Humeral Fractures Without Obvious Etiologies in Children Less Than 3 Years of Age: When Is It Abuse?

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 667-671
Author(s):  
Richard T. Strait ◽  
Robert M. Siegel ◽  
Robert A. Shapiro
Keyword(s):  
Medical Center ◽  
Retrospective Chart Review ◽  
Humeral Fracture ◽  
Humeral Fractures ◽  
Supracondylar Fractures ◽  
Fractures In Children ◽  
Arm Injuries ◽  
Made In

Objective. To determine the occurrence and frequency of abuse in children with humeral fractures without immediately obvious etiologies who are less than 3 years old and present with arm injuries. Methods. A retrospective chart review was conducted of all children less than 3 years old treated for a humeral fracture at Children's Hospital Medical Center between July 1, 1990, and September 10, 1993. One hundred twenty-four charts of children with humeral fractures were reviewed for possible abuse using previously developed criteria. Charts were evaluated independently by the investigators. Consensus was reached on classification of each chart into the following categories: abuse, indeterminate, or not abuse. Results. Abuse was diagnosed in 9 of 25 (36%) children less than 15 months of age, but in only 1 of 99 (1%) children older than 15 months (P < .05). Abuse was excluded in 91 of 124 (73%) children. No determination of abuse (indeterminate) could be made in 23 of 124 (18.5%) children. In children less than 15 months of age, abuse was diagnosed in 2 of 10 (20%) with supracondylar fractures and in 7 of 12 (58%) with spiral/oblique fractures. Conclusion. The prevalence of abuse in our children presenting with humeral fractures was much lower than in other published reports, especially in the children over the age of 15 months. However, we found a higher prevalence of supracondylar fractures associated with abuse than those same reports. Given these findings, abuse should be considered in all children less than 15 months of age with humeral fractures, including those with supracondylar fractures. The majority of humeral fractures in children are accidental, especially beyond the age of 15 months.

scholarly journals Functional outcome of crossed Kirschner wire fixation in pediatric supracondylar humerus fracture

2019 ◽  
Vol 5 (5) ◽  
pp. 772
Author(s):  
Rahat Zahoor Moton ◽  
Adeel Ahmed Siddiqui ◽  
Muhammad Naseem ◽  
Uzair Yaqoob ◽  
Syed Amir Jalil ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Kirschner Wire ◽  
Humeral Fractures ◽  
Treatment Modalities ◽  
Class Iii ◽  
Supracondylar Fractures ◽  
Fractures In Children ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Supracondylar Humeral Fractures

<p class="abstract"><strong>Background:</strong> Distal humeral fractures are one of the most common types of fractures in children, most of them being supracondylar. Supracondylar fractures are usually caused by trauma, most likely falls. It is an emergency, requiring rapid diagnosis and management to avoid serious complications. Recommended treatment modalities vary from no reduction and immobilization to open reduction and internal fixation. Kirschner wire (K-wire) fixation of displaced supracondylar fractures after closed reduction is a preferred method and is being performed for over 50 years now. This study was conducted to determine the functional outcome of crossed K-wire fixation in pediatric supracondylar fracture.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted from May-November 2018 at the department of Orthopedics, Abbasi Shaheed Hospital, Karachi, Pakistan. It was inferred that functional outcome of pediatric displaced supracondylar humeral fractures is satisfactory when managed with percutaneous crossed K-wire fixation. It included 83 children with supracondylar fractures. They were treated with percutaneous crossed K-wire fixation. Patients were then followed up to determine satisfactory functional outcome according to Flynn’s criteria. Data entry and analysis was done using SPSS 21.0.</p><p class="abstract"><strong>Results:</strong> Eight-three patients were included. The mean±standard deviation age of this study population was 7.03±3.39 years. Out of the study participants, 47 (56.6%) were males and 36 (43.4%) were females. 71.1% of the patients were of Gartland class II fractures and 28.9% were of Gartland class III. 43.4% had an injury due to fall while playing while 19.3% had fallen from height. 80.7% were found to have a satisfactory functional outcome.</p><p class="abstract"><strong>Conclusions:</strong> It was inferred that the functional outcome of pediatric displaced supracondylar humeral fractures is satisfactory when managed with percutaneous crossed K-wire fixation.</p>

scholarly journals Tips and pitfalls of reduction and fixation in displaced supracondylar fractures in children

