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Issin A, Yurten H, Özcan S. No-anesthesia for Colles fracture. Injury 2024; 55:111614. [PMID: 38820668 DOI: 10.1016/j.injury.2024.111614] [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] [Received: 04/09/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND This study aims to measure the perceived pain during the reduction of Colles fracture without anesthesia in both children and adults. It describes the process and reveals duration for reduction, total hospital stays and compares them with the same procedure under hematoma block. METHODS We employed the Wong-Baker FACES pain scale to assess pain reduction in 135 adults and 98 pediatric patients undergoing Colles fracture reduction with or without hematoma block. We also measured the time required for the reduction and the overall process. RESULTS For fracture reduction without anesthesia, Wong-Baker FACES scores were 9.2 for children and 8.7 for adults. With hematoma block, scores dropped to 7.5 for children and 5.2 for adults with only a 10 min addition to the hospital stay. Pain scores among pediatric patients exhibited moderate to strong negative correlations with age. The reduction maneuver itself took an average of 5 s. CONCLUSIONS The reduction of a Colles fracture is nearly instantaneous, making the reduction without anesthesia tolerable. Pediatric patients don't benefit from hematoma block as much as adult counterparts. It significantly reduced pain scores by 1.7 points in children and 3.5 points in adults. LEVEL OF EVIDENCE Level I, Randomized Controlled Trial.
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Affiliation(s)
- Ahmet Issin
- Erzincan Binali Yıldırım University, Mengücek Gazi Education and Research Hospital Orthopedics and Traumatology Department, Erzincan, Turkey
| | - Hakan Yurten
- Elazığ Fethi Sekin City Hospital, Orthopedics and Traumatology Department, Elazığ , Turkey
| | - Seçkin Özcan
- Yalova Education and Research Hospital Orthopedics and Traumatology Department, Yalova, Turkey.
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Wu JP, Lu YT, Wei XX, Zou PX, Li YQ, Liu YZ, Canavese F, Xu HW. Epidemiological characteristics and distribution of pediatric supracondylar fractures in South China: a retrospective analysis of 760 cases. J Pediatr Orthop B 2024; 33:136-141. [PMID: 37129032 PMCID: PMC10829903 DOI: 10.1097/bpb.0000000000001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/26/2023] [Indexed: 05/03/2023]
Abstract
To evaluate demographic characteristics and distribution of pediatric supracondylar fractures (SCFs) at a tertiary hospital in South China. A retrospective observational study was conducted on children aged 15 years or younger with a diagnosis of SCFs during the period from January 2016 to December 2018. Patients' medical records and radiographs were retrospectively analyzed for age at the time of injury, sex, site and mechanism of traumatic injury. A total of 760 patients with 761 SCFs were reviewed (453 males, 59.6%, and 307 females, 40.4%). There were 748 extension-type fractures (98.3%) and 13 flexion-type fractures (1.7%). Associated injuries were identified in 30/760 (3.9%) patients: associated fracture ( n = 15; 2%), nerve injury ( n = 12; 1.6%), open fracture ( n = 2; 0.2%) and compartment syndrome ( n = 1; 0.1%). Age at the time of fracture has a bimodal pattern with a first peak around the age of 1 year and a second peak around the age of 4-5 years. The fractures occurred mostly around 11 a.m. and between 4 and 9 p.m. in the evening. Most fractures occurred at home (50.7%), and falling down (62.2%) was the most frequent mechanism of injury. SCFs occurred most frequently in children aged 1 and 4-5 years, and during daylight hours. In about 96% of cases, these were isolated injuries, and falling down was found to be the most frequent traumatic mechanism. Based on our findings, targeted educational efforts and interventions can be set up in order to prevent the occurrence of SCFs in South China. Level of evidence: III.
