Editorial

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3 pages, 191 KiB

Open AccessEditorial

Advances in Pediatric Fracture Diagnosis and Treatment Are Numerous but Great Challenges Remain

by Christiaan J. A. van Bergen

Children 2022, 9(10), 1489; https://doi.org/10.3390/children9101489 - 28 Sep 2022

Viewed by 897

Abstract

Broken bones are very common during childhood [...] Full article

(This article belongs to the Special Issue Pediatric Fractures)

3 pages, 177 KiB

Open AccessEditorial

Pediatric Fractures Are Challenging from Head to Toe

by Christiaan J. A. van Bergen

Children 2022, 9(5), 678; https://doi.org/10.3390/children9050678 - 06 May 2022

Cited by 1 | Viewed by 1179

Abstract

Fractures are extremely common in children [...] Full article

(This article belongs to the Special Issue Pediatric Fractures)

Research

Jump to: Editorial, Review, Other

8 pages, 1554 KiB

Open AccessArticle

Apophyseal Avulsion of the Rectus Femoris Tendon Origin in Adolescent Soccer Players

by Hanneke Weel, A. J. Peter Joosten and Christiaan J. A. van Bergen

Children 2022, 9(7), 1016; https://doi.org/10.3390/children9071016 - 08 Jul 2022

Cited by 3 | Viewed by 3826

Abstract

Apophyseal avulsions of the rectus femorus tendon (RFT) at the anterior inferior iliac spine (AIIS) can occur in adolescents, often while performing soccer. Patient-reported outcomes (PROMs) and time to return to sport of these patients are relatively unknown. Therefore, the aim of this [...] Read more.

Apophyseal avulsions of the rectus femorus tendon (RFT) at the anterior inferior iliac spine (AIIS) can occur in adolescents, often while performing soccer. Patient-reported outcomes (PROMs) and time to return to sport of these patients are relatively unknown. Therefore, the aim of this study was to assess the PROMs and return to sports of patients with AIIS avulsions and compare the results with those reported in the literature. This is a case series of seven consecutive patients presenting at our hospital between 2018 and 2020 with an apophyseal avulsion of the RFT from the AIIS. The patients were assessed with use of the WOMAC and Tegner scores and return to sports was evaluated. All patients were male soccer players (median age 13 years; range, 12–17). They were all initially treated non-operatively. One of the patients subsequently needed excision surgery of a heterotopic ossification because of non-transient hip impingement. All other patients recovered after a period of relative rest. Median time to return to sports was 2.5 months (range, 2–3). At a median follow-up of 33 months (range, 18–45), the WOMAC (median, 100; range, 91–100) and Tegner scores (median, 9; range, 5–9) were high. In accordance with the existing literature, most patients with apophyseal avulsions of the AIIS recover well with non-operative treatment. However, the avulsion can lead to hip impingement due to heterotopic ossifications possibly needing surgical excision. Sport resumption is achievable after 2–3 months, and patient-reported outcomes are highly satisfactory in the long term. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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8 pages, 6041 KiB

Open AccessArticle

Diagnosis and Treatment of Children with a Radiological Fat Pad Sign without Visible Elbow Fracture Vary Widely: An International Online Survey and Development of an Objective Definition

by Maximiliaan A. Poppelaars, Denise Eygendaal, Bertram The, Iris van Oost and Christiaan J. A. van Bergen

Children 2022, 9(7), 950; https://doi.org/10.3390/children9070950 - 25 Jun 2022

Cited by 5 | Viewed by 5134

Abstract

Children often present at the emergency department with a suspected elbow fracture. Sometimes, the only radiological finding is a ‘fat pad sign’ (FPS) as a result of hydrops or haemarthros. This sign could either be the result of a fracture, or be due [...] Read more.

Children often present at the emergency department with a suspected elbow fracture. Sometimes, the only radiological finding is a ‘fat pad sign’ (FPS) as a result of hydrops or haemarthros. This sign could either be the result of a fracture, or be due to an intra-articular haematoma without a concomitant fracture. There are no uniform treatment guidelines for this common population. The aims of this study were (1) to obtain insight into FPS definition, diagnosis, and treatment amongst international colleagues, and (2) to identify a uniform definition based on radiographic measurements with optimal cut-off points via a receiver operating characteristic (ROC) curve. An online international survey was set up to assess the diagnostic and treatment strategies, criteria, and definitions of the FPS, the probability of an occult fracture, and the presence of an anterior and/or posterior FPS on 20 radiographs. Additionally, the research team performed radiographic measurements to identify cut-off values for a positive FPS, as well as test–retest reliability and inter-rater reliability via intraclass correlation coefficients (ICC). A total of 133 (paediatric) orthopaedic surgeons completed the survey. Definitions, further diagnostics, and treatments varied considerably amongst respondents. Angle measurements of the fat pad as related to the humeral axis line showed the highest reliability (test–retest ICC, 0.95 (95% CI 0.88–0.98); inter-rater ICC, 0.95 (95% CI 0.91–0.98)). A cut-off angle of 16° was defined a positive anterior FPS (sensitivity, 1.00; specificity, 0.87; accuracy, 99%), based on the respondents’ assessment of the radiographs in combination with the research team’s measurements. Any visible posterior fat pad was defined as a positive posterior FPS. This study provides insight into the current diagnosis and treatment of children with a radiological fat pad sign of the elbow. A clear, objective definition of a positive anterior FPS was identified as a ≥16° angle with respect to the anterior humeral line. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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10 pages, 1865 KiB

