Tibial and ankle fractures in children

2011 ◽  
Author(s):  
B.W. Scott ◽  
P.A. Templeton
Keyword(s):  
Soft Tissues ◽  
Skeletal Maturity ◽  
Distal Tibia ◽  
Femoral Fractures ◽  
Ankle Fractures ◽  
Minor Importance ◽  
Duration Of Treatment ◽  
Rotational Malalignment ◽  
Fractures In Children ◽  
Clinically Significant

♦ After forearm and digital injuries, tibial and ankle fractures are the commonest fractures in the immature skeleton and the majority of these involve the diaphysis or ankle♦ Compared to the morbidity seen in adults these are relatively forgiving injuries in children as the healing rate of bone and soft tissues is rapid and remodelling will occur♦ It is wise, however, to guard against overconfidence in the remodelling potential of certain injuries; for example, angulated mid-diaphyseal fractures, rotational malalignment, and metaphyseal fractures within 2 years of skeletal maturity♦ Children will tolerate manipulative/cast treatment better than adults as the duration of treatment is usually shorter and rapid rehabilitation is almost the norm with or without physiotherapy♦ Postfracture overgrowth does occur but is less than that following femoral fractures and seldom clinically significant (over 10mm)♦ Isolated fibular fractures are of minor importance but need to be taken into account in managing complex injuries involving the distal tibia♦ It is convenient to discuss injuries according to three anatomical sections: proximal, diaphyseal, and distal.

scholarly journals Validating scoring systems for fracture healing in infants and young children: pilot study

2021 ◽  
Author(s):  
Samuel Crompton ◽  
Fabrizio Messina ◽  
Gillian Klafkowski ◽  
Christine Hall ◽  
Amaka C. Offiah
Keyword(s):  
Pilot Study ◽  
Young Children ◽  
Fracture Healing ◽  
Callus Formation ◽  
Femoral Fractures ◽  
Scoring Systems ◽  
Power Calculation ◽  
Small Pilot Study ◽  
Fractures In Children ◽  
Infants And Young Children

Abstract Background Recent studies have analysed birth-related clavicular fractures to propose time frames for healing that could be applied to dating of all fractures in cases of suspected child abuse. Objective To assess differences in healing rates between femoral fractures and birth-related clavicular fractures in infants and young children. Materials and methods A retrospective 5-year pilot study of femoral fractures in children younger than 3 years of age was performed. Anonymised radiographs were independently scored by two radiologists for stages of fracture healing. In cases of reader disagreement, radiographs were independently scored by a third radiologist. Results In total, 74 radiographs (30 children) met the inclusion criteria. Fracture healing evolved over time with subperiosteal new bone formation (SPNBF) appearing first, followed by callus then remodelling. A power calculation for a single proportion, with a level of confidence of 95% and a margin of error of 5%, showed that in a definitive study, 359 radiographs would be required. Conclusion Although the overall pattern of healing is similar, in this small pilot study, the earliest times for SPNBF and callus formation in femoral fractures appeared to lag behind healing of birth-related clavicular fractures. Remodelling appeared earlier than remodelling of clavicular fractures. A power calculation has determined numbers of femoral radiographs (359) required for a definitive study.

Skin traction in hip spica casting for femoral fractures in children

2007 ◽  
Vol 12 (4) ◽  
pp. 327-333 ◽  
Author(s):  
Cem Zeki Esenyel ◽  
Kahraman Öztürk ◽  
Oktay Adanir ◽  
Bulent Aksoy ◽  
Meltem Esenyel ◽  
...  
Keyword(s):  
Femoral Fractures ◽  
Spica Casting ◽  
Fractures In Children ◽  
Skin Traction

