Greenstick Research Articles

Appraisement of genetic variability and character association of kenaf (Hibiscus cannabinus)

Twenty five genotypes of Kenaf (Hibiscus cannabinus L.) from different geographic origins were grown at the Central Jute Agricultural Experiment station of Bangladesh Jute Research Institute (BJRI), Jagir, Manikganj to study their variability, correlation for nine morphological characters. Significant variation was found for all the characters among the genotypes. PCV was greater than GCV and high GCV values were observed for green weight with leaves, green weight without leaves, stick weight and fibre weight. The high heritability (more than 85%) coupled with high genetic advance in percent of mean were observed for most of the traits. All the characters except green bark thickness and internode length showed significant and positive correlation with fibre weight. Path co-efficient analysis revealed that green weight with leaves, green weight without leaves, green bark thickness and stick weight showed positive direct effect on fibre yield. Considering these agronomic performance genotypes G22 and G25 are suggested for future hybridization program. SAARC J. Agric., 20(2): 31-42 (2022)

Varietal performance of jute based on yield and yield contributing characters under the Terai region of Province -1 Nepal

A research experiment was conducted to know the varietal performance of some jute varieties at the farm of Jute Research Programme, Itahari, Sunsari, Nepal, during the jute growing period in 2019 and 2020. A total of fifteen tossa jute varieties viz. CO-58, JRCM-2, JRO-524, JRO-2407, SM-100, JRO-204, NJ-7010, Mahabij, JBO-2003H, JRO-7835, YA-41, Itahari-2, OM-1, JRO-632 and KEN-DS-058 were used as experimental crops. The experiment was laid out in Randomize Complete Block Design (RCBD) with three replications, and each replicate had 12 lines with an inter and Intra row spacing of 25 cm and 5 to 7cm, respectively. Varietal performances of jute showed statistically significant variation for all the traits. Among the tested varieties, the jute variety NJ-7010 showed the tallest plant height (366 cm), highest basal diameter (20.6 mm), bark thickness (1.7 mm), leaf width (4.8 cm), petiole length (4.7cm), lowest disease incidence (2.5 %) respectively. However, the variety JRCM-2 and JRO-524 showed the highest leaf length (15.1 cm), while the variety JRO-524 showed the lowest pest incidence (4.2 %). Furthermore, the jute variety NJ-7010 also showed greater results on various yield characters viz. green leaf weight (17.3 ton/ha), green plant weight (100.3 ton/ha), green fibre weight (44.7 ton/ha), green stick weight (57 ton/ha), dry fibre weight (7.2 ton/ha), dry stick weight (17.3 ton/ha). Thus, the jute variety NJ-7010 understood superiority in growth, yield, and yield-attributing traits. Therefore, the jute variety NJ-7010 could be a more successful, productive variety than other tested varieties in the terai region of Province-1 Nepal.

Prevalence of paediatric maxillo-facial trauma in India: a single centre, 5-year retrospective study

Background: Trauma is one of the most common reasons of fatalities worldwide. A study on the prevalence is important to know about the common causes of trauma. Such studies and data boost the campaigning on prevention and increasing awareness against trauma.Methods: Traumatised patients who reported to the emergency or casualty department of Mahatma Gandhi hospital, Sitapura, Jaipur or out-patient department of department of oral and maxillofacial surgery of Mahatma Gandhi Dental college and hospital, Sitapura, Jaipur between January 2017 and December 2021 were selected for this study. The hospital records of patients were retrospectively analysed for age, gender, etiology of trauma, distribution of fracture in facial structure and among maxilla and mandible, treatment procedures patients underwent in different age groups.Results: 371 traumatic patients were analysed for paediatric maxillofacial trauma. The commonly affected age group were found to be 13-16 years, with road traffic accidents being the most common etiology leading to mandible green stick fracture with dentoalveolar and Lefort II fracture in majority of cases. The frequent treatment option was found to be either conservative management, circummandibular wiring, splinting or Open Reduction and Internal Fixation according to age groups.Conclusions: The facial injury pattern is influenced by growth and age of patient. The effect and the management of trauma depend on the age of child. Road traffic accident are the most common cause of trauma and mandible bone is the most frequently fractured bone with dentoalveolar fracture during facial injuries. A clear male predilection has also been observed.