Open AccessArticle

The Etiology and Epidemiology of Pediatric Facial Fractures in North-Western Romania: A 10-Year Retrospective Study

by Paul Andrei Țenț, Raluca Iulia Juncar, Abel Emanuel Moca, Rahela Tabita Moca and Mihai Juncar

Children 2022, 9(7), 932; https://doi.org/10.3390/children9070932 - 21 Jun 2022

Cited by 4 | Viewed by 1579

Abstract

Pediatric facial fractures are not as common as facial fractures occurring in the adult population. Their therapeutic approach is different because they affect patients with active growth, and have an etiology and epidemiology that vary depending on different cultural, religious and demographic factors. [...] Read more.

Pediatric facial fractures are not as common as facial fractures occurring in the adult population. Their therapeutic approach is different because they affect patients with active growth, and have an etiology and epidemiology that vary depending on different cultural, religious and demographic factors. This research aimed to identify the main factors involved in the etiology of pediatric facial fractures, as well as the epidemiology of pediatric facial fractures in a sample of children and adolescents from North-Western Romania. This 10-year retrospective study was performed in a tertiary center for oral and maxillofacial surgery in North-Western Romania. Medical files of patients that were admitted between 1 January 2002 and 31 December 2022 were analyzed. Pediatric patients aged 0 to 18 years were included in this study. The final sample consisted of 142 children and adolescents diagnosed with facial fractures, with this number representing 14.1% of all patients affected by facial fractures. Most frequently, fractures were identified in the 13–18 age group (78.9%, n = 112), which were more often associated with fractures caused by interpersonal violence than caused by road traffic accidents, falls or animal attacks. Boys were more affected (88%, n = 125), and were more frequently associated with fractures caused by interpersonal violence. The most frequently identified etiological factors included interpersonal violence (50%, n = 71), falls (18.3%, n = 26) and road traffic accidents (11.3%, n = 16). In terms of location, the mandible was the most affected facial bone structure (66.2%, n = 94), and patients with mandibular fractures were more frequently associated with fractures caused by interpersonal violence. The incidence of pediatric facial fractures should be lowered because they may interfere with the proper development of the facial skeleton. Establishing measures aimed at preventing interpersonal violence, as well as other causes involved in the etiology of facial fractures is imperative. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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9 pages, 1116 KiB

Open AccessArticle

Analysis of Physeal Fractures from the United States National Trauma Data Bank

by Joseph R. Fuchs, Romie F. Gibly, Christopher B. Erickson, Stacey M. Thomas, Nancy Hadley Miller and Karin A. Payne

Children 2022, 9(6), 914; https://doi.org/10.3390/children9060914 - 18 Jun 2022

Cited by 6 | Viewed by 3054

Abstract

Background: Pediatric long-bone physeal fractures can lead to growth deformities. Previous studies have reported that physeal fractures make up 18–30% of total fractures. This study aimed to characterize physeal fractures with respect to sex, age, anatomic location, and Salter–Harris (SH) classification from a [...] Read more.

Background: Pediatric long-bone physeal fractures can lead to growth deformities. Previous studies have reported that physeal fractures make up 18–30% of total fractures. This study aimed to characterize physeal fractures with respect to sex, age, anatomic location, and Salter–Harris (SH) classification from a current multicenter national database. Methods: A retrospective cohort study was performed using the 2016 United States National Trauma Data Bank (NTDB). Patients ≤ 18 years of age with a fracture of the humerus, radius, ulna, femur, tibia, or fibula were included. Results: The NTDB captured 132,018 patients and 58,015 total fractures. Physeal fractures made up 5.7% (3291) of all long-bone fractures, with males accounting for 71.0% (2338). Lower extremity physeal injuries comprised 58.6% (1929) of all physeal fractures. The most common site of physeal injury was the tibia comprising 31.8% (1047), 73.9% (774) of which were distal tibia fractures. Physeal fractures were greatest at 11 years of age for females and 14 years of age for males. Most fractures were SH Type II fractures. Discussion and Conclusions: Our analysis indicates that 5.7% of pediatric long-bone fractures involved the physis, with the distal tibia being the most common. These findings suggest a lower incidence of physeal fractures than previous studies and warrant further investigation. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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12 pages, 1278 KiB

Open AccessArticle

Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures: A 20-Year Single Center Experience of 132 Cases

by Zenon Pogorelić, Viktor Vegan, Miro Jukić, Carlos Martin Llorente Muñoz and Dubravko Furlan

Children 2022, 9(6), 845; https://doi.org/10.3390/children9060845 - 07 Jun 2022

Cited by 3 | Viewed by 4118

Abstract

Objective: The aim of this study was to analyze the outcomes and complications in children treated with elastic stable intramedullary nailing (ESIN) for tibial fractures. Methods: The study included 132 patients (92 males) with a median age of 11 years (IQR 10, 15) [...] Read more.

