02/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE We hypothesized that the exact time of fixation of paediatric proximal femur fractures will have an effect on the ultimate clinical and radiological outcome. This article aimed to compare the clinical-radiological outcomes in paediatric proximal femur fractures having early and delayed presentation. METHODOLOGY A prospective cohort study was conducted from January 2019 to November 2022 in patients of age of 5 to 16 years presented with proximal femur fracture and divided into two groups: group A: early presentation, presented <48hours of injury; group B: delayed presentation, presented >48hours of injury. Patients underwent internal fixation treatment modality and followed up to assess clinical outcomes and radiological outcomes, and final outcome was assessed as per Ratliff's criteria. RESULTS In the study of 44 patients, 72.72% were male, and 27.27% were female, with male-to-female ratio to be 2.6:1. The commonest mode of injury was fall from height accounting for 52.27% followed by road traffic accidents (RTA) in 38.63%. The most common fracture type observed was Delbet type II, which was observed in 43.18%. There was significant shorter duration of surgery in group A (p-value=0.013), VAS score (p=0.045), and limb length discrepancy (p=0.022). Also, there was a statistical difference in AVN (p-value=0.0295) and growth disturbance (p-value=0.0394) between two groups. Also, there was statistically significant difference between Ratliff's criteria two groups (p-value=0.030). CONCLUSION Early presentation has shorter duration of surgery, less VAS score at final follow-up, and less limb length discrepancy, less development of complications like avascular necrosis of the femoral head, and growth disturbance. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anil Regmi
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Vivek Singh
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India.
| | | | - Aditya K S Gowda
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Shivam Bansal
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Rohan Gowda
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Cury Sharma
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Saptarshi Barman
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
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Laitakari E, Koukkula T, Huttunen TT, Mattila VM, Salonen A. The incidence, trends, and costs of treatment of femoral shaft fractures among Finnish children aged 2-12 years between 1998 and 2016. J Child Orthop 2024; 18:49-53. [PMID: 38348435 PMCID: PMC10859116 DOI: 10.1177/18632521231217267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/12/2023] [Indexed: 02/15/2024] Open
Abstract
Purpose The purpose of this study was to determine the incidence and trends of both hip spica casting and elastic stable intramedullary nailing in children aged 2-12 years who sustained femoral diaphyseal fracture between 1998 and 2016 in Finland. We also evaluated the actual hospital costs of both treatment methods as well as calculating the length of hospital stay. Methods This study included all 2- to 12-year-old children with femoral diaphyseal fracture who were treated in Finland between 1998 and 2016. Data were collected from the National Hospital Discharge Register of Finland. Children were classified by age into five groups. The annual incidences per 100,000 persons were calculated using annual mid-year population census data obtained from Statistics Finland. Data on the annual actual daily hospital costs were collected from the Finnish Institute for Health and Welfare. Results In total, 1064 patients aged 2-12 years who had sustained femoral diaphyseal fracture were treated with elastic stable intramedullary nailing or hip spica casting between 1998 and 2016. In children aged 4-5 years, the incidence of elastic stable intramedullary nailing increased during the study period from 5.4 per 100,000 persons in 1998 to 8.1 per 100,000 persons in 2016. Conclusions The length of hospitalization in patients treated with elastic stable intramedullary nailing was shorter and, therefore, the total costs of hospital treatment were lower than in those children treated with hip spica cast. Level of evidence level III.
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Affiliation(s)
- Elina Laitakari
- Department of Pediatric and Adolescent Surgery, Pediatric Clinic and Pediatric Research Centre, Tampere University Hospital, Tampere, Finland
| | - Topias Koukkula
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Tuomas T Huttunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tampere University Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Anne Salonen
- Department of Pediatric and Adolescent Surgery, Pediatric Clinic and Pediatric Research Centre, Tampere University Hospital, Tampere, Finland
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Waghela AB, Oka GA, Ranade AS. Submuscular nonlocking plates: an effective option for pediatric extra-articular proximal femur fractures. J Pediatr Orthop B 2024; 33:65-69. [PMID: 36943677 DOI: 10.1097/bpb.0000000000001076] [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: 03/23/2023]
Abstract
The aim of this study is to evaluate the results of submuscular plating using nonlocking plates for extra-articular proximal femur fractures (EPFF) in children. From our hospital records, we retrieved data of 15 children treated with submuscular plating with nonlocking dynamic compression plates (DCP) for EPFF between January 2010 and September 2021. EPFF was defined as a proximal femur fracture within 10% of the femoral length below the lesser trochanter. Patients' demographics, as well as details of the duration of operation, type of DCP used, time to union, complications, and outcomes using Flynn criteria were noted. There were nine males and six females. Mean age of the patients was 10.8 ± 1.9 years (range 7-14 years). All the patients had fracture union and two patients had union with an angulation less than 10°. All fractures healed uneventfully with a mean time to union of 11.8 ± 1.2 weeks (range 10-15 weeks). No patient required surgery for complications or malunion. Using Flynn criteria, excellent outcomes were seen in 13 out of 15 patients. There were no poor outcomes. Our study shows that submuscular plating using nonlocking plates is an effective option for treating pediatric EPFF. Treatment of these tricky fractures with submuscular plating using nonlocking plates shows excellent outcomes with minimal complications.
