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Patel J, Mangal RK, Stead TS, Wanchu R, Ganti L. Greenstick Fractures of the mid- Radial and Ulnar Diaphysis with Volar Angulation. Orthop Rev (Pavia) 2022; 14:57620. [PMID: 36589510 PMCID: PMC9797015 DOI: 10.52965/001c.57620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- Jai Patel
- Mary Institute and Saint Louis Country Day School
| | | | - Thor S. Stead
- The Warren Alpert Medical School of Brown University
| | - Rohan Wanchu
- Emergency MedicineUniversity of Central Florida College of Medicine
| | - Latha Ganti
- Emergency MedicineUniversity of Central Florida
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Kyriakides J, Peeters W, Ahluwalia AK, Elvey M. Paediatric forearm fractures: assessment and initial management. Br J Hosp Med (Lond) 2022; 83:1-9. [DOI: 10.12968/hmed.2021.0564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The forearm is the most common site of fracture in children. At the time of initial assessment, a thorough examination and neurovascular assessment of the limb is necessary. X-rays allow evaluation of the fracture location and type, in addition to the degree of displacement. With the help of intranasal opiates, manipulation of fracture fragments can be performed in the emergency department. Immobilisation in plaster is the gold standard treatment for paediatric forearm fractures where the degree of displacement is within acceptable parameters. Manipulation and casting should be followed by orthogonal radiographs and a repeated neurovascular assessment of the limb. Oral analgesia and safety netting information should be provided on discharge and the child should be reviewed in fracture clinic within a week of the injury. This article reviews the British Orthopaedic Association Standards for Trauma and Orthopaedics for the early management of paediatric forearm fractures that do not require operative management.
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Affiliation(s)
- Jonathon Kyriakides
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Wouter Peeters
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aashish K Ahluwalia
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Michael Elvey
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
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Manan MR, Rahman S, Komer L, Manan H, Iftikhar S. A Multispecialty Approach to the Identification and Diagnosis of Nonaccidental Trauma in Children. Cureus 2022; 14:e27276. [PMID: 36039273 PMCID: PMC9404682 DOI: 10.7759/cureus.27276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/23/2022] [Indexed: 11/05/2022] Open
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Cain CM, Mandell DJ, Thompson RR, Cummings AL, Van Horne BS, Greeley CS. Trends in Abusive and Nonabusive Injury Hospitalizations in Young Children in Texas, 2004-2018. CHILD MALTREATMENT 2022; 27:246-256. [PMID: 33291969 DOI: 10.1177/1077559520979572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Hospitalization data provide context to understanding abusive and non-abusive injuries and how these hospitalizations change over time. The purpose of this study was to utilize Texas inpatient hospitalization data to assess age-related differences among infants (<12 months of age) and toddlers (12-59 months of age) in injury trends and patterns of injury among abusive and non-abusive hospitalization encounters over a 15-year time period. For both age groups, pediatric hospitalizations for non-abusive injuries decreased significantly over time; however, hospitalizations for abusive injuries did not. Compared to non-abusive injury hospitalizations, abusive injury hospitalizations were statistically more likely to involve more body regions and were associated with fractures, internal organ injuries, and superficial wounds. Abusive injury hospitalizations had longer lengths of stay and resulted in higher illness severity scores. Toddler injury hospitalizations were associated with most of the body regions, with the exception of traumatic brain injury for which the odds of hospitalization were higher for infants. This study confirms the persistence of abusive injury hospitalizations and the age-related susceptibility to certain injuries comparing infants and toddlers. The findings reflect the clinical documentation and decision making of pediatric practitioners in a large state over 15 years and inform the trends in identification of injuries which are most common and consistent by age and intent.
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Affiliation(s)
- Cary M Cain
- Section of Public Health and Child Abuse Pediatrics, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Dorothy J Mandell
- Population Health, The University of Texas Health Science Center at Tyler, TX, USA
| | - Ralph R Thompson
- Section of Public Health and Child Abuse Pediatrics, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Angela L Cummings
- Section of Public Health and Child Abuse Pediatrics, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Bethanie S Van Horne
- Section of Public Health and Child Abuse Pediatrics, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Christopher S Greeley
- Section of Public Health and Child Abuse Pediatrics, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
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Is a Parry Fracture-An Isolated Fracture of the Ulnar Shaft-Associated with the Probability of Abuse in Children between 2 and 16 Years Old? CHILDREN-BASEL 2021; 8:children8080650. [PMID: 34438541 PMCID: PMC8394848 DOI: 10.3390/children8080650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022]
Abstract
A parry fracture is an isolated fracture of the ulnar shaft. It occurs when the ulna receives the full force of an impact when the forearm is raised to protect the face. The aim of this study is to assess a possible association between a parry fracture and the probability of abuse in children. In this retrospective, observational, multicenter study, we identified patients between 2 and 16 years old who had been treated for an isolated ulnar shaft fracture. Patient characteristics were registered, anonymized radiographs were rated, and charts were screened for referral to a child protective team. A total of 36 patients were analyzed. As no referrals were registered during follow-up, the primary outcome was changed to a perpendicular force as trauma mechanism. Univariable regression analysis and independent t-test both showed no significant association between patient factors or radiographic classification, and the reported trauma mechanism. We were unable to determine an association between a parry fracture and the probability of abuse. Since trauma mechanism does have a biomechanical effect on the fracture type, we would advise that a very clear reconstruction (and documentation) of the trauma mechanism should be established when a parry fracture is identified on radiographs.