Objective: The aim of this study was to analyze the outcomes and complications in children treated with elastic stable intramedullary nailing (ESIN) for tibial fractures. Methods: The study included 132 patients (92 males) with a median age of 11 years (IQR 10, 15) treated with ESIN for displaced tibial shaft fractures or dia-metaphyseal distal tibial fractures from March 2002 to March 2022. The median follow-up was 118.5 months (IQR 74.5, 170). The primary outcome was success rate, while secondary outcomes were the time of bone healing, length of hospital stay, and associated injuries. Demographic data, type and nature of fracture, indication for surgery, healing time, operative time, complications of treatment, and time to implant removal were recorded. Results: Complete radiographic healing was achieved at a median of 7 weeks (IQR 6, 9). Most of the patients (n = 111; 84.1%) had fractures localized in the shaft of the tibia. The most common injuries were acquired by road traffic accidents (n = 42) and by a fall in the same level (n = 29), followed by injuries from sport activities (n = 21) or motorbike accidents (n = 18). Associated injuries were reported in 37 (28%) children. Fractures were closed in the majority of the children (n = 100; 76%), while 32 (24%) children presented with an open fracture. Children with open fractures were significantly older than children with closed fractures (13.5 years (IQR 10, 15) vs. 11 years (IQR 8.5, 14.5); p = 0.031). Furthermore, children with open fractures had a significantly longer hospital stay (7 days (IQR 5, 9) vs. 3 days (IQR 3, 6); p = 0.001), a higher rate of associated injuries (n = 14 (43.7%) vs. n = 23 (23%); p = 0.022), and a higher rate of postoperative complications (n = 7 (21.9%) vs. n = 8 (8%); p = 0.031). No intraoperative complications were recorded. A total of 15 (11.4%) postoperative complications were recorded. Most complications (60%) were minor complications, mostly related to the wound at the nail insertion site and were managed conservatively. A total of six (4.5%) patients required reoperation due to angulation of the fragments (n = 5) or refracture (n = 1). Conclusion: ESIN is a minimally invasive bone surgery technique and is a highly effective treatment for pediatric tibial unstable fractures with a low rate of complications. Based on the given results, surgical stabilization of the tibial fractures using titanium intramedullary nailing can be safely performed without casting with early physiotherapy. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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8 pages, 212 KiB

Open AccessArticle

Outcome Analysis of Surgical Timing in Pediatric Orbital Trapdoor Fracture with Different Entrapment Contents: A Retrospective Study

by Pei-Ju Hsieh and Han-Tsung Liao

Children 2022, 9(3), 398; https://doi.org/10.3390/children9030398 - 11 Mar 2022

Cited by 4 | Viewed by 1989

Abstract

Orbital trapdoor fracture occurs more commonly in pediatric patients, and previous studies suggested early intervention for a better outcome. However, there is no consensus on the appropriate timing of emergent intervention due to the insufficient cases reported. In the current retrospective study, we [...] Read more.

Orbital trapdoor fracture occurs more commonly in pediatric patients, and previous studies suggested early intervention for a better outcome. However, there is no consensus on the appropriate timing of emergent intervention due to the insufficient cases reported. In the current retrospective study, we compared the outcomes of patient groups with different time intervals from injury to surgical intervention and entrapment content. Twenty-three patients who underwent surgery for trapdoor fracture between January 2001 and September 2018 at Chang Gung Memorial Hospital were enrolled. There was no significant difference in diplopia and extraocular muscle (EOM) movement recovery rate in patients who underwent surgery within three days and those over three days. However, among the patients with an interval to surgery of over three days, those with muscle entrapment required a longer period of time to recover from EOM movement restriction (p = 0.03) and diplopia (p = 0.03) than those with soft tissue entrapment. Regardless of time interval to surgery, patients with muscle entrapment took longer time to recover from EOM movement restriction (p = 0.036) and diplopia (p = 0.042) and had the trend of a worse EOM recovery rate compared to patients with soft tissue entrapment. Hence, we suggested that orbital trapdoor fractures with rectus muscle entrapment should be promptly managed for faster recovery. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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10 pages, 645 KiB

Open AccessArticle

Levels of Physical Activity in Children with Extremity Fractures a Dutch Observational Cross-Sectional Study

by Amber Carlijn Traa, Ozcan Sir, Sanne W. T. Frazer, Brigitte van de Kerkhof-van Bon, Birgitte Blatter and Edward C. T. H. Tan

Children 2022, 9(3), 325; https://doi.org/10.3390/children9030325 - 01 Mar 2022

Cited by 3 | Viewed by 2099

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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15 pages, 8188 KiB

Open AccessArticle

Bone Fractures Numerical Analysis in a Femur Affected by Osteogenesis Imperfecta

by Viridiana Ramírez-Vela, Luis Antonio Aguilar-Pérez, Juan Carlos Paredes-Rojas, Juan Alejandro Flores-Campos, Fernando ELi Ortiz-Hernández and Christopher René Torres-SanMiguel

Children 2021, 8(12), 1177; https://doi.org/10.3390/children8121177 - 14 Dec 2021

Cited by 4 | Viewed by 2447

Abstract

This work presents a non-invasive methodology to obtain a three-dimensional femur model of three-year-old infants affected with Osteogenesis Imperfecta (OI) type III. DICOM^® Files of a femur were processed to obtain a finite element model to assess the transverse, the oblique, and [...] Read more.