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Affiliation(s)
- Ankit B Waghela
- Department of Orthopaedics, Deenanath Mangeshkar Hospital & Research Center
| | - Gauri A Oka
- Central Research and Publication Unit, Bharati Vidyapeeth University Medical College & Hospital
| | - Ashish S Ranade
- Blooming Buds Centre for Pediatric Orthopaedics, Deenanath Mangeshkar Hospital & Research Center, Pune, India
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Navarro Vergara D, Navarro Fretes A. Femoral fractures in the immature skeleton: Characterization, risk factors, and treatment options in a developing country. Injury 2023; 54 Suppl 6:110819. [PMID: 37217398 DOI: 10.1016/j.injury.2023.05.050] [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: 02/23/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Femur fracture is one of the most frequent reasons for admission to paediatric trauma units and has a bimodal incidence. The trauma mechanism varies according to the patient's age. Non-operative treatment continues to be performed, although surgical treatment has gained popularity in recent years. Paediatric orthopaedic traumatologists should always bear in mind the already known general principles of treatment. In this study, we aimed to provide a general characterization of femoral fractures, risk factors, and current definitive treatment methods in a developing Latin American country. MATERIALS AND METHODS This is an observational, analytical, retrospective study with a non-probabilistic sample of consecutive cases of skeletally immature patients with femoral fractures treated at a trauma hospital in Asunción, Paraguay, from January to December 2022. Patients with diseases fragile bones and femoral fractures were excluded. Demographic and clinical characteristics of the study population were analysed. RESULTS Traffic accidents were the most frequent cause of femoral fractures in our population. Femur fractures were more common in males. The femoral shaft was the most frequent fracture site. Age was one of the most important criteria for defining the treatment approach, considering non-operative management in children younger than 4 years. CONCLUSIONS Fracture of the femoral shaft in male patients is the most frequent presentation at our Institution. Summer vacations and traffic accidents are the main risk factors identified in Paraguayan children who suffer a femoral fracture. Non-operative treatment is preferred in children under 4 years of age, while surgical treatment is preferred in children aged 5 years and above. Paediatric orthopaedic traumatologists should be involved in parent education to promote children's safety, especially by increasing care and vigilance during school vacations and dangers related to traffic accidents.
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Affiliation(s)
- Daniel Navarro Vergara
- Hospital de Trauma "Manuel Giagni"; Hospital Central del IPS, Universidad del Norte, Cátedra de Ortopedia y Traumatología, Asunción, Paraguay.
| | - Alberto Navarro Fretes
- Head of the Children Orthopedic Department, Hospital Central del IPS; Head of Cátedra de Ortopedia y Traumatología, Universidad del Norte, Asunción, Paraguay. Senior Consultant, Pediatric Service, Hospital de Trauma "Manuel Giagni", Paraguay
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Duan L, Canavese F, Li L. Flexible intramedullary nails or Spica casting? A meta-analysis on the treatment of femur fractures in preschool children aged 2-5 years. J Pediatr Orthop B 2023; 32:292-301. [PMID: 35979683 PMCID: PMC10060042 DOI: 10.1097/bpb.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/02/2022] [Indexed: 11/26/2022]
Abstract
The objective of this study is to conduct a meta-analysis (1) to evaluate outcomes of flexible intramedullary nails (FIN) versus Spica casting for treating femur shaft fractures in children aged 2-5 years and (2) to investigate the associated complications. The PubMed , Cochrane Library , Embase and Web of Science databases were searched to identify available studies comparing the outcomes of FIN and Spica casting for the treatment of femoral shaft fracture in preschool children. Meta-analysis was conducted with adherence to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Eight observational studies involving 4995 patients were included. Two were judged to be of moderate quality, with the remainder being high quality. There were 1573 patients treated by FIN and 3422 by Spica casting. Compared to Spica casting, FIN allowed a quicker return to normal activities (40.49 ± 13.43 vs. 46.97 ± 14.32 days; P < 0.001), had a lower incidence of malunion (0.88 vs. 4.19%; P = 0.01) and unplanned interventions (2.87 vs. 7.53%; P < 0.001), but had slightly longer hospital stay (2.01 ± 1.01 vs. 1.10 ± 0.93 days; P = 0.01) and required a second surgery to remove the nails. Compared with Spica casting, FIN has the advantages of faster returning to normal activities and lower incidence of residual deformities and unplanned reoperation, but a slightly longer time of hospitalization and needs a second surgery to remove the hardware. Existing studies on duration of care and financial burden are insufficient, so further studies are warranted on multicenter and high-level evidence studies. Level of evidence: III.
