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Missed fractures in children

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
Kenneth Chin, Joshua M Abzug, Donald S Bae, Bernard D Horn, Martin Herman, Craig P Eberson
Management of pediatric polytrauma patients is one of the most difficult challenges for orthopaedic surgeons. Multisystem injuries frequently include complex orthopaedic surgical problems that require intervention. The physiology and anatomy of children and adolescent trauma patients differ from the physiology and anatomy of an adult trauma patient, which alters the types of injuries sustained and the ideal methods for management. Errors of pediatric polytrauma care are included in two broad categories: missed injuries and inadequate fracture treatment...
February 15, 2016: Instructional Course Lectures
Yuwei Zhou, Uygar Teomete, Ozgur Dandin, Onur Osman, Taner Dandinoglu, Ulas Bagci, Weizhao Zhao
Bowing fractures are incomplete fractures of tubular long bones, often observed in pediatric patients, where plain radiographic film is the non-invasive imaging modality of choice in routine radiological workflow. Due to weak association between bent bone and distinct cortex disruption, bowing fractures may not be diagnosed properly while reading plain radiography. Missed fractures and dislocations are common in accidents and emergency practice, particularly in children. These missed injuries can result in more complicated treatment or even long-term disability...
September 17, 2016: Computers in Biology and Medicine
Jedidiah E Schlung, Tracey P Bastrom, Joanna H Roocroft, Peter O Newton, Scott J Mubarak, Vidyadhar V Upasani
BACKGROUND: The role of femoral aspiration (FA) in the treatment of septic arthritis of the hip is controversial. The purpose of this study was to determine if FA conducted concomitantly with irrigation and debridement (I&D) of the septic hip aids in microorganism and osteomyelitis identification and alters the treatment plan, or if the risks of the procedure outweigh its potential benefit. We also compare preoperative magnetic resonance imaging (MRI) with FA for diagnosis of osteomyelitis cooccurring with septic arthritis...
September 3, 2016: Journal of Pediatric Orthopedics
Y Xi, D J Hu, W W Yao, M Li
OBJECTIVE: To accelerate the detection rate and accuracy of diagnosis in damage imaging of Lisfranc joint through research on the information of X-ray, CT, and MR imaging of tarsometatarsus joint (also called Lisfranc joint) damage. METHODS: A total of 153 cases of tarsometratisus damage or Lisfranc ligamentous injury patients were chosen during November 2012 to November 2015. Lisfranc injuries were classified according to the Myerson fracture displacements classification and Nunley-Vertullo low-grade injury classification...
July 5, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Hsuan-Kai Kao, Wei-Chun Lee, Wen-E Yang, Chia-Hsieh Chang
INTRODUCTION: Anterior humeral line (AHL) location is commonly used to evaluate sagittal alignment after fracture reduction in children with supracondylar humeral fractures. However, the position of the AHL for acceptable fracture reduction has not been validated by clinical outcome. The purpose of this study was to investigate the relationship between the location of AHL and range of elbow motion. PATIENTS AND METHODS: We retrospectively reviewed 101 children who underwent closed reduction and percutaneous pinning for Gartland type III supracondylar humeral fractures between January 2009 and June 2014...
July 1, 2016: Injury
Christiane Caouette, Nicole Ikin, Isabelle Villemure, Pierre-Jean Arnoux, Frank Rauch, Carl-Éric Aubin
Lower limb deformation in children with osteogenesis imperfecta (OI) impairs ambulation and may lead to fracture. Corrective surgery is based on empirical assessment criteria. The objective was to develop a reconstruction method of the tibia for OI patients that could be used as input of a comprehensive finite element model to assess fracture risks. Data were obtained from three children with OI and tibia deformities. Four pQCT scans were registered to biplanar radiographs, and a template mesh was deformed to fit the bone outline...
June 17, 2016: Medical & Biological Engineering & Computing
Nicola Blucher, Shyamsundar Srinivasan, Alfie Bass
INTRODUCTION: Dislocation of the metacarpophalangeal joint (MCPJ) of the thumb is rare in children and delayed presentation of this injury is even more uncommon in the literature. We report two cases, both children, who presented to fracture clinic with a dislocated thumb over one week after initial injury. In each case closed reduction was attempted but failed, and open reduction was necessary. CASE REPORT: Case Presentation 1: A 4 year-old right-hand dominant girl sustained a hyper-extension injury to her right thumb while on holiday abroad...
