Injuries In Children Research Articles

Association between the guardians’ educational levels and unintentional injuries in children aged 6–18 in Shenzhen, China

BackgroundUnintentional injuries is the leading cause of death in children aged 6–18 in China. Previous studies on the association between the guardians’ educational levels and unintentional injuries in children have been inconclusive, and it remains unclear among the Chinese population. Therefore, this study aimed to identify the association between guardians’ educational levels and unintentional injuries in children aged 6–18 in Shenzhen, China.MethodsThis cross-sectional study enrolled 9,903 children aged 6–18 in Shenzhen in 2020 using a multistage cluster sampling method. Information on the children and guardians were collected, and unintentional injuries in the past year was examined by using two nested questions. Logistic regression analyses were used to test the association between the guardians’ educational levels and unintentional injuries in children aged 6–18, and the crude odds ratios (ORs) and adjusted ORs with 95% confidence intervals (95% CI) were calculated.Results275 of the 9,903 children reported experiencing at least one unintentional injuries in the past year, and the weighted incidence of unintentional injuries was 6.3% (95% CI: 5.8–6.8%) in children aged 6–18 in Shenzhen, China. The incidence of unintentional injuries differed significantly in the guardians’ education levels (P < 0.05). After adjustment for the children’s variables, multiple binary logistic regression analysis showed that compared to children whose guardians’ educational levels were low, children whose guardians’ educational levels were high (adjusted OR = 0.57, 95% CI: 0.37–0.87) and medium (adjusted OR = 0.56, 95% CI: 0.39–0.81) had a lower odds of unintentional injuries. Similar results were also observed when further adjustment for both the children’s and guardians’ variables.ConclusionThe overall incidence of unintentional injuries in children aged 6–18 in Shenzhen was low, and it was associated with the guardians’ educational levels. Children whose guardians’ educational levels were low should be given special concern to prevent unintentional injuries, and it is suggested to reduce the incidence of unintentional injuries in children by improving the guardians’ educational levels.

Diagnostic criteria for optimizing treatment tactics for children with traumatic splenic ruptures

BACKGROUND: Damage to the spleen is the leading cause of abdominal trauma in children. This often becomes the main indication for splenectomy. This article addresses concerns on the safety of conservative treatment of these injuries in children. Most studies have found that asplenization results in the complete loss of the immunological and hematological functions of the spleen. Thus, spleen-preserving surgeries are crucial to prevent post-splenectomy hyposplenism and associated life-threatening complications. AIM: This study aimed to develop a mathematical model using logistic regression to determine aggregate variables associated with the possibility of surgical treatment and identify safe shock index parameters for the conservative treatment of traumatic splenic ruptures in children. MATERIALS AND METHODS: This prospective study included 91 patients with traumatic splenic rupture: 80 (87.9%) children received conservative treatment and 11 (12.1%) underwent surgical treatment. The age of the children was 11 (8; 13) years; there were 3.3 times more boys (70 versus 21). To assess the need for surgical treatment, an analysis of categorical variables was conducted using a mathematical model using logistic regression. RESULTS: Increased shock index (β = −0.264 ± 0.083; t(86) = −3.191; p = 0.002) and the need for blood transfusion (β = 0.464 ± 0.089; t(86) = 5.218; p = 0.001) were cumulative factors associated with a high possibility of surgical treatment of splenic ruptures in children. With the combination of parameters of increased shock index and blood transfusion for surgical treatment, moderate sensitivity was determined at 85.7% (95% CI: 52.1–99.6; p = 0.001) and a positive predictive value at 75% (95% CI: 34.9–96.8). In the absence of these factors, the probability of conservative treatment of children with splenic ruptures reached 100% (specificity: 97.5%; 95% CI: 91.1–99.7; p = 0.001). When summarizing the identified parameters, the area under the curve was 0.941 ± 0.026 (95% CI: 0.872–0.980), and the assessment of the model’s suitability showed a positive test (χ2 = 32.7; p = 0.264). In nonoperative treatment, the frequency of identified cumulative factors was 2.5% (n = 2). Safe shock index parameters for successful conservative treatment of splenic ruptures in children have been determined: SIPA 1.1 (age up to 6 years), 0.85 (7–12 years), and 0.83 (over 13 years). CONCLUSIONS: An increased shock index and the need for blood transfusion are combined factors that determine the high probability of surgical treatment for traumatic ruptures of the spleen in children. In nonoperative treatment, the frequency of identified cumulative factors was 2.5%, which indicates a strong argument for justifying the safety of conservative therapy.