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Affiliation(s)
- Lian Duan
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Centre, Jeanne de Flandre Hospital, Lille, France
| | - Lianyong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
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Modeste Ouédraogo SF, Diallo M, Tapsoba WT, Thiombiano K, Ouedraogo I, Wandaogo A. Simultaneous bilateral femoral fracture in children. Afr J Paediatr Surg 2023; 20:120-123. [PMID: 36960507 DOI: 10.4103/ajps.ajps_91_21] [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] [Indexed: 01/06/2023] Open
Abstract
Introduction Bilateral femoral fractures in children (BFFC) are an uncommon condition. Only a few cases were reported in the literature. The frequency and outcome in low-setting facilities are unknown. This study aims to describe our experience in managing BFFC. Patients and Methods A 10-year ongoing study spanning from 2010 to 2020 was held in a level-1 paediatric facility. We included all cases of BFFC on a bone-free disease with at least 10 months of follow-up time. Data were collected and analysed with statistical software. Results A total of eight patients with ten BFFC were collected. It involved mainly boys (n = 7/8) with median age of 8 years. Mechanism of injury were a road traffic accident (n = 4), a fall from height (n = 3), and been crushed by a falling wall (n = 1). Associated injuries were frequent (n = 6/8). Patients were managed nonoperatively with spica cast (n = 5) and by elastic intramedullary nails (n = 3). After 6.11 years of mean follow-up time, all fractures healed. The outcome was excellent and good in 7 cases. One patient sustained knees stiffness. Conclusion Non-operative management of BFFC showed satisfactory outcomes. Early surgical care must be developed in our low-income settings to reduce in-hospital stay and encourage early weight-bearing.
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Affiliation(s)
| | - Malick Diallo
- Department of Trauma and Orthopaedics, Hospital Center End University Souro Sanou of Bobo Dioulasso, Burkina Faso
| | - W Toussaint Tapsoba
- Department of Pediatric Surgery and Hospital Center and University Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Koundja Thiombiano
- Department of Pediatric Surgery and Hospital Center and University Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Isso Ouedraogo
- Department of Pediatric Surgery and Hospital Center and University Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Albert Wandaogo
- Department of Pediatric Surgery and Hospital Center and University Charles de Gaulle, Ouagadougou, Burkina Faso
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Wang M, Su Y. Suitability of skin traction combined with braces for treating femoral shaft fractures in 3-5 years old children. J Orthop Surg Res 2023; 18:63. [PMID: 36683037 PMCID: PMC9869502 DOI: 10.1186/s13018-023-03547-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In children aged 3-5 years, femoral fractures are common and are frequently treated using flexible intramedullary nails (FIN) or spica casting. Recently, more surgeons have been relying on FIN surgery because of the high rate of complications associated with spica casts, such as skin irritation and re-adjustment surgery. We aimed to evaluate the effect of skin traction combined with braces in 3-5 years old children at our hospital. METHODS We retrospectively analyzed 125 children aged 3-5 years with femoral shaft fractures treated at our hospital between January 2010 and December 2020. We assigned 68 patients who underwent FIN surgery to Group A and 57 patients treated with skin traction and braces to Group B. Comparative analysis included the children's age, sex, side of the affected limb, cause of fracture, function of the knee joint, healing time of the fracture, duration of hospitalization, cost of hospitalization, and complications. The complications evaluated included joint dysfunction, pain, infection, pressure ulcers, angular deformities, limb length differences, re-fractures, nonunion fractures, and delayed union. RESULTS There were significant differences in and hospital costs (p = 0.001). Conversely, no statistically significant differences were observed in sex (p = 0.858), injury type (p = 0.804), age (p = 0.231), hospitalization time (p = 0.071), bone healing time (p = 0.212), and complications. Pressure ulcers, nonunion fractures, and delayed union did not occur in both groups. CONCLUSION Both methods had similar therapeutic effects and postoperative complications in children aged 3-5 years with femoral shaft fractures. Therefore, skin traction combined with braces is recommended for this population and for patients hospitalized in institutions where several beds are available, with a consequent possibility of prolonged hospitalization. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Menglei Wang