July 2015: Journal of Orthopaedic Case Reports
Lindsey Caldwell, Charles M Chan, James O Sanders, John T Gorczyca
BACKGROUND: Ipsilateral femoral neck fractures occur in 1% to 9% of adult trauma patients with femoral shaft fractures making dedicated imaging important. This is not as clear in children. Our purpose is to establish the incidence of ipsilateral femoral neck fractures in children with femoral shaft fractures and to provide recommendations regarding diagnostic imaging protocols. METHODS: A retrospective analysis of medical records was performed for pediatric patients (below 18 y) with femoral shaft fractures seen at our trauma center over a 10-year period...
June 2, 2016: Journal of Pediatric Orthopedics
Joseph Yeen Young, Ann-Christine Duhaime, Paul Albert Caruso, Sandra Patricia Rincon
CT is considered the first-line study for acute intracranial injury in children because of its availability, detection of acute hemorrhage, and lack of sedation. An MRI study with rapidly acquired sequences can obviate the need for sedation and radiation. We compared the detection rate of rapid non-sedated brain MRI to CT for traumatic head injury in young children. We reviewed a series of children 6 years of age or less who presented to our ED during a 5-year period with head trauma and received a non-sedated brain MRI and CT within 24 h of injury...
August 2016: Emergency Radiology
Kenneth Chin, Joshua Abzug, Donald S Bae, Bernard D Horn, Martin Herman, Craig P Eberson
Management of pediatric polytrauma patients is one of the most difficult challenges for orthopaedic surgeons. Multisystem injuries frequently include complex orthopaedic surgical problems that require intervention. The physiology and anatomy of children and adolescent trauma patients differ from the physiology and anatomy of an adult trauma patient, which alters the types of injuries sustained and the ideal methods for management. Errors of pediatric polytrauma care are included in two broad categories: missed injuries and inadequate fracture treatment...
2016: Instructional Course Lectures
Daniela Hesse, Mariana Pinheiro de Araujo, Isabel Cristina Olegário, Nicola Innes, Daniela Prócida Raggio, Clarissa Calil Bonifácio
BACKGROUND: In many parts of the world, school-age children have high dental treatment needs; however, there is often low, or no, dental care provision. Although Atraumatic Restorative Treatment (ART) was developed to address this, its survival rate in occluso-proximal lesions is low. An alternative, the Hall Technique (HT) has shown better relative outcomes for occluso-proximal lesions, but has not been directly compared to ART or tested in field settings. This trial will compare ART and the HT for the most clinically- and cost-effective strategy for managing occluso-proximal lesions in primary molars, in a school setting, using low-technology and child-friendly dental techniques...
2016: Trials
Sarah Depallens, Nicolas Lutz, Raffaella Carlomagno, Blaise Meyrat, Mirjam Schuler Barazzoni, Yves Yamgoue Tchameni, Andres Pascual, François Scerba, Andrea Superti-Furga
Every pediatrician will be confronted with newborns oryoung infants with skin lesions in proximity of the vertebral column. It is important not to miss a spinal dysraphism because of the risk of meningeal infection or of the possible presence of a tethered cord. A practical algorithm is presented. Non-accidental injury in young infants and toddlers is not rare but difficult to detect. Bruises and fractures are highly suspicious for non-accidental injury and should trigger specific investigations. Emergency departments and hospitals are switching from hypotonic to isotonic solutions as maintenance infusions of children...
January 13, 2016: Revue Médicale Suisse
Andrew G Marsh, James S Robertson, Anna Godman, Jennifer Boyle, James S Huntley
BACKGROUND: Neurological examination in children presenting with upper limb fractures is often poorly performed in the Emergency Department (ED). We aimed to assess the improvement in documented neurological examination for children presenting with upper limb fractures following introduction of a simple guideline. METHODS: We developed and introduced a simple guideline for upper limb neurological assessment in children ('rock, paper, scissors, OK'). We compared documentation of neurological examination and nerve injury detection at our hospital before and after introduction of this guideline, as well as for children admitted from external hospitals (where the guideline had not been introduced)...