This work presents a non-invasive methodology to obtain a three-dimensional femur model of three-year-old infants affected with Osteogenesis Imperfecta (OI) type III. DICOM^® Files of a femur were processed to obtain a finite element model to assess the transverse, the oblique, and the comminuted fractures. The model is evaluated under a normal walking cycle. The loads applied were considered the most critical force generated on the normal walking cycle, and the analyses considered anisotropic bone conditions. The outcome shows stress concentration areas in the central zone of the diaphysis of the femur, and the highest levels of stress occur in the case of the comminuted fracture, while the transverse fracture presents the lowest values. Thus, the method can be helpful for determining the bone fracture behavior of certain pathologies, such as osteogenesis imperfecta, osteopenia, and osteoporosis. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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11 pages, 3632 KiB

Open AccessArticle

Diagnosis and Treatment for Pediatric Supracondylar Humerus Fractures with Brachial Artery Injuries

by Tu Ngoc Vu, Son Hong Duy Phung, Long Hoang Vo and Uoc Huu Nguyen

Children 2021, 8(10), 933; https://doi.org/10.3390/children8100933 - 18 Oct 2021

Cited by 7 | Viewed by 3148

Abstract

(1) Background: This study aims to describe the clinical and paraclinical characteristics of and the diagnostic approach to brachial artery injuries in pediatric supracondylar humerus fractures, as well as to evaluate intraoperative vascular anatomical lesions and early postoperative results. (2) Methods: A retrospective, [...] Read more.

(1) Background: This study aims to describe the clinical and paraclinical characteristics of and the diagnostic approach to brachial artery injuries in pediatric supracondylar humerus fractures, as well as to evaluate intraoperative vascular anatomical lesions and early postoperative results. (2) Methods: A retrospective, hospital-based analysis of medical records at Viet Duc University Hospital (Vietnam), using a sample of children under 16 years who met the diagnostic criteria for supracondylar humerus fractures with brachial artery injuries between January 2016 and December 2020, was performed. A total of 50 patients were included in the analysis. (3) Results: Out of 50 pediatric patients, 36 patients were male (72%) and the mean age was 5.85 years (range, 1.5–14 years). Before treatment, there were 46 patients with severely displaced fractures which were classified as Gartland type III (92%). Following casting, the percentage of those with severely displaced fractures was reduced significantly to 12%, while there were no patients with Gartland type III fractures after percutaneous pinning. Doppler sonography failed to assess vascular lesions at the fracture site before and after casting in most patients. Two-thirds of surgical cases had only vasospasm, without physical damage to the vessel wall or intravascular thrombosis. Preoperative Doppler spectrum analysis was not consistent with the severity of intraoperative brachial artery injury. Out of 24 patients with vasospasm, we performed vascular blockade using papaverin in 11 cases and intraoperative balloon angioplasty of the brachial artery using the Fogarty catheter in 13 cases. Brachial artery graft was performed with 12 patients who had anatomical damage to the vascular wall. A complication of embolism occurred in one patient immediately after surgery, and two patients had superficial infections. One month following surgery, 2 out of 36 patients had a temporary loss of sensation in the area of incision. (4) Conclusions: Most pediatric patients did not present with symptoms of critical limb ischemia similar to those associated with lower extremity vascular injuries. The diagnosis and treatment of pediatric supracondylar humerus fractures with vascular injury is difficult and time-consuming, especially in cases of transverse fractures. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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7 pages, 631 KiB

Open AccessArticle

A Prospective Cohort Study on Quality of Life among the Pediatric Population after Surgery for Recurrent Patellar Dislocation

by Alexandru Herdea, Vlad Pencea, Claudiu N. Lungu, Adham Charkaoui and Alexandru Ulici

Children 2021, 8(10), 830; https://doi.org/10.3390/children8100830 - 22 Sep 2021

Cited by 6 | Viewed by 2021

Abstract

Patellofemoral instability is a frequent cause of knee pathology affecting quality of life among the pediatric population. Here, we present a prospective cohort study which included patients who had undergone surgical management using the lateral release and medial imbrication approach (LRMI) or medial [...] Read more.

Patellofemoral instability is a frequent cause of knee pathology affecting quality of life among the pediatric population. Here, we present a prospective cohort study which included patients who had undergone surgical management using the lateral release and medial imbrication approach (LRMI) or medial patellofemoral ligament reconstruction (MPFL-R). The object of this study was to assess the quality of life among children that have undergone surgical treatment for patellar dislocation. Quality of life was assessed before and after surgery using the Pediatric International Knee Documentation Committee form (Pedi-IKDC), a questionnaire that aims to quantify knee functionality. Postoperative scarring was evaluated using The Stony Brook Scar Evaluation Scale. One hundred and eight patients were selected and grouped according to the type of procedure. Before surgery, the two groups had similar mean Pedi-IKDC scores (41,4 MPFL-R vs. 39,4 LRMI p = 0.314). Improvements were observed in the postoperative scores. The MPFL-R technique showed promising outcomes. When comparing the two surgical groups, there was a significant difference in favor of MPFL-R group (MPFL-R 77.71 points vs. LRMI 59.74 points, p < 0.0001–95% CI (11.22–24.72)). Using the Stony Brook Scar Evaluation Scale, a significant difference in scar quality in favor of MPFL-R was observed (4,5 MPFL-R vs. 2,77 LRMI p = 0.002). In conclusion, this study provides objective evidence-based outcome assessments that support the medial patellofemoral ligament reconstruction technique as the gold standard for patellofemoral instability. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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12 pages, 2052 KiB