- grid.488412.3Department of Orthopedics, Chongqing Key Laboratory of Pediatrics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children’s Hospital of Chongqing Medical University, 136# Zhongshan 2 Road, Yuzhong District, Chongqing, 400014 China
| | - Yuxi Su
- grid.488412.3Department of Orthopedics, Chongqing Key Laboratory of Pediatrics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children’s Hospital of Chongqing Medical University, 136# Zhongshan 2 Road, Yuzhong District, Chongqing, 400014 China
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Roshanaei G, Khoshravesh S, Abdolmaleki S, Bathaei T, Farzian M, Saatian M. Epidemiological pattern of trauma patients based on the mechanisms of trauma: trends of a regional trauma center in Midwest of Iran. BMC Emerg Med 2022; 22:210. [PMID: 36572877 PMCID: PMC9793657 DOI: 10.1186/s12873-022-00756-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/24/2022] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Trauma is one of the important issues in public health because it is responsible for 90% of mortality in Low and Middle-Income Countries (LIMCs). The present study aimed to determine the epidemiological pattern of trauma patients in a regional trauma center in the Midwest of Iran from 2014 to 2020. METHODS This study was a retrospective study that was performed on 29,804 trauma patients admitted to Be'sat Hospital in Hamadan from January 2014 to December 2020. Data was collected using Health Information Management (HIM) Center of the Be'sat Hospital. For investigating the relationship of the characteristics of trauma patients and the mechanisms of trauma, Multiple Multinomial Logistic Regression (MMNLR) model was used. All statistical analyses were performed using the IBM SPSS Statistics version 24. RESULTS The mean age of all patients was 35.4 (SD = 21.9) years. Most of them were men (71.7%). The most common mechanism of trauma was road traffic accidents (RTAs) (39.6%) followed by falls (30.2%), other (19.7%), violence (6.2%), and burn (4.4%). 1.5% of the trauma patients expired. The results of multiple multinomial logistic regression indicated that significant affected factor on odds referring because of RTAs compared to other mechanism were: season and hospital length of stay (LOS); in falls and violence: age, sex, season, and LOS; and in burn: age, sex, season, evening time, and LOS (p < 0.05). CONCLUSION Based on the investigation of 29,804 trauma patients, in Iran as a developing country, RTAs and falls were two common mechanisms of trauma. It seems that as a short-term plan, it is possible to focus on road safety, to improve the quality of vehicles, to hold training courses for drivers. Also, as a long-term goal, considering that the elderly population in Iran is increasing, it is necessary to pay attention to fall reduction programs.
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Affiliation(s)
- Ghodratollah Roshanaei
- grid.411950.80000 0004 0611 9280Department of Biostatistics, School of Public Health, Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sahar Khoshravesh
- grid.411950.80000 0004 0611 9280Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sajjad Abdolmaleki
- grid.411950.80000 0004 0611 9280Department of Neurosurgery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Tayebeh Bathaei
- grid.411950.80000 0004 0611 9280Department of Operating Room, School of Para Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Mohammadreza Saatian
- grid.411950.80000 0004 0611 9280Department of Neurosurgery, Hamadan University of Medical Sciences, Hamadan, Iran ,grid.411950.80000 0004 0611 9280School of Medicine, Hamadan University of Medical Sciences, Shaheed Fahmideh Ave, Hamadan, Islamic Republic of Iran
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Gothefors M, Wolf O, Hailer YD. Epidemiology and treatment of pediatric tibial fractures in Sweden: a nationwide population-based study on 5828 fractures from the Swedish Fracture Register. Eur J Trauma Emerg Surg 2022; 49:911-919. [PMID: 36334101 PMCID: PMC10175428 DOI: 10.1007/s00068-022-02157-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 10/21/2022] [Indexed: 11/08/2022]
Abstract
Abstract
Purpose
Pediatric tibial fractures have been described internationally as mainly caused by fall during leisure activities and organized sports and showing a higher incidence in boys. Still, most studies are single center studies or have a small sample size. This study aimed to analyze sex and age distribution, seasonal variation, injury mechanisms and treatment of pediatric tibial fractures based on the nationwide Swedish Fracture Register (SFR).
