Epidemiology of proximal and diaphyseal humeral fractures in children: an observational study from the Swedish Fracture Register

Global burden of self-harm and interpersonal violence and influencing factors study 1990-2019: analysis of the global burden of disease study

INTRODUCTION

Widespread concern exists in today's world regarding self-harm and interpersonal violence. This study to analyze the changes in temporal trends and spatial patterns of risk factors and burdens of self-harm and interpersonal violence using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.

METHODS

Temporal trends in self-harm and interpersonal violence were initially summarized using the estimated annual percentage change (EAPC). Data were compiled and visualized to delineate changes in disease burden and factors influencing self-harm and interpersonal violence from 1990 to 2019, stratified by gender, age and GBD region.

RESULTS

In 2019, the DALY rates of self-harm were 424.7(95% UI 383.25, 466.93). Over the period from 1999 to 2019, self-harm exhibited an overall decreasing trend, with the EAPC of -1.5351 (95% CI -1.6194, -1.4507), -2.0205 (95% CI -2.166, -1.8740) and -2.0605 (95% CI -2.2089, -1.9119), respectively. In contrast, the incidence rate of interpersonal violence was significantly higher than self-harm, with a rate of 413.44 (95% UI 329.88, 502.37) per 100,000 population. Mortality and DALYs of interpersonal violence were lower than those of self-harm, at 5.22 (95% UI 4.87, 5.63) and 342.43 (95% UI 316.61, 371.55). Disease burden of self-harm and interpersonal violence varied by gender, age groups and region. Specific risk factors showed that alcohol use, high temperature and drug use were the main risk factors for self-harm, while alcohol use, intimate partner violence and high temperature were associated with interpersonal violence. Low temperature was a common protective factor for both self-harm and interpersonal violence. The burden of self-harm and interpersonal violence was attributed to different factors influences in different SDI regions.

CONCLUSIONS

The study explored temporal trends and spatial distribution of the global disease burden of self-harm and interpersonal violence, emphasizing the significant impact of factors such as alcohol use, temperature, and drug use on disease burden. Further research and policy actions are needed to interpret recent changes of disease burden of self-harm and interpersonal violence, and dedicated efforts should be implemented to devise evidence-based interventions and policies to curtail risk factors and protect high-risk groups.

A Rare Combined Injury in Children during Side Impact: The Possible Mechanism and Treatment Results

OBJECTIVE

Proximal humeral fracture combined with contralateral midshaft clavicle fracture is an extremely rare injury in children. Few studies focus on the injury mechanism and treatment scheme. The aim of this study is to propose the possible mechanism of this injury and present the treatment results.

METHODS

This retrospective study included children diagnosed with proximal humeral fractures combined with contralateral midshaft clavicle fractures from August 2016 to March 2019 in the corresponding author's institution. The patients received elastic stable intramedullary nails and external fixation as treatment. The radiological and clinical outcomes of treatments were evaluated using the imaging and the Constant-Murley score (CMS) in follow up.

RESULTS

Twelve patients (eight males and four females) with an average age of 7.83 years old (age 5-12) were included in this research. All the patients had suffered a side impact in a road traffic accident or outdoor environment. Hypothesis about the mechanism was the proximal humerus was directly impacted at first and caused the surgical neck fracture, then the contralateral shoulder hits the solid object and the contralateral midshaft clavicle was fractured. During the average 45.2 months (range 36-57) follow-up, all the patient's fractures achieved clinical and radiological union before 14 weeks without complications. Every patient had a satisfactory score (range from 92 to 100) on the CMS criteria for both shoulders.

CONCLUSION

The hypothesis about the mechanism of this combined injury in this study sounds reasonable. It highlights the need for safety-related education about using a safety seat or wearing a seat belt to parents and caregivers, so as to avoid such injury even if the treatment with external fixation (EF) and proximal humeral and elastic stable intramedullary nailing (ESIN) showed good results.

Kirschner wire versus external fixation in the treatment of proximal humeral fractures in older children and adolescents: a comparative study

OBJECTIVE

The purpose of this study was to compare the therapeutic effects of Kirschner wire fixation and external fixation in the treatment of proximal humeral fractures in older children and adolescents.

METHODS

A retrospective analysis was performed on the clinical data of older children and adolescents who underwent surgery at our institution for proximal humeral fractures between April 2014 and May 2022. One group (n = 28) underwent fracture reduction and Kirschner wire fixation, and the other group (n = 23) underwent external fixation. During the follow-up, the differences in shoulder joint function between the two groups were compared by analysing Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) and Constant-Murley scores. Postoperative complications were also recorded.

RESULTS

The operation time of the Kirschner wire group was shorter than that of the external fixation group (69.07 ± 11.34 min vs. 77.39 ± 15.74 min, P = 0.33). The time to remove the fixator in the external fixation group was shorter than that in the Kirschner wire group (6.74 ± 1.57 vs. 7.61 ± 1.22, P = 0.032). The Quick DASH score and Constant-Murley score of the patients in the external fixation group were significantly better than those in the Kirschner wire group at 3 months after surgery (5.63 ± 4.33 vs. 8.93 ± 6.40, P = 0.040; 93.78 ± 2.43 vs. 91.75 ± 2.15, P = 0.003). There was no significant difference in the Quick DASH score or Constant-Murley score between the patients in the external fixator group and those in the Kirschner wire group at 9 months after the operation (2.77 ± 3.14 vs. 3.17 ± 3.68, P = 0.683; 97.39 ± 1.80 vs. 96.57 ± 2.15, P = 0.152). The most common complication of the two groups was pin tract infection. The incidence rate of infection was higher in the external fixation group than that in the Kirschner wire group (9 vs. 4, P = 0.043).

