Injuries In Pediatric Age Group Research Articles

ROTATIONAL AND ANGULAR MALALIGNMENT FOLLOWING TITANIUM ELASTIC NAILING SYSTEM AND HIP SPICA CAST FOR FEMUR DIAPHYSEAL FRACTURES IN FOUR- TO SIX-YEAR-OLD CHILDREN: A RANDOMIZED PROSPECTIVE STUDY

Femoral shaft fractures are fairly common injuries in paediatric age group. The treatment protocols are clear in patients of age less than 4 years and greater than 6 years. The real dilemma lies in the age group of 4–6 years. The aim of this study is to find whether a conservative line should be followed, or a more aggressive surgical intervention can provide significantly better results in these injuries.This study was conducted in a tertiary care hospital in Bhubaneswar, India from January 2020 to March 2021. A total of 40 patients with femur shaft fractures were included and randomly divided in two treatment groups. Group A were treated with a TENS nail while group B were treated with skin traction followed by spica cast. They were regularly followed up with clinical and radiological examination to look out for signs of healing and any complications. TENS was removed at 4–9 months’ time in all Group A patients.Group A patients had a statistically significant less hospital stay, immobilisation period, time to full weight bearing and radiological union. Rotational malunions were significantly lower in Group A (p-value 0.0379) while there was no statistically significant difference in angular malunion in coronal and sagittal plane at final follow up. Complications unique to group A were skin necrosis and infection.We conclude that TENS is better modality for treatment of shaft of femur fractures in patients of 4–6 years age as they significantly reduce the hospital stay, immobilization period and rotational malalignment.

Role of high-resolution ultrasound in assessment of iatrogenic sciatic nerve injury in pediatric age group in correlation with electrophysiological studies.

Role of high-resolution ultrasound in assessment of iatrogenic sciatic nerve injury in pediatric age group in correlation with electrophysiological studies.

Comparing Lateral Versus Both Medial and Lateral Percutaneous K-Wire Fixation of Displaced Supracondylar Humerus Fracture in Paediatric Patients

Supracondylar humerus fractures are the most common injuries in paediatric age group. For displaced fractures [III and IV], closed reduction and internal fixation with K-wires is the most preferred option. The current study aims to compare the outcomes of the management of Gartland type III and IV supracondylar humerus fractures with crossed and lateral pinning. We included 40 patients in our study between the age of 2-12 years with Gartland Type III and IV fractures, Weight < 40 kg, less than 10 days old, closed fractures. Randomization was done where the Odd numbered patients were put in Group 1 and even number in Group 2. Group 1 participants were managed by lateral K-wire fixation and Group 2 by crossed K-wire fixation. All the patients were assessed for any loss of reduction and iatrogenic neurovascular injuries, alignment, Flynn’s criteria, Mayo elbow score. The flexion-extension range in Group 1 was about 110.27° ± 14.39° as compared to 103° ± 12.05° in Group 2. Supination to pronation was about 87.7° ± 1.62° in Group 1 as compared to 87° ± 2.42° in Group 2. Functionally (p>0.05) and radiographically both groups did not show any significant difference. Thus, we concluded that lateral pinning in good hands is as stable as crossed pinning with lower chances of nerve injury and is relatively safe.

Outcome of Closed Reduction and Percutaneous Cross K-Wire Fixation of Supracondylar Fractures of Humerus in Children

Background: Supracondylar fractures of humerus are common skeletal injuries in paediatric age group in between 50-70% of elbow injuries. They are often associated with complications and are very notorious for neurovascular injuries between 5 to 9 years of age. Objective: To evaluate the outcome of supracondylar fracture of humerus with closed reduction and percutaneous cross k-wires fixation. Materials and method: A prospective study of 30 patients of Gartland type III fractures admitted in the orthopaedics department of 250 Bedded General Hospital, Tangail from January 2021 to December 2021. Results: Regarding FLYNN CRITERIA, there were 24 excellent, 3 good,2 fair, and 1 poor results. Fair and poor results were due to poor compliance to follow-up and postoperative rehabilitation. There were 4 cases with pin tract infection, 1 with elbow stiffness, and 1 with cubitus varus. Conclusion: Closed reduction and percutaneous cross k-wire fixation is a very effective and minimally invasive way of treatment of displaced supracondylar fractures of humerus. Crossed K-wire biomechanically better way of the stability of fracture reduction J Shaheed Suhrawardy Med Coll 2022; 14(1): 16-19