April 2016: Emergency Medicine Journal: EMJ
Lisa L Schroeder, Elizabeth R Alpern, Shuntel M Blecher, Patty A Peska, Marjorie L White, Julie A Shaw, Carla Hronek, Cary W Thurm, Evaline A Alessandrini
BACKGROUND AND OBJECTIVE: Emergency departments must have appropriate resources and equipment available to meet the unique needs of children. We assessed the availability of stakeholder-endorsed quality structure performance measures for pediatric emergency department patients. METHODS: A survey of Child Health Corporation of America member hospitals was conducted. Six broad equipment groups were queried: general, monitoring, respiratory, vascular access, fracture-management, and specialized pediatric trays...
February 2016: Pediatric Emergency Care
Kurt W Alt, Stephanie Zesch, Rafael Garrido-Pena, Corina Knipper, Anna Szécsényi-Nagy, Christina Roth, Cristina Tejedor-Rodríguez, Petra Held, Íñigo García-Martínez-de-Lagrán, Denise Navitainuck, Héctor Arcusa Magallón, Manuel A Rojo-Guerra
The analysis of the human remains from the megalithic tomb at Alto de Reinoso represents the widest integrative study of a Neolithic collective burial in Spain. Combining archaeology, osteology, molecular genetics and stable isotope analysis (87Sr/86Sr, δ15N, δ13C) it provides a wealth of information on the minimum number of individuals, age, sex, body height, pathologies, mitochondrial DNA profiles, kinship relations, mobility, and diet. The grave was in use for approximately one hundred years around 3700 cal BC, thus dating from the Late Neolithic of the Iberian chronology...
2016: PloS One
Kristen M Delaney, Srinivas H Reddy, Anand Dayama, Melvin E Stone, James A Meltzer
BACKGROUND: Bladder and/or urethral injuries (BUIs) secondary to pelvic fractures are rare in children and are associated with a high morbidity. These injuries are much less likely to occur in females and are often missed in the emergency department. To help clinicians detect these injuries in female children, larger studies are needed to identify risk factors specific to this patient population. This study aimed to identify risk factors associated with BUI in female children with a pelvic fracture...
March 2016: Journal of Trauma and Acute Care Surgery
M AlSarheed
BACKGROUND: Trisomy 21 (T21) is a genetic disorder stemming from a chromosomal abnormality and characterized by general and mental retardation. Depending on the population, T21 is known to affect 1 in every 600-2000 live births. The current literature provides a mixed view on the oral health status of T21 individuals. AIM: To establish the prevalence of dental caries, malocclusion, and trauma amongst children with T21 compared with non-T21 children in Riyadh, Saudi Arabia...
October 2015: Saudi Dental Journal
Fernanda Cunha Soares, Mariane Cardoso, Michele Bolan
PURPOSE: This study's purpose was to determine preschool-age children's social perceptions and self-perceptions regarding altered dental esthetics. METHODS: A cross-sectional study was carried out involving 431 four- to five-year-olds. The participants were shown four photographs of children with incisors exhibiting discoloration, crown fracture, missing tooth, or normal teeth. The children were asked four questions for analysis of social perceptions and two additional questions for analysis of self-perceptions...
September 2015: Pediatric Dentistry
K Eckert, R-B Tröbs, B Schweiger, P Liedgens, E Radeloff, O Ackermann
INTRODUCTION: Carpal fractures in children are rare, but can be missed, as their clinical symptoms are unspecific and discrete. Even X-ray diagnosis is difficult. Timely diagnosis and consistent therapy are especially important for scaphoid fractures, as they can help to avoid complications such as non-union or avascular necrosis. A diagnostic approach to paediatric carpal fractures will be discussed on the basis of the following group of patients. METHODS: Retrospective analysis of children under 14 years treated in our institution between 09/2010 and 02/2012 for clinically suspected carpal fracture...
February 2016: Zeitschrift Für Orthopädie und Unfallchirurgie
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