2021 ◽  
Vol 0 ◽  
pp. 1-7
Author(s):  
Joon-Woo Kim ◽  
Kyeong-Hyeon Park ◽  
Chang-Wug Oh
Keyword(s):  
Closed Reduction ◽  
Humeral Fractures ◽  
Cubitus Varus ◽  
Supracondylar Fractures ◽  
Fixation Technique ◽  
Lateral Entry ◽  
Reduction Techniques ◽  
Fractures In Children ◽  
Loss Of Reduction ◽  
Supracondylar Humeral Fractures

Supracondylar humeral fractures are the most common injury of the elbow in children. Compared to flexion type fractures, extension type fractures are more common, up to 98%. Gartland classification has been used to guide the management of this injury, which is based on the extent of the displacement. If not adequately managed, completely displaced (type III) fractures may have a higher incidence of concomitant injury or complications, including neurovascular injury, compartment syndrome, or cubitus varus. Closed reduction followed by percutaneous pinning has been suggested as the standard operative method for the displaced supracondylar humeral fractures. However, these fractures can be challenging to reduce, with the traditional technique of closed reduction. Lateral-entry pinning is known as a sufficient method of fixation for this injury. However, the lateral pin only fixation technique may also result in loss of reduction in some particular patterns of fractures, such as fractures with medial column comminution. We discuss and describe the reduction techniques of completely displaced supracondylar humeral fractures, including technical tips and pitfalls for closed reduction and open reduction. We also discuss indications of medial pinning, and its safe method, when the lateral-entry pins may not achieve adequate stability.

scholarly journals A direct determination of nuclear distribution in heterokaryons of Aspergillus nidulans

1966 ◽  
Vol 7 (2) ◽  
pp. 185-194 ◽  
Author(s):  
A. J. Clutterbuck ◽  
J. A. Roper
Keyword(s):  
Aspergillus Nidulans ◽  
Cytological Study ◽  
Direct Determination ◽  
Size Distributions ◽  
Projected Area ◽  
Nuclear Distribution ◽  
Tip Cells ◽  
Made In

A cytological study has been made, in Aspergillus nidulans, of haploid and diploid homokaryons and of heterokaryons formed between them. The effective region of growth was shown to extend about 600 μ behind the growing edge of the colony and to correspond largely with the tip cells. Acridine fluorescence gave unselective staining of all nuclei; projected nuclear areas, and their distributions in individual hyphae, were determined for the homokaryons and heterokaryons. Diploid and haploid nuclei differ in mean projected area but the overlap of their size distributions precluded unequivocal classification of individual nuclei in diploid–haploid heterokaryons. However, it was shown that the hyphae of a heterokaryon differ in nuclear ratios. This, and other evidence, strongly support the suggestion that heterokaryon maintenance and adaptation occur through interhyphal rather than intrahyphal selection.

scholarly journals Management of Breast Cancer during Pregnancy: Are We Compliant with Current Guidelines?

2017 ◽  
Vol 07 (01) ◽  
pp. e39-e43 ◽  
Author(s):  
Victoria Shlensky ◽  
Sigrun Hallmeyer ◽  
Lourdes Juarez ◽  
Barbara Parilla
Keyword(s):  
Breast Cancer ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
International Classification Of Diseases ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
Classification Of Diseases ◽  
Cancer In Pregnancy ◽  
In Pregnancy

Introduction The purpose of this study was to evaluate the management of patients with breast cancer in pregnancy treated at the Advocate Health Care, to determine whether these patients were treated according to guidelines for pregnant patients, which aim to maximize both fetal and maternal outcomes. Methods A retrospective chart review was performed at the Advocate Lutheran General Hospital, Christ Medical Center, and Illinois Masonic Medical Center from 2002 to 2012 on patients diagnosed with breast cancer during pregnancy using ICD-9 (International Classification of Diseases - 9th version) codes. Results Eleven patients between 12 and 37 weeks' gestation matched the search criteria. One patient terminated the pregnancy. Patients in our study were treated appropriately according to guidelines with the following exceptions. Trastuzumab was used in one patient during pregnancy which likely caused the oligohydramnios resulting in an induction of labor at 33 weeks. Three patients were delivered preterm between 34 and 36 weeks without an obstetric indication. Two patients underwent sentinel node biopsy. Conclusion The diagnosis of breast cancer in pregnancy is an infrequent but devastating diagnosis that is likely to increase. Although sentinel lymph node biopsy is not generally recommended in pregnancy, this may be an outdated guideline as using a low-dose lymphoscintigraphic technique appears to be safe in pregnancy.

