Management Of Pediatric Fractures Research Articles

Patterns and Management of Upper and Lower Limb Fractures in Pediatric Patients Presenting to the Pediatric Emergency Department at a Tertiary Care Hospital: A Retrospective Study in Riyadh, Saudi Arabia

Background: Pediatric fractures constitute a significant public health concern globally, with varying implications on healthcare systems and affected individuals. While global trends have been well-documented, research in Saudi Arabia, particularly within a tertiary care setting, continues to contribute significantly to the understanding of this issue. Methods: This retrospective chart review, conducted over a four-year period from 2019 to 2023, analyzed pediatric fracture cases at a major hospital in Riyadh, Saudi Arabia. The study included 286 children aged 14 years or younger presenting with new fractures. Data on demographics, fracture types, anatomical locations, and treatment modalities were extracted from electronic health records and analyzed using IBM SPSS Statistics Version 25. Results: The study found a higher incidence of fractures in males, particularly increasing after age 8, with radial, metatarsal, and humeral fractures being the most common. Radial fractures, especially distal radial fractures, were predominant, and the majority were treated with casts and backslabs. Metatarsal fractures were more prevalent in males, predominantly treated with backslabs, while humeral fractures were more common in females, mainly treated with backslabs and slings. Conclusion: This study provides essential insights into pediatric fracture patterns in a Saudi Arabian tertiary care setting, echoing global trends and underscoring the need for conservative treatment approaches. Future research should expand on long-term outcomes, broader demographic factors, and the impact of comorbidities to enhance pediatric fracture management and healthcare strategies.

Impacts of COVID-19 pandemic on pediatric fractures: a 4-year evaluation of epidemiology and delayed treatment from prepandemic to pandemic period at a tertiary referral hospital.

Definitive fracture surgery should be performed as soon as the patient's condition allows. However, there may be some delays in the treatment during a pandemic. This study aimed to investigate and compare the epidemiology and delays in pediatric fracture management during the pandemic and prepandemic periods in terms of how many cases were delayed, how long were the delays, and the causes for the delays of fracture treatment. This comparative-retrospective study was conducted in a tertiary referral hospital in Yogyakarta, Indonesia. The authors included all patients who presented to the hospital from 1 December 2019 to 30 November 2021 (pandemic group period) and from 1 December 2017 to 30 November 2019 (prepandemic group period). The collected data included: patients' age and sex, fractured bone, fracture type, concurrent fracture, hospital stay duration, treatment, need for multidisciplinary treatment, interval from arrival to treatment, and reasons for delayed surgical treatment. The data were obtained from the patients' medical records. Results showed a decrease in the pediatric fracture cases during the 2 years pandemic period compared to the prepandemic period (75 vs. 135 cases). There was no significant difference in the evaluated parameters of demographic, fractured bone and type, hospital stay duration, treatment, other department involvement, and delayed surgical treatment for the fracture. The most common reason for the definitive surgical management delay was the need for medical condition improvements (n=63, 79.7%) and it was significantly associated with the need for multidisciplinary treatment approach (22.83 in isolated orthopedic cases vs. 87.5% in multidisciplinary cases; P=0.000). There was a decrease in the pediatric fracture cases during the 2-year pandemic period compared to the prepandemic period. The delay in definitive surgical management was mainly due to the need for the medical condition improvements and it was associated with the need for a multidisciplinary treatment approach.

Decreasing Radiation Exposure in the Treatment of Pediatric Long Bone Fractures Using a DXA Scan: A Proof of Concept

