scholarly journals Pediatric Calcaneus Fractures and Associated Injuries

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0048
Author(s):  
Norman H. Ward ◽  
Brennan P. Roper ◽  
John W. Munz ◽  
William C. McGarvey ◽  
Alfred Mansour
Keyword(s):  
Pediatric Patients ◽  
Common Mechanism ◽  
Skeletally Immature ◽  
Associated Injuries ◽  
Calcaneus Fracture ◽  
Articular Fractures ◽  
Fracture Patterns ◽  
Tibia Fractures ◽  
Fractures Of The Spine ◽  
Calcaneus Fractures

Category: Trauma; Hindfoot Introduction/Purpose: The objective of the study was to determine the injuries associated with calcaneus fractures in pediatric patients and to determine if the skeletally immature sustain different injury patterns than the skeletally mature. In the adult population, these concurrent injuries are well-defined and consistent with a large axial load; however in the pediatric population, we anticipate that the differences in the mechanism of injury and developmental anatomy will alter the types of injuries observed with calcaneus fractures. Additionally, given the plasticity of immature bone, the skeletally immature patients may sustain different fracture patterns than the skeletally mature. Methods: A retrospective chart review was performed of pediatric patients presenting with a calcaneus fracture from 2008 to 2017. Patients under the age of 18 with an ICD code consistent with a calcaneus fracture were included. Patients who sustained penetrating trauma were excluded along with medical records with incomplete data. Demographics, injury information, associated injuries, skeletal maturity, fracture characteristics, and treatment were recorded. As defined by calcaneal apophyseal closure, the cohort was divided into the skeletally mature and immature for analysis. Student’s t-test and Fisher’s exact tests were used to determine significance. Results: 199 records were reviewed resulting in a sample of 81 pediatric patients with 91 calcaneus fractures. 37(40.7%) patients were immature at the time of injury. The most common mechanism witnessed was a fall in 52(64.2%) patients, with an average age of 12.8 years-old (range 0-17). There were 50(54.9%) intra-articular fractures and 15(16.5%) who underwent reduction and fixation. In the immature, open reduction internal fixation was performed on 6(14.3%) fractures which demonstrated a significantly decreased average Bohler’s angle than the conservatively treated, 14 degrees(p= 0.048). Fractures of the spine were the most commonly associated injury in 10(12.3%) pediatric patients however tibia fractures were the most commonly observed injury in the skeletally immature cohort, 7(18.9%). There were no associated injuries significantly unique to the skeletally immature. Conclusion: The present study provides one of the largest published cohorts to date of pediatric calcaneus fractures. They were most commonly associated with fractures of the spine however in the skeletally immature group as defined by apophyseal staging, tibia fractures were most often observed. No injuries were found to be significantly associated with immature patients. The skeletally immature calcanei produce fracture patterns which may be difficult to observe on radiographs and often require advanced imaging to delineate. While the majority may be treated with conservative therapy, there are no current concrete operative indications for the closed skeletally immature calcaneus fracture.

scholarly journals PEDIATRIC ORTHOPAEDIC TRAUMA AND ASSOCIATED INJURIES AT AN INNER-CITY LEVEL 1 TRAUMA CENTER

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0011
Author(s):  
Michael Levidy ◽  
Rahul Rai ◽  
Alice Chu ◽  
Neil Kaushal ◽  
O. Folorunsho Edobor-Osula
Keyword(s):  
Lower Extremity ◽  
Inner City ◽  
Trauma Center ◽  
Pediatric Patients ◽  
Orthopaedic Trauma ◽  
Associated Injuries ◽  
Tibia Fractures ◽  
Pediatric Orthopaedic ◽  
Level 1 ◽  
Level 1 Trauma Center