Preclinical Detection of Early Glomerular Injury in Children with Kidney Diseases-Independently of Usual Markers of Kidney Impairment and Inflammation.

Glomerular kidney diseases typically begin insidiously and can progress to end stage kidney failure. Early onset of therapy can slow down disease progression. Early diagnosis is required to ensure such timely therapy. The goal of our study was to evaluate protein biomarkers (BMs) for common nephropathies that have been described for children with Alport syndrome. Nineteen candidate BMs were determined by commercial ELISA in children with congenital anomalies of the kidneys and urogenital tract, inflammatory kidney injury, or diabetes mellitus. It is particularly essential to search for kidney disease BMs in children because they are a crucial target group that likely exhibits early disease stages and in which misleading diseases unrelated to the kidney are rare. Only minor differences in blood between affected individuals and controls were found. However, in urine, several biomarker candidates alone or in combination seemed to be promising indicators of renal injury in early disease stages. The BMs of highest sensitivity and specificity were collagen type XIII, hyaluronan-binding protein 2, and complement C4-binding protein. These proteins are unrelated to inflammation markers or to risk factors for and signs of renal failure. In conclusion, our study evaluated several strong candidates for screening for early stages of kidney diseases and can help to establish early nephroprotective regimens.

Transphyseal arthroscopic anterior cruciate ligament reconstruction in children under 12 years.

The incidence of anterior cruciate ligament (ACL) injuries in children is on the rise. Despite this trend, the optimal management of these injuries remains a matter of ongoing debate. In this light, our study seeks to assess the clinical, radiological, and functional outcomes of transphyseal ACL reconstruction in preadolescent patients in the medium-term. This prospective study included preadolescent patients aged up to 12 years who underwent ACL transphyseal reconstruction between 2010 and 2020 and had a minimum follow-up of 2 years. Clinical assessments encompassed joint stability and range of motion. Furthermore, leg length discrepancy (LLD) and femorotibial alignment were evaluated both clinically and radiologically using full-length lower limb standing radiographs. Pre- and postoperative functional outcomes were assessed using the International Knee Documentation Committee (IKDC) and Lysholm scales, and the return to normal sports activity was evaluated using the ACL-Return to Sport after Injury (ACL-RSI) scale. Complications and relevant follow-up data were also recorded. Statistical analyses were conducted to evaluate these outcomes. A total of 35 preadolescent patients, consisting of 24 males and 11 females, with a mean age at surgery of 11.2 ± 0.7 years (8.7-12), were included in the study. The mean follow-up was 52.3 ± 20.7 months (24.1-95.9). No significant growth disturbances or clinically relevant LLD were evidenced. All patients demonstrated clinically stable knees with full range of motion at the 2-year follow-up. There were statistically significant improvements in pre- and postoperative IKDC (39.3 ± 13.5 vs. 99.7 ± 0.8, p < 0.005) and Lysholm scores (48.2 ± 15.1 vs. 99.6 ± 1.4, p < 0.005). All but two patients were able to return to their pre-injury level of sports activity, with a mean ACL-RSI score of 93.5 ± 1.3. The analysis revealed an 8.6% rerupture rate and an11.4% rate of contralateral ACL injuries, with 5-year survival rates of 92.3% and 88.8%, respectively. Subgroup analyses based on age, gender, surgical delay, or associated meniscal lesions did not reveal any significant differences in functional outcomes. Additionally, there was no discernible relationship between age or timing of ACL reconstruction and the risk of meniscal injuries. Our study reinforces the value of ACL reconstruction in skeletally immature preadolescent patients, with transphyseal technique proven to be a safe, effective, and technically simpler option, even for children under the age of 12. The findings indicate excellent functional outcomes, a high rate of successful return to sporting activities, and minimal to no incidence of growth-related complications in the medium-term. Level II, prospective comparative cohort study, before and after intervention.

Development of an Internet-based Product-related Child Injury Textual Data Platform (IPCITDP) in China.