Methods
All tibial fractures in patients < 16 years at injury and registered in 2015–2019 were extracted from the SFR. We analyzed patient characteristics such as sex and age, injury mechanism, fracture location and treatment.
Results
The study cohort consisted of 5828 pediatric tibial fractures in 5719 patients. Median age of the patients was 7 years and 58% were boys. Shaft fractures were most common, followed by the distal and proximal tibia. The lowest incidence was observed during autumn. The most common cause of injury was fall mostly involving winter sports, stumbles and fall from play equipment. Play/free time and sports were the most common activities, common places of injury were sports facility and home. 1% were open fractures. 78% were treated non-surgically. Screw fixation was performed in 52% of surgically treated fractures, predominantly in the distal segment.
Conclusion
Injury mechanism differs between age groups; play/free time injuries are common in younger children compared with sport activities in older children. Most patients are treated non-surgically. Open fractures are rare. Information on injury patterns is useful working preventively, for example safety work in playgrounds.
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Affiliation(s)
- Matilda Gothefors
- Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Olof Wolf
- Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Yasmin D Hailer
- Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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Sung J, Yao A, Antoniou G, Cooksey R, Winters J, Ee M, Williams N. Failure to initiate trauma team activation for patients who meet the criteria in a level 1 paediatric trauma centre: which patients are missing out? ANZ J Surg 2022; 92:2628-2634. [PMID: 35833510 PMCID: PMC9796087 DOI: 10.1111/ans.17906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/10/2022] [Accepted: 07/01/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Trauma team activation (TTA) is paramount in the early hospital management of trauma patients. This study aimed to evaluate factors which contribute to failure to activate the Trauma team for management of paediatric trauma. METHODS A retrospective cohort study of Emergency Department (ED) presentations at the paediatric major trauma hospital in Adelaide, South Australia was conducted over a 16-month period. Data from the hospital's trauma registry, individual case files and digital medical records were evaluated to determine factors that were associated with no TTA. RESULTS During the study period, 617 trauma patients who met Level 1 or Level 2 TTA criteria attended the trauma centre. For 29 (4.7%) of these patients, there was no TTA. Predictors of no TTA included sustaining abdomen and/or pelvis injuries compared to limb injuries (unadjusted odds ratio [OR] = 10.59, 95% confidence interval [CI] 1.98-56.69, P = 0.006), sustaining non-accidental injury (NAI) versus an injury with vehicle involvement (OR = 30.13, 95% CI 6.43-141.21, P < 0.001), and arriving via emergency medical retrieval service compared to private vehicle (OR = 14.23, 95% CI 3.94-51.36, P < 0.001). No patients transferred directly to Paediatric Intensive Care Unit (PICU), or High Dependency Unit (HDU) received an appropriate TTA. CONCLUSION Multiple factors were associated with no TTA in paediatric trauma patients. The results highlight that even in PICU and HDU admissions and transfer patients, vigilant clarification of mechanism of injury and potential for occult injuries should be undertaken to ensure appropriate TTA and improve patient outcome.
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Affiliation(s)
- Jonghoo Sung
- Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Angela Yao
- Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Georgia Antoniou
- Department of Orthopaedic SurgeryWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - Rebecca Cooksey
- Paediatric Major Trauma Service, Division of Surgical ServicesWomen's and Children's HospitalAdelaideSouth AustraliaAustralia,Department of Paediatric SurgeryWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - Jacqueline Winters
- Paediatric Major Trauma Service, Division of Surgical ServicesWomen's and Children's HospitalAdelaideSouth AustraliaAustralia,Department of Paediatric MedicineWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - Michael Ee
- Paediatric Major Trauma Service, Division of Surgical ServicesWomen's and Children's HospitalAdelaideSouth AustraliaAustralia,Department of Paediatric SurgeryWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - Nicole Williams
- Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia,Paediatric Major Trauma Service, Division of Surgical ServicesWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
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Muacevic A, Adler JR. Treatment of Diaphyseal Fractures of the Femur in Paediatric Age Group: A Comparative Study of Locking Compression Plate Versus Titanium Elastic Nailing System (TENS). Cureus 2022; 14:e28924. [PMID: 36225519 PMCID: PMC9541844 DOI: 10.7759/cureus.28924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Diaphyseal femur fractures are commonly seen in the paediatric age group as there is an increase in the incidence of road traffic accidents. Titanium elastic nailing system (TENS) and plating are the common methods used for paediatric long bone fracture fixation. The purpose of our study was to evaluate and compare functional and radiological outcomes of paediatric femur diaphyseal fractures treated with locking compression plates and with TENS. METHODS Our study included 59 patients diagnosed with femur shaft fracture. Twenty-eight patients included in group one underwent open reduction and internal fixation with locking compression plates and 31 patients in group two underwent open reduction/closed reduction with intramedullary TENS. All post-operation patients were evaluated at four, eight, 10, 12, 16, 20, 24, and 36 weeks. The functional outcome was assessed based on the Flynn scoring system and radiological union based on fracture union on X-ray. RESULTS We analyzed our data using the Flynn scoring system. In group one, out of 28 cases treated with locking compression plates, 25 (89%) were excellent, two (7.5%) were satisfactory, and one (3.5%) was poor. In group two, out of 31 cases treated with intramedullary TENS, 26 (83.8%) were excellent and five (16.2%) were satisfactory. In our study, the average union time in group one was 11.4 weeks and in group two was 14.41 weeks. Fracture union was 100% in both groups. CONCLUSION In our study, we noted that the union of the femur shaft was early with the use of locking compression plates. In TENS, there was less intraoperative blood loss, very minimal postoperative scar, and less soft tissue damage. Also, implant removal was easier compared to locking compression plates.
