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Pediatric extremity fractures

Yunzhu Meng, Wansoo Pak, Berkan Guleyupoglu, Bharath Koya, F Scott Gayzik, Costin D Untaroiu
Child pedestrian protection deserves more attention in vehicle safety design since they are the most vulnerable road users who face the highest mortality rate. Pediatric Finite Element (FE) models could be used to simulate and understand the pedestrian injury mechanisms during crashes in order to mitigate them. Thus, the objective of the study was to develop a computationally efficient (simplified) six-year-old (6YO-PS) pedestrian FE model and validate it based on the latest published pediatric data. The 6YO-PS FE model was developed by morphing the existing GHBMC adult pedestrian model...
October 16, 2016: Accident; Analysis and Prevention
Robert P Olympia, Robert Wilkinson, Jennifer Dunnick, Brendan J Dougherty, Debra Zauner
OBJECTIVE: The aims of this study were to describe pediatric emergency department (ED) referrals from urgent care centers and to determine the percentage of referrals considered essential and serious. METHODS: A prospective study was conducted between April 2013 and April 2015 on patients younger than 21 years referred directly to an ED in central Pennsylvania from surrounding urgent care centers. Referrals were considered essential or serious based on investigations/procedures performed or medications/consultations received in the ED...
October 8, 2016: Pediatric Emergency Care
Kerrin C DePeter, Stephen M Blumberg, Sarah Dienstag Becker, James A Meltzer
BACKGROUND: Despite being an effective analgesic for children with fractures, some clinicians may avoid prescribing ibuprofen due to its potentially harmful effect on bone healing. OBJECTIVE: To determine if exposure to ibuprofen is associated with an increased risk of bone healing complications in children with fractures. METHODS: We performed a retrospective study of children aged 6 months to 17 years who presented to the pediatric emergency department (PED) with a fracture of the tibia, femur, humerus, scaphoid, or fifth metatarsus and who followed up with the orthopedic service...
October 14, 2016: Journal of Emergency Medicine
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
Joyce Li, Stephanie Pryor, Ben Choi, Chris A Rees, Mamata V Senthil, Nicholas Tsarouhas, Sage R Myers, Michael C Monuteaux, Richard G Bachur
OBJECTIVES: The aim of this study was to determine the reasons for pediatric emergency department (ED) transfers and the professional characteristics of transferring providers. METHODS: We performed a multicenter, cross-sectional survey of ED medical providers transferring patients younger than 18 years to 1 of 4 tertiary care children's hospitals. Referring providers completed surveys detailing the primary reasons for transfer and their medical training. RESULTS: The survey data were collected for 25 months, during which 641 medical providers completed 890 surveys, with an overall response rate of 25%...
September 23, 2016: Pediatric Emergency Care
Daniel L Miranda, Melissa Putman, Ruby Kandah, Maria Cubria, Sebastian Suarez, Ara Nazarian, Brian Snyder
Prolonged immobilization in hospitalized children can lead to fragility fractures and muscle contractures and atrophy. The purpose of this study was to develop a lower-extremity disuse rabbit model with musculoskeletal changes similar to those observed in children subjected to prolonged immobilization. Six-week-old rabbits were randomly assigned to control (CTRL, n=4) or bilateral sciatic and femoral neurectomy (bSFN, n=4) groups. Trans-axial helical CT scans of each rabbit׳s hind limbs were acquired after eight weeks...
August 24, 2016: Journal of Biomechanics
Nicholas A Smith, Thiphalak Chounthirath, Huiyun Xiang
OBJECTIVE: To investigate the epidemiology of youth soccer-related injuries treated in emergency departments in the United States. METHODS: A retrospective analysis was conducted of soccer-related injuries among children 7 through 17 years of age from 1990 through 2014 with data from the National Electronic Injury Surveillance System. Injury rates were calculated from soccer participation data. RESULTS: An estimated 2 995 765 (95% confidence interval [CI], 2 309 112-3 682 418) children 7 through 17 years old were treated in US emergency departments for soccer-related injuries during the 25-year study period, averaging 119 831 (95% CI, 92 364-147 297) annually...