Greenstick Fractures of the mid- Radial and Ulnar Diaphysis with Volar Angulation.

The authors present the case of a patient who was brought to the emergency department (ED) with severe left forearm pain following a classroom fall. This incident exacerbated the fractures that the patient experienced three months earlier in an accident. He had partial fractures of the middle radial and ulnar diaphyses. A review of the various presentations of forearm fractures and the nonoperative and surgical treatment options are discussed.

Greenstick fractures of the proximal metaphyseal tibia: a retrospective multicenter study on the outcome after non-surgical or surgical treatment and the occurrence of posttraumatic tibia valga

PurposeThis study investigates the occurrence of (progressive) posttraumatic valgus deformity after proximal metaphyseal greenstick fractures of the tibia in young children, and whether non-surgical or surgical treatment influences the outcome.MethodsA retrospective multi-center study was conducted including surveys and X-rays of patients < 12 years of age with a fracture of the proximal tibia. In patients with greenstick fractures, the medial proximal tibia angle (MPTA; defined as the angle of the tibial axis and the joint-line of the knee) was measured at trauma, short-term follow-up (st-FU), and long-term FU (lt-FU) as defined for the 2 groups of non-surgically and surgically treated patients.ResultsOf a total of 322 fractures, 91 were greenstick fractures. Of these, 74 were treated non-surgically and 17 were treated surgically. The mean MPTA at trauma of non-surgically treated patients was 91.14°, and of surgically treated patients was 95.59° (p = 0.020). The MPTA in non-surgically treated patients significantly increased from the timepoint of trauma to st-FU (92,0°; p = 0.030), and lt-FU (92,66°, p = 0.016). In surgically treated patients, the MTPA improved after trauma to st-FU (94.00°; p = 0.290), and increased again to lt-FU (96.41°; p = 0.618).ConclusionProgressive valgus deformity after greenstick fractures of the proximal tibia occurred in both non-surgically and surgically treated patients. In non-surgically treated patients, this was of statistical, but not clinical significance. In surgically treated patients, progressive valgus was observed after metal removal for an unknown reason. Therefore, surgery for proximal greenstick fractures of the tibia in this age group has only limited effect and may be indicated only in selected cases. Further studies are needed to explain the responsible mechanisms.Level of evidenceIII, retrospective analysis.

Trauma management protocol in maxillofacial medicine

The most common cause of jaws fractures remains fifths, accidents, falls and sports,according to recent studies. They occur chiefly in males between 15 and 35 years of age and twice as frequently in the mandible as in the maxilla. Fractures may be direct, following a blow at the point where the break occurs, or may be indirect as a result of a blow on the bone at some distance from where the lesion occurs. They may be single, linear or comminuted, that is fragmented into two or more small pieces, and are said to be compound when they communicate with a wound in the skin or mucous membrane of the mouth, nose or air sinuses. Where there is a tooth in the line of the fracture the latter is almost certainly compound into the mouth through the periodontal membrane. In the young, incomplete or greenstick fractures of the mandible can occur. Diseases of the bone predispose to spontaneous pathological fractures, and traumatized patients need to be fully assessed, proper diagnosed and treated.

Fractures of limbs specific to children: the experience of a Senegalese tertiary hospital