Background/Purpose: Pediatric orthopaedic trauma in inner city communities often present with unique and modifiable risk factors. The purpose of this study was to characterize and evaluate the pattern and nature of orthopaedic and associated injuries in pediatric patients involved in motor vehicle accidents (MVA), falls, sports related injuries and pedestrian struck either on foot or on bicycle at an inner-city level 1 trauma center. Methods: 260 pediatric patients who presented to the emergency department after a fall, a sports related injury, MVA, pedestrian struck on foot (PSoF), or pedestrians struck on bicycle (PSoB) with orthopaedic injuries at our institution between 2013 and 2020 were retrospectively reviewed. Results: The mean age of our cohort was 9.1 years (SD ±4.60). 36.5% (95/260) were girls, 63.5% (165/260) were boys. There were a total of 260 patients with a total of 331 fractures. 96.3% (319/331) of the fractures were appendicular while 3.6% (12/331) were axial. 43.8% (114/260) of patients had lower extremity fractures and 49.2% (128/260) had upper extremity fractures. Of all mechanisms, MVAs were most commonly associated with axial fractures (p<0.01). Falls were associated most commonly with upper extremity fractures (p<0.01), lower patient age (p<0.01) and negatively correlated with lower extremity fractures (p<0.01). Sports related injuries were most commonly correlated with tibia fractures (p<0.01). Sports etiologies were subdivided into Basketball (29%), Football (27%), Soccer (11%), and other physical activities like Rollerblading (11%) and Skateboarding (9%). PSoF was associated with tibia fractures (p<0.05) and open fractures (p<0.01). PSoB was the most likely mechanism to lead to lower extremity fractures (p=0.01) and head trauma (p<0.01). 75% (6/8) of PSoB were not wearing a helmet at the time of injury. Conclusion: Not surprisingly, falls represent the most common mechanism of pediatric orthopaedic injury. Other mechanism of injuries included MVAs, pedestrian struck on foot or bicycle were associated with more significant trauma including vertebral fractures, open fractures, head trauma and compartment syndrome. Preventative measures including education on car seat and seat belt use, helmet use and bicycle safety in children may reduce the incidence of these serious injuries. [Figure: see text]

scholarly journals Cost-utility Analysis of Extensile Lateral Approach Versus Sinus Tarsi Approach in Sanders type II/III Calcaneus Fractures

2020 ◽  
Author(s):  
Zihua Li ◽  
Xinbo Wu ◽  
Haichao Zhou ◽  
Shaochen Xu ◽  
Fajiao Xiao ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Internal Fixation ◽  
Incremental Cost ◽  
Lateral Approach ◽  
Type Ii ◽  
Calcaneus Fracture ◽  
Sinus Tarsi Approach ◽  
Significant Difference ◽  
Extensile Lateral Approach ◽  
Calcaneus Fractures

Abstract Background Extensile lateral approach had been recognized as the gold standard technique for displaced intra-articular calcaneus fractures (DIACFs) while sinus tarsi approach had been increasingly valued by surgeons. And comparative clinical outcome was shown in both techniques. Appropriate decisions could be made by the clinicians with the help of CUA about optimal healthcare for type II/III calcaneus fracture. Method A single-center, retrospective study was conducted in which basic characteristics, clinical outcomes and health care costs of 109 patients had been obtained and analyzed. Changes in health-related quality of life (HRQoL) scores, validated by EuroQol five-dimensional-three levels (EQ-5D-3L), were used to enumerate quality-adjusted life-years (QALYs). Cost-effectiveness was determined by the incremental cost per QALY. Results 109 patients were enrolled in our study including 62 in the ELA group and 47 in the STA group. There were no significant differences between these two groups in mean total cost, laboratory and radiographic evaluation expense, surgery, anesthesia and antibiotic expense. The expense of internal fixation materials ($3289.0 ± 543.9) versus ($2630.6 ± 763.7) and analgesia ($145.8 ± 85.6) versus ($102.9 ± 62.7) in ELA group were significantly higher than in the STA group ( P <.001, P =.008, respectively). Visual Analogue Scale (VAS) scores showed significant difference at postoperative 3 and 5 days ( P <.001). American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and the Bohlers’ and Gissane angle showed no significant differences between the two groups before and after the operation. The cost-effectiveness ratios of ELA and STA were $8766.8±2835.2/QALY and $7914.9 ± 1822.0/QALY respectively and incremental cost-effectiveness ratio (ICERs) of ELA over STA was $32110.00/QALY, but both showed no significant difference. Conclusion Both ELA and STA techniques are effective operative procedures for the patients with calcaneus fracture. Moreover, STA seems to be more reasonable for its merits including less postoperative pain, and less expense of analgesia as well as internal fixation materials.