Clinical Profile of Ocular Injuries in Pediatric Age Group Attending Department of Ophthalmology- VIMS, Ballari- A Prospective Study

Clinical Profile of Ocular Injuries in Pediatric Age Group Attending Department of Ophthalmology- VIMS, Ballari- A Prospective Study

Prospective study to evaluate pediatric ocular trauma and its assessment with pediatric ocular trauma score at a tertiary carecentre in western Maharashtra

Vision” is a very much valuable gift given by the God. It is most cared for the function of a person and is possible only with healthy eyes. Eyeball is a well secured tissue in our body, but a minute trauma can cause such a damage that can lead to severe morbidity than any other organ. Eyes are protected by anatomical as well as physiological factors. The anatomical factors elastic fatty tissue and the bony orbit. Head turning reflex, blink reflex and lacrimation which following intrusion of any irritant material are the physiological factors. Ocular Injury represents a major threat to vision in the house, work,school, playground and in sports. 4 As Krishna Hospital, Karad is located on National highway we come across many cases of vehicle accidents. Also the presence of a school and playing ground nearby has led to increase in number cases of sports related ocular injuries. Therefore, this study is done to assess the clinical profile of ocular injuries in paediatric age group presenting to us, to estimate the visual prognosis with the help of Paediatric Ocular Trauma Score and to assess visual prognosis following effective treatment.

CLINICAL REVIEW OF EAR, NOSE AND THROAT INJURIES IN CHILDREN

Objective: The aim of present study was to carry out a retrospective analysis of types and causes of ENT injuries in pediatric age group. Patients and Methods: We carried out a retrospective analysis of types and causes of 40 children up to the age of 14 years with ENT injuries managed in the department in the period from March 2019 to April 2021. Results: The total number of patients was 40 and it comprised of 31 males (77.5%) and 9 females (22.5%). Twelve (30%) of the children were under the age of 5 years, 14(35%) were 6-10 years of age and 14 (35%) in the age group of 11–14 years. The most common injury was nasal bone fracture (28.45%) The lacerated soft palate was the second common injury which account for (22.5 percent). The most prevalent site of injury was the nose region. About 32.5 percent of the injuries were caused by falls and accidents, which included falling from roof, trees, beds or cribs, and falls while sporting. About 35% of all injuries are caused by pointy items in the mouth and traffic accidents. The falls while playing in addition to injury with pointy materials was observed in patients under the age of five years. Blunt trauma, falls from stairs and during playing, as well as damage with pointed items, were the most common etiological causes in children aged 6–10. The ages of 11–14 years were shown to be the most vulnerable to falls and traffic accidents. Conclusion: ENT injuries in children differ from those in adults in terms of type and mechanism. Prophylactic measures should be adopted for children who are at risk of ENT injuries.

Effect of Ultrasound Guided Supraclavicular Brachial Plexus Block on Intraoperative Opioid Consumption and Quality of Postoperative Analgesia in Closed Reduction and Pinning of Paediatric Supracondylar Fracture of Humerus

Background: Supracondylar fracture of the humerus is one of the commonly encountered injuries in paediatric age group accounting for 16% of all paediatric fractures and 60% of all paediatric elbow fractures, classically occurring as a result of fall on an outstretched hand. Regional anesthesia may represent one of the best solutions for intraoperative and postoperative paediatric pain management however, due to lack of proficiency and the increased risk of complications in children and difficulty in obtaining cooperation compared to adults, it is not the method of choice for most of the anesthesiologists in children.
 Methods: A total of 50 paediatric patients were included who were to undergo CRPP and divided into two groups Group I- General anaesthesia alone (n = 25), Group II- General anaesthesia with USG guided supraclavicular brachial plexus block studied for the intraoperative opioid consumption as well as postoperative analgesia quality, duration and Opioid consumption.
 Results: Demographic data were similar in both groups (I and II). Time to first dose of analgesia after surgery in the group I was 54.8±5.4 min and 746.6±40.2 min (p<0.001). The incidence of PONV was 24% (group I) and 16% (GroupII). Duration of analgesia was significantly higher (746.6±40.2 min) and mean pain scores lower in first 24 hour. The fentanyl consumption was higher intraoperatively and rescue analgesic doses were more in group I.
 Conclusion: USG guided brachial plexus block is an excellent and effective means for analgesia in CRPP for supracondylar fracture with lower intraoperative Opioid consumption and better postoperative analgesia , lower pain scores and Opioid consumption in first 24 hour post operative period.