Nerve blocks for initial pain management of femoral fractures in children

2012 ◽  
Author(s):  
Karen JL Black ◽  
Nancy G Murphy ◽  
Kara Thompson ◽  
Catherine A Bevan ◽  
Jason J Howard
Keyword(s):  
Pain Management ◽  
Femoral Fractures ◽  
Nerve Blocks ◽  
Fractures In Children

scholarly journals Observational study on titanium elastic nailing in femoral shaft fractures in children

2018 ◽  
Vol 5 (1) ◽  
pp. 32
Author(s):  
Jyotirtmayee Bahinipati ◽  
R. G. Asutosh Mohapatra
Keyword(s):  
Femoral Shaft Fracture ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Limb Length Discrepancy ◽  
Shaft Fracture ◽  
Titanium Elastic Nailing ◽  
Fractures In Children ◽  
Group 5 ◽  
One Year ◽  
Prolonged Immobilization

<p class="abstract"><strong>Background:</strong> Nowadays femoral fractures in children are more commonly managed with operative fixation rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization. Our aim of study was to assess the outcome of titanium elastic nailing in femoral shaft fracture in children.</p><p class="abstract"><strong>Methods:</strong> Twenty five children in age group 5-15 years with femoral shaft fracture were stabilized with two titanium nails. Children were followed up for one year. The operative outcome was evaluated using criteria of Flynn. Complications associated with procedure were recorded and analyzed.<strong></strong></p><p class="abstract"><strong>Results:</strong> The final outcome was excellent in 67% (19 of 25) of patients, satisfactory in 16% (4 of 25) of patients and poor in 8% (2 of 25) of patients. Poor outcome was due to limb length discrepancy, pain in the knee and angular misalignment.</p><p class="abstract"><strong>Conclusions:</strong> We concluded that titanium elastic nailing is an ideal method of femoral shaft fixation in children.</p>

scholarly journals Co-producing a multi-stakeholder Core Outcome Set for distal Tibia and Ankle fractures (COSTA): a study protocol

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Nathan A. Pearson ◽  
Elizabeth Tutton ◽  
Alexander Joeris ◽  
Stephen Gwilym ◽  
Richard Grant ◽  
...  
Keyword(s):  
Core Outcome Set ◽  
Distal Tibia ◽  
Ankle Fractures ◽  
Core Outcome ◽  
Core Domain ◽  
Outcome Reporting ◽  
The Core ◽  
Outcome Set ◽  
Multi Stakeholder ◽  
Core Domain Set

Abstract Background Ankle fracture is a common injury with a strong evidence base focused on effectiveness of treatments. However, there are no reporting guidelines on distal tibia and ankle fractures. This has led to heterogeneity in outcome reporting and consequently, restricted the contribution of evidence syntheses. Over the past decade, core outcome sets have been developed to address this issue and are available for several common fractures, including those of the hip, distal radius, and open tibial fractures. This protocol describes the process to co-produce—with patient partners and other key stakeholders—a multi-stakeholder derived Core Outcome Set for distal Tibia and Ankle fractures (COSTA). The scope of COSTA will be for clinical trials. Methods The study will have five-stages which will include the following: (i) systematic reviews of existing qualitative studies and outcome reporting in randomised controlled trial studies to inform a developing list of potential outcome domains; (ii) qualitative interviews (including secondary data) and focus groups with patients and healthcare professionals to explore the impact of ankle fracture and the outcomes that really matter; (iii) generation of meaningful outcome statements with the study team, international advisory group and patient partners; (iv) a multi-round, international e-Delphi study to achieve consensus on the core domain set; and (v) an evidence-based consensus on a core measurement set will be achieved through a structured group consensus meeting, recommending best assessment approaches for each of the domains in the core domain set. Discussion Development of COSTA will provide internationally endorsed outcome assessment guidance for clinical trials for distal tibia and ankle fractures. This will enhance comparative reviews of interventions, potentially reducing reporting bias and research waste.

scholarly journals Сomputed tomography for fractures of the ankle joint in children

