A retrospective study of all paediatric fractures presenting to hospital in Edinburgh, Scotland in 2000 was undertaken. It showed that the incidence of fractures was 20.2/1000/year and that 61% of children's fractures occurred in males. Analysis of paediatric fractures shows that there are six basic fracture distribution curves with six fractures showing a bimodal distribution but most having a unimodal distribution affecting younger or older children. The incidence of fractures increases with age with falls from below bed height (<1m) being the commonest cause of fracture. The majority of fractures in children involve the upper limb. Lower limb fractures are mainly caused by twisting injuries and road traffic accidents. The incidence of fractures in cyclists and pedestrians remains relatively high whereas the incidence in vehicle occupants is low suggesting that road safety programs have been successful. Similar programs should be instituted for young cyclists. The importance of accident prevention programmes in the home is also highlighted.
"Fracture rates in adult patients with classic galactosemia have been reported between 31 and 63% (Waisbren et al. 2012; Batey et al. 2013), which is slightly higher than in the general population in which rates between 21 and 53% have been reported for this age category (van Staa et al. 2001). Only one study addresses the fracture rates in pediatric patients (Waisbren et al. 2012), and the reported prevalence of 18% is not higher than in the healthy pediatric population (Landin 1997). Although the pathophysiological mechanism is still not fully understood, several factors could negatively affect bone metabolism in this disease. "
[Show abstract][Hide abstract] ABSTRACT: Decreased bone mass is frequently encountered in classic galactosemia, an inborn error of galactose metabolism. This decrease is most prominent in adults, but is already seen in prepubertal children with increased risk of osteoporosis and fractures later in life. Therefore, bone health in patients with classic galactosemia is increasingly monitored. Although the pathophysiological mechanism is still not fully understood, several factors could negatively affect bone metabolism in this disease. Patients are at risk of nutritional deficiencies due to the galactose-restricted diet. Primary ovarian insufficiency (POI) in female patients also contributes to decreased bone mass. Furthermore, patients with classic galactosemia might be less physically active due to motor or neurological impairments. A disease-specific intrinsic abnormality has been suggested as well. This revised proposal is an update of the 2007 recommendations. In this current approach, we advise comprehensive dietary evaluation, optimization of calcium intake if needed, monitoring and if necessary supplementation of vitamin D, hormonal status evaluation and hormone replacement therapy (HRT) consideration, as well as a regular exercise and assessment of skeletal deformities and clinically significant fractures. We propose bone mineral density (BMD) assessment by serial DXA scans of the lumbar spine, femoral neck, and total hip in adults and lumbar spine and total body less head (TBLH) in children.
"Injuries are one of the primary causes of morbidity in children [4,5]. According to existing epidemiological data, about a quarter of children suffer from at least one injury every year [4-6]. Incidence of fractures range from 2 to 3.6 per 100 children a year [4-7], with one-third of boys and girls expected to suffer from a fracture before 16 years of age . "
[Show abstract][Hide abstract] ABSTRACT: Background
The growing cost of health care and lack of specialised staff have set e-Health high on the European political agenda. In a prospective study we evaluated the effect of providing images for remote consultation through an iPad on the number of in-hospital orthopaedic consultations for children with bone fractures.
Children from 0 to 18 years diagnosed with a bone fracture by the radiologist during the hours when an orthopaedic service is provided only on-call were eligible for enrollment. Cases were enrolled prospectively during September and October 2013. A standard approach (verbal information only, no X-Ray provided remotely) was compared to an experimental approach (standard approach plus the provision of X-ray for remote consultation through an iPad). The primary outcome was the number of orthopaedic in-hospital consultations that occurred. Other outcomes included: immediate activation of other services; time needed for decision-making; technical difficulties; quality of images and diagnostic confidence (on a likert scale of 1 to 10).
Forty-two children were enrolled in the study. Number of in-hospital consultancies dropped from 32/42 (76.1%) when no X-ray was provided to 16/42 (38%) when the X-rays was provided (p < 0.001). With remote X-ray consultation in 14/42 (33.3%) cases services such as surgery and plaster room could be immediately activated, compared to no service activated without teleradiology (p < 0.001). Average time for decision making was 23.4 ± 21.8 minutes with remote X-ray consultation, compared to 56.2 ± 16.1 when the X-ray was not provided (p < 0.001). The comparison between images on the iPad and on the standard system for X- Ray visualisation resulted in a non statistically significant difference in the quality of images (average score 9.89 ± 0.37 vs 9.91 ± 0.30; p =0.79), and in non statistically significant difference in diagnostic confidence (average score 9.91 ± 0.32 vs 9.92 ± 0.31; p = 0.88).
Remote X-ray consultation through Aycan OsiriX PRO and iPad should be considered as a means for reducing the need of in-hospital orthopaedic consultation during on-call times, and potentially decrease the cost of care for the health system. In the future, alternative systems less expensive than Aycan OsiriX PRO should be further developed and tested.
BMC Health Services Research 07/2014; 14(1):327. DOI:10.1186/1472-6963-14-327 · 1.71 Impact Factor
"Tibial fractures are among the most common long-bone fractures in children (Shannak 1988, Landin 1997, Mäyränpää et al. 2010). Primary complications such as vascular or nerve injuries or compartment syndrome are rare. "
[Show abstract][Hide abstract] ABSTRACT: Background
Tibial fracture is the third most common long-bone fracture in children. Traditionally, most tibial fractures in children have been treated non-operatively, but there are no long-term results.
94 children (64 boys) were treated for a tibial fracture in Aurora City Hospital during the period 1980–89 but 20 could not be included in the study. 58 of the remaining 74 patients returned a written questionnaire and 45 attended a follow-up examination at mean 27 (23–32) years after the fracture.
89 children had been treated by manipulation under anesthesia and cast-immobilization, 4 by skeletal traction, and 1 with pin fixation. 41 fractures had been re-manipulated. The mean length of hospital stay was 5 (1–26) days. Primary complications were recorded in 5 children. The childrens’ memories of treatment were positive in two-thirds of cases. The mean subjective VAS score (range 0–10) for function appearance was 9. Leg-length discrepancy (5–10 mm) was found clinically in 10 of 45 subjects and rotational deformities exceeding 20° in 4. None of the subjects walked with a limp. None had axial malalignment exceeding 10°. Osteoarthritis of the hip and/or knee was seen in radiographs from 2 subjects.
The long-term outcome of tibial fractures in children treated non-operatively is generally good.
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