Background: Fractures are typically evaluated and monitored using plain radiographs, but in the pediatric population the goal is always to reduce radiation exposure when possible. Dual-energy X-ray absorptiometry (DXA) is an imaging modality that uses less radiation. The evaluation of upper and lower extremity fractures in the pediatric population using DXA imaging has not yet been studied.Method: Radiographs of 19 patients treated for forearm or tibia fractures were compared to images taken with a DXA machine. The angulation and translation of the fractures were measured twice each by two independent observers. Correlation of these values between plain radiographs and DXA scans along with intra- and inter-observer reliability was calculated.Results: A total of 19 patients with a forearm or tibia fracture were enrolled in the study. Correlation with conventional radiographs for angulation was r=0.77, p<0.001, while for translation was r=0.76, p<0.001. The mean difference between the methods was 0.5 degrees (range of -6.7 to 7.7) for angulation and 4% (range of -28% to 37%) for translation. For plain radiographs the inter-rater reliability was 0.90 (95% confidence interval of 0.84-0.93) for angulation and 0.89 (0.68-0.95) for translation. The inter-rater reliability for DXA imaging was 0.77 (0.69-0.83) for angulation and 0.76 (0.41-0.88) for translation.Conclusion: Our study showed that DXA imaging correlates well with plain radiographs when measuring angulation and translation of forearm and tibia fractures in the pediatric population. This study is a proof of concept that DXA, a low-dose radiation alternative to plain radiographs, may be useful in the management of pediatric fractures.Level of Evidence: Level III Key Concepts•Decreasing radiation exposure in the pediatric population is an ongoing goal in pediatric orthopaedics.•Fracture follow-up imaging in the pediatric population currently is mainly restricted to plain radiographs.•A lower dose imaging modality might be an alternative to plain radiographs to monitor long bone fracture alignment.

Implicit Racial Bias in Pediatric Orthopaedic Surgery.

Racial and ethnic minority patients continue to experience disparities in health care. It is important to understand provider-level factors that may contribute to these inequities. This study aims to evaluate the presence of implicit racial bias among pediatric orthopaedic surgeons and determine the relationship between bias and clinical decision making. A web-based survey was distributed to 415 pediatric orthopaedic surgeons. One section measured for potential implicit racial bias using a child-race implicit association test (IAT). IAT scores were compared with US physicians and the US general population using publicly available data. Another section consisted of clinical vignettes with associated questions. For each vignette, surgeons were randomly assigned a single race-version, White or Black. Vignette questions were grouped into an opioid recommendation, management decision, or patient perception category for analysis based on subject tested. Vignette answers from surgeons with IAT scores that were concordant with their randomized vignette race-version (ie, surgeon with pro-White score assigned White vignette version) were compared with those that were discordant. IAT results were obtained from 119 surveyed surgeons (29% response rate). Overall, respondents showed a minor pro-White implicit bias ( P <0.001). Implicit bias of any strength toward either race was present among 103/119 (87%) surgeons. The proportion of pediatric orthopaedic surgeons with a strong pro-White implicit bias (29%) was greater than that of US physicians overall (21%, P =0.032) and the US general population (19%, P =0.004). No differences were found in overall opioid recommendations, management decisions, or patient perceptions between concordant and discordant groups. Most of the pediatric orthopaedic surgeons surveyed demonstrated implicit racial bias on IAT testing, with a large proportion demonstrating strong pro-White bias. Despite an association between implicit bias and clinical decision making in the literature, this study observed no evidence that implicit racial bias affected the management of pediatric fractures. Level IV.

341 Alder Hey Experience of Paediatric Virtual Fracture Clinic During The COVID-19 Pandemic

Abstract Introduction The SARS-CoV2/COVID-19 pandemic represented an unprecedented emergency prompting a drive to minimise non-essential patient contact and the need for a virtual fracture clinic (VFC); an uncommon practice in paediatric units. Management of paediatric fractures requires a greater degree of vigilance to safeguard children. The current climate has created social challenges that theoretically increase the risk of harm and exploitation to children. This study investigates VFC in the management of paediatric fractures to determine the efficiency of such a process and the risk of safeguarding. Method A protocol was devised in affiliation with BSCOS for the immediate management and streamlining of paediatric fractures into VFC. We retrospectively audited 235 VFC consults over a 1-month period. Patient sex was roughly evenly distributed, and age ranged from 9 months to 16 years (mean 8.4 years). Results 42% of patients were recalled for a face-to-face (F2F) review (26% expedited), primarily for clinical assessment, plaster complaints and imaging requirements. 33% were discharged and 15% continued follow-up in VFC. All clavicle fractures were discharged. Forearm, hand, foot and elbow injuries were more likely to be discharged. Lower leg, upper arm and knee presentations more frequently required a F2F review. 2.3% of cases required safeguarding reviews. Conclusions Given the rapid transition to VFC without the use of triage we have determined a number of non-complex fractures safely managed and discharged via VFC. The low percentage of recall due to safeguarding concern highlights this may not be a barrier to the continuation of virtual care outside of the context of a pandemic.

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

INTRODUCTIONIn 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 METHODSRetrospective 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.RESULTSBetween 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.CONCLUSIONSThe 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.