scholarly journals Intra-Articular Bupivacaine Injection is An Ideal Method for Postoperative Pain Control in Children with Supracondylar Humeral Fracture

2021 ◽  
Author(s):  
Qian Wang ◽  
Jingxin Zhao ◽  
Yu Wang ◽  
Man He
Keyword(s):  
Treatment Group ◽  
Postoperative Pain ◽  
Pain Control ◽  
Humeral Fracture ◽  
Humeral Fractures ◽  
Control Group ◽  
Postoperative Pain Control ◽  
Supracondylar Humeral Fracture ◽  
Fractures In Children ◽  
Supracondylar Humeral Fractures

Abstract Objective: Supracondylar humeral fracture is the most common fracture in children. Currently there are a large number of studies on supracondylar humeral fractures addressing the epidemiology of supracondylar fractures, injury mechanisms, treatments and complications, however there are few studies on how to control the pain in children after fractures and operation. Therefore, we retrospectively analyzed the effectiveness of an intra-articular injection of 0.25% bupivacaine on pain control after CRPP of supracondylar humeral fractures in children. To our knowledge, this is the largest study on the use of an intra-articular injection for pain control after surgery for supracondylar humeral fractures.Methods: This clinical trial was designed to evaluate the efficacy of intra-articular injection of 0.25% bupivacaine as a postoperative pain control in children with supracondylar humeral fractures who underwent closed reduction and percutaneous pinning (CRPP).Subjects (n = 120) were randomized to treatment with 0.25% bupivacaine (treatment group) (n = 60) or no injection (control group) (n =71). After surgery, all patients were prescribed Ibuprofen for analgesia. The Ibuprofen doses and the times of administration were recorded. The Faces Pain Scale-Revised (FPS-R) scores were blindly recorded during postoperative day 1.Results: The results suggested that the use of intra-articular injection of 0.25% bupivacaine improved pain control and decreased the need for Ibuprofen on postoperative day 1. FPS-R scores were also significantly lower in the treatment group as compared with those of the control group. No intra-articular injection-associated complications were reported. Conclusion: Therefore, the intra-articular injection of bupivacaine significantly improves postoperative pain control following CRPP of supracondylar humeral fractures in children.

scholarly journals Management of delirium at an academic medical center: Plans for antipsychotic prescribing upon discharge

2020 ◽  
Vol 10 (1) ◽  
pp. 25-29
Author(s):  
Lauren Halavonich ◽  
Sophie Robert ◽  
Dan McGraw ◽  
Erin Weeda ◽  
Kristen Mullinax ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Positive Association ◽  
International Classification Of Diseases ◽  
Discharge Instructions ◽  
Academic Medical ◽  
Classification Of Diseases ◽  
Antipsychotic Prescribing

Abstract Introduction Delirium is an acute, fluctuating change in mental status, often associated with behavioral manifestations such as agitation. Literature suggests that many patients who continue on antipsychotics for extended management of delirium are not provided instructions for discontinuation. However, there is a positive correlation between consult services and instructions for discontinuation. The objective of this study was to determine the frequency at which patients with delirium were prescribed an antipsychotic at hospital discharge and to characterize discharge antipsychotic prescribing for psychiatric consult and nonconsult cohorts. Methods This study was a retrospective chart review of adult patients with an International Classification of Diseases 10th revision code of delirium who received at least 1 dose of antipsychotic during their admission. Inclusion criteria were all patients aged 18 years or older with a diagnosis of or relating to delirium who were administered antipsychotics during their admission. Results A total of 152 patients were included, of which 43 received a psychiatric consult. Antipsychotics were prescribed at discharge for management of delirium for 52 (34.2%) of 152 total patients. More patients in the psychiatric consult cohort were discharged with an antipsychotic as compared to those in the nonconsult cohort (53.3% vs 26.6%, P =  .02). Discussion Compared to previous studies, patients in this retrospective review were more likely to be discharged on an antipsychotic that was initiated during admission for management of delirium. Findings from this study also align with prior research demonstrating a positive association between antipsychotic discharge instructions and specialty consult recommendations.

scholarly journals Emergency or Delayed Surgical Treatment of Unstable Supracondylar Humeral Fractures in Children?