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Syed S, Ashwick R, Schlosser M, Gonzalez-Izquierdo A, Li L, Gilbert R. Predictive value of indicators for identifying child maltreatment and intimate partner violence in coded electronic health records: a systematic review and meta-analysis. Arch Dis Child 2021; 106:44-53. [PMID: 32788201 PMCID: PMC7788194 DOI: 10.1136/archdischild-2020-319027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Electronic health records (EHRs) are routinely used to identify family violence, yet reliable evidence of their validity remains limited. We conducted a systematic review and meta-analysis to evaluate the positive predictive values (PPVs) of coded indicators in EHRs for identifying intimate partner violence (IPV) and child maltreatment (CM), including prenatal neglect. METHODS We searched 18 electronic databases between January 1980 and May 2020 for studies comparing any coded indicator of IPV or CM including prenatal neglect defined as neonatal abstinence syndrome (NAS) or fetal alcohol syndrome (FAS), against an independent reference standard. We pooled PPVs for each indicator using random effects meta-analyses. RESULTS We included 88 studies (3 875 183 individuals) involving 15 indicators for identifying CM in the prenatal period and childhood (0-18 years) and five indicators for IPV among women of reproductive age (12-50 years). Based on the International Classification of Disease system, the pooled PPV was over 80% for NAS (16 studies) but lower for FAS (<40%; seven studies). For young children, primary diagnoses of CM, specific injury presentations (eg, rib fractures and retinal haemorrhages) and assaults showed a high PPV for CM (pooled PPVs: 55.9%-87.8%). Indicators of IPV in women had a high PPV, with primary diagnoses correctly identifying IPV in >85% of cases. CONCLUSIONS Coded indicators in EHRs have a high likelihood of correctly classifying types of CM and IPV across the life course, providing a useful tool for assessment, support and monitoring of high-risk groups in health services and research.
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Affiliation(s)
- Shabeer Syed
- UCL Great Ormond Street Institute of Child Health, Population, Policy and Practice, University College London, London, UK
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
| | - Rachel Ashwick
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
| | - Marco Schlosser
- Division of Psychiatry, University College London, London, UK
| | | | - Leah Li
- UCL Great Ormond Street Institute of Child Health, Population, Policy and Practice, University College London, London, UK
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, Population, Policy and Practice, University College London, London, UK
- Institute of Health Informatics and Health Data Research UK, University College London, London, UK
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Sharkey MS, Buesser KE, Gaither JR, Tate V, Cooperman DR, Moles RL, Silva CT, Ehrlich LJ, Leventhal JM. Abusive fracture incidence over three decades at a level 1 pediatric trauma center. CHILD ABUSE & NEGLECT 2018; 76:364-371. [PMID: 29195174 DOI: 10.1016/j.chiabu.2017.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/03/2017] [Accepted: 11/13/2017] [Indexed: 06/07/2023]
Abstract
Few studies have examined the incidence of abusive fractures in children. Only one study to date, from a single pediatric trauma center,has reported on the incidence of abusive fractures over time. That study showed a decrease in abusive fractures over a 24-year period. Our objective for this current study was to compare these published data with recent data from this same trauma center, allowing for a detailed comparison of the incidence of abusive fractures over a 30-year period. We included children <36months of age who presented to the emergency department of a level 1 pediatric trauma center (2007-2010) with≥1 fracture. Six experts from 3 different fields rated each case on the likelihood the fracture(s) was caused by abuse using an established 7- point scale, and a consensus rating was agreed upon for each case. The incidence of abusive fractures was calculated per 10,000 children <36months of age living in the geographic region and per 10,000 ED visits and was compared to previously published data for three prior time periods (1979-1983, 1991-1994, and 1999-2002) at the same pediatric trauma center. From 2007-2010, 551 children were identified, including 31 children who were rated as abused. The incidence of a child presenting with an abusive fracture in the county per year was 2.7/10,000 children <36months of age. The previous three time periods showed a countywide incidence of 3.2/10,000 (1979-1983), 1.7/10,000 (1991-1994), and 2.0/10,000 (1999-2002) (p for trend 0.34). The incidence per ED visit was 2.5/10,000 in the recent time period compared to 6.0/10,000 (1979-1983), 3.4/10,000 (1991-1994), and 2.5/10,000 (1999-2002) (p for trend <0.001). In this single institution review of fractures in children <36months of age, the incidence of abusive fractures has remained relatively constant over a 30-year period.
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Affiliation(s)
- Melinda S Sharkey
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Avenue, New Haven, CT, 06510, USA.
| | - Katherine E Buesser
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Avenue, New Haven, CT, 06510, USA
| | - Julie R Gaither
- Yale Center for Medical Informatics, 300 George Street, Suite 501, New Haven, CT, 06511, USA
| | - Victoria Tate
- Department of Surgery, Greenville Health System,701 Grove Road, Greenville, SC, 29605, USA
| | - Daniel R Cooperman
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Avenue, New Haven, CT, 06510, USA
| | - Rebecca L Moles
- Department of Pediatrics, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
| | - Cicero T Silva
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, P.O. Box 208042, 333 Cedar Street, New Haven, CT, 06520-8042, USA
| | - Lauren J Ehrlich
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, P.O. Box 208042, 333 Cedar Street, New Haven, CT, 06520-8042, USA
| | - John M Leventhal
- Department of Pediatrics, Yale University School of Medicine, P.O. Box 208064, 333 Cedar Street, New Haven, CT, 06520-8064, USA
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