September 12, 2016: Pediatrics
Matthew A Sullivan, Charles J Cogan, Joshua M Adkinson
Pediatric hand injuries are extremely common. Although many hand injuries are adequately managed in the emergency department, some may need evaluation and treatment by a pediatric hand surgeon to ensure a good functional outcome. This article discusses the diagnosis and management of the most common pediatric hand maladies: fingertip injuries/amputation, tendon injuries, and phalangeal and metacarpal fractures. The plastic surgery nurse should be familiar with hand injuries that require intervention to facilitate efficient management and optimal postoperative care...
July 2016: Plastic Surgical Nursing
Sachin Baldawa
Growing skull fracture is an extremely rare complication of pediatric head injury, especially in infants. Repair of the dural tear early in the course of development of growing skull fracture has been suggested for a better outcome. Surgical repair of large, tense growing skull fractures, especially those in the communication of the ventricles can lead to potentially life-threatening complications. The author reports a rare case of remote intracranial hemorrhage following surgery for large, tense growing skull fracture in a 12-year-old girl and discusses the likely pathogenesis and possible ways to avoid this life-threatening complication...
April 2016: Journal of Pediatric Neurosciences
Sebastian Farr, Gabriel Mindler, Rudolf Ganger, Werner Girsch
➤Bone lengthening has been used successfully for several congenital and acquired conditions in the pediatric clavicle, humerus, radius, ulna, and phalanges.➤Common indications for bone lengthening include achondroplasia, radial longitudinal deficiency, multiple hereditary exostosis, brachymetacarpia, symbrachydactyly, and posttraumatic and postinfectious growth arrest.➤Most authors prefer distraction rates of <1 mm/day for each bone in the upper extremity except the humerus, which can safely be lengthened by 1 mm/day...
September 7, 2016: Journal of Bone and Joint Surgery. American Volume
E A Gorter, W Oostdijk, A Felius, P Krijnen, I B Schipper
OBJECTIVE: Although vitamin D levels are not routinely monitored in pediatric fracture patients, identification of children with a vitamin D deficiency may be clinically relevant because of the potential role of vitamin D in fracture healing. This study aimed to determine the prevalence of vitamin D deficiency in a pediatric fracture population and to identify risk factors for deficiency. METHODS: In this cross-sectional study all pediatric patients (<18 years), who were treated for a fracture of the upper or lower extremity from September 2012 to October 2013 in the outpatient setting of a level one trauma center, were included...
August 23, 2016: Journal of Clinical Research in Pediatric Endocrinology
Leopold Berger, Johannes Eichler, E Jonathan S Ryll, Stefan Fischerauer, Michael J Raschke, Andreas Kolbitsch, Christoph Castellani, Annelie-Martina Weinberg
Flexible intramedullary nailing (FIN) is a minimally invasive and widespread standard method for osteosynthesis of pediatric long bone fractures. In the case of unstable fractures of the lower extremity, interlocking systems need to be used to prevent axial shortening and subsequent perforation of the nail at its insertion site. In the present study, four different screw-fixed interlocking systems for FINs (Hofer TwinPlug with two 3-mm titanium interlocking screws, Hofer FixPlug with 3-mm titanium interlocking screw, Hofer Plug with 3...
November 1, 2016: Materials Science & Engineering. C, Materials for Biological Applications
Mary Kirkilas, David M Notrica, Crystal S Langlais, Jared T Muenzer, Jozef Zoldos, Kathleen Graziano
BACKGROUND: Vascular trauma in children, although rare, carries significant risk for repair. Here we report outcomes from a single trauma center for children with extremity vascular trauma, proximal to the digits. METHODS: Retrospective chart review of patients less than age 18years with an acute, non-iatrogenic traumatic arterial vascular injury of the upper and/or lower extremity between January 2008 and December 2013. Abstracted patient demographics, injury characteristics, surgical management, and disposition were summarized and compared with nonparametric methods...
November 2016: Journal of Pediatric Surgery
Steven F Shannon, Nicholas M Hernandez, Stephen A Sems, Annalise N Larson, Todd A Milbrandt
OBJECTIVES: The purpose of this study was to evaluate the type and severity of orthopaedic and associated injuries for snowmobile, All-terrain vehicles (ATV) and motorized dirtbike accidents in a pediatric patient population. METHODS: A total of 758 patients who presented following either snowmobile (n=87), ATV-related (n=308) or dirtbike (n=363)-related trauma at our institution between 1996 and 2015 were retrospectively reviewed. RESULTS: A total of 441 axial and appendicular fractures occurred requiring 533 procedures...