Beyond the Supracondylar Humeral Fracture

Pediatric fractures are quite common and are a substantial part of subspecialist and general orthopaedic trauma practices. The differences in bone biomechanics, capacity to remodel, and strength and regenerative capacity of the periosteum require considerably different theory and approaches to fracture management compared with adults. Specifically, pediatric trauma care often involves growth-respecting minimally invasive or percutaneous fixation techniques that utilize indirect or closed reduction. The management of pediatric fractures, in contrast with those in adults, focuses less on the newest hardware to solve mechanical problems of bone and more on the potential for managing the dynamic system of an immature skeleton. The clinician must consider the growth plate for fixation strategies but also for the potential of further growth to remodel injuries. Diagnostically, the clinician must consider which fractures can be treated less invasively and which are likely to worsen if left alone or with minimal treatment. Overtreatment of a simple fracture may result in increased burden on the child and their family, as well as in additional procedures and exposure to complications, whereas undertreatment can expose them to loss of reduction, malalignment, and potential long-term complications many years in the future. JBJS Essential Surgical Techniques, in a collaborative effort with Children’s ORthopaedic Trauma and Infection Consortium for Evidence-based Study (CORTICES), is excited to present this digital collection of commonly encountered or enigmatic injuries that are unique to children. These techniques represent cutting-edge as well as tried-and-true techniques that on-call orthopaedists can utilize in their practice whether they are pediatric orthopaedists or generalists who are called on to navigate these sometimes unfamiliar waters.

Fore! A 10-year Analysis of Golf-related Facial Fractures.

Background:Over 30 million people in the United States play golf, which, while considered a low-impact sport, involves balls and clubs moving >100 miles/h (>160.93 km/h), creating potential for a significant facial trauma. The objective of this study was to characterize the epidemiology of golf-related facial fractures in the United States.Methods:The National Electronic Injury Surveillance System, which records injuries from approximately 100 US emergency departments, was queried for golf-related facial fractures from 2009 to 2018. Entries were tabulated for mechanism of injury and fracture location. Age, gender, seasonality of injury, type of fracture, and injury mechanism were analyzed using SPSS. Because of the different nature and management of pediatric fractures, we looked at pediatric patients as a distinct subgroup.Results:There were 114 reported cases of golf-related craniofacial fractures in patients 2–91 years of age with male predominance (73.7%). This rate extrapolates to an estimated 3,850 ED presentations. Although accounting for about 10% of total players, patients under 18, commonly referred to as “junior golfers,” comprised 55.3% of the cohort. Nasal fractures (25.4%), skull fractures (23.7%), unspecified facial fractures (17.5%), and mandible fractures (10.5%) predominated, which most commonly result from clubs (63.2%), balls (23.7%), and falls (11.4%).Conclusions:Facial fractures resulting from golf clubs and balls may not be as common as in other traditionally identified “high-impact sports,” but they affect pediatric patients disproportionately and with a greater morbidity. Parents and children engaging the sport should be aware of the risk of head trauma, especially with any form of off-course participation.

The Epidemiology and Management of Pediatric Maxillary Fractures.

Most literature regarding traumatic Le Fort or maxillary fractures exists in the adult population, with limited information regarding the epidemiology and management of pediatric fractures. The purpose of this study was to evaluate fracture mechanism, surgical management, and associated injuries in pediatric patients with Le Fort fractures. A retrospective chart analysis of all pediatric patients age ≤18 years diagnosed with facial fractures at a single level 1 trauma center over a 10-year period (January 2006-December 2015) was performed. Demographics, fracture location, mechanism of injury, and hospital course were abstracted as well as associated injuries and need for operative management. A total of 1274 patients met inclusion criteria. Sixty-nine (5.4%) presented with Le Fort fractures. Factors associated with Le Fort fractures included motor vehicle collisions (P < 0.001), increased age (P < 0.001), and traumatic brain injury (P < 0.04). Patients with Le Fort fractures were more likely to need intensive care unit admission (P < 0.001), surgical management (P < 0.001), transfusions (P < 0.001), secondary fixation surgery (P < 0.001), and have a longer length of stay (P < 0.001). Multivariate showed increased odds for increased age (OR 1.1; 95%CI 1.04-1.17) and concomitant orbit fractures (OR 8.33; 95%CI 4.08-19.34). Decreased odds were associated for all mechanisms of injury other than motor vehicle collisions (Other blunt trauma: OR 0.36; 95%CI 0.2-0.6. Penetrating trauma: OR 0.13; 95%CI 0.01-0.6). Maxillary or Le Fort fractures represent a small portion of pediatric facial fractures but require high rates of operative management. The high velocity required to create this fracture type is associated with significant traumatic comorbidities, which can complicate the hospital course.