IntroductionFractures specific to the pediatric age group represent a particular injury due to their pattern, diagnosis, management, and outcomes. In sub-Saharan Africa, studies on this particular injury are scarce. This study reports sociodemographic, diagnostic, and therapeutic aspects and outcomes of these fractures.MethodsWe conducted a descriptive cross sectional study at the pediatric surgery department of Aristide Le Dantec University Teaching Hospital in Dakar, Senegal, from January 2012 to December 2015.ResultsA fracture specific to children was diagnosed in 180, of whom 47.7% were school-aged, with 59.4% of males. The mean time from injury to the attendance of our department was 48.2 h. Domestic accidents occurred in 51.1%. A total of 243 fractures occurred, mainly on the upper limbs (75.3%), as the most affected bones were the radius (47.3%), ulna (22.6%), and tibia (13.6%). Greenstick fractures represented 46.9%, buckle fractures, 42.8%, plastic deformations 9%, and subperiosteal fractures 0.7%. In all patients, management was orthopedic, with associated analgesic treatment. No sequel nor other complication was registered.ConclusionFractures proper to the child are a particular entity in children’s trauma, frequently happening in boys, with greenstick and buckle fractures being the most common. Their treatment is exclusively orthopedic, with excellent outcomes.

Evaluation of the effect of different complete denture impression techniques on dental anxiety levels

Background: There are several different impression materials and techniques utilized in the fabrication of complete dentures.&#x0D; Aim of the study: To determine the anxiety levels and the clinical procedure time for maxillary completely edentulous patients by the use of two different impression techniques; the use of a low-fusing green stick compound along with zinc oxide eugenol impression paste and addition silicone (polyvinyl siloxane) along with light body material.&#x0D; Materials and Methods: Twelve maxillary edentulous subjects aged between 44 and 68 were randomly recruited for the study. After having the primary impression two special trays were fabricated for each patient; the first tray for the sectional border moulding group using impression compound along with ZOE final impression material (Group Z), and the second tray for the single-step border moulding technique using additional polyvinyl siloxane impression along with light body final impression materials (Group P). Comparisons between the two groups' procedure time and patients' visual analog scale (VAS) levels were made.&#x0D; Results: The results showed that group P had significantly reduced the VAS compared to group Z 17.5±12.88 and 57.5±16.03, respectively (P=0.000). The mean total procedure times for single-step border moulding and sectional border moulding impression techniques were 12.25±5.16 and 27.5±4.00, respectively (P=0.000). Also, a significant association between the treatment groups and VAS scores was observed by the multiple regression analysis model (P=0.000).&#x0D; Conclusion: As a result of the better patients' perceptions and reduced clinical time, the study findings suggested using a single-step border moulding technique in the upper arch together with additional vinyl silicon material.

Health-Related Quality of Life after Fractures of the Distal Forearm in Children and Adolescents-Results from a Center in Switzerland in 432 Patients.

(1) Background: We aimed to evaluate the health-related quality of life (HRQoL) in children with fractures of the distal forearm and to assess if HRQoL was associated with fracture classification; (2) Methods: We followed up on 432 patients (185 girls, 247 boys) who sustained a fracture of the distal radius or forearm from 1/2007 to 6/2007, 1/2014 to 6/2014, and 11/2016 to 10/2017. Patients filled in the Quick-DASH (primary outcome) and the Peds-QL; (3) Results: The radius was fractured in 429 and the ulna in 175 cases. The most frequent injury of the radius was a buckle fracture (51%, mean age 8.5 years), followed by a complete metaphyseal fracture (22%, 9.5 years), Salter-Harris-2 fracture (14%, 11.4 years), greenstick fracture (10%, 9.3 years), Salter-Harris-1 fracture (1%, 12.6 years), and other rare injuries. The most common treatment was closed reduction and an above-elbow cast in 138 cases (32%), followed by a cast without reduction (30%), splint (28%), and K-wire fixation and cast (9%). Definite treatment was performed initially in 95.8%, a new cast or cast wedging was performed in 1.6%, and revision surgery was performed in 2.5%. There were no open reductions and no plate fixations. After a mean follow-up of 4.2 years, patients with buckle fractures had a mean Quick-DASH of 3.3 (scale of 0–100) (complete fracture: 1.5; greenstick: 1.5; SH-1: 0.9; SH-2: 4.1; others: 0.9). The mean function score of the PedsQL ranged from 93.0 for SH-2 fractures to 97.9 for complete fractures; (4) Conclusions: In this cohort of 432 children with fractures of the distal forearm, there was equally good mean mid- and long-term HRQoL when assessed by the Quick-DASH and the PedsQL. There was a trend for children with complete metaphyseal fractures reporting better HRQoL than patients with buckle fractures or patients with Salter-Harris II fractures, however, these differences were not statistically significant nor clinically relevant.

