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Ahmed A, Imran AS, Kastrati Z, Daudpota SM, Ullah M, Noor W. Learning from the few: Fine-grained approach to pediatric wrist pathology recognition on a limited dataset. Comput Biol Med 2024; 181:109044. [PMID: 39180859 DOI: 10.1016/j.compbiomed.2024.109044] [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] [Received: 11/01/2023] [Revised: 05/25/2024] [Accepted: 08/17/2024] [Indexed: 08/27/2024]
Abstract
Wrist pathologies, particularly fractures common among children and adolescents, present a critical diagnostic challenge. While X-ray imaging remains a prevalent diagnostic tool, the increasing misinterpretation rates highlight the need for more accurate analysis, especially considering the lack of specialized training among many surgeons and physicians. Recent advancements in deep convolutional neural networks offer promise in automating pathology detection in trauma X-rays. However, distinguishing subtle variations between pediatric wrist pathologies in X-rays remains challenging. Traditional manual annotation, though effective, is laborious, costly, and requires specialized expertise. In this paper, we address the challenge of pediatric wrist pathology recognition with a fine-grained approach, aimed at automatically identifying discriminative regions in X-rays without manual intervention. We refine our fine-grained architecture through ablation analysis and the integration of LION. Leveraging Grad-CAM, an explainable AI technique, we highlight these regions. Despite using limited data, reflective of real-world medical study constraints, our method consistently outperforms state-of-the-art image recognition models on both augmented and original (challenging) test sets. Our proposed refined architecture achieves an increase in accuracy of 1.06% and 1.25% compared to the baseline method, resulting in accuracies of 86% and 84%, respectively. Moreover, our approach demonstrates the highest fracture sensitivity of 97%, highlighting its potential to enhance wrist pathology recognition.
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Affiliation(s)
- Ammar Ahmed
- Intelligent Systems and Analytics (ISA) Research Group, Department of Computer Science (IDI), Norwegian University of Science & Technology (NTNU), Gjøvik, 2815, Norway.
| | - Ali Shariq Imran
- Intelligent Systems and Analytics (ISA) Research Group, Department of Computer Science (IDI), Norwegian University of Science & Technology (NTNU), Gjøvik, 2815, Norway.
| | - Zenun Kastrati
- Department of Informatics, Linnaeus University, Växjö, 351 95, Sweden.
| | | | - Mohib Ullah
- Intelligent Systems and Analytics (ISA) Research Group, Department of Computer Science (IDI), Norwegian University of Science & Technology (NTNU), Gjøvik, 2815, Norway.
| | - Waheed Noor
- Department of Computer Science & Information Technology, University of Balochistan, Quetta, 87300, Pakistan.
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Cassidy BP, Yeramosu T, Mbomuwa FJ, Chidothi P, Wu HH, Martin C, Harrison WJ, Chokotho L, Agarwal-Harding KJ. Epidemiology and Management of Pediatric Fractures in Malawi. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202407000-00013. [PMID: 39042502 PMCID: PMC11254115 DOI: 10.5435/jaaosglobal-d-24-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/29/2024] [Accepted: 06/07/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Pediatric fractures are common in Malawi, and surgical care, when needed, remains inaccessible to many. Understanding which children in Malawi receive surgery or nonsurgical treatment would help set priorities for trauma system development. METHODS We used multivariate logistic regression to evaluate associations between surgical treatment and age, sex, school enrollment, injury mechanism, fracture type, open fracture, referral status, hospital of presentation, delayed presentation (≥2 days), healthcare provider, and inpatient vs outpatient treatment. RESULTS From 2016 to 2020, 10,400 pediatric fractures were recorded in the Malawi Fracture Registry. Fractures were most commonly of the wrist (26%), forearm (17%), and elbow (14%). Surgical fixation was performed on 4.0% of patients, and 24 (13.0%) open fractures were treated nonsurgically, without débridement or fixation. Fractures of the proximal and diaphyseal humerus (odds ratio [OR], 3.72; 95% confidence interval [CI], 2.36 to 5.87), knee (OR, 3.16; 95% CI, 1.68 to 5.95), and ankle (OR, 2.63; 95% CI, 1.49 to 4.63) had highest odds of surgery. Odds of surgical treatment were lower for children referred from another facility (OR, 0.62; 95% CI, 0.49 to 0.77). CONCLUSIONS Most Malawian children with fractures are treated nonsurgically, including many who may benefit from surgery. There is a need to increase surgical capacity, optimize referral patterns, and standardize fracture management in Malawi.
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Affiliation(s)
- Benjamin P. Cassidy
- From the Virginia Commonwealth University, Richmond, VA (Mr. Cassidy and Mr. Yeramosu); the Harvard Global Orthopaedics Collaborative, Boston, MA (Mr. Cassidy, Mr. Yeramosu, Dr. Wu, and Dr. Agarwal-Harding); the Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi (Mr. Mbomuwa and Mr. Chidothi); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wu); the AO Alliance Foundation, Davos, Switzerland (Dr. Martin and Dr. Harrison); the Countess of Chester Hospital NHS Trust, Chester, United Kingdom (Dr. Harrison); the Malawi University of Science and Technology, Limbe, Malawi (Dr. Chokotho); and the Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr. Agarwal-Harding)
| | - Teja Yeramosu
- From the Virginia Commonwealth University, Richmond, VA (Mr. Cassidy and Mr. Yeramosu); the Harvard Global Orthopaedics Collaborative, Boston, MA (Mr. Cassidy, Mr. Yeramosu, Dr. Wu, and Dr. Agarwal-Harding); the Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi (Mr. Mbomuwa and Mr. Chidothi); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wu); the AO Alliance Foundation, Davos, Switzerland (Dr. Martin and Dr. Harrison); the Countess of Chester Hospital NHS Trust, Chester, United Kingdom (Dr. Harrison); the Malawi University of Science and Technology, Limbe, Malawi (Dr. Chokotho); and the Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr. Agarwal-Harding)
| | - Foster J. Mbomuwa
- From the Virginia Commonwealth University, Richmond, VA (Mr. Cassidy and Mr. Yeramosu); the Harvard Global Orthopaedics Collaborative, Boston, MA (Mr. Cassidy, Mr. Yeramosu, Dr. Wu, and Dr. Agarwal-Harding); the Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi (Mr. Mbomuwa and Mr. Chidothi); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wu); the AO Alliance Foundation, Davos, Switzerland (Dr. Martin and Dr. Harrison); the Countess of Chester Hospital NHS Trust, Chester, United Kingdom (Dr. Harrison); the Malawi University of Science and Technology, Limbe, Malawi (Dr. Chokotho); and the Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr. Agarwal-Harding)
| | - Paul Chidothi
- From the Virginia Commonwealth University, Richmond, VA (Mr. Cassidy and Mr. Yeramosu); the Harvard Global Orthopaedics Collaborative, Boston, MA (Mr. Cassidy, Mr. Yeramosu, Dr. Wu, and Dr. Agarwal-Harding); the Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi (Mr. Mbomuwa and Mr. Chidothi); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wu); the AO Alliance Foundation, Davos, Switzerland (Dr. Martin and Dr. Harrison); the Countess of Chester Hospital NHS Trust, Chester, United Kingdom (Dr. Harrison); the Malawi University of Science and Technology, Limbe, Malawi (Dr. Chokotho); and the Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr. Agarwal-Harding)
| | - Hao-Hua Wu
- From the Virginia Commonwealth University, Richmond, VA (Mr. Cassidy and Mr. Yeramosu); the Harvard Global Orthopaedics Collaborative, Boston, MA (Mr. Cassidy, Mr. Yeramosu, Dr. Wu, and Dr. Agarwal-Harding); the Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi (Mr. Mbomuwa and Mr. Chidothi); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wu); the AO Alliance Foundation, Davos, Switzerland (Dr. Martin and Dr. Harrison); the Countess of Chester Hospital NHS Trust, Chester, United Kingdom (Dr. Harrison); the Malawi University of Science and Technology, Limbe, Malawi (Dr. Chokotho); and the Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr. Agarwal-Harding)
| | - Claude Martin
- From the Virginia Commonwealth University, Richmond, VA (Mr. Cassidy and Mr. Yeramosu); the Harvard Global Orthopaedics Collaborative, Boston, MA (Mr. Cassidy, Mr. Yeramosu, Dr. Wu, and Dr. Agarwal-Harding); the Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi (Mr. Mbomuwa and Mr. Chidothi); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wu); the AO Alliance Foundation, Davos, Switzerland (Dr. Martin and Dr. Harrison); the Countess of Chester Hospital NHS Trust, Chester, United Kingdom (Dr. Harrison); the Malawi University of Science and Technology, Limbe, Malawi (Dr. Chokotho); and the Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr. Agarwal-Harding)
| | - William James Harrison
- From the Virginia Commonwealth University, Richmond, VA (Mr. Cassidy and Mr. Yeramosu); the Harvard Global Orthopaedics Collaborative, Boston, MA (Mr. Cassidy, Mr. Yeramosu, Dr. Wu, and Dr. Agarwal-Harding); the Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi (Mr. Mbomuwa and Mr. Chidothi); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wu); the AO Alliance Foundation, Davos, Switzerland (Dr. Martin and Dr. Harrison); the Countess of Chester Hospital NHS Trust, Chester, United Kingdom (Dr. Harrison); the Malawi University of Science and Technology, Limbe, Malawi (Dr. Chokotho); and the Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr. Agarwal-Harding)
| | - Linda Chokotho
- From the Virginia Commonwealth University, Richmond, VA (Mr. Cassidy and Mr. Yeramosu); the Harvard Global Orthopaedics Collaborative, Boston, MA (Mr. Cassidy, Mr. Yeramosu, Dr. Wu, and Dr. Agarwal-Harding); the Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi (Mr. Mbomuwa and Mr. Chidothi); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wu); the AO Alliance Foundation, Davos, Switzerland (Dr. Martin and Dr. Harrison); the Countess of Chester Hospital NHS Trust, Chester, United Kingdom (Dr. Harrison); the Malawi University of Science and Technology, Limbe, Malawi (Dr. Chokotho); and the Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr. Agarwal-Harding)
| | - Kiran J. Agarwal-Harding
- From the Virginia Commonwealth University, Richmond, VA (Mr. Cassidy and Mr. Yeramosu); the Harvard Global Orthopaedics Collaborative, Boston, MA (Mr. Cassidy, Mr. Yeramosu, Dr. Wu, and Dr. Agarwal-Harding); the Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi (Mr. Mbomuwa and Mr. Chidothi); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wu); the AO Alliance Foundation, Davos, Switzerland (Dr. Martin and Dr. Harrison); the Countess of Chester Hospital NHS Trust, Chester, United Kingdom (Dr. Harrison); the Malawi University of Science and Technology, Limbe, Malawi (Dr. Chokotho); and the Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr. Agarwal-Harding)
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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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Soerensen S, Larsen P, Korup LR, Ceccotti AA, Larsen MB, Filtenborg JT, Weighert KP, Elsoe R. Epidemiology of Distal Forearm Fracture: A Population-Based Study of 5426 Fractures. Hand (N Y) 2024; 19:24-29. [PMID: 35856325 PMCID: PMC10786118 DOI: 10.1177/15589447221109967] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite intensive research into the epidemiology of adult distal forearm fractures, the literature is limited. This study aimed to provide a full overview of adult distal forearm fracture epidemiology, including incidence, fracture classification, mode of injury, and trauma mechanism in patients sustaining a distal forearm fracture, based on an accurate at-risk population with manually validated data leading to a high quality in data. METHODS This was a population-based cohort study with a manual review of X-rays and charts. The primary outcome measure was the incidence of adult distal forearm fractures. The study was based on an average at-risk population of 522 607 citizens. A total of 5426 adult distal forearm fractures were included during the study period. Females accounted for 4199 (77%) and males accounted for 1227 (23%) of fractures. RESULTS The overall incidence of adult distal forearm fractures was 207.7/100 000/year. Female incidence was 323.4/100 000/year, and male incidence was 93.3/100 000/year. A marked increase in incidence with increasing age was observed for females after 50 years of age. The incidence of distal radius fractures was 203.0/100 000/year, and the incidence of isolated ulna fractures was 3.8/100 000/year. The most common fracture type was an extra-articular AO type 2R3A (69%), and the most common mode of injury was a fall from own height (76%). A small non-trending year-to-year variation was observed during the 5-year study period. CONCLUSION Results show that adult distal forearm fractures are very common in women after the postmenopausal period. The overall incidence of adult distal forearm fractures was 207.8/100 000/year. Female incidence was 323.4/100 000/year.
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Ju RY, Cai W. Fracture detection in pediatric wrist trauma X-ray images using YOLOv8 algorithm. Sci Rep 2023; 13:20077. [PMID: 37973984 PMCID: PMC10654405 DOI: 10.1038/s41598-023-47460-7] [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] [Received: 05/16/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023] Open
Abstract
Hospital emergency departments frequently receive lots of bone fracture cases, with pediatric wrist trauma fracture accounting for the majority of them. Before pediatric surgeons perform surgery, they need to ask patients how the fracture occurred and analyze the fracture situation by interpreting X-ray images. The interpretation of X-ray images often requires a combination of techniques from radiologists and surgeons, which requires time-consuming specialized training. With the rise of deep learning in the field of computer vision, network models applying for fracture detection has become an important research topic. In this paper, we use data augmentation to improve the model performance of YOLOv8 algorithm (the latest version of You Only Look Once) on a pediatric wrist trauma X-ray dataset (GRAZPEDWRI-DX), which is a public dataset. The experimental results show that our model has reached the state-of-the-art (SOTA) mean average precision (mAP 50). Specifically, mAP 50 of our model is 0.638, which is significantly higher than the 0.634 and 0.636 of the improved YOLOv7 and original YOLOv8 models. To enable surgeons to use our model for fracture detection on pediatric wrist trauma X-ray images, we have designed the application "Fracture Detection Using YOLOv8 App" to assist surgeons in diagnosing fractures, reducing the probability of error analysis, and providing more useful information for surgery.
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Affiliation(s)
- Rui-Yang Ju
- Graduate Institute of Networking and Multimedia, National Taiwan University, Taipei City, 106335, Taiwan
| | - Weiming Cai
- Department of Hand and Foot Surgery, Jingjiang People's Hospital, Jingjiang City, 214500, China.