CONCLUSION

Both Kirschner wire fixation and external fixation of N-H III and IV proximal humeral fractures in older children and adolescents produce good outcomes. External fixation is a preferred surgical treatment option for paediatric proximal humerus fractures because early mobilization of the affected limb can be realized.

Correlation of temperament characteristics and early functional exercise compliance in school-age children with limb fractures: Implication for clinical nursing care

Early functional exercise plays a very important role in the rehabilitation and nursing care of children with fractures. We aimed to evaluate the role of temperament characteristics in the early functional exercise compliance in school-age children with limb fractures, to provide evidence to clinical nursing care. School-age children with limb fractures admitted to our hospital from January 1, 2021 to June 30, 2022 were selected. We collected the general information, evaluated the temperament characteristics and their functional exercise compliance in school-age children. Correlation and regression analyses were conducted to assess the correlation of temperament characteristics and early functional exercise compliance. A total of 126 school-age children with limb fractures were finally included. There were 68, 36, and 22 children that were rated as easy-going, troublesome and initiate slow temperament, respectively. The children with easy-going temperament had the best early functional exercise compliance, followed by children with initiate slow temperament, and compliance of children with troublesome temperament was the worst. The reaction intensity factor in the temperament characteristics of school-age children with fracture was negatively correlated with early functional exercise compliance (P = .007). Reaction intensity was a risk factor for early functional exercise compliance in school-age children with fractures (P = .004). Health care providers must consider the influence of temperament characteristics on compliance in school-age children with fractures, and take targeted nursing measures according to different temperament characteristics of children to improve early functional exercise compliance in school-age children with fractures, so as to improve the functional recovery and prognosis of children.

Efficacy analysis of a double-Schanz screw external fixator combined with anti-rotating Kirschner wire in the treatment of proximal humerus fractures in skeletally immature patients

OBJECTIVES

The objective of this study is to evaluate the efficacy of a double-Schanz screw external fixator combined with anti-rotating Kirschner wire in the treatment of displaced Salter-Harris type II proximal humerus fractures in skeletally immature patients.

METHODS

A retrospective analysis was performed on 22 cases of displaced Salter-Harris type II proximal humerus fractures in skeletally immature patients who were treated with a double-Schanz screw external fixator combined with anti-rotating Kirschner wire. Patients included were the Neer-Horowitz (N-H) type 2, 3, and 4 of fracture. The basic information of the patients was recorded, fracture healing and shoulder range of motion were assessed at the last follow-up visit. The disabilities of the arm, hand (DASH) score and Constant-Murley score of the shoulder were performed to observe the occurrence of complications.

RESULTS

The mean age at the time of surgery was 12.41 years, and all patients completed a median follow-up of 18.18 months. There were two cases of N-H type 2, 12 cases of N-H type 3, and eight cases of N-H type 4 among the patients. At the last follow-up, all patients were able to achieve pain-free shoulder movement. There was no significant difference in shoulder function between the injured side and the uninjured side. The DASH score mean was 2.43 (95% CI 1.44-3.52). The constant score mean was 98.55 (95% CI 97.73-99.27). All patients returned to their pre-injury daily life and physical activities, and there was no significant difference in bilateral limb length at the last follow-up (p < 0.05). The most common complication of double-Schanz screw external fixator combined with anti-rotating Kirschner wire surgery was pin tract infection, which occurred in 5 cases (22.7%). There were no complications such as deep infections, vascular and nerve damage, failure of fixation, secondary fracture displacement, non-union of fracture, osteonecrosis of the humerus, joint stiffness, rotator cuff weakness and limb deformity.

CONCLUSION

The double-Schanz screw external fixator combined with anti-rotating Kirschner wire is a safe and effective treatment for displaced Salter-Harris type II proximal humerus fractures in skeletally immature patients over the age of 10 years.

Artificial intelligence for radiological paediatric fracture assessment: a systematic review

BACKGROUND

Majority of research and commercial efforts have focussed on use of artificial intelligence (AI) for fracture detection in adults, despite the greater long-term clinical and medicolegal implications of missed fractures in children. The objective of this study was to assess the available literature regarding diagnostic performance of AI tools for paediatric fracture assessment on imaging, and where available, how this compares with the performance of human readers.

MATERIALS AND METHODS

MEDLINE, Embase and Cochrane Library databases were queried for studies published between 1 January 2011 and 2021 using terms related to 'fracture', 'artificial intelligence', 'imaging' and 'children'. Risk of bias was assessed using a modified QUADAS-2 tool. Descriptive statistics for diagnostic accuracies were collated.

RESULTS

Nine eligible articles from 362 publications were included, with most (8/9) evaluating fracture detection on radiographs, with the elbow being the most common body part. Nearly all articles used data derived from a single institution, and used deep learning methodology with only a few (2/9) performing external validation. Accuracy rates generated by AI ranged from 88.8 to 97.9%. In two of the three articles where AI performance was compared to human readers, sensitivity rates for AI were marginally higher, but this was not statistically significant.

CONCLUSIONS

Wide heterogeneity in the literature with limited information on algorithm performance on external datasets makes it difficult to understand how such tools may generalise to a wider paediatric population. Further research using a multicentric dataset with real-world evaluation would help to better understand the impact of these tools.