scholarly journals Do Acute Inflammatory Cytokines Affect 3- and 12-Month Postoperative Functional Outcomes–A Prospective Cohort Study of 12 Patients With Proximal Tibia Fractures

2021 ◽  
Author(s):  
Imran Iversen ◽  
That Minh Pham ◽  
Hagen Schmal
Keyword(s):  
Cohort Study ◽  
Clinical Outcomes ◽  
Inflammatory Cytokines ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cartilage Damage ◽  
Articular Fractures ◽  
Tibia Fractures ◽  
Anti Inflammatory ◽  
Injured Knee

Abstract BackgroundPatients with intra-articular fractures tend to develop post-traumatic osteoarthritis (PTOA). The initial inflammatory response with elevation of inflammatory cytokines following joint trauma might be responsible for triggering cartilage catabolism and degradation. We aimed to identify and quantify cytokine levels in fractured and healthy knee joints and the correlation of these cytokines with clinical outcomes.Methods In this prospective cohort study, synovial fluid and plasma were collected from 12 patients with proximal intra-articular tibia fractures before surgery. The concentration of sixteen inflammatory cytokines, two cartilage degradation products and four metabolic mediators where measured, comparing the acute injured knee with the healthy contralateral knee. Patients were evaluated 3- and 12-months after surgery with clinical parameters and radiographical scanning. Non-parametrical Wilcoxon rank-sum and Spearman tests were used for statistical analysis, and a P-value below 0.05 was considered significant.ResultsWe found an elevation of the pro-inflammatory cytokines IL-1β, IL-2, IL-6, IL-8, IL-12p70, TNF-α, IFN-y, MMP-1, MMP-3, and MMP-9 and a simultaneous elevation of the anti-inflammatory cytokines IL-1RA, IL-4, IL-10, and IL-13 in the injured knee. Several pro- and anti-inflammatory cytokines and metabolic mediators were correlated with clinical outcomes 12 months after surgery, especially with pain perception. ConclusionsOur results support that an inflammatory process occurs after intra-articular knee fractures, which is characterized by the elevation of both pro- and anti-inflammatory cytokines. There was no sign of cartilage damage within the timeframe from injury to operation. We found a correlation between the initial inflammatory reaction with clinical outcomes 12 months after surgery.

scholarly journals Ipsilateral femur and tibia fractures in pediatric patients: A systematic review

2017 ◽  
Vol 8 (8) ◽  
pp. 638 ◽  
Author(s):  
Jason B Anari ◽  
Alexander L Neuwirth ◽  
B David Horn ◽  
Keith D Baldwin
Keyword(s):  
Systematic Review ◽  
Pediatric Patients ◽  
Tibia Fractures

FUNCTIONAL OUTCOME OF ARTHROSCOPIC ACL RECONSTRUCTION WITH HAMSTRING GRAFT

2021 ◽  
pp. 36-37
Author(s):  
Sai Bharath Kanugula ◽  
Atchuta Rao Ampolu ◽  
Ashok Kumar Patnala
Keyword(s):  
Anterior Cruciate Ligament ◽  
Functional Outcome ◽  
Cruciate Ligament ◽  
Common Mechanism ◽  
Associated Injuries ◽  
Hamstring Graft ◽  
Sports Activity ◽  
Anterior Drawer Test ◽  
Anterior Cruciate