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Park H, Kang H, Yoon S, Jeong S, Lee S. The Effect of the COVID-19 Pandemic on Early Adolescent Fractures in the Republic of Korea. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1671. [PMID: 37763789 PMCID: PMC10537179 DOI: 10.3390/medicina59091671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Restrictions on daily activities to slow down the propagation of COVID-19 have changed the epidemiological pattern of pediatric fractures in many countries. However, the effect of the pandemic on pediatric fractures has not been fully studied. In this study, we investigated the impact of COVID-19 on early adolescent fractures in Korea. Materials and methods: We conducted a retrospective follow-up on a nationwide cohort of Korean early adolescents born between 2006 and 2009. The prevalence and incidence of pediatric fractures and the frequency of surgical treatment were compared between two different eras. Results: The prevalence and incidence of fractures during the pandemic have both shown a significant decrease: prevalence reduced from 34,626 to 24,789 (p < 0.001), while incidence decreased from 29,804 to 18,898 (p < 0.001). Considering sex, the shift in fracture prevalence was statistically significant (p = 0.020), whereas the incidence was not (p = 0.862). The decline in both fracture prevalence and incidence exhibited significant variation across birth year groups (prevalence, p < 0.001; incidence, p < 0.001), with a more pronounced reduction observed in the older age groups. While the proportion of patients who required surgeries has increased, the mean frequency of surgical treatment per patient remained at a similar level (by prevalence, p = 0.181; by incidence, p = 0.735). The decline in both fracture prevalence and incidence has shown significant variation in relation to fracture sites (prevalence, p < 0.001; incidence, p < 0.001), with a decrease in distal limb fractures and an increase in forearm and axial body fractures. Conclusions: The pediatric fracture pattern in Korea has been notably influenced by the COVID-19 pandemic, warranting further investigation into causal factors. Our findings should help predict epidemiology in the post-pandemic period and thus aid policymaking and patient management.
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Affiliation(s)
- HyunSeo Park
- CHA University School of Medicine, 120 Hyeryong-ro, Pocheon-si 11160, Gyeonggi-do, Republic of Korea; (H.P.); (H.K.)
| | - Hogyeong Kang
- CHA University School of Medicine, 120 Hyeryong-ro, Pocheon-si 11160, Gyeonggi-do, Republic of Korea; (H.P.); (H.K.)
| | - Siyeong Yoon
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea; (S.Y.); (S.J.)
| | - Simho Jeong
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea; (S.Y.); (S.J.)
| | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea; (S.Y.); (S.J.)
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Van Scoy GK, Sajadi KR, Uhl TL. Consequences of delayed surgical intervention of a displaced midshaft clavicle fracture: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:410-415. [PMID: 37588482 PMCID: PMC10426505 DOI: 10.1016/j.xrrt.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
| | | | - Tim L. Uhl
- Department of Physical Therapy, University of Kentucky, Lexington, KY, USA
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Ando J, Takahashi T, Ae R, Ajiki T, Matsumura T, Sasao W, Abe M, Takeshita K. Epidemiology of distal radius fracture: a regional population-based study in Japan. BMC Musculoskelet Disord 2023; 24:478. [PMID: 37312071 DOI: 10.1186/s12891-023-06608-2] [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: 03/26/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Distal radius fracture (DRF) is very common worldwide. In particular, aging countries have numerous patients with DRF, resulting in an urgent need for active preventive measures. As few epidemiological studies have investigated DRF in Japan, we aimed to identify the epidemiological characteristics of patients of all ages with DRF in Japan. METHODS This descriptive epidemiologic study analyzed data obtained from clinical information of patients diagnosed with DRF from January 1, 2011, to December 31, 2020, at a prefectural hospital in Hokkaido, Japan. We calculated the crude and age-adjusted annual incidences of DRF and described the age-specific incidence, injury characteristics (injury location and cause, seasonal differences, and fracture classification), and 1- and 5-year mortality rates. RESULTS A total of 258 patients with DRF were identified, of which 190 (73.6%) were female and the mean age (standard deviation) was 67.0 (21.5) years. The crude annual incidence of DRF ranged from 158.0 to 272.6 per 100,000 population/year, and the age-adjusted incidence among female patients demonstrated a significant decreasing trend during 2011-2020 (Poisson regression analysis; p = 0.043). The age-specific incidence differed by sex, with peaks at 10-14 years for males and 75-79 years for females. The most common cause of injury was a simple fall in patients > 15 year of age and sports injuries in patients ≤ 15 years of age. DRFs were most frequently sustained outdoors and were more common in the winter season. In patients > 15 years of age, the proportions of AO/OTA fracture types A, B, and C were 78.7% (184/234), 1.7% (4/234), and 19.6% (46/234), respectively, and 29.1% (68/234) of patients received surgical treatment for DRF. The 1- and 5-year mortality rates were 2.8% and 11.9%, respectively. CONCLUSIONS Our findings were mostly consistent with previous global studies. Although the crude annual incidence of DRF was relatively high because of recent population aging, the age-adjusted annual incidence among female patients showed a significant decreasing trend during this decade.
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Affiliation(s)
- Jiro Ando
- Department of Orthopedics, School of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Tsuneari Takahashi
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimokoyama 1-15-4, Shimotsuke, Tochigi, 329-0502, Japan.
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Takashi Ajiki
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimokoyama 1-15-4, Shimotsuke, Tochigi, 329-0502, Japan
| | - Tomohiro Matsumura
- Jichi Medical University Hospital Life Saving Emergency Center, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Wataru Sasao
- Hokkaido Prefecture Haboro Hospital, Hokkaido, Sakaemachi 110, Haborochou, Tomamaegun, Hokkaido, 078-4197, Japan
| | - Masahiko Abe
- Hokkaido Prefecture Haboro Hospital, Hokkaido, Sakaemachi 110, Haborochou, Tomamaegun, Hokkaido, 078-4197, Japan
| | - Katsushi Takeshita
- Department of Orthopedics, School of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
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Schuetze K, Pankratz C, Schütze S, Zieger J, Gebhard F, Cintean R. Road Traffic Accidents, Climbing Frames, or Trampolines: What Harms Children in the 2020s? Cureus 2023; 15:e35781. [PMID: 37025721 PMCID: PMC10072073 DOI: 10.7759/cureus.35781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 03/07/2023] Open
Abstract
Background In the modern Western world, activities and the daily routine of children have changed over time. Detailed analyses of the mechanisms of injuries and current fracture patterns in children are rare. The aim of the study was to elicit and investigate the most dangerous leisure and sporting activities leading to fractures in children today. Materials and methods This is a retrospective study focusing on children that were treated in a level-one trauma center in Germany between 2015 and 2020. All children who were 14 years of age or younger and suffered a traumatic injury treated in our emergency department were included in this study. From the database, mechanisms of injury, type of injury, age, and gender were analyzed. Results The study included 12508 patients, including 7302 males and 5206 females. Among the 10 most common mechanisms of injury were collisions (8.6%), falls (7.7%), injuries while playing (6.1%) or while running or walking (5.9%), soccer (5.9%), bicycle accidents (3.8%), and trampoline falls (3.4%). Road traffic accidents involving passengers or pedestrians caused 3.3% of the injuries but were the most common cause of death. The most common mechanisms of injury causing a fracture were falls, playing soccer, and bicycle accidents. Sorting the mechanisms of injury by the percentage that caused a fracture, the most dangerous activities were falling from heights above 2 meters, skiing and snowboarding, climbing and bouldering, skateboarding, and horseback riding. In the five-year study period, four out of six children died due to road traffic accidents. Conclusion Injured children must be provided with the best quality of care 24/7 in orthopedic trauma departments and have to be kept as a focus in the training of orthopedic trauma surgeons. Road traffic accidents are still the main cause of death in children, but they are overall less common. Falls and sports activities are the most likely to cause a fracture.
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Bolzinger M, Lopin G, Accadbled F, Sales de Gauzy J, Compagnon R. [Pediatric traumatology in "green zone" during Covid-19 lockdown: A single-center study]. REVUE DE CHIRURGIE ORTHOPEDIQUE ET TRAUMATOLOGIQUE 2023; 109:36-40. [PMID: 34188721 PMCID: PMC8229904 DOI: 10.1016/j.rcot.2021.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/28/2020] [Indexed: 02/02/2023]
Abstract
Introduction La période de confinement de 8 semaines, imposée en raison de l’épidémie liée au Covid-19, a entraîné une restriction de la circulation, un arrêt de la scolarité et des activités sportives. Notre hypothèse est que cette situation inédite a modifié temporairement l’épidémiologie des traumatismes chez l’enfant. Matériel et méthode Il s’agit d’une étude prospective réalisée pendant les 8 semaines de confinement. L’activité d’urgence traumatologique pédiatrique a été comparée à l’activité des 3 années précédentes à la même période. Résultats Pendant le confinement, le taux de passage aux urgences a diminué de 50 %. Le taux de patients opérés représentait 86 % par rapport aux 3 années précédentes. Les patients opérés pendant le confinement avaient une moyenne d’âge de 7,6 ans (âge médian 7,5) contre 9,3 ans (âge médian 9,4) les années précédentes. On notait une augmentation des accidents domestiques (59 % versus 23 %) et des accidents de trampoline (16 % versus 5 %), et une diminution des accidents de sport et des accidents de locomotion. Les plaies étaient plus fréquentes en période de confinement, représentant 35 % des actes chirurgicaux contre 13 % les années précédentes. Le nombre de patients opérés pour fracture au membre supérieur a diminué alors qu’il restait similaire pour le membre inférieur. Les fractures distales de l’avant-bras étaient moins fréquentes, ainsi que les fractures distales de jambe. Discussion Notre étude a montré pendant le confinement une réduction de 50 % de l’activité de traumatologie aux urgences sans diminution de l’activité au bloc opératoire. En cas de nouvelle période de confinement, nous recommanderions une réorganisation de l’accueil aux urgences permettant de libérer des équipes pour l’accueil des patients Covid-19; et le maintien d’un bloc opératoire pour les urgences chirurgicales. Une information pourrait être proposée au public pour la prévention des accidents domestiques, ainsi que des risques liés aux activités de trampoline. Niveau de preuve III.
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Affiliation(s)
- Manon Bolzinger
- Service d’Orthopédie, Hôpital des Enfants, 330, avenue de grande bretagne, 31300 Toulouse, France,Auteur correspondant
| | | | - Franck Accadbled
- Service d’Orthopédie, Hôpital des Enfants, 330, avenue de grande bretagne, 31300 Toulouse, France
| | - Jérôme Sales de Gauzy
- Service d’Orthopédie, Hôpital des Enfants, 330, avenue de grande bretagne, 31300 Toulouse, France
| | - Roxane Compagnon
- Service d’Orthopédie, Hôpital des Enfants, 330, avenue de grande bretagne, 31300 Toulouse, France
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Bolzinger M, Lopin G, Accadbled F, Sales de Gauzy J, Compagnon R. Pediatric traumatology in "green zone" during Covid-19 lockdown: A single-center study. Orthop Traumatol Surg Res 2023; 109:102946. [PMID: 33901717 PMCID: PMC8064820 DOI: 10.1016/j.otsr.2021.102946] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The 8-week lockdown for the Covid-19 epidemic in France restricted travel, and interrupted schooling and sports. The study hypothesis was that this exceptional situation temporarily altered childhood trauma epidemiology. MATERIAL AND METHOD A prospective study was performed during the 8 weeks of lockdown. Pediatric traumatology emergency activity was compared to that during the same period in the previous 3 years. RESULTS During lockdown, emergency consultations decreased by 50%. The number of patients operated on was 86% of that in the previous 3 years. Patients operated on during lockdown had a mean age of 7.6 years (median, 7.5 years) compared to 9.3 years (9.4 years). The rate of domestic accidents (59% versus 23%) and trampoline accidents (16% versus 5%) increased, while those of sport and locomotion-related accidents decreased. Wounds were more frequent, at 35% of procedures, versus 13% previously. The rate of surgery for upper-limb fracture deceased, while that of lower-limb fracture was unchanged. Distal forearm fracture was less frequent, as was distal tibial fracture. DISCUSSION The present study found a 50% decrease in pediatric traumatology emergency activity during lockdown, without decrease in surgery. In case of renewed lockdown, we recommend reorganizing emergency admission to free teams for management of Covid-19 patients, while maintaining operative rooms for emergency surgery. A general public information campaign could help prevent domestic accidents and risk related to use of trampolines. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Manon Bolzinger
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France,Corresponding author
| | | | - Franck Accadbled
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France
| | - Jérôme Sales de Gauzy
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France
| | - Roxane Compagnon
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France
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Descriptive Epidemiology of Isolated Distal Radius Fractures in Children: Results From a Prospective Multicenter Registry. J Pediatr Orthop 2023; 43:e1-e8. [PMID: 36299238 DOI: 10.1097/bpo.0000000000002288] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION More than 1 in 4 pediatric fractures involves the distal radius. Most prior epidemiologic studies are limited to retrospective, single center investigations, and often include adults. This study aims to describe the contemporary epidemiology of pediatric distal radius fractures using prospectively collected data from a multicenter Pediatric Distal Radius Fracture Registry. METHODS Patients aged 4 to 18 years diagnosed with a distal radius fracture from June 2018 through December 2019 at 4 tertiary care pediatric centers were screened and enrolled in this prospective longitudinal cohort study. Patients were excluded if they presented with bilateral distal radius fractures, polytrauma, or re-fracture. Demographic information, mechanism of injury, fracture characteristics, associated injuries, and procedural information were recorded. All radiographs were reviewed and measured. Descriptive statistics and bivariate analyses were performed. RESULTS A total of 1951 patients were included. The mean age was 9.9±3.3 years, and 61.3% of patients were male ( P <0.001). Most injuries occurred during a high-energy fall (33.5%) or sports participation (28.4%). The greatest proportion of fractures occurred during the spring months (38.5%). Torus fractures (44.0%) were more common than bicortical (31.3%) or physeal (21.0%) fractures. Of the physeal fractures, 84.3% were Salter-Harris type II. Associated ulnar fractures were observed in 51.2% of patients. The mean age at injury was higher for patients with physeal fractures (11.6±2.9 y) than patients with torus or bicortical fractures (9.4±3.1 and 9.6±3.1 y, respectively; P <0.001). Thirty-six percent of distal radius fractures underwent closed reduction and 3.3% underwent surgical fixation. Patients treated with closed reduction were more likely to be male (68.7% vs. 57.2%; P <0.001), obese (25.3% vs. 17.2%; P <0.001), and have bicortical fractures (62.2% vs. 14.5%; P <0.001). CONCLUSIONS Distal radius fractures in children have a male preponderance and are most likely to occur in the spring months and during high-energy falls and sports. Physeal fractures tend to occur in older children while torus and bicortical fractures tend to occur in younger children. LEVEL OF EVIDENCE Level I-prognostic.