Internet-based media stories provide valuable information for emerging risks of product-related child injury prevention and control, but critical methodological challenges and high costs of data acquisition and processing restrict practical use by stakeholders. We constructed a data platform through literature reviews and multi-round research group discussions. Developed components included standard search strategies, filtering criteria, textual document classification, information extraction standards and a keyword dictionary. We used ten thousand manually labelled media stories to validate the textual document classification model, which was established using the Bidirectional Encoder Representation from Transformers (BERT). Multiple information extraction methods based on natural language processing algorithms were adopted to extract data for 29 structured variables from media stories. They were evaluated through manual validation of 1000 media stories about product-related child injury. We mapped the geographic distribution of media sources and media-reported product-related child injury events. We developed an internet-based product-related child injury textual data platform, IPCITDP, consisting of four layers - automatic data search and acquisition, data processing, data storage, and data application - concerning product-related child injury online media stories in China. Each layer occurred daily. External validation demonstrated high performance for the BERT classification model we established (accuracy = 0.9703) and the combined information extraction strategies (accuracy >0.70 for 25 variables). As of 31 December 2023, IPCITDP collected 35 275 eligible product-related child injury reports from 13 261 news media websites or social media platform accounts which were geographically located across all 31 mainland Chinese provinces and covered over 97% of prefecture-level cities. The injury cases in IPCITDP were typically reported several months or years earlier than official announcements about the product-related child injury risks. Our data platform added data concerning 15 supplementary variables that the national product-related injury surveillance system lacks. Two examples demonstrate the value of IPCITDP in supplementing existing data and providing early epidemiological detection of emerging signals concerning product-related child injury: magnetic beads and electric self-balancing scooters. Our data platform provides injury data that can support early detection of new product-related child injury characteristics and supplement existing data sources to reduce the burden of product-related injury among Chinese children.

Prevalence, Characteristics, and Management of Pediatric Ocular Trauma in Riyadh, Saudi Arabia: A Retrospective Analysis.

Ocular trauma is a major cause of visual impairment; however, little is known about its burden in Saudi Arabia. Therefore, this study aimed to determine the epidemiological characteristics of ocular trauma in pediatric patients in Riyadh, Saudi Arabia. Medical records of pediatric patients diagnosed with eye injuries between January 2016 and December 2020 were retrospectively reviewed. Demographic and injury characteristics were collected, and ocular trauma injuries were classified according to the Birmingham Eye Trauma Terminology. A total of 855 injured patients were included in the study, of whom 525 (61.4%) were boys. Patient age ranged from one month to 18 years. Most ocular injuries occurred in children aged 5-9 years. The injuries were more prevalent in boys than in girls. Closed globe injuries accounted for 70% of cases, open globe injuries for 21%, and other injuries for 9%. Most ocular injuries occurred at home (n = 87, 42%), followed by school (n = 61, 30%). These results may inform the implementation and targeting of interventions to reduce or prevent eye injuries in children. Further, they highlight the importance of well-planned prevention programs to prevent eye injuries from occurring in children's daily lives.

Analysis of the occurrence and liver function characteristics of arsenic-associated liver injury during the treatment of pediatric patients with acute promyelocytic leukemia.

Liver injury during arsenic treatment for acute promyelocytic leukemia was previously reported in adults, but not comprehensively in children until now. This study aims to investigate liver injury in pediatric patients with APL, changes in liver function during treatment, and compare the effects of Arsenic trioxide (ATO) and Realgar-Indigo naturalis formula (RIF) on liver function. One hundred and eighty-six patients with 3076 patient tests were analyzed, who were enrolled in the Chinese Children's Leukemia Group (CCLG)-APL2016 Protocol database between November 2016 and November 2018 in 38 hospitals across China(ChiCTR-OIN-17011227). Twenty of 164 patients (12.2%) suffered from liver injury after treatment with arsenic. In addition, sixteen (80%) cases of liver injury occurred during the induction period of treatment. What's not disheartening was that 18 (90%) cases of liver injury were transient, occurring at a median time of 17 days after exposure to arsenic. More importantly, the risk of liver injury associated with RIF was not higher than that associated with ATO (RR = 0.854, 95% CI: 0.292-2.495). Otherwise, the ALP of 18 cases of liver injury was not higher than the ULN of ALP. Thus, the incidence of liver injury associated with arsenic in pediatric patients with APL was similar to that in adult patients and the risk of liver injury associated with RIF was not higher than that associated with ATO. Since ALP was not higher in pediatric APL patients with liver injury, further research is needed to explore whether ALP is an index of liver injury in children.

Characteristics and outcomes of children ≤ 10 kg receiving continuous kidney replacement therapy: a WE-ROCK study.