Open AccessArticle

Analysis of Clinical Outcome and Predictors of Mortality in Pediatric Trauma Population: Evidence from a 10 Year Analysis in a Single Center

by Ya-Chih Yang, Tsung-Han Hsieh, Chi-Yuan Liu, Chun-Yu Chang, Yueh-Tseng Hou, Po-Chen Lin, Yu-Long Chen, Da-Sen Chien, Giou-Teng Yiang and Meng-Yu Wu

Children 2021, 8(8), 688; https://doi.org/10.3390/children8080688 - 10 Aug 2021

Cited by 4 | Viewed by 2141

Abstract

The shock index (SI) is a useful tool for predicting the injury severity and mortality in patients with trauma. However, pediatric physiology differs from that of adults. In the pediatric trauma population, the shock status may be obscured within the normal range of [...] Read more.

The shock index (SI) is a useful tool for predicting the injury severity and mortality in patients with trauma. However, pediatric physiology differs from that of adults. In the pediatric trauma population, the shock status may be obscured within the normal range of vital signs. Pediatric age-adjusted SI (SIPA) is reported more accurately compared to SI. In our study, we conducted a 10 year retrospective cohort study of pediatric trauma population to evaluate the SI and SIPA in predicting mortality, intensive care unit (ICU) admission, and the need for surgery. This retrospective cohort study included 1265 pediatric trauma patients from January 2009 to June 2019 at the Taipei Tzu Chi Hospital, who had a history of hospitalization. The primary outcome of this investigation was in-hospital mortality, and the secondary outcomes were the length of hospital and ICU stay, operation times, and ICU admission times. The SIPA group can detect changes in vital signs early to reflect shock progression. In the elevated SIPA group, more severe traumatic injuries were identified, including high injury severity score (ISS), revised trauma score (RTS), and new injury severity score (NISS) scores than SI > 0.9. The odds ratio of elevated SIPA and SI (>0.9) to predict ISS ≥ 16 was 3.593 (95% Confidence interval [CI]: 2.175–5.935, p < 0.001) and 2.329 (95% CI: 1.454–3.730, p < 0.001). SI and SIPA are useful for identifying the compensatory phase of shock in prehospital and hospital settings, especially in corresponding normal to low-normal blood pressure. SIPA is effective in predicting the mortality and severity of traumatic injuries in the pediatric population. However, SI and SIPA were not significant predictors of ICU admission and the need for surgery analysis. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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8 pages, 3136 KiB

Open AccessArticle

Is a Parry Fracture—An Isolated Fracture of the Ulnar Shaft—Associated with the Probability of Abuse in Children between 2 and 16 Years Old?

by Kyra Hermans, Duncan Fransz, Lisette Walbeehm-Hol, Paul Hustinx and Heleen Staal

Children 2021, 8(8), 650; https://doi.org/10.3390/children8080650 - 28 Jul 2021

Cited by 3 | Viewed by 4303

Abstract

A parry fracture is an isolated fracture of the ulnar shaft. It occurs when the ulna receives the full force of an impact when the forearm is raised to protect the face. The aim of this study is to assess a possible association [...] Read more.

A parry fracture is an isolated fracture of the ulnar shaft. It occurs when the ulna receives the full force of an impact when the forearm is raised to protect the face. The aim of this study is to assess a possible association between a parry fracture and the probability of abuse in children. In this retrospective, observational, multicenter study, we identified patients between 2 and 16 years old who had been treated for an isolated ulnar shaft fracture. Patient characteristics were registered, anonymized radiographs were rated, and charts were screened for referral to a child protective team. A total of 36 patients were analyzed. As no referrals were registered during follow-up, the primary outcome was changed to a perpendicular force as trauma mechanism. Univariable regression analysis and independent t-test both showed no significant association between patient factors or radiographic classification, and the reported trauma mechanism. We were unable to determine an association between a parry fracture and the probability of abuse. Since trauma mechanism does have a biomechanical effect on the fracture type, we would advise that a very clear reconstruction (and documentation) of the trauma mechanism should be established when a parry fracture is identified on radiographs. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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7 pages, 1119 KiB

Open AccessArticle

Effect of the COVID-19 Outbreak on Pediatric Patients’ Admissions to the Emergency Department in an Italian Orthopedic Trauma Hub

by Fabio Verdoni, Martina Ricci, Cristina Di Grigoli, Nicolò Rossi, Michele Davide Maria Lombardo, Domenico Curci, Riccardo Accetta, Marco Viganò, Giuseppe Maria Peretti and Laura Mangiavini

Children 2021, 8(8), 645; https://doi.org/10.3390/children8080645 - 27 Jul 2021

Cited by 8 | Viewed by 2194

Abstract

Background: The rapid diffusion of Coronavirus disease (COVID-19) in Northern Italy led the Italian government to dictate a national lockdown from 12 March 2020 to 5 May 2020. The aim of this observational cohort study is to analyze the differences in the number [...] Read more.