Background: The most common joint to be injured in our body is knee joint, and the commonest ligament to be injured is anterior cruciate ligament in the knee.Etiology includes road trafc accidents and sport injuries. The ACL, along with other ligaments, the capsule are the stabilizers of the knee and prevents anterior translation, and limits valgus and rotational stress. The articular cartilage injuries in acute ACL tears constitutes from 16 – 46%, and in chronic tears, the incidence increases further2. For prevention of further worsening of the existing lesions and also to prevent formation of new lesions, stablity of the knee should be achieved.The present study is to assess the functional outcome of arthroscopic anterior cruciate ligament reconstruction using hamstring tendon (gracilis and semitendinosus) autograft in patients with ACL tears. Methods: Study design: Hospital Based Observational study. Study period: September 2019 to August 2021. Sample size: 30 30 consecutive patients who underwent arthroscopic ACL reconstructions with hamstring graft were taken for this study. Results: Out of these, 27 patients were male and 3 were female. Right side affected in 18 patients and left side in 12 patients. The most common mechanism of the injury was sports activity in 17 patients, RTA injuries in 10 patients and other job related injuries in 3 patients. Isolated ACL tears in thirteen patients in our study and rest had associated injuries to menisci in same knee.Better postoperative functional scores are seen with patients with isolated ACL injuries compared to those patients with associated injuries of the knee like meniscal tears. Observations include anterior drawer test was negative in 83.33% of patients at 3 months, 86.67% of patients at 6 months and at 1 year 96.15% of patients had a negative anterior drawer test. Full range of motion attained in 86.67% of patients at 3 months, 93.33% of patients at 6 months and at 1 year 96.15% of patients.Pivot shift test was negative postoperatively for all the patients at any follow-up. Postoperatively at 3 months 25 (83.33%) patients had 5/5 quadriceps power (MRC grading) 92.3% of them had 5/5 power at latest follow up. Complications include Supercial infection and Deep infection in our study. Conclusion: Anterior cruciate ligament tears are most common at a mean age of 28 years with preponderance to male gender. The most common mechanism of the injury was sports activity. Isolated ACL injury is more common than along with associated meniscal injuries.Anatomic single bundle reconstruction with quadrupled hamstring graft gives good functional results.Hamstring graft xation with endobutton and interference screw gives better functional outcome.

Abstract 15472: The Utility of Isoproterenol Testing in Pediatric Patients Following Atrioventricular Nodal Reentry Ablation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tahmina Samad ◽  
Eric S Silver ◽  
Leonardo Liberman
Keyword(s):  
Catheter Ablation ◽  
Pediatric Patients ◽  
Common Mechanism ◽  
Slow Pathway ◽  
Significant Cost ◽  
Prior Use ◽  
Acute Success ◽  
Group 2 ◽  
Procedural Success ◽  
Group 1

Intro: AVNRT is a common mechanism of SVT in pediatric patients. Catecholamines such as isoproterenol (ISO) are routinely given during post ablation (ABL) testing to confirm acute success. In light of its recent significant cost increase, the aim of our study was to determine if ISO is necessary in all pediatric patients after AVNRT ablation to ensure acute procedural success. Method: Retrospective study of patients <21 years with AVNRT from 1/06-12/18 who had undergone catheter ablation. We excluded patients with congenital heart disease (CHD), prior ABL, without inducible tachycardia (presumed AVNRT), unsuccessful ABL and those who required ISO to induce tachycardia (TACHY) prior to ABL lesions. All patients were tested after ABL without ISO and if AVNRT was not induced they were retested while on ISO. Result: We identified 232 patients with AVNRT of whom 65 (28%) met the study criteria; 123 (53%) were excluded for requiring ISO to induce AVNRT prior to ABL, 23 (10%) for CHD, 12 (5%) with presumed AVNRT and 9 (4%) with an unsuccessful ABL. The average age was 14.4 yrs (±3.5) and 54% were female. All patients received anesthesia, 40/65 were intubated (62%). Evidence of slow pathway conduction (Spath) (AH jump with atrial extrastimulus testing, presence of AV nodal echo beats or PR>RR) was seen in 35/65 patients (54%). Patients were divided into 2 groups: group 1 (n= 57, 88%) consisted of patients without inducible TACHY post ABL while receiving ISO, group 2 (n = 8, 12%) of patients in whom TACHY was inducible with ISO thus required further ABL. There was no difference between the groups with regards to sex, age, intubation status, prior use of antiarrhythmic meds, or in the incidence of Spath (31/57, 54% vs. 4/8, 50%, p=1). Four of the 8 patients in group 2 with no evidence of Spath had inducible TACHY with ISO. Conclusion: We found that 12% of pediatric patients who did not require ISO to induce AVNRT prior to ABL had inducible TACHY only with ISO after AVNRT ABL. Presence of dual AV nodal physiology after ABL lesions did not predict inducibility of AVNRT on ISO, and 50% of the patients with no evidence of slow pathway conduction by conventional testing had inducible AVNRT with ISO. ISO testing is useful in all pediatric patients to test for inducibility following catheter ablation of AVNRT.

