This observational study examines the effect of the COVID-19 pandemic upon the paediatric trauma burden of a district general hospital. We aim to compare the nature and volume of the paediatric trauma during the first 2020 UK lockdown period with the same period in 2019. Prospective data was collected from 23 March 2020 to 14 June 2020 and compared with retrospective data collected from 23 March 2019 to 14 June 2019. Patient demographics, mechanism of injury, nature of the injury, and details of any surgery were tabulated and statistically analyzed using the independent-samples Aims
Methods
The aim of this study was to report the clinical, functional
and radiological outcomes of children and adolescents with tibial
fractures treated using the Ilizarov method. Between 2013 and 2016 a total of 74 children with 75 tibial fractures
underwent treatment at our major trauma centre using an Ilizarov
frame. Demographic and clinical information from a prospective database
was supplemented by routine functional and psychological assessment
and a retrospective review of the notes and radiographs.Aims
Patients and Methods
Following the introduction of national standards in 2009, most
major paediatric trauma is now triaged to specialist units offering
combined orthopaedic and plastic surgical expertise. We investigated
the management of open tibia fractures at a paediatric trauma centre,
primarily reporting the risk of infection and rate of union. A retrospective review was performed on 61 children who between
2007 and 2015 presented with an open tibia fracture. Their mean
age was nine years (2 to 16) and the median follow-up was ten months
(interquartile range 5 to 18). Management involved IV antibiotics,
early debridement and combined treatment of the skeletal and soft-tissue injuries
in line with standards proposed by the British Orthopaedic Association.Aims
Patients and Methods
End caps are intended to prevent nail migration
(push-out) in elastic stable intramedullary nailing. The aim of
this study was to investigate the force at failure with and without
end caps, and whether different insertion angles of nails and end caps
would alter that force at failure. Simulated oblique fractures of the diaphysis were created in
15 artificial paediatric femurs. Titanium Elastic Nails with end
caps were inserted at angles of 45°, 55° and 65° in five specimens
for each angle to create three study groups. Biomechanical testing
was performed with axial compression until failure. An identical
fracture was created in four small adult cadaveric femurs harvested
from two donors (both female, aged 81 and 85 years, height 149 cm and
156 cm, respectively). All femurs were tested without and subsequently
with end caps inserted at 45°. In the artificial femurs, maximum force was not significantly
different between the three groups (p = 0.613). Push-out force was
significantly higher in the cadaveric specimens with the use of
end caps by an up to sixfold load increase (830 N, standard deviation
(SD) 280 These results indicate that the nail and end cap insertion angle
can be varied within 20° without altering construct stability and
that the risk of elastic stable intramedullary nailing push–out
can be effectively reduced by the use of end caps. Cite this article:
The management of children’s fractures has evolved
as a result of better health education, changes in lifestyle, improved
implant technology and the changing expectations of society. This
review focuses on the changes seen in paediatric fractures, including
epidemiology, the increasing problems of obesity, the mechanisms
of injury, non-accidental injuries and litigation. We also examine
the changes in the management of fractures at three specific sites:
the supracondylar humerus, femoral shaft and forearm. There has
been an increasing trend towards surgical stabilisation of these
fractures. The reasons for this are multifactorial, including societal
expectations of a perfect result and reduced hospital stay. Reduced hospital
stay is beneficial to the social, educational and psychological
needs of the child and beneficial to society as a whole, due to
reduced costs. Cite this article:
We analysed retrospectively the risk factors
leading to femoral overgrowth after flexible intramedullary nailing
in 43 children (mean age 7.1 years (3.6 to 12.0)) with fractures
of the shaft of the femur. We reviewed their demographic data, mechanism
of injury, associated injuries, the type and location of the fractures,
the nail–canal diameter (NCD) ratios and femoral overgrowth at a
mean follow-up of 40.7 months (25.2 to 92.7). At that time, the
children were divided into two groups, those with femoral overgrowth
of <
1 cm (Group 1), and those with overgrowth of ≥ 1 cm (Group
2). The mean femoral overgrowth of all patients was 0.6 cm at final
follow-up. Overgrowth of ≥ 1 cm was noted in 11 children (25.6%).
The NCD ratio was significantly lower in Group 2 than in Group 1,
with an odds ratio of 30.0 (p = 0.003). We believe that a low NCD ratio is an indicator of an unstable
configuration with flexible intramedullary nailing, and have identified
an association between a low NCD ratio and femoral overgrowth resulting
in leg-length discrepancy after flexible intramedullary nailing
in paediatric femoral shaft fractures. Cite this article:
Elastic stable intramedullary nailing (ESIN)
is generally acknowledged to be the treatment of choice for displaced diaphyseal
femoral fractures in children over the age of three years, although
complication rates of up to 50% are described. Pre-bending the nails
is recommended, but there are no published data to support this.
Using synthetic bones and a standardised simulated fracture, we
performed biomechanical testing to determine the influence on the
stability of the fracture of pre-bending the nails before implantation.
Standard ESIN was performed on 24 synthetic femoral models with
a spiral fracture. In eight cases the nails were inserted without
any pre-bending, in a further eight cases they were pre-bent to
30° and in the last group of eight cases they were pre-bent to 60°. Mechanical
testing revealed that pre-bending to 60° produced a significant
increase in the stiffness or stability of the fracture. Pre-bending
to 60° showed a significant positive influence on the stiffness
compared with unbent nails. Pre-bending to 30° improved stiffness
only slightly. These findings validate the recommendations for pre-bending,
but the degree of pre-bend should exceed 30°. Adopting higher degrees
of pre-bending should improve stability in spiral fractures and
reduce the complications of varus deformity and shortening.
We present the results of 90 consecutive children with displaced fractures of the forearm treated by elastic stable intramedullary nailing with a mean follow-up of 6.6 months (2.0 to 17.6). Eight (9%) had open fractures and 77 (86%) had sustained a fracture of both bones. The operations were performed by orthopaedic trainees in 78 patients (86%). All fractures healed at a mean of 2.9 months (1.1 to 8.7). There was one case of delayed union of an ulnar fracture. An excellent or good functional outcome was achieved in 76 patients (84%). There was no statistical difference detected when the grade of operating surgeon, age of the patient and the diaphyseal level of the fracture were correlated with the outcome. A limited open reduction was required in 40 fractures (44%). Complications included seven cases of problematic wounds, two transient palsies of the superficial radial nerve and one case each of malunion and a post-operative compartment syndrome. At final follow-up, all children were pain-free and without limitation of sport and play activities. Our findings indicate that the functional outcome following paediatric fractures of the forearm treated by elastic stable intramedullary nailing is good, without the need for anatomical restoration of the radial bow.
This study compares the initial outcomes of minimally invasive techniques for single-event multi-level surgery with conventional single-event multi-level surgery. The minimally invasive techniques included derotation osteotomies using closed corticotomy and fixation with titanium