Incidence and Causes of Open Globe Injury in Pediatric Age Group in Salmaniya Medical Complex between 2015–2020

Incidence and Causes of Open Globe Injury in Pediatric Age Group in Salmaniya Medical Complex between 2015–2020

Analysis and follow up of shotgun injuries in pediatric age group

Analysis and follow up of shotgun injuries in pediatric age group

Study of risk factors, clinical spectrum, and outcome for head injury in pediatric age group in Western India.

Aim:To study various risk factors which leads to head injury, severity of head injury and to compare survival as predicted by the Revised Trauma Score (RTS) and Pediatric Trauma Score (PTS) in pediatric patients admitted in a tertiary care hospital.Methods:300 consecutive pediatric patients below 12 years of age with head injury admitted in our institute were analysed as per a set proforma. Data pertaining to patient's demographic details, mode of injury, computed tomography (CT) findings, type of management, severity of head injury, and outcome were recorded. The results were tabulated and analyzed. RTS and PTS scores were calculated to predict the survival of an individual patient.Results:The most commonly affected age group was 1–5 years. Boys outnumbered girls in the incidence. Fall was the most common injury, with road traffic accident being the most common cause of mortality. Skull fracture was the most common CT scan finding. Most of the patients presented with mild head injury (Glasgow Coma Scale 13–15), and they improved with conservative management only. RTS and PTS scores were calculated and were equally effective in predicting the outcome for a particular patient.Conclusion:Head injury occurs more commonly in 1–5 years' age group due to fall from unprotected roof tops. The overall prognosis in majority of the cases is excellent. However, road traffic accident shows the highest mortality and hence, we propose to include mode of injury as a variable for designing future predictive outcome models.

A prospective cohort study on the epidemiology of ocular trauma associated with closed-globe injuries in pediatric age group.

Purpose:To study the epidemiology of mechanical ocular trauma and closed globe injury using the Birmingham Eye Trauma Terminology System in patients belonging to the pediatric age group.Methods:This work involved a prospective cohort study of all ocular trauma patients (pediatric age group) registered between 2002 and 2017 at the ocular trauma care center. The data were collected using the international ocular trauma society form through our online MIS data and exported to the Excel sheet. The statistical analyses including the univariate analysis and cross tabulation were carried out using SPSS 22 software.Results:Our cohort consisted of 12687 patients with mechanical ocular trauma. There were 7546 (59.4%) eyes with open globe ocular injuries and 5328 (41.9%) with closed globe injuries. Of all closed globe injury patients, 1010 (19.0%) belonged to the pediatric age group (0-18 years), including 690 males (68.3%) and 320 females (31.7%). The mean age of the patients was 10.2 ± 5.1 years. Of all closed globe injuries, 692 (68.5%) were closed globe contusion and 318 (31.5%) were lamellar laceration.Conclusion:Closed globe injury is an important in cause of vision loss in children (24% <1/60). The condition is more prevalent in males and >51.7% in children under 10 years of age. The treatment has significant impact on the visual outcome in patients belonging to the pediatric age group.

Brachial artery injury in pediatric patients: review of management and outcome in 29 patients

Background: The brachial artery is the most frequently injured artery in the upper extremity due to its vulnerability and commonly it is associated with road traffic accidents and occupational injuries. But brachial artery injury in pediatric age group is not very frequent as in adults and commonly associated with supracondylar fracture of humerus. They may present with or without features of ischemia. Prompt diagnosis and treatment is essential for salvage of limb in established ischemia. Obscure presentation of arterial injury poses challenge in early diagnosis and treatment. Repair of the injured artery in these cases is not clearly recommended. We are presenting a series of 29 pediatric brachial artery injuries and their outcome in our institute over the last 5 years.Methods: Twenty nine pediatric patients with brachial artery injury managed in our institute between 2014 to 2018 are assessed retrospectively for operative procedure and outcome.Results: Supracondylar fracture was the most common cause (55.17%). Ischemic and non-ischemic presentation was noted in 41.37% and 69.63% cases respectively. Artery repair was done in 17 (58.62%) cases. Primary repair and interposition vein graft repair was done 8 and 9 cases respectively. Among the 17 repaired artery good functional outcome with Grade 5/5 muscle power noted in 14cases. Amputation was done in two cases.Conclusions: Good functional recovery may be achieved in segmental injury repair with a vein graft. Though in closed injury without ischemic features artery may not be repaired, full functional recovery is possible due to collateral circulations. Obscure presentation detected and repaired early also has a satisfactory result.