scholarly journals Prevalence of Peroneal Tendon Instability in Calcaneus Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0014
Author(s):  
Abduljabbar Alhammoud ◽  
Karim Mahmoud Khamis
Keyword(s):  
English Language ◽  
Lateral Wall ◽  
Calcaneal Fracture ◽  
Peroneal Tendon ◽  
Foot And Ankle ◽  
Calcaneal Fractures ◽  
Distal Fibula ◽  
Calcaneus Fracture ◽  
Orthopedic Surgeons ◽  
Calcaneus Fractures

Category: Trauma Introduction/Purpose: Peroneal tendon instability (PI) associated with intraarticular calcaneal fractures is a significant and commonly missed injury. It has been proposed that the peroneal tendon dislocates with the occurrence of a calcaneal fracture because the axial force transmitted blows out the lateral wall causing either impingement of the peroneal tendon or avulsion of the superficial peroneal retinaculum from the distal fibula, allowing the peroneal tendons to dislocate anteriorly. To date, peroneal tendon instability with a calcaneal fracture has often passed undiagnosed by both radiologists and orthopedic surgeons. The present review aimed to determine the global reported prevalence of peroneal instability associated with calcaneus fractures according to the severity of the calcaneus fracture classification and the significance of a fleck sign as an indicator of PI. Methods: An electronic search of MEDLINE, Scopus, and Google Scholar was conducted until June 2017 without a date restriction and for English-language reports only in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Database searching was augmented by manual searches of common journals in the field (JBS, Foot and Ankle International, Foot and Ankle Surgery, Journal of Orthopedic Trauma). The reference lists from the identified studies were also scrutinized for any additional reports.The studies that reported the prevalence/incidence of peroneal tendon subluxation/ dislocation in association with a calcaneus fracture were included whereas patients with calcaneus fractures combined with other fractures, extraarticular calcaneus fractures, and old calcaneus fractures were excluded.The data analysis was performed using a comprehensive meta-analysis with a random effects model. Results: Of 31 initial studies, 9 were included, contain 1027 patients/1050 calcaneus fractures.Most of the patients were male, with an average age of 42.03 (range 18 to 79) years.Of the 1050 calcaneus fractures, PI was found in association with 305.The pooled odds ratio of the prevalence of PI with calcaneus fractures was 29.3%(95% CI 25.9%-32.9%; p < .001).The prevalence of PI increased with an increased fracture severity using the Sanders classification, with a prevalence of 5.4% with Sanders I,19% with Sanders II, 39.4% in Sanders III, and 49.5% with Sanders IV. The prevalence of PI in the tongue type fracture using the Essex-Lopresti classification was 19%, and for joint depression, was 30.8% (p < .001). The prevalence of the fleck sign as an indicator of PI was 54.7%. Conclusion: The global reported prevalence of peroneal tendon dislocation associated with intraarticular calcaneal fractures was 29.3% and that the prevalence of PI increases with increased severity of the calcaneus fracture. Such a high prevalence should raise suspicions in both radiologists and orthopedic surgeons about this injury. The assessment should begin with a careful review of preoperative radiographs to search for the fleck sign and CT scans for a dislocated tendon, followed later by intraoperative assessment of superior peroneal retinaculum integrity.