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Affiliation(s)
- Jian Ping Wu
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - Yang Tao Lu
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - Xing Xing Wei
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - Pan Xin Zou
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - Yi Qiang Li
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - Yuan Zhong Liu
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
| | - Federico Canavese
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
- Department of Pediatric Orthopedic Surgery, Lille University Center and Faculty of Medicine Henri Warenbourg, Jeanne de Flandre Hospital, Lille, France
| | - Hong Wen Xu
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou, China
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Şahin AA, Şahin AK, Uzun A, Değirmenci E. The relationship between extremity fractures and visual impairment in childhood: A case-control study. ULUS TRAVMA ACIL CER 2022; 28:662-667. [PMID: 35485477 PMCID: PMC10442978 DOI: 10.14744/tjtes.2022.90235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/27/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Fractures are common extremity injuries in pediatric orthopedic practice. The aim of this study is to determine the relationship between pediatric extremity fractures and visual impairments. METHODS Thirty pediatric patients who were admitted to the emergency and orthopedics and traumatology clinic due to an extremity fracture after a fall were included in the study. Following fracture treatment, the patients were evaluated in terms of ocu-lar findings before discharge from the hospital. Thirty age- and sex-matched healthy children who presented to the ophthalmology department for routine care were also recruited as the control group. All participants underwent a comprehensive ophthalmologic examination, including cycloplegic refraction, visual acuity levels, and near stereoacuity measurement. RESULTS The number of male participants was higher in both groups. There was no significant difference between the groups in terms of age and gender distribution. The most common upper extremity fractures were observed to be distal radius (52%) and distal humerus fractures (28%). The number of patients who had a refractive error that required spectacles was significantly higher in the fracture group (p=0.039). When the visual acuity levels of the better eye were evaluated, the mean visual acuity was significantly lower in the fracture group (p=0.016). The mean stereoacuity was also significantly lower in the study group (<0.001). In the binary logistic regression analysis model, low stereopsis levels were associated with the risk of pediatric extremity fractures (95% CI: 1.056-1.385; p=0.006). CONCLUSION Our study showed that low-energy pediatric extremity fractures are more common in children with visual im-pairments that require treatment, and low stereopsis is a risk factor for fractures. Consequently, regular eye examinations and early treatment of visual impairments in children may help to prevent fall-related injuries.
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Affiliation(s)
- Abdullah Alper Şahin
- Department of Orthopaedic and Traumatology, Ordu University Training and Research Hospital, Ordu-Turkey
| | - Asena Keleş Şahin
- Department of Ophthalmology, Ordu University Training and Research Hospital, Ordu-Turkey
| | - Aslıhan Uzun
- Department of Ophthalmology, Ordu University Training and Research Hospital, Ordu-Turkey
| | - Erdem Değirmenci
- Department of Orthopaedic and Traumatology, Şişli Kolan International Hospital, İstanbul-Turkey
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Qiu X, Deng H, Su Q, Zeng S, Han S, Li S, Cui Z, Zhu T, Tang G, Xiong Z, Tang S. Epidemiology and management of 10,486 pediatric fractures in Shenzhen: experience and lessons to be learnt. BMC Pediatr 2022; 22:161. [PMID: 35351043 PMCID: PMC8962138 DOI: 10.1186/s12887-022-03199-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 03/08/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose To explore and analyze the causes and related influencing factors of pediatric fractures, and provide theoretical basis for reducing the incidence and adverse effects of pediatric fractures. Methods This study retrospectively analyzed the epidemiological characteristics of fractures in pediatric aged ≤18 years old who were admitted to the our hospital between July 2015 and February 2020. Results A total of 10,486 pediatric patients were included in the study, of whom 6961 (66.38%) were boys, and 3525 (33.62%) were girls. For the fracture incidence, age group of the 3-6 years reached the peak. 5584 (60.76%) children were operated upon within 12 h after admission. The top three types of fractures were the distal humerus (3843 sites, 27.49%), distal ulna (1740 sites, 12.44%), and distal radius (1587 sites, 11.35%). The top three causes of injury were falls (7106 cases, 82.10%), car accidents (650 cases, 65.72%), and clipping (465 cases, 5.37%). Fractures predominantly occurred between July and November (4664 cases, 48.87%) and on Saturdays and Sundays (3172 cases, 33.24%). The highest number of hospital visits occurred between 20:00 and 00:00 (4339 cases, 45.46%). Conclusion For pediatric fractures, we should take appropriate and effective preventive measures to reduce the incidence of children’s fractures according to the distribution characteristics of age, gender, cause of injury, and fracture site. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03199-0.