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Cintean R, Eickhoff A, Zieger J, Gebhard F, Schütze K. Epidemiology, patterns, and mechanisms of pediatric trauma: a review of 12,508 patients. Eur J Trauma Emerg Surg 2023; 49:451-459. [PMID: 36001123 PMCID: PMC9925538 DOI: 10.1007/s00068-022-02088-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pediatric traumas are common and remain a unique challenge for trauma surgeons. Demographic data provide a crucial source of information to better understand mechanisms and patterns of injury. The aim of this study was to provide this information to improve treatment strategies of potentially preventable morbidity and mortality in children. MATERIAL AND METHODS A retrospective review of every pediatric trauma treated in the emergency department (ED) between 2015 and 2019 was performed. Inclusion criteria were the age between 0 and 14 years and admission to the ED after trauma. Demographic data, time of presentation, mechanism of injury and pattern of injury, treatment, and outcome were analyzed. Different injury patterns were assessed in relation to age group, sex, mechanism of injury and treatment. RESULTS A total of 12,508 patients were included in this study. All patients were stratified into five age groups: babies under the age of 1 (8.8%), toddlers between 1 and 3 (16.8%), preschool children between 4 and 6 (19.3%), young school children between 7 and 10 (27.1%), and young adolescents between 11 and 14 (27.9%). The predominant sex in all age groups was male. 47.7% of patients were admitted between 4 and 10 pm; 14.8% of the patients arrived between 10 pm and 8 am. Peak months of admissions were May to July. Overall, 2703 fractures, 2924 lacerations and superficial tissue injury, 5151 bruises, 320 joint dislocations, 1284 distortions, 76 burns, and 50 other injuries were treated. Most common mechanisms for fractures were leisure activities, falls, and sports-related activities. Forearm fractures were the most common fractures (39.5%) followed by humerus fractures (14%) and fractures of the hand (12.5%). A total of 700 patients with fractures (25.9%) needed surgery. 8.8% of all patients were hospitalized for at least one day. 4 patients died in the hospital (0.03%). CONCLUSION Despite of higher risk, severe injuries in children are rare. Minor injuries and single fractures are common. Treatment should be managed in specialized centers to ensure an interdisciplinary care and fast recovery. Peak times in the late afternoon and evening and summer months should be taken into consideration of personnel planning.
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Affiliation(s)
- Raffael Cintean
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Alexander Eickhoff
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Jasmin Zieger
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Florian Gebhard
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Konrad Schütze
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Goodwin Davies AJ, Xiao R, Razzaghi H, Bailey LC, Utidjian L, Gluck C, Eckrich D, Dixon BP, Deakyne Davies SJ, Flynn JT, Ranade D, Smoyer WE, Kitzmiller M, Dharnidharka VR, Magnusen B, Mitsnefes M, Somers M, Claes DJ, Burrows EK, Luna IY, Furth SL, Forrest CB, Denburg MR. Skeletal Outcomes in Children and Young Adults with Glomerular Disease. J Am Soc Nephrol 2022; 33:2233-2246. [PMID: 36171052 PMCID: PMC9731624 DOI: 10.1681/asn.2021101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 08/10/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Children with glomerular disease have unique risk factors for compromised bone health. Studies addressing skeletal complications in this population are lacking. METHODS This retrospective cohort study utilized data from PEDSnet, a national network of pediatric health systems with standardized electronic health record data for more than 6.5 million patients from 2009 to 2021. Incidence rates (per 10,000 person-years) of fracture, slipped capital femoral epiphysis (SCFE), and avascular necrosis/osteonecrosis (AVN) in 4598 children and young adults with glomerular disease were compared with those among 553,624 general pediatric patients using Poisson regression analysis. The glomerular disease cohort was identified using a published computable phenotype. Inclusion criteria for the general pediatric cohort were two or more primary care visits 1 year or more apart between 1 and 21 years of age, one visit or more every 18 months if followed >3 years, and no chronic progressive conditions defined by the Pediatric Medical Complexity Algorithm. Fracture, SCFE, and AVN were identified using SNOMED-CT diagnosis codes; fracture required an associated x-ray or splinting/casting procedure within 48 hours. RESULTS We found a higher risk of fracture for the glomerular disease cohort compared with the general pediatric cohort in girls only (incidence rate ratio [IRR], 1.6; 95% CI, 1.3 to 1.9). Hip/femur and vertebral fracture risk were increased in the glomerular disease cohort: adjusted IRR was 2.2 (95% CI, 1.3 to 3.7) and 5 (95% CI, 3.2 to 7.6), respectively. For SCFE, the adjusted IRR was 3.4 (95% CI, 1.9 to 5.9). For AVN, the adjusted IRR was 56.2 (95% CI, 40.7 to 77.5). CONCLUSIONS Children and young adults with glomerular disease have significantly higher burden of skeletal complications than the general pediatric population.
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Affiliation(s)
- Amy J Goodwin Davies
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rui Xiao
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hanieh Razzaghi
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - L Charles Bailey
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Levon Utidjian
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caroline Gluck
- Division of Nephrology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Daniel Eckrich
- Division of Nephrology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Bradley P Dixon
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
| | | | - Joseph T Flynn
- Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children's Hospital, Seattle, Washington
| | | | - William E Smoyer
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
- Nationwide Children's Hospital, Columbus, Ohio
| | | | - Vikas R Dharnidharka
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
- St. Louis Children's Hospital, St. Louis, Missouri
| | | | - Mark Mitsnefes
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Michael Somers
- Boston Children's Hospital, Harvard University, Boston, Massachusetts
| | - Donna J Claes
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Evanette K Burrows
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ingrid Y Luna
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan L Furth
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher B Forrest
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle R Denburg
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Jaques A, Hanrahan J, Islam S, Sofat R, Vella-Baldacchino M. Under the Weather: The Meteorological Effect on Orthopaedic Trauma in Hertfordshire. Cureus 2022; 14:e31146. [PMID: 36382318 PMCID: PMC9637454 DOI: 10.7759/cureus.31146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/07/2022] Open
Abstract
Background Effective and efficient use of operating theatres is essential to the smooth running of a trauma service. The paper aims to understand the effect of meteorological factors on the number of referrals and volume and nature of trauma operating cases within our local area. Methods Trauma data over two seasons were analysed in our database, a digital clinical platform that coordinates all admissions and trauma theatre activity. Data consisted of the number of referrals per day, patient age, mechanism of injury, and type of orthopaedic injury. Weather data were gathered from 'Weather Underground', https://www.wunderground.com/history, which records daily weather observations, located 12 miles away from our trauma unit. Results During the study period's last two seasons, 1160 consultations were analysed and 779 required operative intervention. The neck of femur fractures and ankle trauma were the two most common causes of trauma, accounting for 27% and 15%, respectively. The neck of femur fracture pathologies were not significantly correlated with any meteorological factor studied. On the contrary, ankle trauma was the only injury significantly correlating with temperature (p < 0.03) and dew point (p < 0.04). The most common mechanism of trauma was a ground-level fall (n = 590) whilst the least common was a motor vehicle accident (n = 39). Analysing the effect of weather and its effect on the age group of presentation, temperature (p < 0.01), sunlight (p < 0.002), and dew point (p < 0.03) were all significantly correlated with trauma in patients aged younger than 21 years of age. Conclusion The weather has no effect on the neck of femur fractures, the most common trauma pathology treated in our department. In all seasons, allocated specific trauma lists for the latter should be arranged irrelevant of the weather conditions. A strong correlation was identified between ankle trauma and weather. We identified that Tuesdays and Fridays received the highest referral rate and peaked between the months of October-November. These data lay the groundwork for local clinical directors to shape the future on-call trauma service.
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Affiliation(s)
| | - John Hanrahan
- Trauma and Orthopaedics, Lister Hospital, Stevenage, GBR
| | - Sumaya Islam
- Trauma and Orthopaedics, Lister Hospital, Stevenage, GBR
| | - Rajesh Sofat
- Trauma and Orthopaedics, Lister Hospital, Stevenage, GBR
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Voth M, Sommer K, Schindler C, Frank J, Marzi I. Rise of extremity fractures and sport accidents in children at 8-12 years and increase of admittance via the resuscitation room over a decade. Eur J Trauma Emerg Surg 2022; 48:3439-3448. [PMID: 34519864 PMCID: PMC9532303 DOI: 10.1007/s00068-021-01785-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In an emergency department, the majority of pediatric trauma patients present because of minor injuries. The aim of this study was to evaluate temporal changes in age-related injury pattern, trauma mechanism, and surgeries in pediatric patients. METHODS This retrospective study included patients < 18 years of age following trauma from 01/2009 to 12/2018 at a level I trauma center. They were divided into two groups: group A (A: 01/2009 to 12/2013) and group B (B: 01/2014 to 12/2018). Injury mechanism, injury pattern, and surgeries were analyzed. As major injuries fractures, dislocations, and organ injuries and as minor injuries contusions and superficial wounds were defined. RESULTS 23,582 patients were included (58% male, median age 8.2 years). There was a slight increase in patients comparing A (n = 11,557) and B (n = 12,025) with no difference concerning demographic characteristics. Significant more patients (A: 1.9%; B: 2.4%) were admitted to resuscitation room, though the number of multiple injured patients was not significantly different. In A (25.5%), major injuries occurred significantly less frequently than in B (27.0%), minor injuries occurred equally. Extremity fractures were significantly more frequent in B (21.5%) than in A (20.2%), peaking at 8-12 years. Most trauma mechanisms of both groups were constant, with a rising of sport injuries at 8-12 years. CONCLUSION Although number of patients increases only slightly over a decade, there was a clear increase in major injuries, particularly extremity fractures, peaking at 8-12 years. At this age also sport accidents significantly increased. At least, admittance to resuscitation room rose but without an increase of multiple injured patients.
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Affiliation(s)
- M. Voth
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - K. Sommer
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - C. Schindler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - J. Frank
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - I. Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Risk factors for upper limb fractures due to unintentional injuries among adolescents: a case control study from Sri Lanka. BMC Public Health 2022; 22:1825. [PMID: 36162991 PMCID: PMC9513863 DOI: 10.1186/s12889-022-14154-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Injuries are the number one cause for morbidity and mortality among adolescents. Adolescent fractures are a hidden public health problem in Sri Lanka. Upper limb fractures are common in adolescents due to various risk factors. Many injuries are predictable and can be prevented by identifying the risk factors. The aim of the study was to determine the risk factors for upper limb fractures among adolescents in Sri Lanka. Methods A case control study was undertaken with 450 cases and 450 controls. Cases were recruited consecutively from all major hospitals among the adolescent victims who had admitted with newly diagnosed upper limb fractures in the district of Colombo. Controls were apparently healthy adolescents from the same district and excluded who had previous upper limb fractures. The age and gender were not matched in selecting controls since these two factors were potential risk factors for adolescent fractures according to previous literature. Risk factors for upper limb fractures were assessed by odds ratio (OR) with 95% confidence interval (CI) and adjusted for possible confounding by performing logistic regression analysis. Results The mean age of the cases was 13.62 years with a Standard Deviation (SD) of 2.8 and controls was 12.75 years (SD = 2.7) respectively. Having a high standard of living index (OR = 3.52; 95%CI: 2.3–5.2, p < 0.001), being in a high social class category (social class I & II) (OR = 2.58, 95%CI: 1.7–3.92, p < 0.001), engage in physical or sports activity (OR = 9.36; 95%CI: 3.31–26.47, p < 0.001), watching television (OR = 1.95; 95%CI: 1.18 -3.22, p = 0.009), playing video or computer games (OR = 2.35; 95%CI: 1.7–3.24, p < 0.001), and attending extra classes (OR = 1.82; 95%CI: 1.2–2.7, p = 0.007) were risk factors for having a upper limb fracture. Risk factors for upper limb fractures following adjusted for confounders were siblings in the family (aOR = 11.62, 95% CI: 6.95–41.29, p = 0.03) and attend extra classes after school hours (aOR = 2.51, 95%CI: 0.68–0.93, p = 0.04). Two significant effect modifications between being a Buddhist and low standard of living index (p < 0.001) and having one sibling in the family and attend extra classes after school hours (p = 0.01) were observed. Conclusions Modifiable risk factors in relation to lifestyle factors and socioeconomic position were important determinants of upper limb fracture risk in adolescents. Many fractures can be prevented by strengthening awareness programmes in the community.
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Clark P, Montiel-Ojeda D, Rascón-Pacheco RA, Guagnelli MA, Lopez-Gonzalez D, Bremer A, Borja-Aburto VH. Fracture incidence in children and adolescents 0-19 years old in Mexico: a 12-year cross-sectional analysis. Arch Osteoporos 2022; 17:127. [PMID: 36129580 DOI: 10.1007/s11657-022-01162-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/05/2022] [Indexed: 02/03/2023]
Abstract
The objective was to know the behavior of fractures in Mexican children and adolescents. According to our study, fractures in Mexican male children and adolescents seem to be decreasing; however, we still need more national studies to know the possible causes of these fractures. PURPOSE To describe the trends of fractures in Mexican children and adolescents across a 12-year period (2007 to 2019), and to analyze if these trends have changed over time between sexes and age groups. METHODS We identified all fracture cases registered in children and adolescents (0 to 19 years) at the emergency rooms and surgical departments of the Mexican Institute of Social Security between January 2007 and December 2019. We used ICD-10 to classify the fractures. The population was divided into two age groups: children (0 to 9 years) and adolescents (10 to 19 years). Additional information regarding sex and age was gathered up as well. We calculated annual incidence; incidence rates are presented per 10,000 population at risk. Changes in fracture trends were calculated using the average annual percentage change (AAPC). RESULTS Over 12 years, 1,400,443 fractures were registered. The most frequent site of fracture was forearm in 37.1% followed by shoulder (18.1%). The overall rates of fractures have remained similar over 12 years (86.5, IQR 81.0-94.2); however, a significant decrease in fractures was observed the last 3 years (2017-2019). According to the AAPC, only in men, in both age groups, a significant decrease in fractures was observed. CONCLUSION This is the first study in Mexico to follow the behavior of fractures in the pediatric population over 12 years. Fractures seem to be decreasing in children and adolescents. An epidemiological follow-up of childhood fractures is necessary to understand the causes of fractures to generate better prevention and treatment strategies.
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Affiliation(s)
- Patricia Clark
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Diana Montiel-Ojeda
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico.
| | | | - Miguel A Guagnelli
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Desirée Lopez-Gonzalez
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Alhelí Bremer
- Faculty of Medicine and Psychology, Autonomous University of Baja California (UABC), Tijuana, Baja California, Mexico
| | - Víctor Hugo Borja-Aburto
- Teaching and Research Unit, Directorate of Medical Benefits, Mexican Institute of Social Security, IMSS, Mexico City, Mexico
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Bchini S, Hammami N, Ouerghi N, Zalleg D, Bouassida A. The relationship between lower limb muscle volume and peak vertical jump power in children. ISOKINET EXERC SCI 2022. [DOI: 10.3233/ies-220024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Vertical jump is an index representing leg power. It is important to determine factors that influence the vertical jump to help athletes improve their leg power. OBJECTIVE: This study aimed to determine the relationship between lower limbs muscle volume and peak vertical jump (VJ) power in children for both sexes. METHODS: Fourty children healthy boys (n= 20) and girls (n= 20) aged 10 to 12 years old, randomly performed three VJ modalities: squat jump (SJ), counter movement jump without (CMJ) and with arm swings (CMJarms). Lower limbs muscle volume (MV) estimated using a standard anthropometric method. Peak power (PP) calculated by Sayers equation. RESULTS: significant correlations between MV and Peak vertical jump power showed for both sexes. Likewise, significant correlations were found between MV and body mass for boys (r= 0.66; p= 0.001) and for girls (r= 0.59; p= 0.006). CONCLUSIONS: The correlation observed between peak vertical jump power and MV in both sexes can be considered as estimation tool of the lower limbs muscle power. Lower limb’s muscle volume are determining factor in muscle power for both sexes.