OPEN EXTENSOR TENDON INJURIES: AN EPIDEMIOLOGIC STUDY

Hand Surgery ◽  
2012 ◽  
Vol 17 (01) ◽  
pp. 37-42 ◽  
Author(s):  
Dominic Patillo ◽  
Ghazi M. Rayan
Keyword(s):  
Soft Tissue ◽  
Epidemiologic Study ◽  
Retrospective Chart Review ◽  
Extensor Tendon ◽  
Tendon Injuries ◽  
Common Mechanism ◽  
Anatomical Location ◽  
Mechanism Of Injury ◽  
Associated Injuries ◽  
Extensor Tendon Injuries

Purpose: To report the epidemiology, mechanism, anatomical location, distribution, and severity of open extensor tendon injuries in the digits, hand, and forearm as well as the frequency of associated injuries to surrounding bone and soft tissue. Methods: Retrospective chart review was conducted for patients who had operative repair of open digital extensor tendon injuries in all zones within an 11-year period. Data was grouped according to patient characteristics, zone of injury, mechanism of injury, and presence of associated injury. Statistical analysis was used to determine the presence of relevant associations. Results: Eighty-six patients with 125 severed tendons and 105 injured digits were available for chart reviews. Patients were predominantly males (83%) with a mean age of 34.2 years and the dominant extremity was most often injured (60%). The thumb was the most commonly injured (25.7%), followed by middle finger (24.8), whereas small finger was least affected (10.5%). Sharp laceration was the most common mechanism of injury (60%), and most of these occurred at or proximal to the metacarpophalangeal joints. Most saw injuries occurred distal to the metacarpophalangeal joint. Zone V was the most commonly affected in the fingers (27%) while zone VT was the most commonly affected in the thumb (69%). Associated injuries to bone and soft tissue occurred in 46.7% of all injuries with saw and crush/avulsions being predictive of fractures and damage to the underlying joint capsule. Conclusions: The extensor mechanism is anatomically complex, and open injuries to the dorsum of the hand, wrist, and forearm, especially of crushing nature and those inflicted by saws, must be thoroughly evaluated. Associated injuries should be ruled out in order to customize surgical treatment and optimize outcome.

scholarly journals Traumatic diaphragmatic hernia: 28-years analysis at a Brazilian university hospital

2020 ◽  
Author(s):  
Vitor Kruger ◽  
Thiago Calderan ◽  
Rodrigo Carvalho ◽  
Elcio Hirano ◽  
Gustavo Fraga
Keyword(s):  
Diaphragmatic Hernia ◽  
Chest Radiography ◽  
Motor Vehicle ◽  
Morbidity And Mortality ◽  
University Hospital ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Associated Injuries ◽  
Abdominal Injuries ◽  
Traumatic Diaphragmatic Hernia

Abstract Background The objective of the study is evaluate the approach to patients with acute traumatic diaphragmatic hernia at a Brazilian university hospital during a 28-year period. Traumatic diaphragmatic hernia is an uncommon injury, however its real incidence may be higher than expected. Sometimes is missed in trauma patients, and is usually associated with significant morbidity and mortality, this analysis may improve outcomes for the trauma patient care.Methods Retrospective study of time series using and analisys database records of trauma patients at HC- Unicamp was performed to investigate the incidence, trauma mechanism, diagnosis, herniated organs, associated injuries, trauma score, morbidity, and mortality of this injury.Results Fifty-five cases were analyzed. Blunt trauma was two-fold frequent than penetrating trauma, are associated with high grade injury and motor vehicle collision was the most common mechanism. Left side hernia was four-fold frequent than right side. Diagnose was mostly performed by chest radiography (31 cases; 56%). Associated intra-abdominal injuries were found in 37 patients (67.3%) and extra-abdominal injuries in 35 cases (63.6%). The mortality was 20% (11 cases).Conclusions Computed tomography scan identified associated injuries and had high specificity. Isolated injuries were rare, and the presence of associated injuries increased morbidity and mortality. Despite advances in imaging methods, chest radiography in the trauma bay is useful as an initial approach. Despite the use of laparoscopy in a few cases, laparotomy was the most frequent approach for repair.

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