White-Eyed Orbital Blowout Fracture With Oculocardiac Reflex Secondary to Extraocular Entrapment in a Pediatric Patient

White-eyed orbital blowout fractures in the pediatric population can present with acute onset diplopia, ophthalmalgia, and abnormal duction. These findings are attributed to the tendency of younger bone to break and reapproximate owing to greater elasticity. This phenomenon, commonly referred to as the greenstick fracture, increases the risk of entrapment of surrounding soft tissue structures in orbital floor fractures. Further concern arises in the presence of an oculocardiac reflex, which requires urgent intervention to prevent serious bradycardia. Prolonged entrapment can go unnoticed and result in irreversible ischemic damage to entrapped tissues. This case discusses the presentation 16-year-old female who sustained a left sided, white-eyed blowout fracture from a face-first ground level fall. On admission, she displayed restrictive strabismus and mild periorbital edema around the left eye. Vertical gaze was restricted when looking inferiorly on the affected side. With sustained upward gaze, her heart rate decreased from 99 to 81 beats per minute. High-resolution non-contrast computed tomography scans of the head showed entrapment of the inferior rectus muscle and periorbital fat. Liberation of entrapped tissues with reduction of bony segments was performed urgently, utilizing a MEDPOR® Titan 3D orbital floor plate and secured with two screws. The patient had an uneventful postoperative period and showed considerable improvements in periorbital edema, duction, and ophthalmalgia on the affected side. In addition, the oculocardiac reflex could no longer be elicited on prolonged upward gaze. Mild and improving paresthesia was noted in the maxillary distribution of the left trigeminal nerve. Sensory deficits like this are the result of fracture communication with the infraorbital canal, which may cause irritation of the infraorbital nerve responsible for sensation by the maxillary division. By postoperative week 7, she had complete resolution of periorbital edema, indiscernible duction abnormalities, and complete healing of surgical incision sites, and an oculocardiac reflex could not be elicited.

Proposal for a modified classification of isolated zygomatic arch fractures.

BackgroundAlthough the zygomatic arch is an important structure determining facial prominence and width, no consensus exists regarding the classification of isolated zygomatic arch fractures, and the literature on this topic is scarce. To date, five papers have subdivided zygomatic arch fractures; however, only one of those proposed classifications includes the injury vector, although the injury vector is one of the most important factors to consider in fracture cases. Furthermore, the only classification that does include the injury vector is too complicated to be suitable for daily practice. In addition, the existing classifications are clinically limited because they do not consider greenstick fractures, nondisplaced fractures, or coronoid impingement. In the present study, we present a rearrangement of the previously published classifications and propose a modified classification of isolated zygomatic arch fractures that maximizes the advantages and overcomes the disadvantages of previous classification systems.MethodsThe classification criteria for isolated zygomatic arch fractures described in five previous studies were analyzed, rearranged, and supplemented to generate a modified classification. The medical records, radiographs, and facial bone computed tomography findings of 134 patients with isolated zygomatic arch fractures who visited our hospital between January 2010 and December 2019 were also retrospectively analyzed.ResultsWe analyzed major classification criteria (displacement, the force vector of the injury, V-shaped fracture, and coronoid impingement) for isolated zygomatic arch fracture from the five previous studies and developed a modified classification by subdividing zygomatic arch fractures. We applied the modified classification to cases of isolated zygomatic arch fracture at our hospital. The surgery rate and injury severity differed significantly from fracture types I to VI.ConclusionUsing our modified classification, we could determine that both the injury force and the injury vector meaningfully influenced the surgery rate and the severity of the injuries.

Prescribing braces after forearm fractures does not decrease refracture rate.