2017 ◽  
Vol 18 (2) ◽  
pp. 145-150
Author(s):  
Branko Stefanovic ◽  
Zoran Vukasinovic ◽  
Srbobran Stankovic ◽  
Jovana Jeremic ◽  
Nevena Jeremic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Options ◽  
Humeral Fractures ◽  
Type I ◽  
Supracondylar Fractures ◽  
Fractures In Children ◽  
Group I ◽  
Elbow Fractures ◽  
Retrospective Clinical Study ◽  
Supracondylar Humeral Fractures

AbstractSupracondylar humeral fractures (SCHF) are the most common elbow fractures in children, representing 3% of all paediatric fractures. Treatment options for SCHF in children are based on the Gartland classification. Treatment of non-displaced fractures (type I) is non-operative. Plaster immobilization for 3 to 4 weeks is recommended, depending on the age of the child and fracture healing. Treatments of displaced supracondylar fractures (type II and III) of the humerus in children are still undefined in clinical practice. Because of divided opinions, the aim of this study was to evaluate whether delayed or immediate surgical treatment has an advantage in the treatment of supracondylar fractures in children. This is a prospective – retrospective clinical study. This study included 64 patients from 5 to 15 years old; 47 (73.4%) were boys and 17 (26.6%) were girls. The most common age range (59.4%) in this study was 5-8 years old. All patients were diagnosed with supracondylar fractures at the Institute for Orthopaedic Surgery “Banjica”. We analysed 17 parameters, which were obtained either from direct patient interviews or from their medical history. All patients were divided into two groups with matched characteristics. Group I consisted of 26 patients who had immediate operations. Group II consisted of 38 patients who had delayed operations.Based on the results of the analysed parameters, consisting primarily of functional results, the absence of subjective symptoms and myositis ossificans one year after surgery suggests that emergency surgical treatment of displaced supracondylar humeral fractures is optimal.

The quantitative comparison of experimental and simulated diffraction contrast images

1995 ◽  
Vol 53 ◽  
pp. 102-103
Author(s):  
Stuart McKernan
Keyword(s):  
Image Processing ◽  
Personal Computer ◽  
Close Agreement ◽  
Quantitative Comparison ◽  
Image Simulation ◽  
Computing Power ◽  
Diffraction Contrast ◽  
Simulated Images ◽  
Made In

For many years the concept of quantitative diffraction contrast experiments might have consisted of the determination of dislocation Burgers vectors using a g.b = 0 criterion from several different 2-beam images. Since the advent of the personal computer revolution, the available computing power for performing image-processing and image-simulation calculations is enormous and ubiquitous. Several programs now exist to perform simulations of diffraction contrast images using various approximations. The most common approximations are the use of only 2-beams or a single systematic row to calculate the image contrast, or calculating the image using a column approximation. The increasing amount of literature showing comparisons of experimental and simulated images shows that it is possible to obtain very close agreement between the two images; although the choice of parameters used, and the assumptions made, in performing the calculation must be properly dealt with. The simulation of the images of defects in materials has, in many cases, therefore become a tractable problem.

Science of Ahangyol and Its Importance for Modern Scientific Thought

2019 ◽  
Vol 10 (5) ◽  
pp. 473-478
Author(s):  
Ahmad Gashamoglu ◽  
Keyword(s):  
Modern Science ◽  
Scientific Basis ◽  
New Paradigm ◽  
Islamic Philosophy ◽  
Scientific Thought ◽  
Religious Books ◽  
Strategic Approach ◽  
Scientific Potential ◽  
Made In

The Article briefly discusses the need for generation of the Science of Ahangyol, and this science’s scientific basis, object and subject, category system, scientific research methods and application options. Ahangyol is a universal science and may be useful in any sphere. It may assist in problem solving in peacemaking process and in many areas such as ecology, economics, politics, culture, management and etc. This science stipulates that any activity and any decision made in the life may only and solely be successful when they comply with harmony principles more, which are the principles of existence and activity of the world. A right strategic approach of the Eastern Philosophy and the Middle Age Islamic Philosophy and scientific thought has an important potential. This strategic approach creates opportunities to also consider irrational factors in addition to rational ones comprehensively in scientific researches. The modern scientific thought contributes to implementation of these opportunities. Ahangyol is a science of determination of ways to achieve harmony in any sphere and of creation of special methods to make progress in these ways through assistance of the modern science. Methods of the System Theory, Mathematics, IT, Astronomy, Physics, Biology, Sociology, Statistics and etc. are more extensively applied. Information is given on some of these methods. Moreover, the Science of Ahangyol, which is a new philosophical worldview and a new paradigm contributes to clarification of metaphysic views considerably and discovery of the scientific potential of religious books.

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