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Yuan H, Yu H, Zhu Y, Xiang L, Wang H. Effect of Age on the Patterns of Traumatic Femoral Fractures: Seven Years of Experience at a Regional Tertiary Hospital. Orthop Surg 2022; 14:2132-2140. [PMID: 35929600 PMCID: PMC9483057 DOI: 10.1111/os.13410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/11/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Femoral fractures are a common cause of mortality and functional loss, mainly among older people, and there are few studies about the age in relation to traumatic femoral fractures. The aim of this study was to investigate the effect of age on the patterns of traumatic femoral fractures in patients presenting to our regional tertiary hospital. Methods The records of 2020 patients who presented with traumatic femoral fractures between 2013 and 2019 were retrospectively reviewed. The patients' clinical and radiographic records were reviewed. Univariate and multivariable logistic regression were used to identify independent risk factors for associated injuries and complications. Results The patients were divided into a child group (CH group, n = 342) aged under 18 years, a young adult group (YA group, n = 484) aged 18–60 years, and an older people group (OP group, n = 1194) aged 60 years and over. There were significant differences among the three groups in several indexes, such as sex ratio (χ2 = 301.699, p < 0.001), osteoporosis (χ2 = 375.463, p < 0.001), injury time of day (χ2 = 114.913, p < 0.001), injury cause (χ2 = 748.187, p < 0.001), injury location (χ2 = 490.153, p < 0.001), fracture side (χ2 = 57.000, p < 0.001), fracture site (χ2 = 806.650, p < 0.001), associated injuries (χ2 = 322.921, p < 0.001), coma after injury (χ2 = 147.814, p < 0.001), non‐surgery‐related complications (χ2 = 7.895, p = 0.019), and surgery‐related complications (χ2 = 82.186, p < 0.001). The YA group had a significantly higher percentage of patients with surgery‐related complications than the OP group. The OP group had a higher frequency of non‐surgery‐related complications than the YA group and CH group. The most common non‐surgery‐related complications were pneumonia (7.1%) in the OP group and deep venous thrombosis (6.4%) in the YA group. Multivariable logistic regression showed that young adults, high‐energy injury, outdoors, coma after injury, and fracture sites except for the proximal region were independent risk factors for associated injuries. Older age, male, and fracture site except for the proximal region were independent risk factors for complications. Conclusions Traumatic femoral fractures are mostly the result of low‐energy trauma and predominantly affect the proximal site of the femur among older people. A higher rate of shaft fractures, fractures occurring outdoors, and associated injuries were observed among young adults and children than among older people.
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Affiliation(s)
- Hong Yuan
- Department of Orthopaedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Hailong Yu
- Department of Orthopaedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Yunpeng Zhu
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Liangbi Xiang
- Department of Orthopaedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Hongwei Wang
- Department of Orthopaedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
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Beume JS, Schmittenbecher PP. [Shaft fractures of the lower limb in adolescents]. Unfallchirurg 2022; 125:479-491. [PMID: 35522269 DOI: 10.1007/s00113-022-01184-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Abstract
Shaft fractures of the lower extremities are rare during adolescence. Conservative treatment is no longer used for the upper leg and the significance is declining for the lower leg, as only minor axis deviations and malrotations of the shaft are acceptable and conservative therapy is associated with severe impairments in the daily routine; however, conservative treatment is still an option for femoral fractures in children < 3 years of age and for stable fractures of the lower leg. Various osteosynthesis procedures can be used depending on the body weight and epiphyseal maturation. Elastic stable intramedullary nailing is the first choice, followed by solid adolescent femoral or tibial nailing for higher body weights and external fixation for open or multifragmentary fractures. Plate osteosynthesis is an established alternative. Following correct surgical treatment, all fractures have movement and at least partial load-bearing stability and the results are satisfactory. Regular controls are recommended up to the end of the growth period.
