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Fracture + pediatric + review

Ramesh Kumar, Frederic W B Deleyiannis, Corbett Wilkinson, Brent R O'Neill
OBJECTIVE The authors' goals in this study were to describe a series of dog attacks on children that required neurosurgical consultation and to better understand the pattern of injuries inflicted, the circumstances that place children at risk for attack, and the dog breeds involved. In addition, the authors review the surgical and medical management of these patients. METHODS The authors performed a retrospective review of all children requiring neurosurgical consultation for dog bite at a regional Level 1 pediatric trauma center over a 15-year period...
October 21, 2016: Journal of Neurosurgery. Pediatrics
Eugene T H Ek, Sophia K Paul, Robert N Hotchkiss
BACKGROUND: The role of elbow contracture release in the very young is unclear, with existing studies reporting conflicting results. This study evaluated the long-term results after open elbow contracture release in patients aged younger than 18 years. METHODS: Between 1994 and 2012, 32 patients underwent open elbow contracture release at a mean age of 13.8 years (range, 5-18 years), and their outcomes were reviewed. The primary cause was traumatic in 30 patients (4 radial head/neck fractures, 5 intra-articular distal humeral fractures, 11 extra-articular distal humeral fractures, 10 complex fracture-dislocations), and the mean time from the index injury to contracture release was 16...
October 14, 2016: Journal of Shoulder and Elbow Surgery
Erin Mills, Simon Craig, Ed Oakley
OBJECTIVE: The primary objective was to assess if a computerized pop-up reminder increased splint application before X-ray in pediatric emergency department patients with deformed upper limb fractures. The secondary objective was to evaluate whether this same reminder improved pharmaceutical analgesia provision in this population. METHODOLOGY: This was a prospective study of 518 pediatric emergency department patients with upper limb fractures after the implementation of a computerized pop-up reminder to give analgesia and apply a splint...
October 2016: Pediatric Emergency Care
Merritt D Kinon, Rani Nasser, Jonathan Nakhla, Rupen Desai, Jessica R Moreno, Reza Yassari, Carlos A Bagley
Pediatric emergency physicians must have a high clinical suspicion for atlantoaxial rotatory subluxation (AARS), particularly when a child presents with neck pain and an abnormal head posture without the ability to return to a neutral position. As shown in the neurosurgical literature, timely diagnosis and swift initiation of treatment have a greater chance of treatment success for the patient. However, timely treatment is complicated because torticollis can result from a variety of maladies, including: congenital abnormalities involving the C1-C2 joint or the surrounding supporting muscles and ligaments, central nervous system abnormalities, obstetric palsies from brachial plexus injuries, clavicle fractures, head and neck surgery, and infection...
October 2016: Pediatric Emergency Care
Rohan A Ramasubbu, Benjamin M Ramasubbu
BACKGROUND: Management of open tibial fractures is well documented in adults, with existing protocols outlining detailed treatment strategies. No clear guidelines exist for children. Surgical stabilization of tibial fractures in the pediatric population requires implants that do not disrupt the open epiphyses (growth plate). Both elastic stable intramedullary nails and external fixation can be used. The objective of this study was to identify the optimal method of surgical stabilization in the treatment of open tibial fractures in children...
September 2016: Indian Journal of Orthopaedics
Yuki Fujihara, Masahiro Tatebe, Nasa Fujihara, Hiromasa Tanaka, Hitoshi Hirata
OBJECTIVE: The aim of this study was to verify the use of initial plain radiographs, specifically the presence of a longitudinal crack on the olecranon, for diagnosing olecranon occult fractures in children. METHODS: We retrospectively reviewed all patients younger than 16 years who were diagnosed with proximal radial fractures treated at our hospital between April 1, 2006 and September 31, 2014. We included 22 patients (9 boys and 13 girls) with a mean age of 8...
October 6, 2016: Pediatric Emergency Care
Derrick M Knapik, Cameron L Fausett, Allison Gilmore, Raymond W Liu
BACKGROUND: Medial epicondyle fractures may occur in isolation or with associated elbow dislocation. In the absence of open fracture or fragment incarceration, nonoperative management with immobilization has been shown to result in generally successfully outcomes comparable with those reported after surgical fixation. However, no comparative investigation has assessed outcomes after nonoperative treatment based on the presence or absence of elbow dislocation. METHODS: A systematic review was conducted investigating all studies in the literature reporting nonoperative outcomes for isolated medial epicondyle fractures and fracture-dislocations...