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Eastman J, White H, Evans J, Augsburger S, Wallace J, Riley S, Iwinski H. What is the minimum torque required to obtain passive elbow end range of motion? Gait Posture 2022; 93:235-239. [PMID: 35190315 DOI: 10.1016/j.gaitpost.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/26/2022] [Accepted: 02/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Passive range of motion is a common clinical assessment. The point at which passive end range of motion is measured is typically described by the 'end-feel'of the joint. RESEARCH QUESTION What is the minimum amount of torque required to obtain passive elbow flexion and extension in children? METHODS Twenty-five children (age, 7.5 ± 1.6 years-old), who had previously sustained unilateral distal humeral fractures, participated in this prospective study.Passive elbow flexion and extension was measured at least 8 weeks and up to one year out of cast. Motion capture cameras were used to track twenty-one reflective markers placed on subjects and two markers attached to the pad of a force transducer.Five trials of passive range of motion (flexion and extension) were performed on both arms. Elbow joint moments were calculated as products of the forces applied and lengths to the elbow centers. A one way ANOVA was used to determine differences in moments for flexion and extension for both involved and uninvolved limbs. Pairedsamples t-tests were used to determine differences between the involved and the uninvolved limbs for both maximum flexion and extension. RESULTS There was no difference in the minimum mean joint moment (2.7 ± 1.1 Nm) at end range of motion. However, differences in passive range of motion was found between involved and uninvolved elbows (flexion p < .001; extension p = .001). SIGNIFICANCE The results demonstrate therapists obtained end range of passive elbow flexion and extension applying the same amount of minimum torque. A small torque is sufficient to achieve end range of elbow motion for children. This torque can be used in guiding clinical practice for assessing passive range of elbow motion in pediatric population. Because of a paucity of data for any joint, future research developing force data for other joints should be conducted.
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Affiliation(s)
- Joel Eastman
- Motion Analysis Center Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA
| | - Hank White
- Motion Analysis Center Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA.
| | - Jenn Evans
- Motion Analysis Center Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA
| | - Sam Augsburger
- Motion Analysis Center Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA
| | - Juanita Wallace
- Department of Health and Exercise Science, Transylvania University, 300 North Broadway, Lexington, KY 40508, USA
| | - Scott Riley
- Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA; University of Kentucky Department of Orthopaedic Surgery and Sports Medicine, 740 S. Limestone Street, Lexington, KY 40536, USA
| | - Henry Iwinski
- Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA; University of Kentucky Department of Orthopaedic Surgery and Sports Medicine, 740 S. Limestone Street, Lexington, KY 40536, USA
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Cebula M, Modlińska S, Machnikowska-Sokołowska M, Komenda J, Cebula A, Baron J, Gruszczyńska K. Hand Injuries in the Polish Silesian Paediatric Population-An Exploratory Cross-Sectional Study of Post-Traumatic X-rays. MEDICINA-LITHUANIA 2020; 56:medicina56100550. [PMID: 33092076 PMCID: PMC7590142 DOI: 10.3390/medicina56100550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: In the paediatric population, hand injuries are one of the most frequent injuries and the second most frequent area of fracture. It is estimated that hand injuries account for up to 23% of the trauma-related causes of emergency department visits. Not only are they a significant factor in health care costs, but they may also lead to detrimental and long-term consequences for the patient. The discrepancy observed between the published studies suggests a geographical variation in their epidemiology. The aim of this study is to determine the localisation of injuries and fractures involving the hand in the paediatric population of the Polish Silesia region. This exploratory cross-sectional study involved 1441 post-traumatic hand X-ray examinations performed at the Department of Diagnostic Imaging of the John Paul II Upper Silesian Child Health Centre in Katowice between January and December 2014. Materials and Methods: The study group consisted of 656 girls and 785 boys who were 11.65 ± 3.50 and 11.51 ± 3.98 years old, respectively (range: 1-18 years). All examinations were evaluated for the location of the injury and presence of fracture(s). Results: Finger injuries were dominant (n = 1346), with the fifth finger being the most frequently injured (n = 381). The majority of injuries were observed among children who were 11 years old (n = 176), with a visible peak in the 11- to 13-year-old group. A total of 625 bone fractures were detected. Fractures of the proximal phalanges (n = 213) and middle phalanges (n = 159) were most common, and fifth finger (n = 189) predominance was again observed. A gender-independent positive correlation was found between patients' age and finger injuries (p < 0.01) as well as metacarpal injuries (p < 0.01). There was no correlation between patients' age and fractures in these locations (p > 0.05). Metacarpal injuries (p < 0.01), finger injuries (p < 0.01), fractures (p = 0.01), and fractures with displacement (p = 0.03) were more common among males regardless of age. Conclusions: The results indicate that 11-year-old boys are at an increased risk of hand injuries and fractures. The distal and middle phalanges of the right hand, especially of the fifth digit, were the most susceptible to fracture localisation. Thus, injuries in these areas should be perceived as most likely to cause fractures and therefore demand careful examination.
