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Raspopovic KM, Bankovic D, Petrovic A, Opancina V, Nikolic S, Vojinovic RH. Evaluation of Risk Factors for the Occurrence of Limb Fractures in Children Due to Unintentional Injury in Podgorica, Montenegro, Mediterranean. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:129. [PMID: 38256390 PMCID: PMC10820898 DOI: 10.3390/medicina60010129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/31/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Limb injuries in childhood are very common, with most of them being unintentional and often accompanied by soft tissue injuries. The aim of our study was to determine the risk factors that contribute to the occurrence of limb fractures as the most common type of accidental injury to children in our conditions. Materials and Methods: This study was designed as a prospective clinical analysis of predictive factors with a "nested" case-control study. It included all patients under the age of 18 who were diagnosed with unintentional limb injury and limb fracture due to accidental injury, at the Clinical Center of Montenegro, Podgorica, in the period of 7 January 2020-30 June 2021. Results: The gender of the child and the occurrence of the fracture are not related, and a statistically significant relationship was found between the occurrence of the fracture and the place of residence, the child's age, body mass index (BMI), the affected limb, the method of injury, and the mental state of the parents of the injured child, as well as their economic status. It was proved that the older the child was, the lower the chance of injury, while multivariate analysis proved that BMI could be a predictor of accidental fracture. The most common method of accidental limb fractures in children was a fall from a height. Conclusions: The analysis of factors that influence the occurrence of children's injuries is of great importance for public health. Such and similar research can enable a better understanding of the factors that influence accidental injuries, and therefore influence the prevention of these injuries by organizing various educational materials at the primary healthcare level or at the school level, for both children and parents.
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Affiliation(s)
- Katarina M. Raspopovic
- Institute for Children’s Diseases, Clinical Center of Montenegro, 81000 Podgorica, Montenegro;
| | - Dragic Bankovic
- Faculty of Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Aleksandra Petrovic
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Valentina Opancina
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Simon Nikolic
- Faculty of Medicine, University of Kosovska Mitrovica, 11000 Belgrade, Serbia;
| | - Radisa H. Vojinovic
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
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Wang H, Yuan H, Liu L, Wu D, Ou L, Li C, Yu H. Incidence, characteristics, and treatments of traumatic open fractures in children and adolescents: A retrospective observational study. Medicine (Baltimore) 2022; 101:e29828. [PMID: 35777018 PMCID: PMC9239622 DOI: 10.1097/md.0000000000029828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We aimed to investigate the incidence, characteristics, and treatments of open fractures in children and adolescents (≤18 years old). We retrospectively reviewed the records of 2418 children and adolescents who presented with traumatic fractures and were admitted to our university-affiliated hospitals, among which 206 patients (8.5%) presented with open fractures. The patients' clinical and radiographic records were reviewed, and the age, gender, cause of injury, injury season, injury week, associated injuries and complications were collected. This study enrolled 1789 males (74.0%) and 629 females (26.0%) with an average age of 11.2 ± 5.0 years. The patients were divided into an open fracture group (OF group, n = 206) and a group with no open fracture (No-OF group, n = 2212). There were 206 patients (8.5%) who presented with open fractures and the most common fracture sites were the tibia (31.1%, 64/206) and fibula (20.9%, 43/206). The patients in the OF group presented with higher frequency of emergency admission (P < 0.001), self-supporting medical insurance (P < 0.001), MVCs (P < 0.001), wounded by machine (P < 0.001), struck by object (P < 0.001), hurt/cut by others (P < 0.001), lower limb fractures (P < 0.001), multiple fractures (P = 0.010), associated injuries (P < 0.001) and wound infection (P = 0.003) then the patients in the No-OF group. The most common complication were wound infection (5.8%) and pneumonia (1.0%) in the OF group, wound infection (2.1%) and pressure sores (2.0%) in the No- OF group. Multivariate logistic regression analysis indicated that mechanical trauma (OR = 64.229, P < 0.001), being hurt/cut by others (OR = 26.757, P < 0.001), and being struck by an object (OR = 15.345, P < 0.001) were stronger risk factors for open fracture than were low falls; additionally, lower limb fractures (OR = 5.970, P < 0.001), upper limb fractures (OR = 5.865, P < 0.001) and multiple fractures (OR = 5.414, P < 0.001) were stronger risk factors than craniofacial fractures for open fractures. The frequency of surgical treatment for the patients with traumatic open fractures (87.9%, 181/206) was significantly higher than those without open fractures (72.2%, 1596/2212) (P < 0.001). The hospital stays and fees for surgical treatment for the patients with traumatic open fractures were significantly higher than those without open fractures (P < 0.001). Etiology (especially being injured by a machine or being hurt/cut by others) and the fracture site (including lower limb fractures and upper limb fractures) were independent risk factors for open fractures. Traumatic open fractures presented with higher surgical treatment rate, hospital stays and fees.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, China