Epidemiology of Pediatric Musculoskeletal Injuries and Their Pattern in a Tertiary Care Center of North India.

Background:Trauma is emerging as an epidemic and a leading cause of morbidity and mortality in children. Children <15 years of age comprise about 32.8% or about 1/3rd of the total Indian population. In India, up to one fourth of hospital admissions and approximately 15% of deaths in children are due to injury. This study presents the epidemiology, various causes and pattern of musculoskeletal injuries in pediatric population of North India.Materials and Methods:This is an observational, prospective hospital-based study conducted in a tertiary care center of North India for 6 months from July to December 2016. All pediatric patients in the age group 0-15 years who presented to the orthopedic emergency and out patient department with a history of trauma were included in the study.Results:Children aged 6-15 years (58%) suffered more injuries than children under 5 years of age (42%). Male pediatric population (58.5%) had more musculoskeletal injuries as compared to female pediatric population of the same age group (41.5%) in both the groups. Urban pediatric population (68.78%) suffered more injuries as compared to rural population of the same age group. Right extremities were more commonly involved in both the age groups. Upper limb injuries (50.59% in 0-5 years age group and 47.42% in 6- 15 years age group) were most common followed by lower limb and pelvic injuries. Very few (2.9% in 0- 5 years age group and 4.8% in 6-15 years age group) patients sustained isolated spinal injuries. Out of the 3712 patients 59.40% of patients had a history of fall, followed by road traffic accident related injuries (32%). The most common injuries were superficial injuries i.e., abrasions and bruises. The second most common injury was cut or open wounds mostly seen on hand, forearm and legs.Conclusion:The high incidence of pediatric trauma on roads and falls indicates the need for more supervision during playing and identification of specific risk factors for these injuries in our setting. Injuries in pediatric age group by and large is a preventable condition. Therefore, injury prevention in children should be a priority.

Incidental Findings in CT scan in Pediatric Populations with Head Injury

Objective: To investigate the incidental findings in computed tomography scans performed for mild head injury in pediatric patients at Nepalgunj Medical College and Teaching Hospital, Kohalpur, Banke, Nepal.&#x0D; Materials and methods: It is a cross sectional hospital based study performed on two hundred and eighteen patients of age &lt; 18 years presenting with mild head injury with no known neurological problem, recent surgery, and time of scanning &lt; 24 hrs of sustaining injury were included in the study between Dec 2016 and June 2017.&#x0D; Results: Among the 218 patients, 134 were males and 84 females, age ranged from 3 months to 18 years. 196 out of 218 patients (89.9%) had incidental findings in CT scan images with greater than 2 incidental findings present in 54 patients. Sinus opacification was the most common incidental finding noted in 86 cases (43.9 %) followed by calcified granuloma in 27 cases (13.8 %). Incidental findings unrelated to trauma which required further investigation was present in 5 cases.&#x0D; Conclusion: Incidental findings are being increasingly encountered in computed tomography scan performed for mild head injury in pediatric age group with sinus opacification as the most common finding. Recognition of these findings and communication with the treating physician is helpful in the overall management of such cases.

MR neurography in traumatic, non-obstetric paediatric brachial plexopathy.

Many studies have elaborated on the role of magnetic resonance neurography (MRN) in evaluating traumatic brachial plexopathies. Most of these deal with MR findings in adult traumatic plexopathies or children with obstetric brachial plexus palsy (OBPP). Hence, the authors felt the need for this particular study, which focuses on MRN findings in children with non-obstetric traumatic brachial plexus palsy, to find out the distribution and severity of injuries in these patients. This was a single-institution, prospective study conducted between April 2015 and June 2016. All children presenting to the hospital with features of brachial plexopathy and a history of non-obstetric trauma were included in the study. At MRN, we looked for signs of injury at three levels: roots, trunks and cords. Signs of injury were found at the level of the roots in 22 patients (88%), at the level of the trunks in 20 patients (80%) and at the level of the cords in 22 patients (88%). This study, conducted on children suffering from non-obstetric, traumatic brachial plexopathy returned some interesting conclusions including that when the paediatric plexus is injured, the injury is severe and multi-level, with a very high incidence of root injuries. • Brachial plexus injury in paediatric age group is a devastating injury. • The most common cause of this is trauma sustained during birth. • Other causes include road traffic accidents and blunt injury. • MR neurography has revolutionised the diagnosis of brachial plexopathy.