Continuous kidney replacement therapy (CKRT) is often used for acute kidney injury (AKI) or fluid overload (FO) in children ≤ 10kg. Intensive care unit (ICU) mortality in children ≤ 10kg reported by the prospective pediatric CRRT (ppCRRT, 2001-2003) registry was 57%. We aimed to evaluate characteristics associated with ICU mortality using a contemporary registry. The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry is a retrospective, multinational, observational study of children and young adults aged 0-25years receiving CKRT (2015-2021) for AKI or FO. This analysis included patients ≤ 10kg at hospital admission. ICU mortality and major adverse kidney events at 90days (MAKE-90) defined as death, persistent kidney dysfunction, or dialysis within 90days, respectively. A total of 210 patients were included (median age 0.53years (IQR, 0.1, 0.9)). ICU mortality was 46.5%. MAKE-90 occurred in 150/207 (72%). CKRT was initiated at a median 3days (IQR 1, 9) after ICU admission and lasted a median 6days (IQR 3, 16). On multivariable analysis, pediatric logistic organ dysfunction score (PELOD-2) at CKRT initiation was associated with increased odds of ICU mortality (aOR 2.64, 95% CI 1.68-4.16), and increased odds of MAKE-90 (aOR 2.2, 95% CI 1.31-3.69). Absence of comorbidity was associated with lower MAKE-90 (aOR 0.29, 95%CI 0.13-0.65). We report on a contemporary cohort of children ≤ 10kg treated with CKRT for acute kidney injury and/or fluid overload. ICU mortality is decreased compared to ppCRRT. The extended risk of death and morbidity at 90days highlights the importance of close follow-up.

A Single-center Clinical Analysis of Drug-Induced Liver Injury in Children with Acute Leukemia

A Single-center Clinical Analysis of Drug-Induced Liver Injury in Children with Acute Leukemia

Acute Kidney Injury in Children: A Focus for the General Pediatrician.

Acute kidney injury (AKI) presents significant challenges in pediatric care, often remaining underrecognized. This paper provides an overview of pediatric AKI, highlighting its epidemiology, pathophysiology, diagnosis, predisposing conditions, and treatment. AKI in children stems from diverse causes, including renal tubular damage, vasoconstriction, and inflammation. Diagnosis relies on traditional markers such as serum creatinine and urine output, alongside emerging biomarkers such as Cystatin C, NGAL, KIM-1, IL-18, TIMP-2 and IGFBP7, urinary calprotectin, URBP4, L-FABP, and clusterin. Various pediatric conditions predispose to AKI, including type 1 diabetes, pneumonia, bronchiolitis, appendicitis, gastroenteritis, COVID-19, multisystem inflammatory syndrome, sickle cell disease, and malignancies. Treatment entails supportive care with fluid management and, in severe cases, renal replacement therapy. Timely recognition and management are essential to mitigating adverse outcomes. Enhanced awareness and integration of novel biomarkers could improve pediatric AKI care, warranting further research for better diagnosis and management.

Injury mortality in South Africa: a 2009 and 2017 comparison to track progress to meeting sustainable development goal targets

ABSTRACT Background Injuries, often preventable, prompted urgent action within the United Nations’ 2030 Agenda for Sustainable Development Goals (SDGs) to improve global health. South Africa (SA) has high rates of injury mortality, but accurate reporting of official national data is hindered by death misclassification. Objective Two nationally representative surveys for 2009 and 2017 are utilised to assess SA’s progress towards SDG targets for violence and road traffic injuries, alongside changes in suicide and under-5 mortality rates for childhood injuries, and compare these estimates with those of the Global Burden of Disease for SA. Methods The surveys utilised multi-stage, stratified cluster sampling from eight provinces, with mortuaries as primary sampling units. Post-mortem files for non-natural deaths were reviewed, with additional data from the Western Cape. Age-standardised rates, 95% confidence intervals (CIs), and incidence rate ratios (IRRs) were calculated for manner of death rate comparisons and for age groups. Results The all-injury age-standardised mortality rate decreased significantly between 2009 and 2017. Homicide and transport remained the leading causes of injury deaths, with a significant 31% decrease in road traffic mortality (IRR = 0.69), from 36.1 to 25.0 per 100 000 population. Conclusions Despite a reduction in SA’s road traffic mortality rate, challenges to achieve targets related to young and novice drivers and male homicide persist. Achieving SA’s injury mortality SDG targets requires comprehensive evaluations of programmes addressing road safety, violence reduction, and mental well-being. In the absence of reliable routine data, survey data allow to accurately assess the country’s SDG progress through commitment to evidence-based policymaking.