Background: The rapid diffusion of Coronavirus disease (COVID-19) in Northern Italy led the Italian government to dictate a national lockdown from 12 March 2020 to 5 May 2020. The aim of this observational cohort study is to analyze the differences in the number of pediatric patients’ admission to the Emergency Room (ER) and in the type and causes of injury. Methods: The pediatric population during the pandemic was compared to a similar group of patients admitted to the ER in 2019. Sex, age, triage color-code at admission, cause of trauma and presence of symptoms related to COVID-19 infection, discharge diagnosis and discharge modes were investigated. Results: The lockdown period led to a reduction of 87.0% in ER admissions with a particular decrease in patients older than 12 years old. Moreover, a trend towards more severe codes and an increase in home-related injuries were observed during the pandemic, whereas the diagnosis of fracture was less frequent in the pre-pandemic group (p < 0.0001). Conclusions: A significant decrease in the ER attendances was reported during the lockdown. A shift in the cause and type of injury was observed; only the most serious traumas sought medical care with a higher percentage of severe triage codes and fractures. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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9 pages, 7095 KiB

Open AccessArticle

Plate Fixation for Irreducible Proximal Humeral Fractures in Children and Adolescents—A Single-Center Case Series of Six Patients

by Florian Freislederer, Susanne Bensler, Thomas Specht, Olaf Magerkurth and Karim Eid

Children 2021, 8(8), 635; https://doi.org/10.3390/children8080635 - 26 Jul 2021

Cited by 4 | Viewed by 4614

Abstract

Background: Recommended treatment for severely displaced proximal humeral fractures in children is the closed reduction and percutaneous fixation by K-wires or intramedullary nailing. Methods: From January 2016 to January 2017 6, 21 children/adolescents (range 8 to 16 years) with proximal humeral fractures were [...] Read more.

Background: Recommended treatment for severely displaced proximal humeral fractures in children is the closed reduction and percutaneous fixation by K-wires or intramedullary nailing. Methods: From January 2016 to January 2017 6, 21 children/adolescents (range 8 to 16 years) with proximal humeral fractures were treated surgically for severe displacement. In these six patients, several attempts of closed reduction were unsuccessful, and an open reduction was performed. The humeral head was fixed with a 3.5 mm T-plate without affecting the growth plate. Plate removal was performed at a mean interval of 132 days after initial surgery. Two years after initial surgery, the clinical outcome was assessed by the Constant–Murley score and QuickDASH score (including sport/music and work) and the shoulder joint was evaluated with a standardized sonographic examination for the rotator cuff and the conjoint tendon. Results: In all six patients, dorsal displacement of the fracture was irreducible due to the interposition of tendinous or osseous structures. Intraoperatively, the interposed structures were the long biceps tendon in two, periosteal tissue in two, a bony fragment in one, and the long biceps tendon together with the conjoint tendon in one case. At mean follow-up of 26 months (range 22 months to 29 months), patients showed very good clinical results with an excellent mean Constant–Murley score of 97.5 (range 91 to 100) and mean QuickDASH score (including sport/music and work) of 5.5 (range 0–20.8). An X-ray follow-up 6 weeks after surgery demonstrated early consolidation and correct alignment in all patients. A sonographic evaluation at 2 years post injury showed that the biceps and the conjoined tendon were intact in all patients. Conclusions: If a proximal humeral fracture is not reducible by closed means, a tissue entrapment (most likely biceps tendon) should be considered. Treatment with an open reduction and plate fixation yields very good clinical and radiological results and preserves interposed structures as the biceps and conjoint tendon. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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9 pages, 1975 KiB

Open AccessArticle

Diagnostic Accuracy of 3D Ultrasound and Artificial Intelligence for Detection of Pediatric Wrist Injuries

by Jack Zhang, Naveenjyote Boora, Sarah Melendez, Abhilash Rakkunedeth Hareendranathan and Jacob Jaremko

Children 2021, 8(6), 431; https://doi.org/10.3390/children8060431 - 21 May 2021

Cited by 12 | Viewed by 3054

Abstract

Wrist trauma is common in children, typically requiring radiography for diagnosis and treatment planning. However, many children do not have fractures and are unnecessarily exposed to radiation. Ultrasound performed at bedside could detect fractures prior to radiography. Modern tools including three-dimensional ultrasound (3DUS) [...] Read more.

Wrist trauma is common in children, typically requiring radiography for diagnosis and treatment planning. However, many children do not have fractures and are unnecessarily exposed to radiation. Ultrasound performed at bedside could detect fractures prior to radiography. Modern tools including three-dimensional ultrasound (3DUS) and artificial intelligence (AI) have not yet been applied to this task. Our purpose was to assess (1) feasibility, reliability, and accuracy of 3DUS for detection of pediatric wrist fractures, and (2) accuracy of automated fracture detection via AI from 3DUS sweeps. Children presenting to an emergency department with unilateral upper extremity injury to the wrist region were scanned on both the affected and unaffected limb. Radiographs of the symptomatic limb were obtained for comparison. Ultrasound scans were read by three individuals to determine reliability. An AI network was trained and compared against the human readers. Thirty participants were enrolled, resulting in scans from fifty-five wrists. Readers had a combined sensitivity of 1.00 and specificity of 0.90 for fractures. AI interpretation was indistinguishable from human interpretation, with all fractures detected in the test set of 36 images (sensitivity = 1.0). The high sensitivity of 3D ultrasound and automated AI ultrasound interpretation suggests that ultrasound could potentially rule out fractures in the emergency department. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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Review

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12 pages, 242 KiB

Open AccessReview

Pediatric Supracondylar Humerus Fractures: Should We Avoid Surgery during After-Hours?

by Sietse E. S. Terpstra, Paul T. P. W. Burgers, Huub J. L. van der Heide and Pieter Bas de Witte

Children 2022, 9(2), 189; https://doi.org/10.3390/children9020189 - 02 Feb 2022

Cited by 8 | Viewed by 2000

Abstract

Pediatric supracondylar humerus fractures occur frequently. Often, the decision has to be made whether to operate immediately, e.g., during after-hours, or to postpone until office hours. However, the effect of timing of surgery on radiological and clinical outcomes is unclear. This literature review [...] Read more.