Refracture is one of the most common complications of pediatric forearm fractures. One way to decrease this risk is to extend immobilization with a brace after the cast has been removed to allow for a range of motion exercises. The purpose of this study was to examine whether prescribing a brace after casting was discontinued decreased the risk of refracture. A retrospective, cohort study was performed at one level I trauma center. Girls under 10 years and boys under 12 years who sustained a forearm fracture from January 2013 to December 2018 were included. Patients with open fractures, fractures that required operative intervention, fractures involving the physis, fracture-dislocations, floating elbows, fractures in children with endocrine abnormalities, and fractures in patients lost to follow-up were excluded. The primary endpoint was a refracture within 6 months of the original injury that extended through the original fracture site. In total 2093 patients met the inclusion criteria. There were 19 refractures (0.9%). There was no statistically significant difference in the refracture rate between the braced (11/1091) and unbraced (8/1002) cohorts (Fisher exact value 0.65 at P < 0.05). The most common fracture type that went on to refracture was greenstick fractures. This large, retrospective study aimed to examine whether prescribing a brace had any significant effect on the refracture rate. Bracing after the cast is removed may help ease family anxiety and extend the period of immobilization while allowing for hygiene and range of motion, but it does not significantly decrease the rate of refracture.

Assessment of Maximal Incisal opening using autogenous Inlay Assessment of Maximal Incisal opening using autogenous Inlay Eminoplasty Technique For Treatment Of chronic recurrent Eminoplasty Technique For Treatment Of chronic recurrent temporo mandibular joint Dislocation

Purpose: Different surgical protocols have been introduced for eminence augmentation for treatment of recurrent temporomandibular joint dislocation, The aim of this study is to assess maximal incisal opening (MIO) using inlay (sandwich osteotomy) autogenous block augmentation harvested from patient’s symphesis for more stable condylar movements . Methods: five patients were treated in this study (10 joints) with bilateral autogenous inlay block bone grafting technique, each autogenous cortico-cancellous bone block was harvested from chin and wedged at the created defect of the eminence through a green stick fracture to increase its height . Results: The follow up period ranged from six months to two years to access the maximal incisal opening (MIO). the mean preoperative maximal incisal opening was 45.8mm and that of the postoperative was 32.3 mm . One patient reported postoperative slight unilateral edema and pain that gradually diminishes after one month postoperative.another patient showed intraoperative condylar dislocation that was treated with masseter scarification. Conclusion: autogenous block interpositional eminoplasty technique is a reliable procedure for management of antero-medial recurrent condylar dislocation.

Children's distal forearm fractures: a population-based epidemiology study of 4,316 fractures.

AimsThe aim of this study was to report a complete overview of both incidence, fracture distribution, mode of injury, and patient baseline demographics of paediatric distal forearm fractures to identify age of risk and types of activities leading to injury.MethodsPopulation-based cohort study with manual review of radiographs and charts. The primary outcome measure was incidence of paediatric distal forearm fractures. The study was based on an average at-risk population of 116,950. A total number of 4,316 patients sustained a distal forearm fracture in the study period. Females accounted for 1,910 of the fractures (44%) and males accounted for 2,406 (56%).ResultsThe overall incidence of paediatric distal forearm fractures was 738.1/100,000 persons/year (95% confidence interval (CI) 706/100,000 to 770/100,000). Female incidences peaked with an incidence of 1,578.3/100,000 persons/year at age ten years. Male incidence peaked at age 13 years, with an incidence of 1,704.3/100,000 persons/year. The most common fracture type was a greenstick fracture to the radius (48%), and the most common modes of injury were sports and falls from ≤ 1 m. A small year-to-year variation was reported during the five-year study period, but without any trends.ConclusionResults show that paediatric distal forearm fractures are very common throughout childhood in both sexes, with almost 2% of males aged 13 years sustaining a forearm fracture each year.Cite this article: Bone Jt Open 2022;3(6):448–454.