A longitudinal study of parents’ home-safety practices to prevent injuries during infancy

Unintentional injury represents a significant health threat to children, and infancy marks a particularly vulnerable stage. This multi-method study (questionnaire, diary) measured parents’ (N = 143) use of three popular home-safety practices (teaching about safety, environment modification to reduce access to hazards, supervision) and child injury rates at two stages of motor development during infancy (sitting, walking). Associations between these three safety practices and parental beliefs (protectiveness needed, perceived benefits of the child experiencing minor injuries) were examined, as was the effectiveness of these three practices to prevent injury. Results revealed that different parental beliefs were associated with implementing different safety strategies at each motor development stage. Strategies were differentially effective depending on mobility status of the infant, with supervision being the only strategy that was effective to prevent injury at both motor development stages. Implications for developing safety messages to promote parents’ injury-prevention strategies are discussed.

Modern technologies for medical rehabilitation of children with knee joint injuries

Pathology of the knee joint in children is a pressing problem in pediatric traumatology, orthopedics and pediatrics. The frequency of injuries to the knee joint is determined by the complexity of its structure, biomechanical features with a high probability of overload. At the same time, intra-articular injuries in children and adolescents, accounting for up to 7 % in the structure of inpatient pathology, are the cause of pronounced functional disorders of the lower limb and the risk of developing post-traumatic osteoarthritis Currently, physical factors are widely used at various stages of medical rehabilitation of children with damage to the capsular-ligamentous apparatus of the knee joint. The conducted studies have established the effectiveness of using local air cryotherapy in the early postoperative period, characterized by a pronounced anti-edematous, analgesic effect. Early regression of pain and elimination of microcirculatory disorders in the area of injury as a result of a course of pulsed low-frequency magnetic therapy at various stages of medical rehabilitation of children with damage to the capsular-ligamentous apparatus of the knee joint have been recorded. The beneficial effect of a pulsed low-frequency electrostatic field on indicators of orthopedic status, and thermography indicators in the area of injury in children with knee joint injuries has been established. Data were obtained on more pronounced regression of pain, earlier restoration of range of motion in the damaged joint and relief of signs of post-traumatic synovitis with the complex use of a pulsed low-frequency electrostatic field and robotic mechanotherapy in children with damage to the capsular ligamentous apparatus of the knee joint. The obtained clinical and functional results are of great importance for injuries of the knee joint with the risk of contractures in the postoperative period.

Nomogram for intraoperatively acquired pressure injuries in children undergoing cardiac surgery with cardiopulmonary bypass: a retrospective study

BackgroundWe aimed to develop and validate a nomogram for predicting the risk of intraoperatively acquired pressure injuries (IAPIs) in children undergoing cardiac surgery with cardiopulmonary bypass (CPB).MethodsThis study retrospectively included 208 children aged 21 days to 8 years who underwent cardiac surgery with CPB in a tertiary hospital in China between January 2020 and October 2023. All patients’ data were collected from the hospital’s medical record system and randomly divided into the training (n = 146) and validation (n = 62) cohorts by a ratio of 7:3. Logistic regression analysis was conducted in the training cohort to identify independent risk factors and establish the nomogram. Finally, calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA) were performed in both cohorts to validate the predictive ability of the nomogram.Results43 (14.7%) children developed IAPIs. Multivariate analysis showed that low Braden Q scores, use of steroids, skin abnormalities, and low intraoperative SpO2 were independent risk factors for IAPIs. A nomogram integrating the 4 factors was established. The areas under the curve (AUCs) of the nomogram were 0.836 and 0.903 in the training and validation cohorts, respectively. Furthermore, calibration curves and DCA demonstrated good calibration and clinical applicability of the nomogram.ConclusionWe constructed a reliable nomogram based on specific risk factors for children undergoing cardiac surgery with CPB, which could be used as an effective and convenient tool for prevention of IAPIs.

Pediatric Toy-Related Ocular Injuries in the United States: A National Electronic Injury Surveillance System Study

ABSTRACT Purpose The purpose of this study is to evaluate the epidemiological trends, primary ocular diagnosis, and degree of injury severity in pediatric patients after a toy-related ocular trauma. Methods A cross-sectional analysis was conducted using data from the National Electronic Injury Surveillance System Study (NEISS), encompassing patients who visited emergency departments over a 5-year period from January 1, 2017, to December 31, 2021, with toy-related ocular injuries. Descriptive statistics were employed using Microsoft Excel. Results Among the 1439 toy-related ocular injuries identified, the mean age of injury was 6.67 ± 4.36 years. The highest proportion of injuries occurred in the 2–5 years age group (27.2%). The NEISS database classified the severity of injury – the majority of which were minor anterior segment injuries. Toy guns with projectiles were identified as the most common type of toy associated with ocular eye injury. While most injuries were minor, a small percentage was severe. Conclusion Age-appropriate toy selection and adult supervision during playtime are recommended preventive measures to mitigate the incidence and severity of traumatic eye injuries in children.