BUCKLED: Bedside ultrasound conducted in kids with distal upper limb fractures in the emergency department (observational trial)

Forearm fractures in children are a common presentation to the Emergency Department. Paediatric distal forearm fractures account for almost a third of all fractures in children, with a significant proportion of these diagnosed as buckle (torus) type fractures. These fractures are unique to children, occurring due to deformation of the metaphysis within a thick and strong periosteum. Point-of-care ultrasound has increasing utility in the diagnosis of non-angulated distal forearm fractures given that it is rapid, highly accurate, well-tolerated, and does not involve ionising radiation. Emergency Nurse Practitioners are utilised in the ambulatory care area, where they provide high-quality, cost-effective care. Given that NPs are heavily relied upon for the diagnosis and management of paediatric fractures, it was hypothesised that teaching them to diagnose distal forearm buckle fractures with a rapid POCUS protocol (i.e. less than 10 minutes) could potentially lead to time and resource savings, given that these patients can be appropriately discharged in a wrist splint. During the BUCKLED observational trial, Nurse Practitioners prospectively recruited a convenience sample of more than 200 paediatric patients over a 12-month period at a tertiary paediatric hospital in Australia. Patients were enrolled between the ages of 4-16 years with a non-deformed forearm with clinically suspected fracture to be evaluated with radiograph imaging. This pilot study determined the acceptability (staff, parent, child), tolerability (pain compared to radiograph), feasibility (time of scan), and the accuracy of Nurse Practitioners to diagnose buckle fractures using point-of-care ultrasound compared to radiograph as the gold standard. Besides potential benefits in a tertiary paediatric setting, outcomes from this study may have relevance to resource limited environments. The findings from this trial will be presented, along with future directions.

Management Modalities and Outcomes Following Acute Scaphoid Fractures in Children: A Quantitative Review and Meta-Analysis.

Early evaluation and appropriate management of pediatric scaphoid fractures are necessary to avoid complications. To date, current management of pediatric fractures varies among providers. The objective of this study was to compare clinical outcomes following different treatment modalities. A PubMed literature search identified studies involving acute scaphoid fractures in children. Studies were evaluated for treatment provided and their respective effects on union rate, wrist range of motion, and wrist pain. Data were pooled across studies, and quantitative statistical analysis was conducted to compare outcomes. Seventeen studies representing 812 acute pediatric scaphoid fractures were included in the current analysis. We found 93.5% of scaphoid fractures were treated with cast immobilization vs 6.5% treated surgically as 13 of 17 authors treated all fractures with immobilization vs 4 of 17 studies who offered surgical intervention. We found pediatric scaphoid fractures had excellent bone union rates (96.2%) with no difference between the cast immobilization and surgery groups ( P value NS). Long- and short-arm thumb spica immobilization protocols were commonly employed; however, we found no difference in the rates of union ( P value NS). At follow-up, 99.0% of patients treated nonoperatively had normal wrist range of motion and 96.8% were pain free. Pediatric scaphoid fractures have excellent outcomes. Nonoperative treatment results in a high rate of union with few posttreatment wrist symptoms. Nonsurgical treatment represents an adequate treatment modality in a majority of acute pediatric scaphoid fractures, wherein the role for surgery needs to be better defined.

Informal regionalization of pediatric fracture care in the Greater Toronto Area: a retrospective cross-sectional study.