Chronic non-bacterial osteomyelitis of distal ulna in a paediatric patient: a case report and review of literature

&lt;p class="abstract"&gt;Chronic non-bacterial osteomyelitis (CNO) is a rare disorder characterized by focal aseptic inflammation with a self-limiting, relapsing course of disease with female predominance and usually observed in paediatric age groups diagnosed by clinical, radiological and histopathological findings after ruling out all other differentials. We reported this rare case found in a 7 year old female with a history of greenstick fracture of distal ulna 3 years ago with flaring up of pain and swelling since trivial trauma to left wrist 1 month ago. We emphasize on the relevant data and findings to reach the conclusive diagnosis and treatment of the disease. CNO can present as benign unifocal non-relapsing to more severe form of multifocal relapsing inflammatory lesions involving metaphysis of long bones, vertebrae, clavicle and mandible. Diagnosis is made after excluding infection, malignancy, auto-immune and metabolic disorders. Treatment is mainly empirical to reduce pain and inflammation through NSAIDs, corticosteroids, bisphosphonates and sometimes TNF alpha inhibitors as no proper guidelines are available.&lt;/p&gt;

Feline Femoral Fracture Fixation: What are the options?

The femur is the most commonly fractured bone in cats. Femoral fractures usually result from high-velocity trauma such as a road traffic accident or fall from a height and, as such, are associated with a wide variety of concurrent injuries. The initial focus of treatment should always be on assessment and stabilisation of the major body systems. Once any concurrent injuries have been addressed, all femoral fractures need surgical stabilisation, with the notable exception of greenstick fractures in very young cats, which can heal with cage rest alone. A number of different surgical options are available depending on the fracture type, location, equipment, surgeon experience and owner finances. Femoral fractures can vary hugely in complexity and the small size of feline bones can limit the choice of implants. Furthermore, cats can present unique challenges in the postoperative period due to their active nature and the limited means to control their exercise level. This review is aimed at general and feline-specific practitioners who have some experience of feline orthopaedics, as well as those simply wishing to expand their knowledge. The aim of this review is to help clinicians assess, plan and manage feline femoral fractures. It provides an overview of diagnostic imaging and a discussion of a range of suitable surgical options, including the principles of different types of fixation. It also highlights cat-specific issues, approaches and implants pertinent to the management of these cases. A number of original articles and textbook chapters covering many aspects of femoral fractures in cats and dogs have been published. Where possible, this review draws on information from key feline research and, where necessary, extrapolates from relevant canine literature. The authors also offer practical guidance based on their own clinical experience.

MIND Diet Adherence Might be Associated with a Reduced Odds of Multiple Sclerosis: Results from a Case-Control Study.

IntroductionThe Mediterranean Dietary Approaches to the Stop Hypertension (DASH) Intervention for Neurodegenerative Delay (MIND) diet has been shown to have beneficial neuroprotective effects. The purpose of this research was to evaluate the link between the MIND diet adherence and multiple sclerosis (MS), a degenerative neurological illness.MethodsIn a hospital-based case–control setting, 77 patients with relapsing–remitting multiple sclerosis (RRMS) and 148 healthy individuals were recruited. A validated 168-item semi-quantitative food frequency questionnaire was used to assess participants’ dietary intakes and the MIND diet score. A logistic regression model was used to evaluate the association between MIND diet adherence and MS.ResultsThere was significant difference between RRMS and control groups in the median (Q1-Q3) of age (years, P value < 0.001), body mass index (BMI) (kg/m2, P value < 0.001), and total intake of calories (kcal, P value = 0.032), carbohydrates (g, P value = 0.003), animal-based protein (g, P value = 0.009), and fiber (g, P value = 0.001). Adherence to the MIND diet was associated with a reduced odds of MS [adjusted odds ratio (aOR) = 0.10, 95 percent confidence interval (95% CI) = 0.01–0.88, P for trend = 0.001]. MS odds was significantly lower in the last tertile of green leafy vegetables (aOR = 0.02, 95% CI = 0.00–0.21, P value < 0.001), other vegetables (aOR = 0.17, 95% CI = 0.04–0.73, P value = 0.001), butter and stick margarine (aOR = 0.20, 95% CI = 0.06–0.65, P value = 0.008), and beans (aOR = 0.05, 95% CI = 0.01–0.28, P value < 0.001) consumption. While it was significantly higher in the last tertile of cheese (aOR = 4.45, 95% CI = 1.70–11.6, P value = 0.003), poultry (aOR = 3.95, 95% CI = 1.01–15.5, P value = 0.039), pastries and sweets (aOR = 13.9, 95% CI = 3.04–64.18, P value < 0.001), and fried/fast foods (aOR = 32.8, 95% CI = 5.39–199.3, P value < 0.001).ConclusionThe MIND diet and its components, including green leafy vegetables, other vegetables, and beans, seem to decrease the odds of MS; besides butter and stick margarine, the MIND diet's unhealthy components seem to have the same protective effects, while pastries and sweets, cheese, poultry, and fried/fast foods have an inverse effect.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40120-022-00325-z.