Retrospective Analysis of Dog Bite Injuries in Children with Autism Spectrum Disorder.

Children with autism spectrum disorder (ASD) may suffer a dog bite injury, but the frequency and its clinical impact is unknown. We sought to evaluate the (1) subject characteristics; (2) injury type; (3) clinical care provided; and (4) mortality in children with ASD who suffer a dog bite injury. We hypothesized that children with ASD have higher mortality and require more clinical care than children without ASD. This is a retrospective observational cohort study utilizing the TriNetX ® EHR database of subjects aged 0 to 18 years with dog bite diagnostic codes. Data were analyzed for demographics, diagnostic, medication, procedural codes, and mortality. We analyzed 38,337 subjects (n, %) coded for a dog bite injury [619 (1.6%) with ASD and 37718 (98.4%) without ASD]. Children with ASD had a higher odds of a traumatic injury to the head [1.34 (1.15, 1.57), p < 0.0001] compared to those without. There was no difference in critical care services, hospitalization, mechanical ventilation, and rabies vaccine administration. All-cause mortality at 1 year was low with no deaths reported within the ASD cohort and 37 (0.1%) deaths reported within the no ASD cohort. Children with ASD that suffer dog bite injuries have similar clinical needs to children without ASD but are more likely to suffer a traumatic injury to the head. Future studies are needed to better understand inciting factors for injuries in this population.

Posterior Reversible Encephalopathy Syndrome in a child after Severe Traumatic Brain Injury

Pediatric brain is anatomically and physiologically different from adult brain. Child's brain is more vulnerable to the effects of a brain injury and takes longer to recover. Because the child’s brain is still developing, injury may alter the course of development of the brain and its functions. The child's brain is less "set" than the adult's, its plasticity offers hope to damaged tissue and areas. It is very rare to have posterior reversible encephalopathy syndrome as a complication of traumatic brain injury in children.

Factors associated with under- fives unintentional injuries in Kgalagadi South, Botswana

The study determined the prevalence and factors associated with unintentional injuries among under- fives in Kgalagadi South. A descriptive cross- sectional study was conducted between November 2020 and February 2021 using a multi- stage sampling technique to recruit 389 guardians with children aged five years and below. Self-administered questionnaires were used for the literate population, while interviewer-administered questionnaires were used for the population with limited literacy to elicit information from the guardians. Chi- square, univariate and multivariate logistic regression were used for inferential analysis. The prevalence of unintentional injuries was 48.8%. There was a significant association between injury occurrence and guardians’ employment status, alcohol consumption and non- medicinal drug use by the guardian, cigarette use by the guardian, household income level, gender and age of the child who got injured. The guardians age and cigarette use by the guardian were identified as independent risk factors for injury occurrence among under- five children. The findings highlight the need for policymakers and practitioners to develop policies that support comprehensive health education for caregivers on childhood injury prevention and creating a safe environment for children.

Association of pediatric firearm injury with neighborhood social deprivation in Philadelphia

BackgroundFirearm-related injury is the leading cause of death among children and adolescents. There is a need to clarify the association of neighborhood environment with gun violence affecting children. We evaluated...

Injuries of the knee extensor complex in children

Fractures of the knee extensor complex are relatively rare injuries in children. We distinguish between apure tendon rupture and ruptures with bony avulsions. A mid-substance tear in children is arelatively rare injury, whereas bony avulsions due to skeletal immaturity are seen more often. Sole bony fractures of the patella also only account for alow number of paediatric related fractures. Sleeve fractures are characterized by an avulsion of cartilage and, usually, bone pulled off from the distal patella pole. Avulsion fractures of the tibia tubercle are found in the group of sportive adolescents. Especially dislocated fractures should be conveyed to surgical therapy to avoid excessive bone callus. Timely diagnostics and an efficient and consistent treatment are recommended. Deformities and dislocated avulsions will regularly not remodel spontaneously during further growth. Therefore, it is mandatory to reconstruct the articular surface and the knee extensor complex to avoid future complications such as osteoarthritis or elongation of the knee extensors.