October 12, 2016: Journal of Pediatric Orthopedics
Jorge Delgado, Diego Jaramillo, Nancy A Chauvin
Increased physical activity in childhood has resulted in a large number of sports-related injuries. Although there is overlap between the sports-related injuries seen in pediatric and adult patients, important differences exist in the injury patterns of pediatric patients. These differences are related to the continuous changes in the developing skeleton and its relationship with adjacent soft tissues. The imbalance in strength between the growing bones and the nearby tendons and ligaments makes the bones prone to acute and chronic injuries...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Megan E Gornet, Michael P Kelly
Fractures of the second cervical vertebra (C2, axis) are common in adult spine surgery. Those fractures occurring in younger adult patients are often associated with high-energy mechanism trauma, resulting in a "Hangman's Fracture." Management of these fractures is often successful with nonoperative means, though surgery may be needed in those fractures with greater displacement and injury to the C2-C3 disc. Older patients are more likely to sustain fractures of the odontoid process. The evidence supporting surgical management of these fractures is evolving, as there may be a mortality benefit to surgery...
September 29, 2016: Current Reviews in Musculoskeletal Medicine
Shawn Nguyen, Mitchell McDowell, John Schlechter
Casting is a routine procedure used for fracture care in the pediatric population. The purpose of this review is to provide pearls and pitfalls that our institution has learned from previous literature. When applying the cast, we recommend using cotton padding for the liner and fiberglass or plaster depending on how much swelling is expected. A well-molded cast must be applied in order to prevent further fracture displacement. Cast valving is a valuable technique that allows a decrease in pressure which prevents discomfort and complications like compartment syndrome...
September 18, 2016: World Journal of Orthopedics
Julio J Jauregui, Dean C Perfetti, Frank S Cautela, David B Frumberg, Qais Naziri, Carl B Paulino
BACKGROUND: Although rare, spinal injuries associated with abuse can have potentially devastating implications in the pediatric population. We analyzed the association of pediatric spine injury in abused children and determined the anatomic level of the spine affected, while also focusing on patient demographics, length of stay, and total hospital charges compared with spine patients without a diagnosis of abuse. METHODS: A retrospective review of the Kids' Inpatient Database was conducted from 2000 to 2012 to identify pediatric patients (below 18 y) who sustained vertebral column fractures or spinal cord injuries...
September 22, 2016: Journal of Pediatric Orthopedics
Gaurav Luther, Patricia E Miller, Susan T Mahan, Peter M Waters, Donald S Bae
BACKGROUND: Standardized clinical assessment and management plans (SCAMPs) are a novel quality improvement initiative shown to improve patient care, diminish practice variation, and reduce resource utilization. Unlike clinical practice guidelines, a SCAMP is a flexible algorithm that undergoes iterative updates based on periodic data collection and review. We recently implemented a SCAMP for the closed treatment of pediatric torus fractures. The purpose of this study is to analyze the effect of SCAMP implementation on resource utilization, practice variability, cost of care, and outcomes...
September 15, 2016: Journal of Pediatric Orthopedics
Ciaran S Hill, Aaron L McLean, Mark H Wilson
OBJECTIVE: Pediatric traumatic brain injury is the most common cause of death and a major cause of morbidity in children and young adults worldwide. Despite this, our understanding of epidemiological factors relating to this type of injury is incomplete. The objective of this study was to explore a variety of factors relating to these injuries including mechanism, timing of emergency response, prehospital management, radiological diagnosis, neurosurgical care, and final outcomes. METHODS: A retrospective review of all pediatric traumas attending a single large, densely populated urban area within a 2-year period was undertaken, and all cases with significant pediatric traumatic brain injury, as defined by a computed tomography scan showing an intracranial injury, were included for further analysis...
September 9, 2016: Pediatric Emergency Care
Maria Zulfiqar, Stacy Kim, Jin-Ping Lai, Yihua Zhou
BACKGROUND: Despite the added radiation exposure and costs, the role of computed tomography (CT) in following pediatric skull fractures has not been fully evaluated. METHODS: We reviewed the radiology reports and images of the initial and follow-up head CT examinations of children with skull fractures to determine whether any interval changes in the fracture morphology and associated complications necessitate a change in clinical management. RESULTS: A total of 316 pediatric cases of skull fractures were identified, including 172 patients with and 144 without follow-up scans...