July 20, 2016: Journal of Pediatric Orthopedics
Hirotaka Sugiura, Emiko Horii, Shukuki Koh
Medial condyle fracture of the humerus is extremely rare in pediatric elbow fractures. We report a rare case of malunion of medial condyle fracture in a 10-year-old boy who had an injury on the right elbow at age 4. He was referred to our clinic because of severe varus deformity (the carrying angle was 191°, unaffected side 172°) with instability. Extra-articular closing wedge osteotomy was performed. Five years after surgery, the carrying angle was 172° and the patient had no pain and no difficulties with activities of daily living...
July 7, 2016: Journal of Pediatric Orthopedics. Part B
M Kareem Shaath, Kenneth L Koury, Peter D Gibson, Mark R Adams, Michael S Sirkin, Mark C Reilly
BACKGROUND: Pediatric pelvic fractures are rare injuries resulting from high-energy mechanisms that warrant an extensive work-up for associated injuries. OBJECTIVES: We performed a retrospective study to review concomitant injuries in children who suffered a pelvic fracture and have an open triradiate cartilage. METHODS: Using a database, pediatric pelvic fractures presenting to the authors' institution were extracted. Radiographs and computed tomography scans were reviewed, ensuring that triradiate cartilages were not fused and the pelvic injuries were classified using the Modified Torode Classification...
September 2016: Journal of Emergency Medicine
Matthew J Brown, Michael R Ferrick
Transphyseal femoral neck fractures are an extremely rare event, mainly occurring in children subjected to an significant traumatic force. The diagnosis is usually suggested by clinical examination with radiographic confirmation. Management varies; however, no consensus exists as to proper treatment. Intervention is primarily focused on the prevention of avascular necrosis (AVN) of the femoral epiphysis. We present the case of a 20-month-old male with a delayed diagnosis of transphyseal femoral neck fracture...
2016: Open Orthopaedics Journal
Muayad Kadhim, Ahmed I Hammouda, John E Herzenberg
PURPOSE: Growth modulation with tension band plates (TBPs) and cannulated screws is the current mainstay of treatment for pediatric lower extremity angular deformities. Solid screws have been used as an alternative to cannulated screws to decrease the risk of screw failure, particularly in obese children. The downside of solid screws is the decrease in precision of placement. This study describes a surgical technique to insert solid TBP screws accurately. METHODS: TBP insertion starts with the same conventional steps by inserting the guidewires into the epiphysis and metaphysis, straddling the physis...
August 2016: Journal of Children's Orthopaedics
Adriano Jander Ferreira, Sebastião de Almeida Leitão, Murilo Antônio Rocha, Valdênia das Graças Nascimento, Giovanni Bessa Pereira Lima, Antonio Carlos Oliveira de Meneses
The solid variant of aneurismal bone cysts (ABC) is considered rare. It occurs with greater frequency in pediatric patients and in the tibia, femur, pelvis and humerus. We present a case of a metaphyseal lytic lesion on the distal extremity of the radius in a child whose radiograph was requested after low-energy trauma. The hypothesis of a pathological bone fracture secondary to an aneurysmal bone cyst was suggested. After biopsy, the child underwent intralesional excision without bone grafting and the histopathological findings were compatible with the solid variant of aneurysmal bone cyst...
May 2016: Revista Brasileira de Ortopedia
Jason W Stoneback, Patrick M Carry, Katherine Flynn, Zhaoxing Pan, Ernest L Sink, Nancy H Miller
BACKGROUND: To evaluate lower extremity strength and alignment among children who underwent submuscular plating (SMP). METHODS: Subjects who underwent SMP for a length unstable femoral fracture returned for isokinetic strength testing ≥2 years after surgery. Extensor and flexor strength deficits (percent difference) between the operative and nonoperative limbs were evaluated. Radiographic measurements of mechanical alignment [anatomic lateral distal femoral angle (aLDFA)] and qualitative measurements (The Pediatric Outcomes Data Collection Instrument, PODCI) were obtained from all subjects...
June 2, 2016: Journal of Pediatric Orthopedics
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