Operative management of pediatric fractures is an expected competency in the specialty of Orthopedic Surgery. However, specialized pediatric centres may be providing care for increasing numbers of patients with fractures previously treated at community hospitals. The primary objective of this study was to examine trends in presentation of children with fractures to a specialized pediatric centre. We performed a detailed chart review to examine trends in presentation of children aged 14 years or less with supracondylar humerus or femur fractures to a specialized pediatric centre (Hospital for Sick Children, Toronto) from anywhere in the Greater Toronto Area between Apr. 1, 2008, and Mar. 31, 2015. Consecutive patients admitted to hospital and requiring operative intervention for a supracondylar humerus or femur fracture were considered. We calculated changes in operation incidence rates per year using multivariable negative binomial regression models. A total of 945 children with supracondylar humerus fractures and 421 with femur fractures underwent operative intervention during the study period. The baseline characteristics of the 2 groups were similar irrespective of which year fixation occurred. The annual incidence rate of supracondylar humerus fractures increased from 108 to 169 (56.5%) over the study period, at an adjusted rate of 7.5% per year (adjusted incidence rate ratio [IRR] 1.075, 95% confidence interval [CI] 1.072-1.079, p < 0.001). The annual incidence rate of femur fractures increased from 49 to 69 (40.8%), at an adjusted rate of 5.3% per year (adjusted IRR 1.053, 95% CI 1.044-1.062, p < 0.001). Significant increases were observed independent of fracture classification, stabilization method, whether patients were transferred from an outside hospital or presented directly, patient geographic location or the season in which the fracture occurred. Adjusted annual incidence rates of supracondylar humerus and femur fractures increased significantly over the study period. Further work is needed to assess the clinical impact of informal regionalization of care and to determine whether the phenomenon occurs in other specialties.

Management of paediatric fractures in an Australian emergency department

Management of paediatric fractures in an Australian emergency department

The lost art of conservative management of paediatric fractures

The orthopaedic surgeon practising general trauma will invariably encounter fractures in children. Mercer Rang points out in the opening chapter of his textbook, “children are not just small adults”.1 The paediatric skeleton is more forgiving, demonstrates greater rapidity of healing and has an unrivalled capacity to remodel. Greater angulation, translation, and shortening can be accepted and reliably expected to remodel without clinical, functional or radiological shortcomings. Despite the fact that the outcomes following paediatric fractures are predictable and the healing potential offers considerable latitude for restoration of normality, there has been a global paradoxical shift from conservative treatment to early fracture fixation. This has perhaps been driven by the desire for immediate correction of clinical deformities or by financial incentives to minimise hospital costs accrued with prolonged admissions during periods of immobilisation. This review examines the evidence and indications for conservative treatment, and describes our preferences for the management of some commonly encountered paediatric fractures. The ability of the paediatric skeleton to remodel lies at the heart of non-operative management. Semantically, this process is called modeling; remodeling being the constant homeostatic cycling of calcium and phosphate from bone stores. Everyone understands remodeling so we use it now even though it’s wrong! It is the process by which angulation and translation are corrected to restore acceptable alignment. The potential for remodeling is influenced by a number of factors:

The Inadequacy of Pediatric Fracture Care Information in Emergency Medicine and Pediatric Literature and Online Resources.

Emergency medicine and pediatric physicians often provide initial pediatric fracture care. Therefore, basic knowledge of the various treatment options is essential. The purpose of this study was to determine the accuracy of information commonly available to these physicians in textbooks and online regarding the management of pediatric supracondylar humerus and femoral shaft fractures. The American Academy of Orthopaedic Surgeons Clinical Practice Guidelines for pediatric supracondylar humerus and femoral shaft fractures were used to assess the content of top selling emergency medicine and pediatric textbooks as well as the top returned Web sites after a Google search. Only guidelines that addressed initial patient management were included. Information provided in the texts was graded as consistent, inconsistent, or omitted. Five emergency medicine textbooks, 4 pediatric textbooks, and 5 Web sites were assessed. Overall, these resources contained a mean 31.6% (SD=32.5) complete and correct information, whereas 3.6 % of the information was incorrect or inconsistent, and 64.8% was omitted. Emergency medicine textbooks had a mean of 34.3% (SD=28.3) correct and complete recommendations, 5.7% incorrect or incomplete recommendations, and 60% omissions. Pediatric textbooks were poor in addressing any of the American Academy of Orthopaedic Surgeons guidelines with an overall mean of 7.14% (SD=18.9) complete and correct recommendations, a single incorrect/incomplete recommendation, and 91.1% omissions. Online resources had a mean of 48.6% (SD=33.1) complete and correct recommendations, 5.72% incomplete or incorrect recommendations, and 45.7% omissions. This study highlights important deficiencies in resources available to pediatric and emergency medicine physicians seeking information on pediatric fracture management. Information in emergency medicine and pediatric textbooks as well as online is variable, with both inaccuracies and omissions being common. This lack of high-quality information could compromise patient care. Resources should be committed to ensuring accurate and complete information is readily available to all physicians providing pediatric fracture care. In addition, orthopaedic surgeons should take an active role to ensure that nonorthopaedic textbooks and online resources contain complete and accurate information.