August 16, 2016: American Journal of Surgery
Christine A Ho, David A Podeszwa, Anthony I Riccio, Robert L Wimberly, Brandon A Ramo
BACKGROUND: Neurovascular injury in pediatric supracondylar fractures (SCHFx) has been associated with fracture classification but not with soft tissue injury. The purpose of this study is to correlate clinical soft tissue damage to neurovascular injuries in SCHFx. METHODS: This is an institutional review board approved prospective study from January 2010 through December 2013 of 748 operatively treated pediatric SCHFx. Prospective data were gathered both preoperatively and intraoperatively regarding detailed neurovascular examination as well as soft tissue status, with qualitative descriptives for swelling (mild/moderate/severe), ecchymosis, abrasions, skin tenting, and skin puckering...
September 3, 2016: Journal of Pediatric Orthopedics
Assaf Kadar, Geffen Kleinstern, Mohamed Morsy, Endre Soreide, Steven L Moran
BACKGROUND: Multiple enchodromatosis of bone, termed Ollier's disease, or Maffucci syndrome when associated with hemangiomas, is a rare disease that can affect the pediatric hand. This condition often causes a finger mass, deformity, pain and possible pathologic fractures, and has been associated with malignant transformation to chondrosarcoma. The aim of our study is to describe the long-term sequela of multiple enchondromatosis of the hand in the pediatric population, specifically the rates of malignant transformation, tumor recurrence, rates of pathologic fracture, and phalangeal growth arrest...
September 3, 2016: Journal of Pediatric Orthopedics
Lisa M Knijnenberg, Siem A Dingemans, Maaike P Terra, Peter A A Struijs, Niels W L Schep, Tim Schepers
BACKGROUND: Injuries to the Lisfranc joint in children and adolescents are rare. The incomplete ossification of the bones of the foot makes it difficult to detect injuries.The aim of this study was to determine age-specific radiographic measurements of the Lisfranc joint to provide guidance to the radiologist, emergency physicians, and surgeons to decrease misdiagnosis of Lisfranc injuries and improve detection. METHODS: We retrospectively reviewed all foot radiographs without traumatic injury made between August 2014 and February 2015 in all patients younger than 18...
September 3, 2016: Journal of Pediatric Orthopedics
Shari Cui, Gennadiy A Busel, Aki S Puryear
BACKGROUND: Pediatric spine trauma often results from high-energy mechanisms. Despite differences in healing potential, comorbidities, and length of remaining life, treatment is frequently based on adult criteria; ligamentous injuries are fused and bony injuries are treated accordingly. In this study, we present short-term results of a select group of adolescent patients treated using percutaneous pedicle screw instrumentation without fusion. METHODS: An IRB-approved retrospective review was performed at a level 1 pediatric trauma center for thoracolumbar spine fractures treated by percutaneous pedicle screw instrumentation...
October 2016: Journal of Pediatric Orthopedics
Joshua S Acree, John Schlechter, Scott Buzin
The aim of this study is to compare splint versus cast immobilization for maintaining alignment following closed reduction of distal 1/3 radius and both-bone forearm fractures. We performed a retrospective review of patient records between 5 and 14 years old with a distal 1/3 radius or radius and ulna fracture requiring reduction. A cost comparison was also performed using facility costs for materials. Reduction was maintained with acceptable alignment in most cases (94%). Although a sugar-tong splint slightly maintained fracture alignment better, this was not significant...
September 3, 2016: Journal of Pediatric Orthopedics. Part B
Jaclyn F Hill, Benton E Heyworth, Anneliese Lierhaus, Mininder S Kocher, Susan T Mahan
In this descriptive analysis of pediatric Lisfranc injuries, records of 56 children treated for bony or ligamentous Lisfranc injuries over a 12-year period were reviewed. Overall, 51% of fractures and 82% of sprains were sports-related (P=0.03). A total of 34% of the cohort underwent open reduction internal fixation, which was more common among patients with closed physes (67%). Full weight bearing was allowed in open reduction internal fixation patients at a mean of 14.5 weeks, compared to 6.5 weeks in the nonoperative group...
September 3, 2016: Journal of Pediatric Orthopedics. Part B
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