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Affiliation(s)
- Souhail Bchini
- Higher Institute of Sport and Physical Education of Ksar Said, University of La Manouba, Manouba, Tunisia
- High Institute of Sport and Physical Education of Kef, University of Jendouba, Kef, Tunisia
| | - Nadhir Hammami
- Higher Institute of Sport and Physical Education of Ksar Said, University of La Manouba, Manouba, Tunisia
| | - Nejmeddine Ouerghi
- Higher Institute of Sport and Physical Education of Ksar Said, University of La Manouba, Manouba, Tunisia
- Faculty of Medicine of Tunis, Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Dalenda Zalleg
- Higher Institute of Sport and Physical Education of Ksar Said, University of La Manouba, Manouba, Tunisia
| | - Anissa Bouassida
- Higher Institute of Sport and Physical Education of Ksar Said, University of La Manouba, Manouba, Tunisia
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Oh CH, Yoon S, Ko KR, Kwon YW, Kim KM, Park HS, Kang H, Jang I, Lee S. Epidemiology of pediatric fractures before versus during the coronavirus disease 2019 pandemic. Clin Exp Pediatr 2022; 65:330-336. [PMID: 35681247 PMCID: PMC9263426 DOI: 10.3345/cep.2021.01767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/03/2022] [Indexed: 11/27/2022] Open
Abstract
Several studies have reported changes in the prevalence of childhood fractures between the prepandemic and coronavirus disease 2019 pandemic periods considering the overall decrease in activity during the latter. This review aimed to organize and summarize the global trends in pediatric fracture incidence. Our findings should help predict fracture patterns in the postpandemic period by identifying changes in the past and present, thus aiding patient management.
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Affiliation(s)
- Chi Hoon Oh
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Siyeong Yoon
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Kyung Rae Ko
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Woo Kwon
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Korea
| | - Kyeong Mi Kim
- Department of Laboratory Medicine, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, Korea
| | | | | | - Inseok Jang
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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21
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Salom Taverner M, Martí Ciruelos R, Fernández Ansorena A, Alvarez Muñoz M, García-Chamorro M, Muñoz López C, Sanpera Trigueros I. [Translated article] Effect of the COVID pandemic on paediatric trauma emergencies in three areas of Spain with different incidence. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:T43-T50. [PMID: 35858670 PMCID: PMC9288353 DOI: 10.1016/j.recot.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/21/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction and objectives Although much has been published on the effect of the pandemic on trauma emergencies, it has not been analysed whether the incidence of infection or different organisation of available resources according to the Spanish region were influential factors. We present a multicenter study of three tertiary hospitals in three Spanish cities with different characteristics to study how these factors influenced paediatric trauma emergencies during the first wave of the pandemic. Material and methods We present a retrospective cohort study that compares and analyzes paediatric trauma emergencies in three different hospitals during the period of the first wave of the COVID-19 pandemic and we compare them with the same period of the previous year, analyzing the number of emergencies, the severity of the pathology, the average age of the patients, the days of admission and the waiting time of the cases that required surgical treatment. Results A total of 6474 paediatric trauma emergency episodes have been analysed. There was a drastic reduction in activity in the three hospitals, but in different amounts: 83.5% in the hospital located in Madrid, 75% in the hospital located in Valencia and 65.9% in the one located in Palma, Majorca. The emergencies attended were more serious in 2020 compared to 2019. The average age of patients treated during the pandemic was lower compared to the previous year. There were no differences in the days of admission, but there were differences in the delay in surgery for surgical fractures. Conclusions The impact of the first wave of the COVID-19 pandemic and the decreed confinement had a different impact on paediatric trauma emergencies in the different hospitals according to the incidence of infection and the measures adopted in the different regions. In all cases there was a significant reduction in activity, a greater proportion of medium and severe pathologies were attended to, the average age of the patients attended was lower and a delay was observed in surgeries performed in the emergency room, probably due to the need to request a PCR test to detect a COVID-19 infection.
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22
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Kwan S, Santoro A, Cheesman Q, Matzon J, Wang M, Beredjiklian P, Rivlin M. Efficacy of Waterproof Cast Protectors and Their Ability to Keep Casts Dry. J Hand Surg Am 2022:S0363-5023(22)00292-1. [PMID: 35760649 DOI: 10.1016/j.jhsa.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/26/2022] [Accepted: 05/13/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of the study was to compare the efficacy of 6 different commercially available waterproof cast protectors in their ability to maintain a dry environment and evaluate whether cast protectors perform better than a plastic bag secured with tape in keeping casts dry. METHODS We enrolled 23 adult participants to test 6 different commercially available cast protectors and a plastic bag. Participants trialed all cast protectors twice, with and without motion, by fully submerging each cast protector in water with a paper towel held between their index and middle fingers. Moisture accumulation within the cast protectors was estimated by the change in weight of paper towel. An analysis of variance test was performed to compare differences between cast protectors in their ability to maintain a dry internal environment. RESULTS The plastic bag showed an average moisture accumulation of 5.50 g without motion compared with all other cast protectors, which had 0.0 g of moisture accumulation. One cast protector and the plastic bag had an average moisture accumulation of 0.46 g and 4.51 g with motion compared to all other cast protectors. The plastic bag was ranked the worst by 100% of participants. CONCLUSION Cast protectors appear to offer superior protection from moisture compared with a plastic bag. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Stephanie Kwan
- Department of Orthopaedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ
| | - Adam Santoro
- Department of Orthopaedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ
| | - Quincy Cheesman
- Department of Orthopaedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ
| | - Jonas Matzon
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute - Hand, Wrist, Elbow, & Microvascular Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Rothman Institute, Philadelphia, PA
| | - Mark Wang
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute - Hand, Wrist, Elbow, & Microvascular Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Rothman Institute, Philadelphia, PA
| | - Pedro Beredjiklian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute - Hand, Wrist, Elbow, & Microvascular Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Rothman Institute, Philadelphia, PA
| | - Michael Rivlin
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute - Hand, Wrist, Elbow, & Microvascular Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Rothman Institute, Philadelphia, PA.
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23
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Hikichi T, Takata M, Horii T, Shimanuki K, Suganuma S, Toratani T, Shimokawa K, Yasutake H. Epidemiology of trauma-related paediatric limb fracture using a unique classification: A 10-year retrospective, single-centre study. Injury 2022; 53:2074-2080. [PMID: 35236572 DOI: 10.1016/j.injury.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/21/2022] [Accepted: 02/02/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Research regarding the epidemiology of paediatric trauma is limited. Using our unique classification, we describe paediatric trauma cases in a 10-year single-centre study to improve paediatric care. MATERIALS AND METHODS Data regarding all paediatric trauma cases were extracted using a computerised medical record system that detected fracture diagnosis and epiphyseal injury. Registry search identified cases from January 2008 to December 2017. Age, sex, type of fracture, and details of injury mechanism were analysed, and we categorised the 'falls/turnover' mechanism using a new trauma energy classification based on speed and height. RESULTS A total of 1379 cases (953 boys and 426 girls) were included. The highest number of injuries (553 cases, 40%) was seen in school children (aged 6 to 10 years). Forearm fracture occurred most frequently, followed by humeral fracture. The most frequent injury mechanism in falls/turnover (969 cases, 70%) was sports in 272 cases (28%), playground equipment in 179 cases (18%), furniture in 102 cases (11%), and bicycling in 87 cases (9%). We classified 956 cases of falls/turnover using our trauma energy classification scheme. Most cases (29%) were classified into the L2 category (low height and high speed), followed by the L1 category (low height and low speed) (p < 0.01). Subcategory analysis using the classification revealed that younger children were more likely to be injured by falling from high places because of their physique, whereas older children were more likely to be injured by a turnover from lower places and at higher speed. CONCLUSION We describe the epidemiology of fractures in detail and present a new classification system, which may aid in understanding the injury mechanism independent of children's height. The fact that paediatric fractures occur at relatively low energy levels and are trended by age, activity, and sex, could be of potential universal use for their prevention and parent education.
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Affiliation(s)
- Toshifumi Hikichi
- Department Orthopedics, Kanazawa University Hospital, Takara-machi 13-1, Kanazawa, Ishikawa 920-8641, Japan
| | - Munetomo Takata
- Department Orthopedics, Ishikawa Prefectural Central Hospital, Kuratsuki-higashi 2-1, Kanazawa, Ishikawa 920-8530, Japan.
| | - Takeshi Horii
- Department Orthopedics, Toyama City Hospital, Imaizumi-hokubu-machi 2-1, Toyama, Toyama 939-8511, Japan.
| | - Keito Shimanuki
- Department Orthopedics, Ishikawa Prefectural Central Hospital, Kuratsuki-higashi 2-1, Kanazawa, Ishikawa 920-8530, Japan
| | - Seigo Suganuma
- Department Orthopedics, Ishikawa Prefectural Central Hospital, Kuratsuki-higashi 2-1, Kanazawa, Ishikawa 920-8530, Japan
| | - Tatsuhiro Toratani
- Toratani Orthopaedic & Sports Clinic., Fujiekita4-342, Kanazawa, Ishikawa 920-0345, Japan
| | - Kanu Shimokawa
- Department Orthopedics, Kanazawa University Hospital, Takara-machi 13-1, Kanazawa, Ishikawa 920-8641, Japan
| | - Hidetoshi Yasutake
- Department Orthopedics, Ishikawa Prefectural Central Hospital, Kuratsuki-higashi 2-1, Kanazawa, Ishikawa 920-8530, Japan
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A pediatric wrist trauma X-ray dataset (GRAZPEDWRI-DX) for machine learning. Sci Data 2022; 9:222. [PMID: 35595759 PMCID: PMC9122976 DOI: 10.1038/s41597-022-01328-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 04/19/2022] [Indexed: 01/06/2023] Open
Abstract
Digital radiography is widely available and the standard modality in trauma imaging, often enabling to diagnose pediatric wrist fractures. However, image interpretation requires time-consuming specialized training. Due to astonishing progress in computer vision algorithms, automated fracture detection has become a topic of research interest. This paper presents the GRAZPEDWRI-DX dataset containing annotated pediatric trauma wrist radiographs of 6,091 patients, treated at the Department for Pediatric Surgery of the University Hospital Graz between 2008 and 2018. A total number of 10,643 studies (20,327 images) are made available, typically covering posteroanterior and lateral projections. The dataset is annotated with 74,459 image tags and features 67,771 labeled objects. We de-identified all radiographs and converted the DICOM pixel data to 16-Bit grayscale PNG images. The filenames and the accompanying text files provide basic patient information (age, sex). Several pediatric radiologists annotated dataset images by placing lines, bounding boxes, or polygons to mark pathologies like fractures or periosteal reactions. They also tagged general image characteristics. This dataset is publicly available to encourage computer vision research. Measurement(s) | wrist fracture • pronator quadratus sign • AO classifiction • soft tissue swelling • metal implant • osteopenia • plaster cast • bone Lesion • subperiosteal bone formation | Technology Type(s) | bone radiography |
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25
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Alberghina F, Andreacchio A, Pavone V, Mansour M, Dimeglio A, Canavese F. Review of pediatric functional outcomes measures used to evaluate surgical management in pediatric patients with an upper extremity fracture. J Pediatr Orthop B 2022; 31:260-269. [PMID: 34406161 DOI: 10.1097/bpb.0000000000000909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For two decades, many scores, questionnaires, and rating systems have been used to evaluate the functional outcome of children with an upper extremity fracture (UEF). However, only a few of these were created specifically for children, and many assess only elbow function. In the absence of any published review on this topic, we set out to identify and categorize different scores used to evaluate the clinical and functional outcomes of surgically treated pediatric UEFs. A literature search was performed, and 38 studies were identified. The scores used more often were the shortened version of the Disability of the Arm, Shoulder and Hand questionnaire and the Mayo Elbow Performance Score/Index. In a lower number of studies, authors used other scoring systems, including the Mayo Wrist Score, the Patient-Rated Wrist Evaluation, the Patient-Rated Elbow Evaluation, the Métaizeau functional scoring system, the Oxford Elbow Score, the Price and Flynn criteria, the Hardacre Functional Score, the Neer Shoulder Score, the Constant-Murley Shoulder Score, the Modified Orthopedic Trauma Association Score, the Medical Outcomes Study Short Form-36, and the Pediatric Outcomes Data Collection Instrument. Some specific pediatric scoring systems to evaluate the functional outcome of children with a UEF have been suggested, but a single tool that is valid and reliable for skeletally immature patients of all ages is not yet available. Further studies are needed to identify specific pediatric measurements to increase validity, responsiveness, sensitivity, and interpretability of upper limb functional outcome scores in common clinical practice.
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Affiliation(s)
- Flavia Alberghina
- Pediatric Orthopedic Department, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Antonio Andreacchio
- Pediatric Orthopedic Surgery Department, 'Vittore Buzzi' Children's Hospital, Milano
| | - Vito Pavone
- Department of General Surgery, Section of Orthopedics and Traumatology, A.O.U. Policlinico 'Rodolico - San Marco', University of Catania, Catania, Italy
| | - Mounira Mansour
- Pediatric Surgery Department, University Hospital Estaing, Clermont Ferrand
| | - Alain Dimeglio
- Pediatric Surgery Department, Clinique St. Roch, Montpellier
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Center, Jeanne de Flandre Hospital, Lille, France
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26
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Bodnyk KA, Kim DG, Pan X, Hart RT. The Long-Term Residual Effects of Low-Magnitude Mechanical Stimulation on Murine Femoral Mechanics. J Biomech Eng 2022; 144:1128892. [PMID: 34817049 DOI: 10.1115/1.4053101] [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: 02/15/2021] [Indexed: 11/08/2022]
Abstract
As an alternative to drug treatments, low-magnitude mechanical stimulation (LMMS) may improve skeletal health without potential side effects from drugs. LMMS has been shown to increase bone health short term in both animal and clinical studies. Long-term changes to the mechanical properties of bone from LMMS are currently unknown, so the objective of this research was to establish the methodology and preliminary results for investigating the long-term effects of whole body vibration therapy on the elastic and viscoelastic properties of bone. In this study, 10-week-old female BALB/cByJ mice were given LMMS (15 min/day, 5 days/week, 0.3 g, 90 Hz) for 8 weeks; SHAM did not receive LMMS. Two sets of groups remained on study for an additional 8 or 16 weeks post-LMMS (N = 17). Micro-CT and fluorochrome histomorphology of these femurs were studied and results were published by Bodnyk et al. (2020, "The Long-Term Residual Effects of Low-Magnitude Mechanical Stimulation Therapy on Skeletal Health," J. Biol. Eng., 14, Article No. 9.). Femoral quasi-static bending stiffness trended 4.2% increase in stiffness after 8 weeks of LMMS and 1.3% increase 8 weeks post-LMMS compared to SHAM. Damping, tan delta, and loss stiffness significantly increased by 17.6%, 16.3%, and 16.6%, respectively, at 8 weeks LMMS compared to SHAM. Finite element models of applied LMMS signal showed decreased stress in the mid-diaphyseal region at both 8-week LMMS and 8-week post-LMMS compared to SHAM. Residual mechanical changes in bone during and post-LMMS indicate that LMMS could be used to increase long-term mechanical integrity of bone.