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Affiliation(s)
- Jan-Sebastian Beume
- Kinderchirurgische Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - Peter P Schmittenbecher
- Kinderchirurgische Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.
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14
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Sepúlveda M, Téllez C, Villablanca V, Birrer E. Distal femoral fractures in children. EFORT Open Rev 2022; 7:264-273. [PMID: 37931413 PMCID: PMC9069856 DOI: 10.1530/eor-21-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The physis of the distal femur contributes to 70% of femoral growth and 37% of the total limb growth; therefore, physeal injury can lead to important alterations of axes and length. Distal metaphyseal corner-type fracture prior to walking is classically associated with child abuse. In children aged >10 years, sports-related fractures and car accidents are significant contributors. Imaging includes a two-plane radiographic study of the knee. It is recommended to obtain radiographs that include the entire femur to rule out concomitant injuries. In cases of high suspicion of distal metaphyseal fractures and no radiographic evidence, CT or MRI can show the existence of hidden fractures. Fractures with physeal involvement are conventionally classified according to the Salter-Harris classification, but the Peterson classification is also recommended as it includes special subgroups. Conservative and surgical management are valid alternatives for the treatment of these fractures. Choosing between both alternatives depends on factors related to the fracture type. As there is a high risk of permanent physeal damage, long-term follow-up is essential until skeletal maturity is complete.
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Affiliation(s)
- Matías Sepúlveda
- Universidad Austral de Chile, Valdivia, Chile
- Hospital Base de Valdivia, Valdivia, Chile
- AO Foundation, PAEG Expert Group, Davos, Switzerland
| | - Cecilia Téllez
- Universidad Austral de Chile, Valdivia, Chile
- Hospital Base de Valdivia, Valdivia, Chile
| | - Víctor Villablanca
- Universidad Austral de Chile, Valdivia, Chile
- Hospital Base de Valdivia, Valdivia, Chile
| | - Estefanía Birrer
- Universidad Austral de Chile, Valdivia, Chile
- Hospital Base de Valdivia, Valdivia, Chile
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15
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Möller M, Wolf O, Bergdahl C, Mukka S, Rydberg EM, Hailer NP, Ekelund J, Wennergren D. The Swedish Fracture Register - ten years of experience and 600,000 fractures collected in a National Quality Register. BMC Musculoskelet Disord 2022; 23:141. [PMID: 35148730 PMCID: PMC8832767 DOI: 10.1186/s12891-022-05062-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Before the creation of the Swedish Fracture Register (SFR), there was no national quality register that prospectively collects data regarding all types of fractures regardless of treatment in an emergency setting. Observational data on fractures registered in a sustainable way may provide invaluable tools for quality improvements in health care and research. DESCRIPTION Ten years after its implementation, the Swedish Fracture Register has 100% coverage among orthopaedic and trauma departments in Sweden. The completeness of registrations reached in 2020 69-96% for hip fractures at the different departments, with the majority reporting a completeness above 85%. The Swedish Fracture Register is a fully web-based national quality register created and run by orthopaedic professionals, with financial support from public healthcare providers and the government. All users have full access to both the registration platform and all aggregated statistics in real time. The web-based platform was created for use in health quality registers and it has easily gained acceptance among users. The register has gradually developed by the addition of more fracture types and skeletal parts. Research activity is high and 31 scientific publications have been published since 2016. The strategy from the start was to publish validation data and basic epidemiological data. However, over the past few years, publications on outcomes, such as re-operations and mortality, have been published and four register-based, randomised, controlled trials are ongoing. CONCLUSION It is possible to create a fracture register, to gain professional acceptance and to collect fracture data in a sustainable way on a national level if the platform is easy to use. Such a platform can also be used as a randomisation platform for prospective studies.