The use of arthrography in pediatric orthopaedic surgery.

Surgery near pediatric joints can be challenging because it is difficult to visualize vital articular structures. Assessment of underlying pathology is also challenging because the joint structures have not yet ossified. Arthrography is a useful tool that is quick and minimally invasive and allows adequate visualization of joint anatomy during surgery, which aids intraoperative decision making. In pediatric patients, arthrography is most useful for visualization of the elbow, knee, and hip joints. This tool can help the surgeon to refine the diagnosis and management of pediatric fractures and aids in surgical assessment during joint and limb reconstruction. Arthrography adds minimal time to surgery and carries a low risk of complications; it should be part of the armamentarium of any surgeon who treats pediatric orthopaedic patients.

Complications of Elastic Stable Intramedullary Nailing in Pediatric Fracture Management

Elastic stable intramedullary nailing (ESIN) for pediatric fracture management has gained increasing popularity since its introduction in the late 1970s. Relatively few modifications have been made to the original technique in the last forty years, which illustrates the sound biomechanical principles and simplicity of the technique. Jean-Paul Metaizeau, the originator of the technique, pointed out that poor results after ESIN were typically due to incorrect constructs, incorrect indications, and insufficient surgeon training1. The initial (1977 to 1980) indications for ESIN were limited to pediatric patients with multiple injuries or head trauma in whom cast or traction treatment was not practical. Later, its use was extended to all diaphyseal fractures of long bones in children. With widespread acceptance, the indications have been further expanded to metaphyseal fractures, comminuted fractures, pathologic fractures, and fractures of smaller bones (including clavicular, supracondylar humeral, and metacarpal fractures). ESIN was introduced in the United States in 19972. The literature is replete with reports of the clinical success of ESIN, but reports related to its complications are scarce. The aim of this manuscript was to review the common complications related to ESIN and provide technical pearls to manage and avoid complications. The principle of ESIN involves balanced nailing (i.e., use of two flexible nails of the same diameter to provide elasticity and stability in opposite directions at the fracture site). This principle is different from the principle of the Ender nail, which is based on maximal filling of the medullary canal3. To achieve balanced nailing when two nails are used, the apex of curvature of each nail should be at the fracture site. To achieve this, both nails should have the curvature of the letter “C” if they are inserted from opposite sides of the bone, or one nail should have …

Complications of Pediatric Facial Fractures

Pediatric facial fractures account for only 5% of all facial fractures, with even a much lower incidence in children younger than 5 years (1%-1.5%). The evolution of principles in the management of pediatric facial fractures and the differences in management between adult and pediatric patients have been well documented in the literature. Pediatric facial fracture management presents unique challenges because it might affect growth in the area specific to the trauma segment. Children are, in several ways, at a regenerative advantage: greater osteogenic potential, faster healing rate, primary dentition that is thereby temporary, and the capacity for significant dental compensation. Perhaps because of this, complications such as infection, malunion, nonunion, and postinjury malocclusion are relatively rare compared with the adult population. In this article, we will focus on different approaches to complications that arise after pediatric fracture management.

Comparison of circummandibular wiring with resorbable bone plates in pediatric mandibular fractures

Pediatric patients present a unique challenge to maxillofacial surgeons in terms of their treatment planning as well as in their functional and nutritional needs which are different from that of adult patients. Early literature has advocated conservative closed management of pediatric fractures to prevent complications. However recent advances in maxillofacial surgery has enabled us to use biodegradable plates and screws, which overcomes the limitations of metallic plates. We present a comparison of two cases of parasymphysis fracture treated with circum-mandibular wiring and biodegradable plate fixation their outcome in terms of fracture healing and functional stability.

The Use of Locked Plating in Skeletally Immature Patients

The philosophy and techniques for the management of fractures in the pediatric patient have changed over the past several decades. The immature skeleton has unique properties, and injuries in children have different characteristics, management options, and complications than do similar injuries in adults. The basic surgical techniques used in the management of pediatric fractures include closed reduction and casting, closed or open reduction with internal fixation, and external fixation. The concept of bridging plate osteosynthesis has evolved based on scientific insight into bone biology and the importance of blood supply to bone. The use of locked plating is gaining favor in the treatment of certain fractures in adults. However, the role for this technique in the skeletally immature patient has not been described.