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Affiliation(s)
- Kyle A Bodnyk
- Department of Biomedical Engineering, The Ohio State University, Fontana Labs, 140 West 19th Street, Columbus OH 43210
| | - Do-Gyoon Kim
- Division of Orthodontics, The Ohio State University, 305 West 12th Avenue, 4088 Postle Hall, Columbus, OH 43210
| | - Xueliang Pan
- College of Medicine, Biomedical Informatics, The Ohio State University, 1800 Cannon Drive, Columbus, OH 43210
| | - Richard T Hart
- Department of Biomedical Engineering, Fontana Labs, The Ohio State University, 140 West 19th Street Columbus, OH 43210
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Gimigliano F, Liguori S, Moretti A, Toro G, Rauch A, Negrini S, Iolascon G. A systematic review of Clinical Practice Guidelines for the management of fractures in children to develop the WHO's Package of Interventions for Rehabilitation. Eur J Phys Rehabil Med 2022; 58:236-241. [PMID: 34247473 PMCID: PMC9987461 DOI: 10.23736/s1973-9087.21.06916-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/19/2021] [Accepted: 07/12/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Fractures have been identified as one of the 20 major health conditions for the World Health Organization's (WHO) Package of Interventions for Rehabilitation (PIR) - that includes also the needs of children and youth. The identification of existing interventions for rehabilitation and related evidence is a crucial step along the development of the PIR. The methods for the identification have been developed by WHO Rehabilitation Program and Cochrane Rehabilitation under the guidance of WHO's Guideline Review Committee Secretariat. EVIDENCE ACQUISITION This paper is part of the "Best Evidence for Rehabilitation" (be4rehab) series, developed according to the methodology presented in the PIR introductory paper. It is a systematic review of the existing Clinical Practice Guidelines (CPGs) on fractures in pediatric population published between 2009 to 2019. EVIDENCE SYNTHESIS We identified seven relevant CPGs after title and abstract screening. According to inclusion/exclusion criteria and after checking for quality, publication time, multidisciplinarity and comprehensiveness, we have been able to include two CPGs: one addresses the treatment of supracondylar humerus fractures and the other provides recommendations on the treatment of diaphyseal femur fractures. CONCLUSIONS The selected CPGs on the management of supracondylar humerus and diaphyseal femur fractures in pediatric population include few recommendations considered as interventions for rehabilitation, of low quality of evidence and weak strength. We found several gaps in specific rehabilitative topics. High quality studies are absolutely needed to upgrade the quality of available evidence to inform future development of guidelines.
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Affiliation(s)
- Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, Luigi Vanvitelli University of Campania, Naples, Italy -
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Alexandra Rauch
- Unit of Sensory Functions, Disability and Rehabilitation, Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Stefano Negrini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, La Statale University, Milan, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, Luigi Vanvitelli University of Campania, Naples, Italy
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28
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Salom Taverner M, Martí Ciruelos R, Fernández Ansorena A, Alvarez Muñoz M, García-Chamorro M, Muñoz López C, Sanpera Trigueros I. Efecto de la pandemia COVID en las urgencias traumatológicas pediátricas en tres zonas de España con distinta incidencia. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:461-468. [PMID: 35504506 PMCID: PMC9055783 DOI: 10.1016/j.recot.2022.02.006] [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: 10/14/2021] [Revised: 02/05/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Introducción y objetivos Aunque se ha publicado mucho sobre el efecto de la pandemia en las urgencias traumatológicas, no se ha analizado si la incidencia de la infección o la distinta organización de los recursos disponibles según la comunidad autónoma fueron factores influyentes. Presentamos un estudio multicéntrico de tres hospitales terciarios de tres ciudades españolas con distintas características para estudiar cómo estos factores influyeron a las urgencias traumatológicas pediátricas durante la primera ola de la pandemia. Material y métodos Presentamos un estudio retrospectivo de cohortes que compara y analiza las urgencias traumatológicas pediátricas en tres hospitales distintos durante el periodo de la primera ola de la pandemia COVID-19 y comparamos sus resultados con los del mismo periodo del año anterior, analizando el número de urgencias, la gravedad de la patología, la edad media de los pacientes, los días de ingreso y el tiempo de espera de los casos que requirieron tratamiento quirúrgico. Resultados Se han analizado 6.474 episodios de urgencias traumatológicas infantiles. Se produjo una drástica reducción de la actividad en los tres hospitales, pero en distinta cuantía: del 83,5% en el hospital localizado en Madrid, del 75% en el hospital localizado en Valencia y del 65,9% en el ubicado en Palma de Mallorca. Las urgencias atendidas fueron de mayor gravedad en el año 2020 en comparación con el año 2019. La edad media de los pacientes atendidos durante la pandemia fue menor en comparación con el año anterior. No hubo diferencias en los días de ingreso, pero sí en la demora de la cirugía de las fracturas quirúrgicas. Conclusiones La repercusión de la primera ola de la pandemia COVID-19 y el confinamiento decretado tuvieron una repercusión distinta en las urgencias traumatológicas pediátricas en los distintos hospitales según la incidencia de la infección y las medidas adoptadas en las diferentes comunidades autónomas. En todos los casos hubo una reducción importante de la actividad, se atendió una mayor proporción de patología media y grave, la edad media de los pacientes atendidos fue menor y se observó un retraso en las cirugías realizadas en urgencias, probablemente por la necesidad de solicitar una prueba PCR para detectar una infección por COVID-19.
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29
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Traa AC, Sir O, Frazer SWT, van de Kerkhof-van Bon B, Blatter B, Tan ECTH. Levels of Physical Activity in Children with Extremity Fractures a Dutch Observational Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:325. [PMID: 35327697 PMCID: PMC8947536 DOI: 10.3390/children9030325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/17/2022]
Abstract
Background: Fractures are common in children and a frequent cause of emergency department (ED) visits. Fractures can cause long-term complications, such as growth problems. Research on fractures can reveal useful areas of focus for injury prevention. Objective: To assess the role of physical activity in the occurrence of fractures, this study investigates physical activity among children with extremity fractures based on the Global Recommendations on Physical Activity for Health. Methods: A multi-center, cross-sectional study was performed at two EDs in Nijmegen, the Netherlands. Patients between 4 and 18 years of age visiting these EDs with a fracture were asked to complete a validated questionnaire. Results: Of the 188 respondents, 51% were found to adhere to the recommendations. Among participants between 13 and 18 years of age, 43% were adequately physically active, compared to participants between 4 and 12 years of age among whom 56% were adequately physically active (p = 0.080). Additionally, more males were found to meet the recommendations (60% versus 40%). The most common traumas were sports-related (57%). Sports-related traumas were cited more often among youth between 13 and 18 years of age, compared to those between 4 and 12 (p < 0.001). Conclusions: A relatively high prevalence of adherence to the Global Recommendations on Physical Activity for Health was observed among children with fractures. Most respondents obtained their fractures during participation in sports. This study emphasizes the need for more injury prevention, especially among youth between 13 and 18 years of age and children participating in sports.
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Affiliation(s)
- Amber Carlijn Traa
- Department of Emergency Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands; (O.S.); (E.C.T.H.T.)
| | - Ozcan Sir
- Department of Emergency Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands; (O.S.); (E.C.T.H.T.)
| | - Sanne W. T. Frazer
- Consumer Safety Institute (VeiligheidNL), Overschiestraat 65, 1062 XD Amsterdam, The Netherlands; (S.W.T.F.); (B.B.)
| | | | - Birgitte Blatter
- Consumer Safety Institute (VeiligheidNL), Overschiestraat 65, 1062 XD Amsterdam, The Netherlands; (S.W.T.F.); (B.B.)
| | - Edward C. T. H. Tan
- Department of Emergency Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands; (O.S.); (E.C.T.H.T.)
- Department of Traumasurgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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30
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Agar A, Sahin A, Gunes O, Gulabi D, Erturk C. Seasonal variation in paediatric orthopaedic trauma Patients - A single centre experience from Turkey. J Orthop Surg (Hong Kong) 2022; 30:23094990211068146. [PMID: 35045744 DOI: 10.1177/23094990211068146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE It is known that the incidence of paediatric orthopaedic trauma peaks in the summer months as a result of increased and uncontrolled physical activity. The aim of this study was to review the experience of a single centre with paediatric orthopaedic traumas and determine the relationship between the severity and the variations in the incidence of traumas in relation to the seasons and temperatures during the study period. MATERIALS AND METHODS A single institutional review of the historical data of all patients aged 0-16 years who presented for orthopaedic trauma between January 2018 and December 2020 in the emergency department of Level 1 tertiary orthopaedic trauma centre was conducted. 65,182 paediatric orthopaedic trauma cases had been retrieved from the hospital data base during the 3 -year study period. We classified the traumas according to the variants of the patients' and by holidays, seasons, school days and weekends, months and in which part of the body it occurred. RESULTS After excluding the summer vacation, 77% of paediatric orthopaedic trauma patients attended to the hospital on weekdays and 23% on weekends. While it was observed that hot weather had a statistically positive effect on trauma attendance, rainy weather had an negative effect (p < 0.05). Trauma attendances were found to be statistically higher in summer months, except for injuries that may occur with indoor activities such as metacarpal fracture, phalanx fracture and pulled elbow (p < 0.05). CONCLUSION Orthopaedic trauma at a Level 1 tertiary health care trauma center do vary significantly with the weather and are highest in the summer season. Therefore, it should focus more attention on preventive strategies for paediatric trauma in the summer season.
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Affiliation(s)
- Anil Agar
- Department Orthopaedic and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, 147006Saglik Bilimleri University, Istanbul, Turkey
| | - Adem Sahin
- Department Orthopaedic and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, 147006Saglik Bilimleri University, Istanbul, Turkey
| | - Orhan Gunes
- Department Orthopaedic and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, 147006Saglik Bilimleri University, Istanbul, Turkey
| | - Deniz Gulabi
- Department Orthopaedic and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, 147006Saglik Bilimleri University, Istanbul, Turkey
| | - Cemil Erturk
- Department Orthopaedic and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, 147006Saglik Bilimleri University, Istanbul, Turkey
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Rasmussen MK, Larsen P, Rölfing JD, Kirkegaard BL, Thorninger R, Elsoe R. Epidemiology and incidence of paediatric orthopaedic trauma workload during the COVID-19 pandemic: A multicenter cohort study of 3171 patients. World J Orthop 2022; 13:70-77. [PMID: 35096537 PMCID: PMC8771413 DOI: 10.5312/wjo.v13.i1.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/10/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has a major influence on all parts of society.
AIM To examine the consequences of the national lockdown and political initiatives during the first surge of the COVID-19 pandemic expressed by changes in incidences of musculoskeletal paediatric injuries.
METHODS Study design was a retrospective multicenter cohort study. A ‘pandemic’ cohort was established from 16 March 2020 to 21 April 2020, where all institutions including day care and schools were closed. A ‘pre-pandemic’ cohort was established from the same period in 2019 for comparison. Included were all patients admitted at the emergency departments with paediatric musculoskeletal injuries (aged 0-15 years) identified by a relevant musculoskeletal ICD-10 diagnosis (DSxxx), concussions (DZ033D), or burns (DT2xx).
RESULTS The ‘pre-pandemic’ cohort consisted of 2101 patients, and the ‘pandemic’ cohort consisted of 1070 patients, indicating a decrease of paediatric musculoskeletal injuries of 51%. The incidence of paediatric injury in the ‘pre-pandemic’ cohort was 10460/100000/year. In the ‘pandemic’ cohort, the incidence was 5344/100000/year.
CONCLUSION A resource re-allocation to help serve the COVID-19 patients might be possible without reducing the level of care for injury-related paediatric patients.