2021 ◽  
Vol 25 (3) ◽  
pp. 119-130
Author(s):  
N. Yu. Serova ◽  
T. A. Akhadov ◽  
I. A. Mel'nikov ◽  
O. V. Bozhko ◽  
T. D. Kostikova ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ankle Joint ◽  
Traffic Accidents ◽  
Correct Diagnosis ◽  
Distal Tibia ◽  
Tibial Fractures ◽  
Slice Thickness ◽  
Ray Method ◽  
Intraarticular Fractures ◽  
Fractures In Children

Introduction. Correct diagnosis is based on visualization and knowledge of fracture patterns characteristic of children. Traditionally, radiography is used to visualize bone damage. In fractures in children due to the high risk of damage to the germinal zones, it is necessary to have clear and reliable information about their condition, which cannot always be obtained by x-ray method. For these purposes and the requirements of modern surgery, CT is used, which with high diagnostic accuracy clarifies the degree of displacement of fragments, present a qualitative characteristic of fractures and reveals associated damage.Purpose: to show the capabilities of computed tomography in diagnosis of fractures of ankle joint.Materials and methods. The results of computed tomography (CT) are presented in 226 children and adolescents aged 3 to 17 years. There were 142 boys (62.8%), 84 girls (37.2%). Scanning was carried out depending on the weight and age of the patient with the minimum indicators of kV and mAS, a slice thickness of 0.75 mm.Results. Average time for seeking medical help was 32 hours from moment of injury. Among causes of injury in the first place was domestic injury (73, 8%), followed by sports injury (22, 3%) and traffic accidents (3.9%). Right-sided ankle fractures were found in 147 (65.1%), left-sided – in 79 (34.9%) children. The most common types of tibial fractures were metaepiphysiolysis of the distal tibia and metaepiphysiolysis of the distal tibia of both tibia, which together accounted for 67.7% (n = 153) of all tibial fractures.Conclusion. Computed tomography should be performed in all cases of intraarticular fractures of the ankle joint. It is especially important for evaluating fractures with damage to germ zones. Scanning must be carried out with a cutting thickness of not more than 1 mm. CT with multi-planar data reformatting is an important factor in determining whether a patient needs surgical treatment. As a result of CT, a final diagnosis was established and a decision was made on treatment tactics.

scholarly journals Fracture Nonunion Treated with Low-Intensity Pulsed Ultrasound and Monitored with Ultrasonography: A Feasibility Study

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Peizhen Zhang ◽  
Pengdong Li ◽  
Shihai Liao ◽  
Xuan Li ◽  
Wufan Chen ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Bone Fracture ◽  
Soft Tissues ◽  
Callus Formation ◽  
Distal Tibia ◽  
Pulsed Ultrasound ◽  
Low Intensity Pulsed Ultrasound ◽  
Low Intensity ◽  
Cord Injury ◽  
Fracture Nonunion

The positive effect of low-intensity pulsed ultrasound (LIPUS) on bone fracture healing has been proved. However, during the period of LIPUS therapy, it is undetermined whether LIPUS promotes the formation of heterotopic ossification (HO), which usually occurs in muscle tissues after trauma such as bone fracture and spinal cord injury. Here, we used 6-week LIPUS therapy in a 42-year-old Chinese male patient with a fracture nonunion in combination with ultrasonography for monitoring fracture healing and HO formation. After the LIPUS therapy, the mineralized bone formation in the area of defect of the distal tibia was presented in an ultrasound image, which was consistent with the outcome of plain radiography showing callus formation and the blurred fracture line in the area exposed to LIPUS. In addition, ultrasound images revealed no evidence of HO development within soft tissues during the period of LIPUS therapy. This study suggests that ultrasonography is a potential tool to guarantee the performance of LIPUS therapy with monitoring HO formation. Easy to use, the integration of the handheld ultrasound scanner and the ultrasonic therapeutic apparatus is entirely dedicated to help orthopedists make high-quality care and diagnosis.

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