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Affiliation(s)
- Maciej Cebula
- Department of Radiodiagnostics and Invasive Radiology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (S.M.); (J.K.); (J.B.)
- Correspondence:
| | - Sandra Modlińska
- Department of Radiodiagnostics and Invasive Radiology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (S.M.); (J.K.); (J.B.)
| | - Magdalena Machnikowska-Sokołowska
- Department of Diagnostic Imaging, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (M.M.-S.); (K.G.)
| | - Jacek Komenda
- Department of Radiodiagnostics and Invasive Radiology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (S.M.); (J.K.); (J.B.)
| | - Agnieszka Cebula
- Department of Pediatric Neurology, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Jan Baron
- Department of Radiodiagnostics and Invasive Radiology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (S.M.); (J.K.); (J.B.)
| | - Katarzyna Gruszczyńska
- Department of Diagnostic Imaging, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (M.M.-S.); (K.G.)
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Okubo H, Nakasone M, Kinjo M, Onaka K, Futenma C, Kanaya F. Epidemiology of paediatric elbow fractures: a retrospective multi-centre study of 488 fractures. J Child Orthop 2019; 13:516-521. [PMID: 31695819 PMCID: PMC6808078 DOI: 10.1302/1863-2548.13.190043] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Elbow fractures are common in children and occur during daily activities. The aim of this study is to evaluate the epidemiology of paediatric elbow fractures over a two-year period in Okinawa, a southern subtropical island in Japan. METHODS This was a retrospective study of 488 elbow fractures in children younger than 15 years old treated at 11 hospitals in Okinawa. Data included age, gender, calendar month, type of fracture, operation rate, mechanism of injury, and aetiology. RESULTS The most frequent age was 6 years old, with 47.5% of all elbow fractures occurring in an age range from 6 to 10 years old. The fracture rate for boys was 1.6 times higher than that for girls. The incidence was the highest in May (56 fractures) and the lowest in August (25 fractures). Supracondylar fractures were the most common type (44%), followed by lateral condyle fractures (22%); 45% of all fractures were treated operatively. Medial epicondyle fractures had the highest rate of operative treatment (91%). In the 6 to 10-year-old group, 19% of all fractures occurred while skateboarding or caster-boarding, the most frequent aetiology. CONCLUSIONS Supracondylar fractures are the most common fracture type in 4 to 7-year-old boys. In the 6 to 10-year-old group, skateboarding and caster-boarding are the most frequent and increasing cause of elbow fractures. Therefore, some preventive measures are needed. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- H. Okubo
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Japan,Correspondence should be sent to: H. Okubo, Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, Japan 903-0215. E-mail:
| | - M. Nakasone
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Japan
| | - M. Kinjo
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Japan
| | - K. Onaka
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Japan
| | - C. Futenma
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Japan
| | - F. Kanaya
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Japan
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An epidemiological evaluation of fractures and its determinants among Lebanese schoolchildren: a cross-sectional study. Arch Osteoporos 2019; 14:9. [PMID: 30643980 DOI: 10.1007/s11657-019-0559-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/03/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this study is to establish the prevalence and determinants of fractures among 974 Lebanese schoolchildren aged 8-18. Fractures might be less common in the Lebanese pediatric population compared to western populations. Male gender and high SES are independent risk factors for fractures, while 25(OH)D and BMI have no impact. PURPOSE To establish the prevalence of fractures among Lebanese schoolchildren and its relationship with age, gender, BMI, 25 hydroxyvitamin D (25(OH)D) levels, and socioeconomic status (SES). METHODS In this cross-sectional study, 974 Lebanese schoolchildren aged 8-18 years old, mean age 13.37 ± 2.92 (508 boys and 466 girls), were recruited from 