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Affiliation(s)
- Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden.
| | - Olof Wolf
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Carl Bergdahl
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Science (Orthopaedics), Umeå University, Umeå, Sweden
| | - Emilia Möller Rydberg
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Nils P Hailer
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Jan Ekelund
- Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - David Wennergren
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
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Sananta P, Julana R, Sugiarto MA. Profiles of Children with Lower Extremity Fracture at Saiful Anwar Malang Regional General Hospital from January 2016 to August 2020. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Musculoskeletal injuries in children are a common cause of 25% of children hospitalization. Previous research stated that five pediatric fractures had significant long-term consequences such as disability and activity restriction. In Indonesia, epidemiology studies have discussed the incidence of fracture in general sites, but only a few reported lower limb fractures. The authors expect this research to be used for lower extremities fractures in children’s epidemiologic descriptions. Between January 2016 until September 2020, we included 247 children under 18 years old based on inclusion criteria. The prevalence and fractures were reviewed for detail, such as sex, age, mechanism of injury, location of the fracture, and treatment. Data were analyzed using SPSS version 26. Most common injuries occur at 13-18 years old with 164 children (66.4%). Most of them were caused by traffic accidents, 210 cases (85.0%). Consequently, femur fractures are the most common fractures due to traffic accidents 53.8% (p<0.005). From common fracture sites in this study, plating is the common to use procedure than the others (52.3%). Therefore, we can conclude that MVA were the most common injury in children, and especially for fracture femur relevant with increasing age and plating methods is common to use method for this fracture
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Ho JKM, Chung JYS, Cheung SN, Pang WWY, Yau PY, Lam SC. Self-efficacy of emergency management of domestic helpers in pediatric home accidents: A cross-sectional survey in Hong Kong. Front Pediatr 2022; 10:997834. [PMID: 36340717 PMCID: PMC9627280 DOI: 10.3389/fped.2022.997834] [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: 07/19/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Accidental injuries are the leading cause of deaths and disabilities in children globally and most of them occur at home. To save life and prevent sequelae, domestic helpers (DHs) require providing emergency management (i.e., first aid) to children involved in home accidents. However, their self-efficacy in emergency management for children is rarely investigated. Hence, this study aimed to tap that research gap. METHODS This study adopted a cross-sectional descriptive survey design. A convenience sample of 385 DHs was obtained in Hong Kong. DHs' self-efficacy in emergency management for children involved in home accidents was measured using a 12-item well-validated survey instrument "Self-Efficacy of First Aid in Unintentional Injury at Home". The total score ranged from 0 to 48. A higher score indicates greater confidence in emergency management for children involved in home accidents. RESULTS All the participants were women and most of them were aged between 31 and 35 years (N = 103, 26.8%). The mean score for DHs' self-efficacy in emergency management was 29.0 (SD 10.1). The three items with the lowest self-efficacy were managing bone fractures, performing cardiopulmonary resuscitation, and providing artificial respiration. Bivariate analysis showed that DHs' self-efficacy was significantly related to their educational level, first aid training, caring experience, and working experience. Multiple linear regression indicated that DHs' educational level (β = 0.136, p = 0.001) and first aid training (β = 0.532, p < 0.001) were significantly predicting their self-efficacy. CONCLUSION DH's self-efficacy of emergency management for children involved in home accidents was low, particularly in those severe situations and complicated first aid procedures.
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Affiliation(s)
- Jonathan Ka-Ming Ho
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong SAR, China
| | | | | | | | - Po-Yi Yau
- Medical Unit, Tseung Kwan O Hospital, Hong Kong SAR, China
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13-Year-Old Boy Presenting with Bilateral Femur Fractures in the Setting of Severe Vitamin D Deficiency. Case Rep Pediatr 2021; 2021:2440999. [PMID: 34395009 PMCID: PMC8360739 DOI: 10.1155/2021/2440999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background Femur fractures in adolescents are rare. Severe vitamin D deficiency has important implications for bone health. We describe the case of a 13-year-old boy with autism spectrum disorder (ASD) who presented with low-impact bilateral femur fractures in the setting of severe vitamin D deficiency. Case Presentation. A 13-year-old boy with ASD presented with bilateral leg pain after an unwitnessed fall. Laboratory investigations revealed severe hypocalcemia (S. calcium 4.9 mg/dL) and severe vitamin D deficiency (25(OH)D < 4 ng/mL). Lower extremity X-rays revealed bilateral distal femoral metaphyseal fractures. Conclusion This is the youngest known case of bilateral femoral fractures in the setting of severe 25(OH)D deficiency. Children with ASD are especially at risk for 25(OH)D deficiency as many have inadequate nutritional intake. As such, primary care providers may provide a pivotal role in the routine laboratory screening of 25(OH)D in this population.
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