Pediatric supracondylar humerus fractures occur frequently. Often, the decision has to be made whether to operate immediately, e.g., during after-hours, or to postpone until office hours. However, the effect of timing of surgery on radiological and clinical outcomes is unclear. This literature review with the PICO methodology found six relevant articles that compared the results of office-hours and after-hours surgery for pediatric supracondylar humerus fractures. The surgical outcomes of both groups in these studies were assessed. One of the articles found a significantly higher “poor fixation rate” in the after-hours group, compared with office hours. Another article found more malunions in the “night” subgroup vs. the “all groups but night” group. A third article found a higher risk of postoperative paresthesia in the “late night” subgroup vs. the “day” group. Lastly, one article reported increased consultant attendance and decreased operative time when postponing to office hours more often. No differences were reported for functional outcomes in any of the articles. Consequently, no strong risks or benefits from surgical treatment during office hours vs. after-hours were found. It appears safe to postpone surgery to office hours if circumstances are not optimal for acute surgery, and if there is no medical contraindication. However, research with a higher level-of-evidence is needed make more definite recommendations. Full article

(This article belongs to the Special Issue Pediatric Fractures)

11 pages, 8568 KiB

Open AccessReview

Pediatric Clavicle Fractures and Congenital Pseudarthrosis Unraveled

by Lisa van der Water, Arno A. Macken, Denise Eygendaal and Christiaan J. A. van Bergen

Children 2022, 9(1), 49; https://doi.org/10.3390/children9010049 - 03 Jan 2022

Cited by 5 | Viewed by 8106

Abstract

Clavicle fractures are commonly seen in the pediatric and adolescent populations. In contrast, congenital pseudarthrosis of the clavicle is rare. Although both conditions may present with similar signs and symptoms, especially in the very young, clear differences exist. Clavicle fractures are often caused [...] Read more.

Clavicle fractures are commonly seen in the pediatric and adolescent populations. In contrast, congenital pseudarthrosis of the clavicle is rare. Although both conditions may present with similar signs and symptoms, especially in the very young, clear differences exist. Clavicle fractures are often caused by trauma and are tender on palpation, while pseudarthrosis often presents with a painless protuberance on the clavicle, which becomes more prominent as the child grows. Its presence may only become apparent after trauma, as it is usually asymptomatic. The diagnosis is confirmed on plain radiography, which shows typical features to distinguish both entities. Both clavicle fractures and congenital pseudarthrosis are generally treated conservatively with a high success rate. Operative treatment for a fracture can be indicated in the case of an open fracture, severely displaced fracture, floating shoulder, neurovascular complications or polytrauma. Congenital pseudarthrosis requires operative treatment if the patient experiences progressive pain, functional limitation and late-onset thoracic outlet symptoms, but most operations are performed due to esthetic complaints. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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10 pages, 565 KiB

Open AccessReview

NSAID Use and Effects on Pediatric Bone Healing: A Review of Current Literature

by Stephanie Choo and Julia A. V. Nuelle

Children 2021, 8(9), 821; https://doi.org/10.3390/children8090821 - 18 Sep 2021

Cited by 4 | Viewed by 2078

Abstract

This systematic review evaluates and synthesizes the available peer-reviewed evidence regarding the impact of non-steroidal anti-inflammatory drugs (NSAIDs) on fracture healing in skeletally immature patients. Evidence supports the use of NSAIDs in this patient population for adequate pain control without increasing the risk [...] Read more.

This systematic review evaluates and synthesizes the available peer-reviewed evidence regarding the impact of non-steroidal anti-inflammatory drugs (NSAIDs) on fracture healing in skeletally immature patients. Evidence supports the use of NSAIDs in this patient population for adequate pain control without increasing the risk of nonunion, particularly in long bone fractures and pseudoarthrosis after spine fusion. However, further clinical studies are needed to fill remaining gaps in knowledge, specifically with respect to the spectrum of available NSAIDs, dosage, and duration of use, in order to make broad evidence-based recommendations regarding the optimal use of NSAIDs during bone healing in skeletally immature patients. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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Other

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14 pages, 478 KiB

Open AccessSystematic Review

Pediatric Radial Neck Fractures: A Systematic Review Regarding the Influence of Fracture Treatment on Elbow Function

by Lisette C. Langenberg, Kimberly I. M. van den Ende, Max Reijman, G. J. (Juliën) Boersen and Joost W. Colaris

Children 2022, 9(7), 1049; https://doi.org/10.3390/children9071049 - 14 Jul 2022

Cited by 3 | Viewed by 1609

Abstract

Background: This review aims to identify what angulation may be accepted for the conservative treatment of pediatric radial neck fractures and how the range of motion (ROM) at follow-up is influenced by the type of fracture treatment. Patients and Methods: A PRISMA-guided systematic [...] Read more.

