Implant removal associated complications after ESIN osteosynthesis in pediatric fractures

Purpose ESIN (elastic stable intramedullary nailing) is considered the gold standard for various pediatric fractures. The aim of this study was to analyze the incidence and type of complications during or after TEN (titanium elastic nail) removal. Methods A retrospective data analysis was performed. Metal removal associated complications and preoperative extraosseous length/outlet angle of TENs as possible causes of complications were assessed. Results The complication rate in 384 TEN removals was 3.1% (n = 12). One major complication (rupture of M. extensor pollicis brevis) was documented. One refracture at the forearm occurred, however, remodeling prior TEN removal was completed. Ten minor complications were temporary or without irreversible restrictions (3 infections, 5 scaring/granuloma, 2 temporary paraesthesia). In 38 cases (16 forearms, 10 femora, 9 humeri, 3 lower legs), intra-operative fluoroscopy had to be used to locate the implants. In patients with forearm fractures, extraosseous implant length was relatively shorter than in cases without fluoroscopy (p = 0.01), but outlet angle of TENs was not significantly different in these two groups (28.5° vs 25.6°). In patients with femur fractures, extraosseous implant length and outlet angle were tendentially shorter, respectively, lower, but this did not reach statistical significance. Conclusion Removal of TENs after ESIN is a safe procedure with a low complication rate. Technically inaccurate TEN implantation makes removal more difficult and complicated. To prevent an untimely removal and patient discomfort, nail ends must be exactly positioned and cut. Intraoperative complications may be minimized with removal of TENs before signs of overgrowth. Evidence Level III, retrospective.

The Epidemiology and Management of 10,486 Children With Fractures in Shenzhen: Experience and Lessons to be Learnt

Purpose: To explore and analyze the causes and related influencing factors of pediatric fractures, and provide theoretical basis for reducing the incidence and adverse effects of pediatric fractures.Methods: This study retrospectively analyzed the epidemiological characteristics of fractures in children aged ≤18 years old who were admitted to the our hospital between July 2015 and February 2020.Results: A total of 10486 pediatric patients were included in the study, of whom 6,961 (66.38%) were boys, and 3,525 (33.62%) were girls. For the fracture incidence, age group of the 3-6 years reached the peak. 5,584 (60.76%) children were operated upon within 12 h after admission. The top three types of fractures were the distal humerus (3,843 sites, 27.49%), distal ulna (1,740 sites, 12.44%), and distal radius (1,587 sites, 11.35%). The top three causes of injury were falls (7,106 cases, 82.10%), car accidents (650 cases, 65.72%), and pinch injuries (465 cases, 5.37%). Fractures predominantly occurred between July and November (4,664 cases, 48.87%) and on Saturdays and Sundays (3,172 cases, 33.24%). The highest number of hospital visits occurred between 20:00 and 00:00 (4,339 cases, 45.46%).Conclusion: We should strengthen preschool children health and safety education and increase protective measures. It is necessary to allocate medical resources in a targeted manner, to establish a closed-loop regional pediatric trauma treatment system centered on trauma centers that links together regional trauma centers, and to establish substantively operating comprehensive pediatric trauma treatment teams that follow a multidisciplinary treatment model.

The effects of home confinement on pediatric fractures during the COVID 19 outbreak

Objective To control the transmission of coronavirus disease 2019 (COVID-19), the Chinese government encouraged people to stay at home. This study aimed to evaluate the effects of home confinement on the occurrence of fractures among children. Study design We retrospectively reviewed children admitted to Children’s Hospital of Chongqing Medical University, for traumatic injury from January 24 to March 10, 2020, and the same time period in 2017, 2018 and 2019. At the same time, children with fracture were screened out and the date for the past 4 years was compared in terms of etiology, location of fracture, sex and age to evaluate the effects of home confinement on the epidemiology of pediatric fractures during the COVID-19 outbreak. Results There were 6066 fractures in5,346 patients in 2017–2019, and 1034 fractures in 862 patients in 2020; the number of patients in all years reached a peak at the age of 2 to 4 years. The patients were slightly younger in 2020 than in 2017–2019 (t = 9.953, 95% CI: 0.846–1.262), and the proportion of boys in 2017–2019 is higher than in 2020 (X2 = 6.944, P = 0.008). Home confinement and traffic restriction resulted in a reduction in traffic accidents-associated fractures among children (X2 = 16.399, P < 0.001). Conclusion Home confinement lead to the significant reduction in the number of pediatric fractures, especially in male children, but the number of patients under 4 years old was still considerable, and the proportion of younger patients even increased. Therefore, the perspective of children should not be relaxed during home isolation.

EPIDEMIOLOGY AND MANAGEMENT OF PEDIATRIC FRACTURES DURING THE COVID-19 PANDEMIC

INTRODUCTION In Spain, the state of alarm, decreed by the COVID-19 pandemic, forced a home confinement that included the suspension of school activity. Our purpose is to examine how it affected the epidemiology of pediatric fractures in a tertiary hospital. MATERIAL AND METHODS Retrospective cohort study comparing the epidemiology and management of pediatric fractures in our centre during the COVID-19 pandemic in relation to the previous year. The "pandemic" cohort includes patients seen during this state of alarm (03/14/2020 to 06/21/20); and the "pre-pandemic" cohort the same period of 2019. RESULTS Between both periods, 233 pediatric patients were treated for 258 fractures. There were no significant changes in their age or sex. The incidence of fractures was decreased by 66%. Despite this decrease, the percentage of fractures that required surgical intervention doubled. The time until the evaluation in the emergency room was also modified, with a higher proportion of patients seen more than 24 hours after the trauma. Regarding the anatomical locations, a reduction in bicortical fractures stands out, in contrast to greenstick fractures and epiphysiolysis. CONCLUSIONS The COVID-19 pandemic has changed the epidemiology of pediatric fractures. There was a reduction in the incidence of fractures and a delay in hospital care, probably due to fear of going to the hospital due to the risk of contagion. Home confinement may justify the lower proportion of high-energy distal radius fractures, such as bicortical fractures.