| | - Hong Yuan
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, China
| | - Lu Liu
- Department of Research and Training, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, China
| | - Deluo Wu
- Department of Orthopedics, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China
| | - Lan Ou
- Department of Radiology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, China
- *Correspondence: Hailong Yu (e-mail: )
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The association of hand and wrist injuries with other injuries in multiple trauma patients. A retrospective study in a UK Major Trauma Centre. Injury 2021; 52:1778-1782. [PMID: 33883075 DOI: 10.1016/j.injury.2021.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Approximately 20,000 major trauma cases occur in England every year. However, the association with concomitant upper limb injuries is unknown. This study aims to determine the incidence, injury pattern and association of hand and wrist injuries with other body injuries and the Injury Severity Score (ISS) in multiply injured trauma patients. METHODS Single centre retrospective study was performed at a level-one UK Major Trauma Centre (MTC). Trauma Audit and Research Network (TARN) eligible multiply injured trauma patients that were admitted to the hospital between January 2014 and December 2018 were analysed. TARN is the national trauma registry. Eligible patients were: a trauma patient of any age who was admitted for 72 h or more, or was admitted to intensive care, or died at the hospital, was transferred into the hospital for specialist care, was transferred to another hospital for specialist care or for an intensive care bed and whose isolated injuries met a set of criteria. Data extracted included: age, gender, mode of arrival, location of injuries including: hand and/or wrist and mechanism of injury. We performed a logistic regression analysis to assess the association between hand/wrist injury to ISS score of 15 points or above/below and to the presentation of other injuries. RESULTS 107 patients were analysed. Hand and wrist injuries were the second most common injury (26.2%), after thoracic injuries. Distal radial injuries were found in 5.6%, carpal/carpometacarpal in 6.5%, concurrent distal radius and carpometacarpal in 0.9%, phalangeal injuries in 4.7%, tendon injuries in 0.9% and concurrent hand and wrist injuries in 7.5% cases. There was a significant association between hand or wrist injuries and lower limb injuries (Odds Ratio (OR): 3.84; 95% confidence intervals (CI): 1.09 to 13.50; p = 0.04) and pelvic injuries (OR: 4.78; 95% CI: 1.31 to 17.44; p = 0.02). There was no statistical association between hand and wrist injuries and ISS score (OR: 0.80; 95% CI: 0.11 to 5.79; p = 0.82). CONCLUSIONS Hand and wrist injuries are prevalent in trauma patients admitted to MTCs. They should not be under-estimated but routinely screened for in multiply injured patients particularly those with a pelvic or lower limb injury.
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Bergman E, Lempesis V, Jehpsson L, Rosengren BE, Karlsson MK. Time trends in pediatric hand fracture incidence in Malmö, Sweden, 1950-2016. J Orthop Surg Res 2021; 16:245. [PMID: 33836797 PMCID: PMC8034127 DOI: 10.1186/s13018-021-02380-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background The hand is the second most fractured region in children. It is therefore important to update fracture epidemiology to be able to identify time trends for adequate health care planning. This study reports pediatric hand fracture incidence 2014–2016 and, using published data, also long-term time trends in 1950–2016. Patients and methods The Swedish city of Malmö, with 328,494 inhabitants in 2016, has only one hospital. We used the hospital radiological archive, medical charts, and diagnosis registry to identify hand fractures in city residents < 16 years in 2014–2016. These data were compared to those from three published studies that evaluated periods in 1950–2006. Differences between two periods were calculated as both unadjusted and age- and sex-adjusted incident rate ratios (IRR) with 95% confidence intervals (95% CI). We used joinpoint regression to estimate time trends during the entire period and present annual percent changes (APC) with 95% CI. Results In 2014–2016 phalangeal fractures accounted for 71% of all hand fractures, metacarpal fractures for 24%, and carpal fractures for 5%. We identified 615 hand fractures (419 in boys and 196 in girls) during 181,617 person-years in 2014–2016, resulting in an unadjusted pediatric hand fracture incidence of 339/100,000 person-years (boys 452/100,000 person-years and girls 220/100,000 person-years). The age-adjusted incidence 2014–2016 was similar to 2005–2006, the most recently evaluated period (IRR in boys 0.9; 95% CI 0.8 to 1.01, and in girls 1.0; 95% CI 0.8 to 1.2). Looking at the entire period 1950–2016, we found that age-adjusted incidence increased in 1950–1979, in boys by APC + 3.8%; 95% CI 3.0 to 4.5 and in girls by + 3.9%; 95% CI 2.8 to 5.0, but decreased in 1979–2016, in boys by − 0.7%; 95% CI − 1.4 to − 0.003, and girls by − 1.3%; 95% CI − 2.4 to − 0.1. Conclusions Phalangeal fractures accounted for about three quarters of all hand fractures. The age-adjusted hand fracture incidence increased in both sexes in 1950–1979 and decreased in 1979–2016. Level of evidence III Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02380-y.