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Affiliation(s)
| | - Peter Larsen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg DK-9000, Denmark
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg DK-9000, Denmark
| | - Jan Duedal Rölfing
- Children’s Orthopaedics and Reconstruction, Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Bertram Lahn Kirkegaard
- Children’s Orthopaedics and Reconstruction, Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Rikke Thorninger
- Department of Orthopaedic Surgery, Regional Hospital Randers, Randers 8930, Denmark
| | - Rasmus Elsoe
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg DK-9000, Denmark
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Lawrence JTR, MacAlpine EM, Buczek MJ, Horn BD, Williams BA, Manning K, Shah AS. Impact of Cost Information on Parental Decision Making: A Randomized Clinical Trial Evaluating Cast Versus Splint Selection for Pediatric Distal Radius Buckle Fractures. J Pediatr Orthop 2022; 42:e15-e20. [PMID: 34889832 DOI: 10.1097/bpo.0000000000001980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Price transparency purports to help patients make high-value health care decisions, however, there is little data to support this. The pediatric distal radius buckle fracture (DRBF) has 2 equally efficacious but not equally priced treatment options (cast and splint), serving as an excellent potential model for studying price transparency. This study uses the DRBF model to assess the impact of up-front cost information on a family's treatment decisions when presented with clinically equivalent treatment options for a low-risk injury. METHODS Participants age 4 to 14 presenting with an acute DRBF to a hospital-based pediatric orthopaedic clinic were recruited for this randomized controlled trial. Participants were randomized into cost-informed or cost-blind cohorts. All families received standardized information about the injury and treatment options. Cost-informed families received additional cost information. Both groups were allowed to freely choose a treatment. Families were surveyed regarding their decision factors. Cost-blinded families were subsequently presented with the cost information and could change their decision. Independent samples t tests and χ2 tests were utilized to evaluate differences. RESULTS A total of 127 patients were enrolled (53% cost-informed, 47% cost-blind). The 2 groups did not significantly differ in demographics. Immobilization selection did not differ between groups, with 48% of the cost-informed families selecting the more expensive option (casting), compared with 47% of the cost-blind families. Cost was the least influential factor in the decision-making process according to participant survey, influencing only 9% of families. Only one family changed their decision after receiving cost information, from a splint to a cast. CONCLUSION Families appear to be cost-insensitive when making medical treatment decisions for low-risk injuries for their child. Price transparency alone may not help families arrive at a decision to pursue high-value treatment in low-risk orthopaedic injuries. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- J Todd R Lawrence
- Division of Orthopaedics, Children's Hospital of Philadelphia
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Elle M MacAlpine
- Division of Orthopaedics, Children's Hospital of Philadelphia
- Duke University School of Medicine, Durham, NC
| | | | - B David Horn
- Division of Orthopaedics, Children's Hospital of Philadelphia
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Brendan A Williams
- Division of Orthopaedics, Children's Hospital of Philadelphia
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kassidy Manning
- Division of Orthopaedics, Children's Hospital of Philadelphia
| | - Apurva S Shah
- Division of Orthopaedics, Children's Hospital of Philadelphia
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Shaw KG, Salton RL, Carry P, Hadley-Miller N, Georgopoulos G. Multi-day delay to care identified in pediatric trauma cases during COVID-19. J Pediatr Orthop B 2022; 31:e56-e64. [PMID: 34406164 PMCID: PMC8635079 DOI: 10.1097/bpb.0000000000000910] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aims to establish how pediatric fracture patterns were altered at a level 1 trauma center in a state that implemented a shutdown during the initial height of COVID-19. After IRB approval, we identified 2017 patients treated at a pediatric institution for definitive management of a fracture between 26 March and 31 May 2018, 2019, or 2020. Dates were chosen based on statewide stay-at-home orders for Colorado. Patients were excluded for treatment at another institution (n = 148), no fracture noted in clinic (n = 18), or other (n = 13). Data were retrospectively collected from the remaining 1838 patients regarding demographics, fracture injury, mechanism, and treatment. Odds ratios (ORs) were calculated for each variable during COVID-19 relative to prior years. The number of fractures during 2020 decreased by 26% relative to 2019 and 23% to 2018. A larger proportion of patients experienced at least a 5-day delay to definitive treatment [OR: 1.55, confidence interval (CI): 1.23-1.96, P = 0.0002]. Rates of non-accidental trauma (NAT) increased non-significantly (OR: 2.67, CI: 0.86-8.32, P = 0.0900) during 2020 (1.2%) relative to 2018 (0.6%) and 2019 (0.3%). Fractures occurring at home increased to 79.9% (OR: 6.44, CI: 5.04-8.22, P < 0.0001). Despite less overall trauma during shelter-in-place orders, greater fracture numbers were seen among younger children and severe fractures were likely among older children. Patients may hesitate to seek care during 2020. Rates of NAT doubled during 2020. As communities prepare for future waves, treatment centers should warn against common fracture mechanisms and raise awareness of NAT.
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Affiliation(s)
- Kylie G Shaw
- Department of Orthopedics, University of Colorado School of Medicine, Anschutz Medical Campus
| | - Reba L Salton
- Musculoskeletal Research Center, Orthopedics Institute, Children's Hospital Colorado
| | - Patrick Carry
- Department of Orthopedics, University of Colorado School of Medicine, Anschutz Medical Campus
- Musculoskeletal Research Center, Orthopedics Institute, Children's Hospital Colorado
| | - Nancy Hadley-Miller
- Department of Orthopedics, University of Colorado School of Medicine, Anschutz Medical Campus
- Orthopedics Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Gaia Georgopoulos
- Department of Orthopedics, University of Colorado School of Medicine, Anschutz Medical Campus
- Orthopedics Institute, Children's Hospital Colorado, Aurora, Colorado, USA
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Zacay G, Modan-Moses D, Tripto-Shkolnik L, Levy-Shraga Y. Decreases in pediatric fractures during the COVID-19 pandemic - a nationwide epidemiological cohort study. Eur J Pediatr 2022; 181:1473-1480. [PMID: 34993624 PMCID: PMC8739001 DOI: 10.1007/s00431-021-04323-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 01/05/2023]
Abstract
The COVID-19 pandemic led to fundamental changes in daily routines of children. Our aim was to evaluate the incidence and characteristics of fractures among Israeli children during 2020 compared with 2015-2019. Demographic, clinical data, and incidence rates of fractures in individuals aged < 18 years were derived from the electronic database of Meuhedet Health Services, which provides healthcare services to 1.2 million people in Israel. We further subdivided the year to five periods according to government regulations of lockdown and isolation at each period. Fracture sites were determined according to ICD9 definitions. During 2020, 10,701 fractures occurred compared with 12,574 ± 599 fractures per year during 2015-2019 (p-value < 0.001). Fracture rates were lower during all periods in 2020. The largest decline was observed during the first lockdown for both boys (56% decline, 95% confidence interval [CI] 52-60%) and girls (47% decline CI 41-53%). While the fracture rate declined for most age groups, the largest decline was recorded for the age group 11-14 years, with significant reduction rates of 66% (CI 59-71%) for boys and 65% (CI 54-73%) for girls. The most prominent declines were of fractures of the hand bones of both boys and girls (64% and 59%, respectively). Conclusions: Our data showed a significant decrease in fracture rate in 2020 compared to the previous 5 years, as well as differences between periods within that year. What is New: •The COVID-19 pandemic led to fundamental change in daily routines of children with significant decrease in school attendance and sport activities. •Consequent to these public health measures, the incidence rate of pediatric fractures decreased significantly. What is New: •This study demonstrates declines in fracture rates during lockdown periods, with only partial reversing of the trends between the lockdown periods. •The most pronounced decline was observed during the first lockdown period. •The decline was most prominent in children aged 11-14 years; there was no significant change in fracture incidence of children aged <3 years.
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Affiliation(s)
- Galia Zacay
- Meuhedet Health Services, Tel Aviv, Israel
- Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Dalit Modan-Moses
- Meuhedet Health Services, Tel Aviv, Israel
- Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Liana Tripto-Shkolnik
- Meuhedet Health Services, Tel Aviv, Israel
- Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yael Levy-Shraga
- Meuhedet Health Services, Tel Aviv, Israel.
- Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel.
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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Koetter P, Gallo R, Kasmire KE. Assessing the Necessity for the "Joint Above and Below" Radiography Approach for Lower-extremity Long Bone Fractures in Children. Pediatr Emerg Care 2022; 38:e316-e320. [PMID: 33065675 DOI: 10.1097/pec.0000000000002274] [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: 11/26/2022]
Abstract
OBJECTIVES A common strategy for evaluation of extremity fractures is the "joint above and below" (JAB) radiograph approach, which includes dedicated imaging of the joint proximal and distal to a fracture independent of clinical suspicion for an injury involving the joint. The incidence of concomitant ipsilateral lower-extremity fractures or dislocations associated with lower-extremity long bone fractures in children has not been commonly reported and represents an evidential gap for determining a radiograph approach. Our purpose was to determine the frequency of and risk factors for concomitant ipsilateral lower-extremity fractures or dislocations. METHODS A retrospective study of children aged 1 to 17 years treated at an academic medical center emergency department from 2015 to 2018 with any fracture involving the tibia, fibula, or femur. Children with pathologic fractures, transferred from another facility, and/or designated as a level I trauma were excluded. The primary outcome was the prevalence of a concomitant bony injury (fracture or dislocation) at a distinct site in the same extremity. Differences between the concomitant bony injury group and single injury group were characterized using Fisher exact tests. Regression analysis was used to determine predictors of concomitant bony injuries, including age, sex, and mechanism of injury (with injuries requiring level II or III trauma activation classified as high risk). RESULTS During the study period, 241 patients with lower-extremity long bone fractures were included. Complete JAB radiographs, defined as dedicated orthogonal radiographs of the joint proximal to and distal to the fracture site, were taken in 85 (35.3%) of 241 patients. Concomitant bony injuries were found in 9 (3.73%) of 241 patients (95% confidence interval, 1.7-7.0%). No additional concomitant bony injuries were identified at follow-up. When comparing patients with and without concomitant bony injuries, there was no significant difference in age (P = 0.34) and sex (P = 0.73). However, patients with a high-risk injury were more likely to have a concomitant bony injury (P < 0.01; odds ratio, 21.9; 95% confidence interval, 3.6-131.5). CONCLUSIONS Concomitant ipsilateral lower-extremity fractures or dislocations are uncommon in children sustaining tibia, fibula, and/or femur fractures. Although the JAB approach to radiographs may be useful in identifying additional injuries in children with lower-extremity injuries resulting from a "high-risk" mechanisms, its overall yield is low. To provide safe, cost-effective care, providers should continue to value clinical suspicion, history, and physical examination findings to guide selection of radiographs in those with lower-extremity long bone fractures as significant fractures can typically be identified with limited imaging in patients with low-risk injury mechanisms.
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Affiliation(s)
| | - Robert Gallo
- Department of Orthopaedics, Bone and Joint Institute
| | - Kathryn E Kasmire
- Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey PA
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Eckert AJ, Semler O, Schnabel D, Köstner K, Wurm D, Bechtold-Dalla Pozza S, Schaaf K, Hörtenhuber T, Hammersen J, Holl RW. Bone Fractures in Children and Young Adults With Type 1 Diabetes: Age Distribution, Fracture Location, and the Role of Glycemic Control. J Bone Miner Res 2021; 36:2371-2380. [PMID: 34569646 DOI: 10.1002/jbmr.4451] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/03/2021] [Accepted: 09/24/2021] [Indexed: 12/16/2022]
Abstract
Type 1 diabetes (T1D) is a known risk factor for fractures, but the underlying pathophysiology is still not fully understood. This study aims to define age peaks and frequent fracture sites of children and young adults with T1D. Additionally, associations of fractures with metabolic and lifestyle factors as well as with additional complications in individuals with T1D were analyzed. A total of 750 individuals with T1D aged ≤25 years with fractures were matched to 3750 patients with T1D without fractures by demographics and insulin regimen. Hemoglobin A1c (HbA1c) values were compared using linear regression, and logistic regression was used to calculate odds ratios (OR) for fractures in individuals with acute complications and diseases. Median (Q1-Q3) age was 12.7 (9.9 to 14.9) years in individuals with fractures and 16.3 (12.6 to 17.8) years in the entire control group with 65% versus 53% males. Peak age for fractures was 7 to <15 years in males and 9 to <11 years in females, which is earlier than reported for the general population. HbA1c (%) was significantly higher in individuals with fractures than in controls (difference of estimated means: 0.26%; 95% confidence interval [CI] 0.07-0.46), especially in postpubertal females (0.68; 0.10-1.26). Significantly higher odds for fractures were observed in individuals with severe hypoglycemia (OR = 1.90; 95% CI 1.47-2.47), especially in prepubertal females (OR = 2.81; 1.21-6.52]) and postpubertal males (2.44; 1.11-5.38), celiac disease (2.02; 1.67-2.45), and with a history of smoking (1.38; 1.02-1.88). The age peak of fractures seems to be earlier in T1D than in the general population. Poor glycemic control is related to fractures, even before puberty. Associations of HbA1c and severe hypoglycemia with fractures highly depend on age and sex. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Alexander J Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - Oliver Semler
- Faculty of Medicine and University Hospital Cologne, Department of Paediatrics, University of Cologne, Cologne, Germany
| | - Dirk Schnabel
- Centre for Chronic Sick Children, Paediatric Endocrinology, Charité, University Medicine Berlin, Berlin, Germany
| | - Katharina Köstner
- Social Pediatric Center (SPZ) Garmisch-Partenkirchen, German Centre for Paediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Donald Wurm
- Department of Paediatrics, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Susanne Bechtold-Dalla Pozza
- Paediatric Endocrinology, iSPZ, Dr. von Haunersches Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Katja Schaaf
- Department of Paediatric and Adolescent Medicine, Elisabeth-Hospital Essen, Essen, Germany
| | | | - Johanna Hammersen
- Department of Paediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Neuherberg, Germany
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Percival MA, Pasco JA, Hosking SM, Williams LJ, Holloway-Kew KL, Wark JD, Hyde NK. Maternal vitamin D and offspring fracture risk: the Vitamin D in Pregnancy study. Arch Osteoporos 2021; 16:159. [PMID: 34705148 DOI: 10.1007/s11657-021-01023-3] [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: 03/11/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Vitamin D is important for bone health and strength. Previous studies report 25-hydroxyvitamin D (25(OH)D) exposure during pregnancy may impact offspring bone health later in life. In this study, maternal 25(OH)D at recruitment was associated with a lower fracture risk in boys and an increased fracture risk in girls at 28-32 weeks gestation. PURPOSE Maternal 25-hydroxyvitamin D (25(OH)D) in pregnancy has been shown to be associated with offspring bone measures in some studies, but few have examined fracture risk. We aimed to determine associations between maternal vitamin D status and offspring fracture risk. METHODS In total, 475 mother-child pairs participating in the Vitamin D in Pregnancy study in southeastern Australia were recruited. Maternal serum samples were taken at recruitment (< 16 weeks gestation) and/or 28-32 weeks gestation and analysed for 25(OH)D. Incident fractures in children were ascertained from date of birth (2002-2004) until December 31, 2012. Cox proportional hazard models included maternal age at recruitment, offspring sex, birth weight, gestation length and season of vitamin D sample. RESULTS Complete follow-up data were available for 400 children (median age = 9.5 years). There were 68 (17.0%) children who sustained at least one fracture. Higher maternal 25(OH)D (per 10 nmol/L) in early gestation was weakly associated with a decreased fracture risk in boys (HR 0.82; 95% CI 0.68, 0.99; p = 0.048) but not girls (HR 1.10; 95% CI 0.98, 1.25; p = 0.11). At late gestation, higher maternal 25(OH)D was associated with increased fracture risk in girls (HR 1.11; 95% CI 1.01, 1.23; p = 0.038) but not boys (HR 0.94; 95% CI 0.80, 1.10; p = 0.42). No statistically significant relationships were detected in analyses investigating 25(OH)D as a categorical variable. CONCLUSION There is some evidence that higher maternal 25(OH)D at recruitment was associated with lower fracture risk in boys, while higher maternal 25(OH)D at 28-32 weeks gestation was associated with an increased fracture risk in girls.