Paediatric Salter-Harris type IV injury of distal tibia with talus fracture

Fracture of talus with Salter-Harris injury of the distal end of tibia is a rare injury in paediatric age group. The authors report a case of a 13-year-old male child...

Study of cast index in middle third fractures of both bones of forearm in children

Introduction: Forearm fractures are one of the most common orthopaedic injuries in paediatric age group. Normal function is often achieved with closed reduction and casting. Loss of fracture reduction is the most commonly reported complication of forearm fractures. An important modifiable risk factor for fracture redisplacement is the quality of casting, which can be measured objectively by the use of casting indices. An attempt is made to validate the role of cast index in middle third fractures of both bones of forearm in children. Materials and methods: Patients in the age group of 2 to 12 years with fracture of both bones of forearm involving the middle third treated by closed manipulation and cast application were included in the study. An above elbow cast was applied in the emergency room after closed reduction in all patients. Cast Index, defined as ratio of inner diameter of the cast in lateral view to that in anteroposterior view was measured at the fracture site in all the radiographs.The mean Cast Index in nondisplaced and displaced groups were calculated and compared. Results: Thirty children with middle third fractures of radius and ulna were included in the study. At 1 and 2 week follow-up, all but 5 cases maintained acceptable reduction. The mean cast index in 25 cases which maintained reduction was 0.75 whereas that in the group with significant displacement was 0.84. Conclusion: Majority of paediatric forearm fractures are amenable to conservative treatment. Quality of casting as expressed by indices such as cast index is one of the indicators of satisfactory outcome following middle third forearm fractures when used as a measure of risk of redisplacement.

Paediatric Post-Traumatic Bladder Neck Distraction Injury: Case Series.

The bladder neck distraction is a rare posterior urethral injury in paediatric age group. It mostly occurs secondary to road traffic accidents. We report three cases of paediatric bladder neck distraction injury. Three paediatric patients aged between 4 to 7 years (mean 5 year), who presented with post traumatic bladder neck distraction injury but no other major injury, they were treated with early urethro-vesical anastomosis. Postoperatively all patients were continent and with good urine flow rates. In paediatric bladder neck distraction injury, immediate urethro-vesical anastomosis gives good results.

Save kids, not all children with minor head injury need CT head, QIP in Hamad General Hospital Emergency Department, Qatar

Background: Whilst Head CT scanning carries an important role in the identification of clinically significant intracranial injuries, there are associated risks of radiation. Our initial audit of clinical notes and survey of EM physicians revealed a rate of 45% CT scans for pediatric minor head injuries with around half of requests not indicated. In 36% there were issues with documentation. The aim is to achieve a sustained compliance with Internationally acceptable guidelines of Head CT scanning for pediatric minor head trauma at Hamad General Hospital Emergency Department (ED). Intervention: We conducted staff education through weekly program of Continuing Medical Education for emergency physicians, prominent display and availability of handouts of the International clinical decision rules (NICE guidelines, PECARN) in all clinical areas within the ED, encourage proper documentation for all head injury cases to meet JCI standards of documentation, and formulate a revised pediatric head injury guideline based on the international clinical decision rules. Methods and results: The audit in August 2014 showed that 62 CT head were done, 45% of them were deemed unnecessary when measured against NICE guidelines. Also there was deficient documentation in 36% of cases due to the unavailability and difficulty accessing the guidelines. We supplied all areas in the ED with handouts of the guidelines, and conducted shop floor education for ED physicians. Regular sessions were conducted during educational activities and emergency seminars. The re-audit in January 2015 showed decreasing rate of CT scans at the rate of 22% achieving a reduction by 33% and improvement in the documentation by 31%. The overall reduction of and decreasing the percentage of unindicated CT head by around 30%. Conclusion and recommendation: Managing minor head injury in pediatric age group becomes more safe by increasing the physician awareness about the evidence based updated guidelines.