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Affiliation(s)
- Erika Bergman
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden.
| | - Vasileios Lempesis
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Lars Jehpsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
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Zhang H, Tai H, Ma Y, Li Y, Dang Z, Wang J, Zhao L. Postoperative Serum Levels of Interleukin-1β (IL-1β), Interleukin-17 (IL-17), and Tumor Necrosis Factor-α (TNF-α) in Patients Following Hip Replacement Surgery for Traumatic Fractured Femoral Neck: A Retrospective Study. Med Sci Monit 2019; 25:6120-6127. [PMID: 31417072 PMCID: PMC6708283 DOI: 10.12659/msm.915369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background This study aimed to investigate the clinical significance of postoperative serum levels of interleukin-1β (IL-1β), interleukin-17 (IL-17), and tumor necrosis factor-α (TNF-α) in patients who required hip replacement surgery for traumatic fractured neck of femur. Material/Methods A retrospective study included 180 patients who had hip replacement surgery for traumatic fractured neck of femur and a control group of 100 patients. Differences between the two groups were compared for serum levels of IL-1β, IL-17, and TNF-α, and the Harris Hip Score (HHS) (maximum 100 points) using Pearson’s correlation. Results Serum levels of IL-1β, IL-17, and TNF-α in the control group were significantly lower than those in the study group (P<0.05). According to the HHS, there were 53 patients in the excellent group, 65 patients in the good group, 43 patients in the fair group and 19 patients in the poor group. Postoperative indicator analysis showed significant differences in IL-1β, IL-17, and TNF-α levels between the four groups (P<0.05). Clinical indicators increased from the excellent group to the poor group, with significant differences between the four groups (P<0.05). Postoperative levels of IL-1β, IL-17, and TNF-α were significantly decreased (P<0.05). Pearson’s correlation analysis showed a significant correlation with the clinical indicators (P<0.05). Conclusions In patients with hip replacement surgery for traumatic fractured neck of femur, measurement of postoperative serum levels of IL-1β, IL-17, and TNF-α were shown to be potential prognostic indicators.
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Affiliation(s)
- Hui Zhang
- Department of Orthopedics, Gansu Provincial Hospital West Campus, Lanzhou, Gansu, China (mainland)
| | - Huiping Tai
- Department of Orthopedics, Gansu Provincial Hospital West Campus, Lanzhou, Gansu, China (mainland)
| | - Yuhong Ma
- The Second Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, Gansu, China (mainland)
| | - Yan Li
- Department of Orthopedics, Gansu Provincial Hospital West Campus, Lanzhou, Gansu, China (mainland)
| | - Zongping Dang
- Department of Orthopedics, Gansu Provincial Hospital West Campus, Lanzhou, Gansu, China (mainland)
| | - Junkai Wang
- Department of Orthopedics, Gansu Provincial Hospital West Campus, Lanzhou, Gansu, China (mainland)
| | - Lin Zhao
- Department of Orthopedics, Gansu Provincial Hospital West Campus, Lanzhou, Gansu, China (mainland)
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Xu AA, Breeze JL, Jackson CCA, Paulus JK, Bugaev N. Comparative analysis of traumatic esophageal injury in pediatric and adult populations. Pediatr Surg Int 2019; 35:793-801. [PMID: 31076868 DOI: 10.1007/s00383-019-04481-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Distribution and outcomes of traumatic injury of the esophagus (TIE) in pediatric versus adult populations are unknown. Our study sought to perform a descriptive analysis of TIE in children and adults. METHODS We reviewed the National Trauma Data Bank (NTDB) for the years 2010-2015. Demographics, characteristics, and outcomes of pediatric (age < 16 years) and adult TIE patients were described and compared. RESULTS Among 526,850 pediatric and 3,838,895 adult trauma patients, 90 pediatric (0.02%) and 1,411 (0.04%) adult TIE patients were identified. Demographics and esophageal injury severity did not differ. Children were more likely to sustain blunt trauma (63% versus 37%), with the most common mechanism being transportation-related accidents, were less-severely injured (median ISS 14 versus 22), and had fewer associated injuries (79% versus 95%) and complications (30% versus 51%) (all p < 0.001). Children had shorter hospitalizations (median 5 versus 10 days) and were more likely to be discharged home (84% versus 64%) (both p = 0.01). In-hospital mortality did not differ significantly between children and adults (10% versus 19%, p = 0.09). CONCLUSION TIE in the pediatric population has unique characteristics compared to adults: it is more likely to be a result of blunt trauma, has lower injury burden, and has more favorable clinical outcomes.
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Affiliation(s)
| | - Janis L Breeze
- Tufts Clinical and Translational Science Institute, Tufts University, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Carl-Christian A Jackson
- Floating Hospital for Children at Tufts Medical Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Jessica K Paulus
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA, USA
| | - Nikolay Bugaev
- Division of Trauma and Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St, #4488, Boston, MA, 02111, USA.
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Epidemiological investigation of traumatic upper extremity fractures in children who applied to emergency department. JOURNAL OF CONTEMPORARY MEDICINE 2018. [DOI: 10.16899/gopctd.454562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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