Background: This review aims to identify what angulation may be accepted for the conservative treatment of pediatric radial neck fractures and how the range of motion (ROM) at follow-up is influenced by the type of fracture treatment. Patients and Methods: A PRISMA-guided systematic search was performed for studies that reported on fracture angulation, treatment details, and ROM on a minimum of five children with radial neck fractures that were followed for at least one year. Data on fracture classification, treatment, and ROM were analyzed. Results: In total, 52 studies (2420 children) were included. Sufficient patient data could be extracted from 26 publications (551 children), of which 352 children had at least one year of follow-up. ROM following the closed reduction (CR) of fractures with <30 degrees angulation was impaired in only one case. In fractures angulated over 60 degrees, K-wire fixation (Kw) resulted in a significantly better ROM than intramedullary fixation (CIMP; Kw 9.7% impaired vs. CIMP 32.6% impaired, p = 0.01). In more than 50% of cases that required open reduction (OR), a loss of motion occurred. Conclusions: CR is effective in fractures angulated up to 30 degrees. There may be an advantage of Kw compared to CIMP fixation in fractures angulated over 60 degrees. OR should only be attempted if CR and CRIF have failed. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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10 pages, 3210 KiB

Open AccessPerspective

Fractures in Osteogenesis Imperfecta: Pathogenesis, Treatment, Rehabilitation and Prevention

by Wouter Nijhuis, Marjolein Verhoef, Christiaan van Bergen, Harrie Weinans and Ralph Sakkers

Children 2022, 9(2), 268; https://doi.org/10.3390/children9020268 - 16 Feb 2022

Cited by 12 | Viewed by 7232

Abstract

Fractures in patients with osteogenesis imperfecta (OI) are caused by a decreased strength of bone due to a decreased quality and quantity of bone matrix and architecture. Mutations in the collagen type 1 encoding genes cause the altered formation of collagen type I, [...] Read more.

Fractures in patients with osteogenesis imperfecta (OI) are caused by a decreased strength of bone due to a decreased quality and quantity of bone matrix and architecture. Mutations in the collagen type 1 encoding genes cause the altered formation of collagen type I, one of the principal building blocks of bone tissue. Due to the complexity of the disease and the high variation of the clinical problems between patients, treatment for these patients should be individually tailored. In general, short immobilization periods with flexible casting material, use of intramedullary implants, and simultaneous deformity correction are preferred. Multidisciplinary care with a broad view of the support needed for the patient and his/her living environment is necessary for the optimal rehabilitation of these patients. Increasing bone strength with exercise, medication, and sometimes alignment surgery is generally indicated to prevent fractures. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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9 pages, 1657 KiB

Open AccessSystematic Review

The Orthopedic Effects of Electronic Cigarettes: A Systematic Review and Pediatric Case Series

by Maxwell Luke Armstrong, Nicholas Smith, Rhiannon Tracey and Heather Jackman

Children 2022, 9(1), 62; https://doi.org/10.3390/children9010062 - 04 Jan 2022

Cited by 4 | Viewed by 2851

Abstract

Electronic cigarette (EC) use is highly prevalent, especially in the adolescent population, where 29% of Canadian adolescents have used an EC in the past thirty days per national surveys. Our pediatric orthopedic referral centre observed a cluster of delayed unions of bone fractures [...] Read more.

Electronic cigarette (EC) use is highly prevalent, especially in the adolescent population, where 29% of Canadian adolescents have used an EC in the past thirty days per national surveys. Our pediatric orthopedic referral centre observed a cluster of delayed unions of bone fractures in adolescents using ECs and present the case series here. We then asked whether electronic cigarettes impair bone healing or influence orthopedic outcomes. A PRISMA-compliant systematic review was carried out, which revealed no human clinical studies and a general paucity of evidence around ECs and musculoskeletal health. The existing experimental evidence relevant to orthopedics is summarized. The effect of ECs on the musculoskeletal system is poorly understood and is a target for further research. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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7 pages, 1279 KiB

Open AccessCase Report

Patient-Specific Guided Osteotomy to Correct a Symptomatic Malunion of the Left Forearm

by Femke F. Schröder, Feike de Graaff and Anne J. H. Vochteloo

Children 2021, 8(8), 707; https://doi.org/10.3390/children8080707 - 17 Aug 2021

Cited by 2 | Viewed by 3994

Abstract

We present a case report of a 12-year old female with a midshaft forearm fracture. Initial conservative treatment with a cast failed, resulting in a malunion. The malunion resulted in functional impairment for which surgery was indicated. A corrective osteotomy was planned using [...] Read more.

We present a case report of a 12-year old female with a midshaft forearm fracture. Initial conservative treatment with a cast failed, resulting in a malunion. The malunion resulted in functional impairment for which surgery was indicated. A corrective osteotomy was planned using 3D analyses of the preoperative CT-scan. Subsequently, patient-specific guides were printed and used during the procedure to precisely correct the malunion. Three months after surgery, the radiographs showed full consolidation and the patient was pain-free with full range of motion and comparable strength in both forearms. The current case report shows that a corrective osteotomy with patient-specific guides based on preoperative 3D analyses can help surgeons to plan and precisely correct complex malunions resulting in improved functional outcomes. Full article

(This article belongs to the Special Issue Pediatric Fractures)

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