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Affiliation(s)
- Mia A Percival
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia.
| | - Julie A Pasco
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia.,Barwon Health, Geelong, VIC, 3220, Australia.,Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, 3021, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Prahran, VIC, 3181, Australia
| | - Sarah M Hosking
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia
| | - Lana J Williams
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia
| | - Kara L Holloway-Kew
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia
| | - John D Wark
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3050, Australia.,Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.,Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
| | - Natalie K Hyde
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia
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Schultz JD, Rees AB, Wollenman LC, McKeithan LJ, Tadepalli VR, Wessinger BC, Attipoe G, Gay JC, Martus JE, Moore-Lotridge SN, Schoenecker JG. Factors That Drive Annual Variation in Pediatric Elbow Fracture Occurrence, Severity, and Resource Utilization. J Pediatr Orthop 2021; 41:e755-e762. [PMID: 34325445 DOI: 10.1097/bpo.0000000000001915] [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 Elbow fractures are the most common pediatric fractures requiring operative treatment. To date, few studies have examined what annual factors drive pediatric elbow fracture incidence and no studies have examined which annual factors drive elbow fracture severity or resource utilization. The goal of this study was to not only document the annual patterns of pediatric elbow fracture incidence and severity but also the impact of these patterns on resource utilization in the emergency department, emergency medical service transportation, and the operating room (OR). METHODS Retrospective cohort study of 4414 pediatric elbow fractures from a single tertiary hospital (2007 to 2017). Exclusion criteria included outside treatment or lack of diagnosis by an orthopaedist. Presentation information, injury patterns, transport, and treatment requirements were collected. Pearson correlations were used to analyze factors influencing fracture incidence, severity, and resource utilization. RESULTS Pediatric elbow fracture incidence positively correlated with monthly daylight hours, but significantly fewer elbow fractures occurred during summer vacation from school compared with surrounding in school months. While fewer overall fractures occurred during summer break, the fractures sustained were greater in severity, conferring higher rates of displacement, higher risk of neurovascular injury, and greater needs for emergency transportation and operative treatment. Yearly, elbow fractures required 320.6 OR hours (7.7% of all pediatric orthopaedic OR time and 12.3% of all pediatric orthopaedic operative procedures), 203.4 hospital admissions, and a total of 4753.7 miles traveled by emergency medical service transportation to manage. All-cause emergency department visits were negatively correlated with daylight hours, inversing the pattern seen in elbow fractures. CONCLUSION Increased daylight, while school was in session, was a major driver of the incidence of pediatric elbow fractures. While summer vacation conferred fewer fractures, these were of higher severity. As such, increased daylight correlated strongly with monthly resource utilization, including the need for emergency transportation and operative treatment. This study provides objective data by which providers and administrators can more accurately allocate resources. LEVEL OF EVIDENCE Level III-Retrospective comparative study.
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Affiliation(s)
| | | | | | | | | | | | - Graham Attipoe
- Vanderbilt University School of Medicine
- The Wharton School at the University of Pennsylvania, Philadelphia, PA
| | | | - Jeffrey E Martus
- Division of Pediatric Orthopaedics, Monroe Carell Jr. Children's Hospital at Vanderbilt
- Department of Orthopaedics, Vanderbilt University Medical Center
- Pediatrics
| | - Stephanie N Moore-Lotridge
- Division of Pediatric Orthopaedics, Monroe Carell Jr. Children's Hospital at Vanderbilt
- Department of Orthopaedics, Vanderbilt University Medical Center
- Center for Bone Biology, Nashville, TN
| | - Jonathan G Schoenecker
- Division of Pediatric Orthopaedics, Monroe Carell Jr. Children's Hospital at Vanderbilt
- Department of Orthopaedics, Vanderbilt University Medical Center
- Departments of Pharmacology
- Pediatrics
- Pathology, Microbiology, and Immunology
- Center for Bone Biology, Nashville, TN
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Horn J, Rasmussen H, Bukholm IRK, Røise O, Terjesen T. Compensation claims in pediatric orthopedics in Norway between 2012 and 2018: a nationwide study of 487 patients. Acta Orthop 2021; 92:615-620. [PMID: 34082661 PMCID: PMC8519525 DOI: 10.1080/17453674.2021.1932922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - In Norway all compensation claims based on healthcare services are handled by a government agency (NPE, Norsk Pasientskade Erstatning). We provide an epidemiological overview of claims within pediatric orthopedics in Norway, and identify the most common reasons for claims and compensations.Patients and methods - All compensation claims handled by NPE from 2012 to 2018 within pediatric orthopedics (age 0 to 17 years) were reviewed. Data were analyzed with regard to patient demographics, diagnoses, type of injury, type of treatment, reasons for granted compensation, and total payouts.Results - 487 compensation claims (259 girls, 228 boys) within orthopedic surgery in patients younger than 18 years at time of treatment were identified. Mean age was 12 years (0-17). 150 out of 487 claims (31%) resulted in compensation, including 79 compensations for inadequate treatment, 58 for inadequate diagnostics, 12 for infections, and 1 based on the exceptional rule. Total payouts were US$8.45 million. The most common primary diagnoses were: upper extremity injuries (26%), lower extremity injuries (24%), congenital malformations and deformities (12%), spine deformities (11%), disorders affecting peripheral joints (9%), chondropathies (6%), and others (12%).Interpretation - Most claims were submitted and granted for mismanagement of fractures in the upper and lower extremity, and mismanagement of congenital malformations and disorders of peripheral joints. Knowledge of the details of malpractice claims should be implemented in educational programs and assist pediatric orthopedic surgeons to develop guidelines in order to improve patient safety and quality of care.
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Affiliation(s)
- Joachim Horn
- Division of Orthopaedic Surgery, Section of Children’s Orthopaedics and Reconstructive Surgery, Oslo University Hospital,Institute of Clinical Medicine, University of Oslo, Oslo,Joachim Horn Division of Orthopaedic Surgery, Section of Children’s Orthopaedics and Reconstructive Surgery, Oslo University Hospital
| | | | | | - Olav Røise
- Division of Orthopaedic Surgery, Section of Children’s Orthopaedics and Reconstructive Surgery, Oslo University Hospital,Institute of Clinical Medicine, University of Oslo, Oslo,University of Oslo and Faculty of Health Sciences, SHARE – Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Terje Terjesen
- Division of Orthopaedic Surgery, Section of Children’s Orthopaedics and Reconstructive Surgery, Oslo University Hospital
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Harrison WD, Chan YC, James LA, Nayagam S. The association of socioeconomic deprivation and paediatric open tibia fractures. J Pediatr Orthop B 2021; 30:423-430. [PMID: 32991371 DOI: 10.1097/bpb.0000000000000808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The primary aim of this study is to test the association of open tibial fractures (OTF), in a paediatric age group, with socioeconomic deprivation. The secondary objectives are to more clearly define the epidemiological characteristics of these high-energy injuries. A consecutive series of patients with OTF presenting to a major trauma centre at a children's hospital in Liverpool had age, gender, fracture pattern, mechanism, timing of the injury and their postcode of residence recorded. Those cases outside Liverpool, Sefton and Knowsley local authorities were excluded from incidence calculations. Postcodes were used to generate deprivation scores (Index of Multiple Deprivation, 2010) based on census data (2011). Cases were ranked and allocated to deprivation quintiles. A comparison to the normal population within Merseyside was undertaken using regression analysis. There were 71 cases over a 9-year period. Fifty cases resided within the geographical limits of Merseyside and were included in the incidence calculations. The annual incidence of paediatric OTF is 3.09 per 100 000 children (0-16 years). The median age at injury was 11 years (range 2-16) and this occurred most usually during term-time between 3 and 5 p.m. from road traffic collisions. Paediatric OTFs are strongly associated with socioeconomic deprivation. The association with deprivation reflects an exposure to unsafe roads in busy urban areas with limited access to safe playing spaces. Socioeconomically deprived men are most at risk from this injury. The links between deprivation and outcomes of treatment or long-term prospects are unclear.
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Affiliation(s)
- William D Harrison
- Department of Trauma and Orthopaedics, North-West Deanery (Mersey sector)
| | - Yuen C Chan
- Department of Trauma and Orthopaedics, North-West Deanery (Mersey sector)
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Li J, Yuan X, Cao Y, Liu T, Gou P, Li X, Li M, Liu X. The effects of home confinement on pediatric fractures during the COVID 19 outbreak. Ital J Pediatr 2021; 47:142. [PMID: 34193213 PMCID: PMC8242274 DOI: 10.1186/s13052-021-01092-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/29/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To control the transmission of coronavirus disease 2019 (COVID-19), the Chinese government encouraged people to stay at home. This study aimed to evaluate the effects of home confinement on the occurrence of fractures among children. STUDY DESIGN We retrospectively reviewed children admitted to Children's Hospital of Chongqing Medical University, for traumatic injury from January 24 to March 10, 2020, and the same time period in 2017, 2018 and 2019. At the same time, children with fracture were screened out and the date for the past 4 years was compared in terms of etiology, location of fracture, sex and age to evaluate the effects of home confinement on the epidemiology of pediatric fractures during the COVID-19 outbreak. RESULTS There were 6066 fractures in5,346 patients in 2017-2019, and 1034 fractures in 862 patients in 2020; the number of patients in all years reached a peak at the age of 2 to 4 years. The patients were slightly younger in 2020 than in 2017-2019 (t = 9.953, 95% CI: 0.846-1.262), and the proportion of boys in 2017-2019 is higher than in 2020 (X2 = 6.944, P = 0.008). Home confinement and traffic restriction resulted in a reduction in traffic accidents-associated fractures among children (X2 = 16.399, P < 0.001). CONCLUSION Home confinement lead to the significant reduction in the number of pediatric fractures, especially in male children, but the number of patients under 4 years old was still considerable, and the proportion of younger patients even increased. Therefore, the perspective of children should not be relaxed during home isolation.
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Affiliation(s)
- Jun Li
- Department I of Orthopedic of Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Xiaowei Yuan
- Department I of Orthopedic of Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Yinqiang Cao
- Department I of Orthopedic of Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Tao Liu
- Department I of Orthopedic of Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Pan Gou
- Department I of Orthopedic of Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Xiang Li
- Department I of Orthopedic of Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Ming Li
- Department I of Orthopedic of Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Xing Liu
- Department I of Orthopedic of Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China. .,Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China. .,National Clinical Research Center for Child Health and Disorders, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China. .,China International Science and Technology Cooperation base of Child development and Critical Disorders Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.
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Warden SJ, Wright CS, Fuchs RK. Bone Microarchitecture and Strength Adaptation to Physical Activity: A Within-Subject Controlled HRpQCT Study. Med Sci Sports Exerc 2021; 53:1179-1187. [PMID: 33394902 DOI: 10.1249/mss.0000000000002571] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Physical activity benefits bone mass and cortical bone size. The current study assessed the impact of chronic (≥10 yr) physical activity on trabecular microarchitectural properties and microfinite element analyses of estimated bone strength. METHODS Female collegiate-level tennis players (n = 15; age = 20.3 ± 0.9 yr) were used as a within-subject controlled model of chronic unilateral upper-extremity physical activity. Racquet-to-nonracquet arm differences at the distal radius and radial diaphysis were assessed using high-resolution peripheral quantitative computed tomography. The distal tibia and the tibial diaphysis in both legs were also assessed, and cross-country runners (n = 15; age = 20.8 ± 1.2 yr) included as controls. RESULTS The distal radius of the racquet arm had 11.8% (95% confidence interval [CI] = 7.9% to 15.7%) greater trabecular bone volume/tissue volume, with trabeculae that were greater in number, thickness, connectivity, and proximity to each other than that in the nonracquet arm (all P < 0.01). Combined with enhanced cortical bone properties, the microarchitectural advantages at the distal radius contributed a 18.7% (95% CI = 13.0% to 24.4%) racquet-to-nonracquet arm difference in predicted load before failure. At the radial diaphysis, predicted load to failure was 9.6% (95% CI = 6.7% to 12.6%) greater in the racquet versus nonracquet arm. There were fewer and smaller side-to-side differences at the distal tibia; however, the tibial diaphysis in the leg opposite the racquet arm was larger with a thicker cortex and had 4.4% (95% CI = 1.7% to 7.1%) greater strength than the contralateral leg. CONCLUSION Chronically elevated physical activity enhances trabecular microarchitecture and microfinite element estimated strength, furthering observations from short-term longitudinal studies. The data also demonstrate that tennis players exhibit crossed symmetry wherein the leg opposite the racquet arm possesses enhanced tibial properties compared with in the contralateral leg.
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Okoli M, Silverman M, Abboudi J, Jones C, Kirkpatrick W, Liss F, Takei TR, Wang M, Ilyas AM. Radiographic Healing and Functional Outcomes of Untreated Ulnar Styloid Fractures Following Volar Plate Fixation of Distal Radius Fractures: A Prospective Analysis. Hand (N Y) 2021; 16:332-337. [PMID: 31286791 PMCID: PMC8120582 DOI: 10.1177/1558944719855445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Ulnar styloid fractures (USFs) are common concomitant injuries associated with distal radius fractures (DRFs). Recent studies have found conflicting evidence on whether these fractures treated or untreated effect pain and functional outcomes. The purpose of this study was to prospectively evaluate pain and function outcomes of consecutively untreated USFs in surgically repaired DRFs. The study hypothesis was that there would be no difference in outcomes whether an USF is present or not, with all cases left untreated. Methods: A prospective study at a single institution of consecutive DRF treated surgically with volar locked plating was undertaken. No patients underwent fixation of an USF if present. There were no treated USF that were excluded. Patients with associated ulnar neck and shaft fractures were excluded. Functional outcome measures were analyzed using the Quick Disabilities of the Arm, Shoulder, and Hand score (QDASH) and the Patient-Rated Wrist Evaluation (PRWE) scores. Outcome measures were collected at 3 months and 1 year postoperatively. Results: There was an incidence of 52.2% (n = 70/134) USF associated with surgically treated DRF. By location, there were 52.9% (n = 37/70) ulnar styloid tip fractures and 46.1% (33/70) ulnar styloid base. There were 75.7% of USF (53/70) still not healed by 1-year follow-up. When comparing patients with a DRF without an USF versus DRF with an associated USF at 12 months, there was no statistical difference in the QDASH score (6.7 vs 8.4, P = .47) or the PRWE total score (4.8 vs 7.5, P = .24). Similarly, subgroup analysis showed no statistical difference in QDASH or PRWE scores at final follow-up in united USF versus nonunited USF subjects (QDASH 14.2 vs 6.8, P = .112; PRWE 14.8 vs 5.4, P = .185). Conclusions: USFs are a common concomitant injury occurring in nearly half of DRFs treated surgically. Our prospective cohort analysis showed that neither the presence, type, nor bony union status of a concomitant USF has any significant effect on patient outcomes or reoperations at 1-year postoperatively. Our study confirms our hypothesis that USF of the tip and base should be left untreated.
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Affiliation(s)
- Michael Okoli
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Silverman
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jack Abboudi
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher Jones
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Frederic Liss
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - T. Robert Takei
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark Wang
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Asif M. Ilyas
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA,Asif M. Ilyas, Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA.