10 schools with different SES. For each participant, a questionnaire was used to collect data regarding history of fractures. Serum 25(OH)D was also measured. RESULTS The prevalence of Lebanese children sustaining ≥ 1 fracture was 16.9% and was higher in boys compared to girls (22.2% vs 11.1%, p < 0.0001). A 71.3% of fractures were localized in the upper limbs and 20% of participants had at least one displaced fracture. Children who sustained a fracture had a non-significant higher BMI compared to those without (p = 0.096). The percentage of children with fractures was higher in children from high SES compared to those from middle and low SES (respectively 23.3% vs. 16.3% and 13.8%, p < 0.0001). Fractures occurred at a younger age in girls compared to boys, but this difference was non-significant (p = 0.13). 25(OH)D levels were significantly higher in children with fractures compared to those without (p = 0.017). Finally, female gender was protective against upper limb fractures (p = 0.009). In a logistic regression analysis, male gender and high SES were independently associated with fractures, while BMI and 25(OH)D were not. CONCLUSION Our study demonstrates that the prevalence of fractures in the Lebanese pediatric population might be lower than western populations. It also confirms that male gender and high SES are independent risk factors for fractures, while 25(OH)D and BMI were not independently associated with fracture risk.
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Chua ISY, Chong SL, Ong GYK. Intravenous regional anaesthesia (Bier's block) for pediatric forearm fractures in a pediatric emergency department-Experience from 2003 to 2014. Injury 2017; 48:2784-2787. [PMID: 29056227 DOI: 10.1016/j.injury.2017.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 10/09/2017] [Accepted: 10/16/2017] [Indexed: 02/02/2023]
Abstract
STUDY OBJECTIVES To evaluate the efficacy (length of stay in the emergency department and failure rate of Bier's block) and safety profile (death and major complications) of Bier's block in its use for manipulation and reduction of paediatric forearm fractures. METHODS This is a retrospective cohort study of pediatric patients in KKWomen's and Children's Hospital Children's Emergency Department with forearm fractures between Jan 2003 and Dec 2014 who underwent manipulation and reduction using Bier's block. Demographic data, time from registration to discharge, major complications and success rate were collated in a standardized data collection form. A subanalysis of the Bier's block group from 2009 to 2014 was performed and compared to a corresponding data set of paediatric patients who underwent manipulation and reduction of forearm fractures using ketamine for procedural sedation from 2009 to 2014. RESULTS 1781 cases of paediatric forearm fractures were analysed. The mean age of patients in the Bier's block group was 12.0 years (range 5.5-17.8 years old). Of all patients undergoing Bier's block, 1471 out of 1781 patients were male (82.7%). The mean length of stay (LOS) in the department was 168±72min, measured from time of registration till departure. From our subanalysis of data from 2009 to 2014, the mean LOS for the Bier's block group was shorter - 170min compared to 238min for the ketamine group (P <0.0001). 2 patients had failed Bier's block which required a repeat procedural sedation using ketamine. 96% of patients who underwent Bier's block were discharged with an outpatient orthopaedic appointment. There were no deaths or major complications identified in our study. CONCLUSION Bier's block is a safe technique for reduction of fractures when used in the appropriate population and fracture types, with a low failure rate and no major complications including death. Compared to the ketamine group, it has a shorter length of stay in the emergency department. We recommend the adoption of this practice for manipulation and reduction of pediatric forearm fractures in the Emergency Department with a formalised protocol to reduce and prevent any human errors that can potentially result in complications.
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Affiliation(s)
- Ivan S Y Chua
- Accident & Emergency, Singapore General Hospital, Singapore
| | - S L Chong
- Children's Emergency, KKWomen's and Children's Hospital, Singapore
| | - Gene Y K Ong
- Children's Emergency, KKWomen's and Children's Hospital, Singapore.
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