A Case of Tibial Greenstick Fracture Complicated by Myositis Ossificans in a Child

Greenstick fracture; Complete fracture; Myositis ossificans

Intraoperative imaging of children and adolescents, for selected fractures and in follow-up after conservative and operative treatment : Part2 of the results of a nationwide online survey of the Pediatric Traumatology Section of the German Trauma Society

An online survey by the Pediatric Traumatology Section (SKT) of the German Trauma Society (DGU) from Nov. 15, 2019, to Feb. 29, 2020, targeting trauma, pediatric, and general surgeons and orthopedic surgeons. Participants: 788. Intraoperative applications: Collimation 50% always, postprocessing for magnification 40%, pulsed x-ray 47%, and 89% no continuous fluoroscopy; 63% osteosynthesis never directly on image intensifier. Radiographic controls after implant removal never used by 24%. After operated supracondylar humerus fracture, controls are performed up to 6 times. After distal radius greenstick fracture, 40% refrain from further X-ray controls, after conservatively treated clavicular shaft fracture, 55% refrain from further controls, others X-ray several times. After nondisplaced conservatively treated tibial shaft fracture, 63% recommend radiographic control after 1 week in two planes, 24% after 2weeks, 37% after 4weeks, and 32% after 6weeks. The analysis shows that there is no uniform radiological management of children and adolescents with fractures among the respondents. For some indications for the use of radiography, the benefit does not seem evident. The ALARA principle does not seem to be consistently followed. Comparing the documented results of the survey with the consensus results of the SKT, differences are apparent.

Deformed pediatric forearm fractures: Predictors of successful reduction by emergency providers

Forearm fractures are common pediatric injuries. Most displaced or angulated fractures can be managed via closed reduction in the operating room or in the Emergency Department (ED). Previous research has shown that emergency physicians can successfully perform closed reduction within ED; however, the fracture morphology amendable to ED physician reduction is unclear. The aim of this study is to detail the fracture characteristics associated with successful reduction by ED physicians. We conducted a retrospective study of children (aged <18 years) presenting to the ED of a tertiary care children's hospital (annual census 90,000) between January 2018 and December 2018 with closed distal and midshaft forearm fractures requiring reduction. Data collected included patient demographics, fracture morphology, management, and complications. Successful ED physician reduction was based on predefined criteria. Orthopedic referrals included those patients sent directly to the operating room, closed reductions performed by orthopedic trainees within the ED, and patients requiring orthopedic consultation after failed ED reduction. A total of 340 patients with forearm fractures were included in the study. ED clinicians attempted to reduce 274 (80.6%) of these fractures and were successful in 256/274 (93.4%) cases. Of the 84 orthopedic referrals, 18 were after failed ED clinician attempt, and 66 were ab initio managed by orthopedics (37 in the operating room and 29 in ED). Compared to the fractures with successful ED reduction (n = 256), factors associated with orthopedic referral (n = 84) included: increasing age, midshaft location, higher degree of angulation, and completely displaced fractures. Angulated distal greenstick fractures were most likely to be successfully reduced by ED clinicians. There were no difference in complication rates between the two groups. In this series, fractures most amenable to reduction by ED clinicians include distal greenstick fractures, whereas midshaft and completely displaced fractures are more likely to need treatment by orthopedics.