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Refracture Rate of Both Bone Forearm Fractures: A Retrospective Comparison of Casting Alone Versus Casting and Extended Functional Bracing. J Pediatr Orthop 2021; 41:267-272. [PMID: 33710130 DOI: 10.1097/bpo.0000000000001787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND One of the most common pediatric fractures is a midshaft both bone forearm fracture. The preferred nonoperative treatment is cast immobilization for 6 to 8 weeks; however, 4% to 8% refracture within 6 months. There are no comparative studies evaluating the efficacy of bracing after cast immobilization. We hypothesized that children treated with prolonged functional bracing would have a lower rate of refracture than casting alone or short-term bracing. METHODS This is a retrospective review of children younger than 15 years of age treated nonoperatively following radius and ulnar shaft fractures treated at 3 tertiary pediatric hospitals. We excluded distal radius/ulna fractures, isolated fractures of the radius/ulna, and fractures near the elbow. Logistic regression analysis on casting plus functional bracing was run to determine if age, translation, or the number of days in brace were associated with refracture. The incidence of refracture was compared between groups. RESULTS A total of 1549 patients were screened and 426 were included in the study [111 casting only (CO), 259 casting plus functional brace <8 wk (CFB <8 wk), 56 casting plus functional brace ≥8 wk (CFB ≥8 wk)]. In comparing the groups, CO was the youngest (4.4 y vs. 6.3 and 8.4 y). The initial translation and angulation of the radius and ulna were significantly greater in the CFB ≥8 weeks group. Regression analyses shows no association between refracture and initial fracture characteristics including age, translation, or the number of days in brace. The CO group had 3 refractures (2.7%), the CFB <8 weeks group had 13 (5%) and the CFB ≥8 weeks group had 1 (1.8%); demonstrating no statistical significance. CONCLUSION Extended fracture bracing, following a period of cast immobilization, did not lead to a statistically significant difference in refracture rate. Contrary to previous cases series, the benefit of bracing seems nominal. Larger, prospective studies are needed to better understand targets for treatment. LEVEL OF EVIDENCE This is the first level III retrospective comparison study of its kind.
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Bergman E, Lempesis V, Jehpsson L, Rosengren BE, Karlsson MK. Childhood Distal Forearm Fracture Incidence in Malmö, Sweden 1950 to 2016. J Wrist Surg 2021; 10:129-135. [PMID: 33815948 PMCID: PMC8012093 DOI: 10.1055/s-0040-1720965] [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: 05/31/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022]
Abstract
Background Distal forearm fracture is the most common pediatric fracture. As studies have indicated time trends in fracture incidence, we wanted to update the epidemiology and estimate time trends between 1950 and 2016 in Malmö, Sweden. Methods The city of Malmö, Sweden, had 318,107 inhabitants (58,585 of the population was aged <16 years) in 2014 and one hospital. We, therefore, used the hospital diagnosis registry and hospital medical records to identify and classify distal forearm fractures 2014 to 2016 in children aged 0 to 15 years. For long-term trend calculations, we also included published data from 1950 to 2006 (resulting in 17 evaluated years) and used joinpoint regression to estimate annual percent changes (APC). To describe differences in incidence between two periods, we calculated incident rate ratios (IRR) with 95% confidence intervals (95% CI) to describe uncertainty. Results Childhood distal forearm fracture incidence in 2014 to 2016 was 546/100,000 person-years (660 in boys and 427 in girls). The age-adjusted incidence in 2014 to 2016 and in 2005 to 2006 was similar (boys IRR 1.0, 95% CI: 0.9-1.2 and girls IRR 1.1, 95% CI: 0.9-1.3). Time-trend analyses from 1950 to 2016 revealed increasing age-adjusted incidence in both boys (APC +0.9%, 95% CI: 0.7-1.2) and girls (APC +0.6%, 95% CI: 0.3-0.9). Conclusion Distal forearm fracture incidence was similar in 2014 to 2016 and in 2005 to 2006. Age-adjusted incidence had increased in both sexes from 1950 to 2016. Level of Evidence This is a Level III b study.
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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, Malmö, Sweden
| | - Vasileios Lempesis
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Lars Jehpsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Björn E. Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus K. Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
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Huang Q, Su F, Wang ZM, Xue HZ, Sun L, Ma T, Wang Q, Lu Y, Li M, Ren C, Zhang CM, Zhang K, Li Z. Prying reduction with mosquito forceps versus limited open reduction for irreducible distal radius-ulna fractures in older children: a retrospective study. BMC Musculoskelet Disord 2021; 22:147. [PMID: 33546669 PMCID: PMC7866453 DOI: 10.1186/s12891-021-04024-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are disputes about which reduction technique should be adopted in treatment of distal radius-ulna fractures in older children who failed to achieve manual reduction. This study compared clinical effects between prying reduction with mosquito forceps (PRMF) and limited open reduction (LOR) of treating irreducible distal radius-ulna fractures in older children. METHODS One hundred ten children with irreducible distal radius-ulna fractures were selected from January 2015 to December 2017 in Xi'an Hong Hui hospital. Retrospective analysis was performed. According to different reduction techniques, these children were divided into PRMF group (59 cases) and LOR group (51 cases). All children were treated with percutaneous Kirschner wire fixation and external fixation with plaster. Operation indexes, complications and wrist joint functions were compared between the two groups. RESULTS Operation time of PRMF group was shorter than that of LOR group (P < 0.05). Incision length in PRMF group was less than that in LOR group (P < 0.05). Bleeding volume of PRMF group was less than that of LOR group (P < 0.05). Incidence of complications in PRMF group was lower than that in LOR group. CONCLUSIONS Compared with limited open reduction, it has better clinical effects of prying reduction with mosquito forceps in treatment of irreducible distal radius-ulna fractures in older children. This technique has the advantages of simple operation, less trauma, less bleeding and fewer complications, which is worthy of clinical promotion.
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Affiliation(s)
- Qiang Huang
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Fei Su
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Zhi Meng Wang
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Han Zhong Xue
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Liang Sun
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Teng Ma
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Qian Wang
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Yao Lu
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Ming Li
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Cheng Ren
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Cong Ming Zhang
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China
| | - Kun Zhang
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China.
| | - Zhong Li
- Xi'an Hong Hui hospital, Xi'an Jiaotong University College of Medicine, 710000, Xi'an, China.
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Zhu T, Shi Y, Yu Q, Zhao YJ, Dai W, Chen Y, Zhang SS. Scoring system for poor limb perfusion after limb fracture in children. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.5923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Zhu T, Shi Y, Yu Q, Zhao YJ, Dai W, Chen Y, Zhang SS. Scoring system for poor limb perfusion after limb fracture in children. World J Clin Cases 2020; 8:5926-5934. [PMID: 33344591 PMCID: PMC7723717 DOI: 10.12998/wjcc.v8.i23.5926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/24/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Assessment of the vascular status following limb fracture in children is important to evaluate the risk of compartment syndrome, which is an emergency condition.
AIM To establish a simple and efficient grading scale of limb perfusion in children undergoing surgery for limb fracture.
METHODS This retrospective study included pediatric patients with a limb fracture and postoperative plaster fixation who were admitted at The Department of Pediatric Orthopedics of Xinhua Hospital between February 2017 and August 2017. The outcome was poor limb perfusion, which is defined as the postoperative use of mannitol. The children were divided into two groups: The normal perfusion group and the poor perfusion group. Key risk factors have been selected by univariable analyses to establish the Grading Scale for Vascular Status.
RESULTS A total of 161 patients were included in the study: 85 in the normal perfusion group and 76 in the poor perfusion group. There were no significant differences in age, sex, body mass index, ethnicity, cause of fracture, fixation, or site of fracture between the two groups. After surgery, the skin temperature (P = 0.048) and skin color (P < 0.001) of the affected limb were significantly different between the two groups. The relative risk and 95% confidence interval for skin temperature of the affected limb, skin color, and range of motion of the affected limb are 2.18 (1.84-2.59), 2.89 (2.28-3.66), and 2.16 (1.83-2.56), respectively. The grading scale was established based on those three factors (score range: 0-3 points). Forty-one patients (32.5%) with score 0 had poor limb perfusion; all patients with scores 1 (n = 32) and 2 (n = 3) had poor limb perfusion (both 100%).
CONCLUSION In children undergoing surgery for limb fracture, a higher Grading Scale for Vascular Status score is associated with a higher occurrence of poor limb perfusion. A prospective study is required for validation.
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Affiliation(s)
- Ting Zhu
- Department of Pediatric Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Yu Shi
- Department of Pediatric Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Qun Yu
- Department of Pediatric Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | | | - Wen Dai
- Department of Pediatric Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Yan Chen
- Department of Pediatric Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Shun-Sheng Zhang
- Department of Pediatric Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
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Differences in patient and injury characteristics between sports- and non-sports related distal radius fractures. Orthop Traumatol Surg Res 2020; 106:1605-1611. [PMID: 33160878 DOI: 10.1016/j.otsr.2020.06.021] [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: 03/31/2020] [Revised: 04/30/2020] [Accepted: 06/08/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The incidence of distal radius fractures (DRFs) is increasing as the number of people in recreational or sporting activities rises, due to a combination of increased leisure time and greater public awareness of the health-related benefits of sports. Despite the increases in sports-related distal radius fractures (SR-DRFs), there are limited studies regarding the characteristics of treatment and recovery. HYPOTHESIS There are characteristics specific to SR-DRF treated with conservative or operative management. MATERIAL AND METHODS Retrospective review was carried out between January 2010 and December 2017. Overall, 1706 patients were included in the study analysis. Among them, 317 patients were injured during sports activity (18.6%) and 1389 were injured during non-sports activity (81.4%). Demographic data were compared between the two groups. The type of sports was investigated in SR-DRF. Also, we compared surgically treated DRF patients to describe differences in patient characteristics, fracture characteristics, and postoperative complications. RESULTS The mean age of patients with SR-DRFs was significantly younger (28 vs. 52 years). The proportion of men was also significantly higher in SR-DRF group compared to NSR-DRF group (62.8 vs. 33.8%). We identified 27 kinds of sports associated with DRFs and the 5 sports topping the list associated were soccer (22.7%), cycling (17.7%), snowboarding (11.0%), ice-skating (9.1%), and mountain hiking (9.1%). There was no difference in terms of the treatment method. However, SR-DRF group had higher proportion of AO/OTA type A fracture (32.6 vs. 13.7%), and NSR-DRF group had higher proportion of type C fracture (79.5 vs. 64.2%). Postoperative complications showed no significant differences, except higher implant removal rate in SR-DRF. DISCUSSION Patients with SR-DRF were significantly younger and had higher proportion of men. Proportion of AO/OTA type A was higher in SR-DRF group and proportion of AO/OTA type C was higher in NSR-DRF group. Proportion of surgical treatment was similar in two groups. Given the growing population participating in sports activity worldwide, SR-DRFs are predicted to increase and further study is required. LEVEL OF EVIDENCE III; retrospective, epidemiological study.
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Gohel S, Baldwin KD, Hill JF. Closed Reduction of Pediatric Distal Radial Fractures and Epiphyseal Separations. JBJS Essent Surg Tech 2020; 10:ST-D-19-00059. [PMID: 34055473 DOI: 10.2106/jbjs.st.19.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Sedated, closed reduction of a displaced distal radial fracture followed by cast immobilization is indicated in cases of unacceptable alignment on post-splint imaging. The aim of this procedure is to obtain acceptable reduction and cast immobilization for fracture-healing. Description The patient is positioned supine with the injured arm on the image intensifier. Adequate sedation is achieved with conscious sedation, general anesthesia, or regional anesthesia (hematoma block). The radial or ulnar translation is corrected with in-line traction. The wrist is typically hyperdorsiflexed, and traction is applied to the distal fragment. The distal fragment is then walked up and over as axial traction is applied and the wrist is brought from extension to flexion. The reduced wrist is held in a position of gentle flexion and slight ulnar deviation, and post-reduction fluoroscopy in anteroposterior and lateral views is obtained. A long-arm cast is applied by first applying a short-arm cast and a 3-point mold. Minimal cast padding is utilized to obtain the optimal "cast index." The wrist is re-imaged on the fluoroscopy device to obtain anteroposterior and lateral views. Alternatives Alternative treatments include cast immobilization in situ, closed reduction and percutaneous pinning, and open reduction and internal fixation. Rationale Closed reduction and cast immobilization is a low-risk procedure that has a high rate of union with acceptable alignment without the risk of an additional surgical procedure. Expected Outcomes The long-arm cast is maintained for 6 weeks, and radiographs are obtained at 1 and at 2 weeks postoperatively to confirm maintained alignment. It is advisable to instruct the patient not to put anything down the cast because this can result in skin breakdown. Additionally, care must be taken on removal of the cast. Cast saws should be kept sharp and be replaced frequently. There are commercially available "zip sticks" and other such devices to prevent cast-saw burns that should be utilized if cast technicians or residents are assisting in the removal. Following removal of the cast, we recommend wrist-motion exercises be performed 3 times daily. If the fracture line is clearly visible on radiographs, a removable wrist splint is utilized for another 2 to 4 weeks. A full return to activity is expected at 3 months. Some residual deformity is acceptable if the remodeling capacity is excellent at the distal aspect of the radius. However, the tolerance for malreduction decreases as the patient ages, if the deformity worsens, or if there is a deformity further from the physis. Important Tips Particular attention should be given to the median nerve sensory component. The thumb, index, and long fingers are assessed for sensation and compared with the 2 ulnar digits. Acute carpal tunnel syndrome is possible in children who have distal radial fractures.Waterproof cast padding is not recommended in cases in which a closed reduction is performed because such padding does not provide good protection to the skin with adequate cast molding.After reduction is obtained, no additional traction should be applied. If an assistant applies traction with the wrist in extension, reduction can be lost, so it is preferred to maintain the wrist in slight flexion while placing the cast.Although it is beneficial to hold the fracture in the cotton-loader position, this position should not be exaggerated because this position can cause excessive pressure on the carpal tunnel.The median nerve passes through the carpal tunnel and is often at risk because of hematoma formation as a result of a distal radial fracture.A cast index of 0.8 or more has been found to have an increased risk of failure of closed treatment. The cast index is the ratio of sagittal (measured on a lateral view) to coronal (measured on an anteroposterior view) width from the inside edges of the cast at the fracture site.Keeping cast saw blades sharp, using saws attached to vacuum devices, and cooling the blade while in use can prevent cast-saw burns.Zip sticks can be utilized to protect the skin but can sometimes be difficult to get under the cast.It is important to remember that swelling will occur following fracture reduction. The cast should not be wrapped tightly. Consideration should be given to bivalving the cast at the time of reduction and overwrapping after a few days when acute swelling has improved.Vigilance for growth arrest is necessary in patients with fractures of the distal aspect of the radius. This can occur in up to 4% to 5% of cases and is more common with reduction, particularly late reduction. Radiographic screening 6 to 12 months after the injury can help identify an early arrest.
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Affiliation(s)
- Shivani Gohel
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Keith D Baldwin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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